Important Information Regarding MedicareBlueSM PPO and MedicareBlue Rx
MedicareBlue PPO or MedicareBlue Rx coverage is separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa*, Blue Cross and Blue Shield of Minnesota*, Blue Cross and Blue Shield of Montana*, Blue Cross and Blue Shield of Nebraska*, Blue Cross Blue Shield of North Dakota*, Wellmark Blue Cross and Blue Shield of South Dakota*, and Blue Cross Blue Shield of Wyoming.*
* Independent licensees of the Blue Cross and Blue Shield Association.
Medicare beneficiaries may enroll in MedicareBlue PPO or MedicareBlue Rx through the
Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, contact MedicareBlue Rx toll-free at 1-866-434-2037 or MedicareBlue PPO at 1-866-434-2038, Monday through Friday, 8 a.m. to 8 p.m. Central and Mountain Time. TTY/TDD users may call 1-866-456-1550.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
- MedicareBlue PPO or MedicareBlue Rx Customer Service, or
- 1-800- MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week, or
- The Social Security Administration at 1-800-722-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778, or
- Your State Medicaid Office
MedicareBlue PPO and MedicareBlue Rx members must use contracted network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies. Members who use pharmacies outside the network will pay any difference in the non-network pharmacy’s charge and the Plan’s allowable charge. Types of network pharmacies include: retail, mail order, LTC, and I/T/U. For more information about mail-order service, contact 1-866-434-2037 8 a.m. to 8 p.m., daily, Central and Mountain Time. TTY/TDD users should call 1-866-456-1550. The pharmacies in our network can change at any time. To obtain additional network pharmacy information, call 1-866-434-2037 8 a.m. to 8 p.m., daily, Central Time. TTY/TDD users should call 1-866-456-1550. Or send a request in writing to MedicareBlue PPO Customer Service, P.O. Box 8556, Philadelphia, PA 19101-855 or MedicareBlue Rx, P.O. Box 2190, Chester, VA 23891.
Benefits, formulary, network pharmacies, premium and/or copayments/coinsurance may change on January 1, 2009. Please contact MedicareBlue PPO or MedicareBlue Rx for details.
Members may enroll in Medicare Blue PPO or MedicareBlue Rx only during specific times of the year. For more information about enrollment periods, please contact MedicareBlue PPO or MedicareBlue Rx Customer Service.
MedicareBlue PPO and MedicareBlue Rx’s contracts with CMS are renewed annually, so enrollment in MedicareBlue PPO or MedicareBlue Rx after 2008 cannot be guaranteed.
If you have special needs, this document is available in alternative formats.
MedicareBlue PPO
MedicareBlue PPO is a regional Medicare Advantage Plan with a Medicare contract. You are eligible to enroll in MedicareBlue PPO if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the plan service area. You must continue to pay your Medicare Part B premiums (and Part A, if applicable) if not otherwise paid for by Medicaid or another third party. The MedicareBlue PPO prescription drug benefit is only available to members of the MedicareBlue PPO plan. If you are already enrolled in a Medicare Advantage Prescription Drug plan, you must receive your Medicare prescription drug benefit through that Plan. MedicareBlue PPO has formed a network of doctors, specialists and hospitals. You can use any provider who is part of our network or you may go to doctors out of the network. However, you may have to pay more for services received out of the network, except in emergency/urgent care situations. MedicareBlue PPO provides reimbursement for all covered benefits regardless of whether they are received in- or out-of-network. The providers in our network can change at any time. For a current Provider Directory, contact MedicareBlue PPO Customer Service, or visit our web site at YourMedicareSolutions.com.
MedicareBlue PPO’s contract with CMS is renewed annually, so enrollment in MedicareBlue PPO after 2008 cannot be guaranteed.
MedicareBlue PPO Customer Service:
For members: 1-888-457-3009, Monday through Friday, 8 a.m. to 8 p.m. Central and Mountain Time. TTY/TTD users should call 1-888-457-3005.
For prospective members: 1-866-434-2038, daily 8 a.m. to 8 p.m. Central and Mountain Time. TTY/TTD users should call 1-866-456-1550.
MedicareBlue Rx
MedicareBlue Rx is a regional Medicare Prescription Drug Plan with a Medicare contract.
You are eligible to enroll in MedicareBlue Rx if you are entitled to Medicare benefits under
Part A or enrolled in Medicare Part B and live in the plan service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. You may be enrolled in only one Part D plan at a time. If you are enrolled in a Medicare Advantage plan, you may not join MedicareBlue Rx unless you are a member of a Private-Fee-For-Service MA plan (PFFS) that does not provide Medicare prescription drug coverage, a Medicare Savings Account MA plan (MSA), or an 1876 Cost Plan.
MedicareBlue Rx Customer Service:
For members: 1-888-832-0075, 7 days a week, 8 a.m. to 8 p.m. Central and Mountain Time. TTY/TTD users should call 1-800-693-3819.
For prospective members: 1-866-434-2037, daily 8 a.m. to 8 p.m. Central and Mountain Time. TTY/TTD users should call 1-866-456-1550.
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Individual Members