Frequently Asked Questions | Blue Cross and Blue Shield of Texas

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Frequently Asked Questions

1. I’m retiring soon. How do I join a retiree group Medicare plan?

If your company or union has a group Medicare plan, you can get information from your Human Resources department or benefit administrator about the options offered to retirees.

2. Why would I choose a group Medicare plan over an individual Medicare plan?

As a rule, group Medicare plans have richer benefits than individual plans. And, because many employers or unions offer a defined contribution plan or subsidy, the cost is likely less as well.

3. What is a defined contribution?

It’s a subsidy paid by the employer to help pay the cost of the member’s premium. Each employer calculates the subsidy differently. Ask your employer or union if the plans they offer include a defined contribution. Companies may adjust the defined contribution amount to reflect factors it deems appropriate, which may include premium changes from year to year or information about medical cost trends, and the long-term sustainability of the subsidy program.

4. Will I have access to dental, vision or hearing benefits?

Many companies offer these benefits to eligible retirees. Check with your employer or union for details about what is available to you.

5. What do I need to do to enroll?

Your benefit administrator will provide directions. They may provide an enrollment kit or website for you to visit for more information about your options and instructions for enrolling.

6. Do I need to be enrolled in Medicare to receive my retiree medical and drug benefits?

Yes, enrollment in Medicare Part A and Part B is required for retirees to be eligible for retiree Medicare plans. If you are not currently enrolled in Medicare, please contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or go to www.socialsecurity.gov/retirement to enroll in Medicare.

7. Do I have to enroll as an individual?

Yes. All Medicare beneficiaries enroll as individuals. Spouses, domestic partners, and dependents who are not Medicare-eligible may be eligible for coverage through your employer’s or union’s pre-65 retiree medical plans, provided they are currently enrolled.

8. Do I have to choose a plan offered by my employer or union?

No. However, enrollment in one of the group Medicare plans offered by your employer or union is required to qualify for a defined contribution (subsidy). Usually, if you decline retiree medical coverage, you may not be able to re-enroll yourself or your dependents in the future.

9.  Will I be refused coverage due to a pre-existing condition? Can my policy be canceled once I am enrolled because of my condition? Can my rate be raised for that reason?

If you enroll in a retiree group Medicare plan, your coverage cannot be canceled, your claims cannot be denied, nor can your premium be increased because of a pre-existing condition.

10. Do I still have to pay Medicare premiums if I enroll in a retiree group Medicare plan?

Yes. To participate in a retiree group Medicare plan you will continue to pay Part B premiums.

11. What is the IRMAA surcharge for Part D?

IRMAA is an acronym for Medicare's income-related monthly adjustment amount. This is a higher premium charged by Medicare Part B and Medicare Part D to individuals with higher incomes. In 2021, retirees with modified adjusted gross income more than $88,000 (filing individually) or $176,000 (filing jointly) will pay the Part D IRMAA surcharge. A notice from Medicare will be mailed to those who will pay the IRMAA surcharge.

12. How often will I be billed? By whom? Can I pay by check?

Discuss premium payments with your benefit administrator. Remember, you are still required to pay your Medicare Part B premium.

13. What happens if I do not pay my premiums?

Non-payment of premiums will result in termination of coverage. If you decline retiree medical coverage or lose it by not paying premiums, you cannot re-enroll in the future.

14. Will I receive a periodic Medicare statement based on the plan I select?

If you enroll in a Blue Cross Group Medicare Advantage℠ plan, you will receive your Explanation of Benefits (EOB) from Blue Cross and Blue Shield of Texas (BCBSTX). If you enroll in BlueStages℠ Medicare Supplement Insurance plan, you will receive Medicare statements when a claim is paid (for the portion paid by Medicare Part A and B) and a BCBSTX EOB for the portion paid by BlueStages.

15. Can you switch plans during the next enrollment period?

Yes, if your employer or union offers multiple plans.

16. Can I enroll in a different plan than my spouse?

Yes. If you and your spouse are eligible for Medicare and your employer or union retiree coverage, and you are offered multiple plans from which to choose, you can each sign up for a different plan.

17. For retirees who live outside the BCBSTX service area, what providers can be used?

Under the Blue Cross Group Medicare Advantage (PPO)℠ plan you can go to any provider that accepts Medicare, however, if you choose to see an out of network doctor, your costs may higher than if you’d chosen an in-network provider?

Under the Blue Cross Group Medicare Advantage Open Access (PPO) plan, you can go to providers that: 1) accept Medicare; 2) agree to see you as a patient; and 3) agree to bill the Plan.

With Blue Cross Group Medicare Advantage (HMO)℠ plans, you must use network providers except in emergencies.

With BlueStages℠ you may go to any provider that accepts Medicare.

18. What national retail pharmacies can I use?

All major national retail and grocery pharmacy chains participate in the BCBSTX pharmacy network. Please search for pharmacies by ZIP code at the Pharmacy Finder or call customer service with specific questions.

19. Are there any pharmacies where BCBSTX has a discount?

Yes, all participating pharmacies offer members the BCBSTX contracted rates. You can minimize your coinsurance by shopping for the best price at any of our participating pharmacies. Or you may save by using either of our mail-order pharmacies, AllianceRx Walgreens Prime or Express Scripts Pharmacy

Visit AllianceRx Walgreens Prime or Express Scripts® Pharmacy to learn more.

Prime Therapeutics LLC has an ownership interest in AllianceRx Walgreens Prime, a central specialty pharmacy and home delivery pharmacy. Prime Therapeutics LLC, provides pharmacy benefit management services for Blue Cross and Blue Shield of Texas and is owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

Express Scripts® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of BCBSTX. The relationship between Express Scripts® Pharmacy and BCBSTX is that of independent contractors. Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc.

Express Scripts is an independent company and is solely responsible for the products and services that it provides.

20. What happens after I enroll in a plan? 

Check your mailbox for these items:

  1. Acknowledgment letter: Within 10-14 days of getting your enrollment form, we will send an acknowledgment letter. This can be used as proof of insurance if you have not received your member ID card by your effective date. 

  2. Confirmation letter: After your enrollment is approved by Medicare, we will send a confirmation letter. This can be used as proof of insurance if you have not received your member ID card by your effective date. 

  3. Member ID card: Your member ID card(s) will be mailed next. Show your new card(s) when you get services, so you are giving the right information.

  4. Welcome guide: You will get this helpful kit a couple of weeks after your member ID card. It includes plan documents and other useful information.

21. My member ID card hasn’t arrived yet. How do I show proof of insurance?

If you have not received your member ID card by your effective date, you can still use your plan benefits. You can show either your acknowledgment or confirmation letter as proof of insurance.