Blue Cross Medicare Advantage (PPO)SM

Blue Cross Medicare Advantage plans offer all the same coverage as Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage and extra health and wellness options. Blue Cross and Blue Shield of Texas (BCBSTX) offers both individual and group Medicare Advantage plans.

  • The Blue Cross Medicare Advantage (PPO) plan offers health coverage to members who reside in Bastrop, Bexar, Burnet, Caldwell, Chambers, Collin, Dallas, Denton, Fayette, Fort Bend, Hardin, Harris, Hays, Jefferson, Lee, Liberty, Montgomery, Tarrant, Travis or Williamson counties.
  • Effective January 1, 2020, Blue Cross Medicare Advantage (PPO)SM networks are expanding in the following areas:
    Atascosa, Bandera, Comal, Cooke, Fannin, Guadalupe, Hill, Johnson, Kendall, Llano, Medina, Navarro, Rockwall, Wilson and Wise counties.
  • Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan.
  • Our retiree group Medicare plans are Blue Cross Group Medicare Advantage (PPO)SM, Blue Cross Group Medicare Advantage Open Access (PPO)SM and Blue Cross Group MedicareRx (PDP)SM. BlueStagesSM is a Medicare supplement insurance plan that helps cover some costs beyond what is covered by Original Medicare.
  • Out-of-network Note: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSTX, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) PDF Document members. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. In-network providers will be paid at their contracted rate.
    • BlueStages members also can see providers nationwide who accept Medicare assignment.

BCBSTX believes that our long–standing history in providing affordable health care coverage to the people of Texas, our strong brand recognition, and our historical relationship with Medicare makes BCBSTX an excellent choice for Medicare-eligible individuals. We maintain and monitor a network of participating providers including physicians, hospitals, skilled nursing facilities, ancillary providers and other health care providers through which members obtain covered services.

  • New individual providers and new medical groups desiring to apply for network participation or existing medical groups who wish to add additional providers to their current contract, will need to complete the Provider Onboarding Form
  • Please refer to the Provider Onboarding Form User Guide PDF Document for tips on completing the Provider Onboarding form.

If you have any questions regarding this plan, please feel free to contact your Network Management office.

Participating physician, professional provider, facility or ancillary providers must submit claims to Blue Cross Medicare Advantage (PPO) within 90 days of the date of service, using the standard claim form or electronically. Services billed beyond 90 days from date of service are not eligible for reimbursement. Blue Cross Medicare Advantage (PPO) participating physician, professional provider, facility or ancillary providers may not seek payment from the member for claims submitted after the 90-day filing deadline.

To join our Blue Cross Medicare Advantage network, follow the Provider Onboarding Process:

All providers who contract with BCBSTX to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSTX or Blue Cross Medicare Advantage products or benefits.