Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM Plan | Blue Cross and Blue Shield of Texas

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Welcome to Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)

Whether you’re new to Medicare or just to your plan, here are some tips to make the transition smooth. Feeling a little nervous about your new plan? We understand. Your Medicare plan may be new to you now, but soon you’ll get to know and be comfortable with it. You may even like it better. We hope to answer your basic questions here.

If you need more information or just want a little help understanding your benefits or the Medicare rules, please contact us.

We Stay in Touch With You

Telephone

Our goal is to help you manage your health. We’ll call to welcome you to the plan. We’d like to know if you have questions about your benefits or if you have other special needs that need immediate attention. During your welcome call:

✔ We’ll make sure you received your member ID card and instructions on how to access the Evidence of Coverage (EOC). Please review the EOC as it lets you know how to get your medical care and prescription drugs covered through our plan. 

✔ We’ll ask you a few questions from a voluntary Health Questionnaire. The questions are easy to answer and will help us understand your needs. Based on your answers, we may reach out to you about your health to help you better manage it. We might suggest an in-home assessment with one of our care management professionals.

✔ We’ll help you schedule an Annual Wellness Exam.

You may have caller ID on your phone and may not recognize that your plan is calling you. Remember we’ll be calling, so be sure to answer.

Email Alerts

We’d like to have your email address to send you communications about health plan benefits and programs throughout the year. We never share your email address outside the plan. You can always opt out or ask us to stop sending you emails.

Annual Notice of Change (ANOC)

You will receive an Annual Notice of Change in October. This notice outlines any expected premium/benefit changes for next year. These changes will begin January 1 of the following calendar year. Review this document carefully.

Explanation of Benefits (EOB)

You will receive a statement called the Explanation of Benefits. How often you receive it depends on how often you fill your prescriptions. This statement is not a bill. It simply details what you have paid and indicates the level of benefits you’ve used. Review these to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.

The Drug Formulary May Be Different

Blue Cross Medicare Advantage Dual Care Plus (HMO SNP) covers a broad range of prescription drugs. The formulary may be different from what you’re used to, and it is always available to view online. Share the formulary with your doctor and talk about the drugs you take now. You may find you can save money by choosing generic drugs. Ask if this is an option for you.

PRESCRIPTION DRUGS

In Medicare Advantage Dual Care Plus (HMO SNP) plans, prescription drugs are placed in Tier 1 – preferred generic and brand drugs. 

 

Prior Authorization, Step Therapy and Quantity Limits

Please read the formulary for more information about these rules and exceptions or please visit the Prior Authorization/Utilization Management page for more information. 

You Will Use a Provider From the Plan Network

To get the most from your benefits, you will use providers in our network. Your current doctors may be in the network. The network includes local primary care providers and a wide range of specialists. If you have an HMO plan, you must choose a primary care provider (PCP). In some cases, you may need care from a provider that is out of network, which may cost you more. If your current provider is not in the network, we can help you find a new one. Search for a provider.

 

We’ll Work Closely With Your Provider to Deliver the Best Care

Certain high cost medical services that have more cost-effective alternatives need prior authorization from the plan before your provider can proceed. Our plans follow government guidelines in this area to make sure you receive the most appropriate, cost-effective care available.

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