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 offers both individual and group Medicare Advantage plans.

Blue Cross Medicare Advantage (PPO) Service Areas

Anderson, Andrews, Aransas, Archer, Armstrong, Austin, Bailey, Baylor, Bee, Bell, Bexar, Blanco, Borden, Bosque, Bowie, Brazoria, Brazos, Brewster, Briscoe, Brooks, Burleson, Calhoun, Cameron, Camp, Carson, Cass, Castro, Cherokee, Clay, Cochran, Coke, Coleman, Collin, Concho, Coryell, Crane, Crosby, Culberson, Dallam, Dallas, Dawson, Deaf Smith, Delta, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, Edwards, El Paso, Ellis, Erath, Falls, Fisher, Floyd, Foard, Fort Bend, Franklin, Freestone, Frio, Gaines, Galveston, Garza, Gillespie, Glasscock, Goliad, Grayson, Gregg, Grimes, Hale, Hall, Hamilton, Hansford, Hardeman, Harris, Harrison, Hartley, Haskell, Henderson, Hidalgo, Hockley, Hopkins, Houston, Howard, Hudspeth, Hunt, Hutchinson, Irion, Jack, Jackson, Jeff Davis, Jefferson, Jim Hogg, Jim Wells, Karnes, Kaufman, Kenedy, Kent, Kimble, King, Kinney, Kleberg, Knox, La Salle, Lamar, Lamb, Lavaca, Leon, Liberty, Limestone, Live Oak, Loving, Lubbock, Lynn, Madison, Marion, Martin, Mason, Maverick, McCulloch, McLennan, Menard, Midland, Mills, Mitchell, Montague, Montgomery, Moore, Morris, Motley, Nacogdoches, Nueces, Oldham, Orange, Palo Pinto, Panola, Parker, Pecos, Polk, Potter, Presidio, Rains, Randall, Reagan, Red River, Reeves, Refugio, Roberts, Robertson, Runnels, Rusk, San Augustine, San Jacinto, San Patricio, San Saba, Schleicher, Shackelford, Shelby, Sherman, Smith, Somervell, Starr, Stephens, Sterling, Stonewall, Sutton, Swisher, Tarrant, Terry, Throckmorton, Titus, Tom Green, Travis, Trinity, Tyler, Upshur, Upton, Uvalde, Van Zandt, Victoria, Walker, Waller, Washington, Webb, Wheeler, Willacy, Williamson, Winkler, Wise, Wood, Yoakum, Young, Zapata and Zavala counties.

Additional Blue Cross Medicare Advantage (PPO) Service Areas effective 1/1/2025:

Childress county

Network Participation

BCBSTX would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan.

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.

Retiree Group Medicare Plans

Our plans for retiree groups include Group Medicare Advantage PPO and HMO plans. Learn more.

BlueStagesSM is a Medicare supplement insurance plan that helps cover some costs beyond what is covered by Original Medicare. BlueStages members can see providers nationwide who accept Medicare assignment.

Our open access plans include Blue Cross Group Medicare Advantage Open Access (PPO)SM, a non-differential national PPO plan without network restrictions. Medicare providers can treat these providers even if you don’t participate in our Medicare Advantage or other networks. The only requirements are that you agree to see the member as a patient, accept Medicare and submit claims to the member’s Blue Cross and Blue Shield Plan.  Learn more.

UT CARETM Medicare PPO is an open access retiree plan. Learn more. 

Have questions?

Refer to the Medicare Advantage section on Contact Us for contact information, or contact your Provider Relations Representative.

  • Claims

    Participating physicians, professional providers and facility or ancillary providers must submit Blue Cross Medicare Advantage (PPO) claims 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 physicians, professional providers and facility or ancillary providers may not seek payment from the member for claims submitted after the 90-day filing deadline.

    Refer to the Medicare Advantage section on Contact Us for details on submitting claims payments and appeals, medical appeals, disputes and grievances.

  • Join the Network

    To join our Blue Cross Medicare Advantage network, refer to How to Join

  • Prior Authorization Requirements

  • Medicare Marketing Guidelines

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

    See the Medicare Marketing Guidelines on the CMS website.

  • Value-Based Care Programs

    Our Value-Based Care Program partners with providers to deliver high-quality, patient-centered care while aligning reimbursement with outcomes rather than volume. Through data sharing, performance insights, and coordinated care initiatives, participating providers are supported in closing care gaps, improving clinical quality measures, and enhancing the overall patient experience.  

    The program offers opportunities for shared savings, performance-based incentives, and strengthened collaboration with the health plan to drive sustainable practice growth. For patients, this model promotes proactive care management, improved access, and better health outcomes. Together, we can advance a health care delivery system that rewards quality, efficiency, and meaningful results. 

    For more information, refer to the value-based care provider manual or contact  Medicare Advantage Provider Network at 972-766-7100 or email us.

     

     

  • Resources

 

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX.

BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.