Blue Cross Medicare Advantage Dual Care℠
What You Should Know About Your Plan
Learn the basics of how your Blue Cross and Blue Shield of Texas Blue Cross Medicare Advantage Dual Care plan works. Use these resources and tools to help you get the most from your plan.

Using Your Blue Cross Medicare Advantage Dual Care Plan
We want you to get the most from your new plan. In this section, you’ll find resources to help you get started, maximize your benefits, use online tools, learn about claims and more.
Helpful Documents
Once enrolled in a Blue Cross Medicare Advantage Dual Care plan with Blue Cross and Blue Shield of Texas, you will have access to documents that provide information you may need understand and use your plan. You can find your plan’s specific documents by logging into your online account, Blue Access for Members℠.
You can also find them by going to the Forms and Documents page, searching your Zip Code, and selecting your plan.
Annual Notice of Change (ANOC)
You will get your Annual Notice of Change in October. This document will tell you what changes will be made to your plan for the next year, starting January 1st. It will outline any expected premium or benefit changes.
Evidence of Coverage (EOC)
You will get your Evidence of Coverage in October. This document gives you a detailed description your plan benefits. It explains your rights and responsibilities, what is covered, what you pay as a member of the plan, and how to file a complaint if you are not satisfied with a decision or treatment.
Learn About You Costs and Coverage
Coinsurance and Copays
- Understanding Costs: You may hear the terms "coinsurance" and "copay" while enrolled in a Blue Cross Medicare Options plan. Coinsurance is a percentage of the bill you pay. Copays are a set amount you pay at the time of service.
Quick Facts About Claims and More
- Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will get a statement called the Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
- What is an EOB? The EOB is a statement, not a bill. It simply details what you have paid and indicates the level of benefits you've used.
- How to use an EOB: Review these to be sure they are correct. If you think there are errors on your EOB statement, or you think you are the victim of fraud, please call customer service.
Prescription Drug Coverage
Drugs covered by Blue Cross Medicare Advantage Dual Care plans are listed in formularies (drug lists). Each plan has its own drug list that includes generic and brand name drugs. The list also provides information about drug copays and limitations, such as prior authorization, quantity limit and step therapy.
Drug Formulary
You will have access to the Drug Formulary, which is a list of drugs that are covered, both as a document or online. You can share the formulary with your doctor to talk about your medication options. Drug lists can change, most often in the beginning of each year. Normally, any changes in the drug list are reflected in the list at the beginning of each year. To access your formulary online, .
Medication List
The Medication List is used to record your current medications along with directions, prescriber, and any knock allergies. Bring your Medication List when you go to the doctor, hospital, or emergency room and share it with your family or caregivers.
You can find your plan's specific documents by logging into your Blue Access for Members account.
You can also find them by going to the Forms and Documents page, searching your Zip Code, and selecting your plan.
Prescription Drugs
Prescription Drug Programs That Are Here to Help
- Medicare Prescription Payment Plan
- Medication Therapy Management
- Drug Plan Transition
- Extra Financial Help
How to Address Issues and Problems
At Blue Cross and Blue Shield of Texas, we are here to help guide you through your plan's coverage options. To ensure member safety, a prescribed drug or medical service may need review from our specialized teams. If at any time you have a question or experience any issues during these processes, our customer service team will be able to assist.
If you have issues or problems with your Medicare plan or the care you receive, you have the right to make a complaint. Because Blue Cross Medicare Advantage Dual Care is your Medicare plan, you should call us with all your questions. You can address any Medicare coverage difficulties and concerns you may have via a complaint process.
Learn About Your Plan's Coverage Reviews
Prior Authorization and Step Therapy
Explore how drugs are placed into tiers, how prior authorization works, quantity limits and more.
Visit Prior AuthorizationCoverage Determinations
Want to understand how prescription drug coverage decisions are made and explore how to file a prescription drug appeal or grievance?
Visit Coverage DeterminationsMedical Appeals and Grievances
Learn how medical coverage decisions are made and how to use your rights to file a medical appeal or grievance.
Visit Medical Appeals and GrievancesClinical Guidelines
BCBSTX uses Medicare and internal medical policies based on scientific and medical research to make sure you get the health care you need. These policies are available for review.
Visit Clinical Guidelines