Información para asegurados
What You Should Know About Your Plan
Here’s some basic information about how your Blue Cross and Blue Shield of Illinois Blue Cross Medicare AdvantageSM plan works. Plus, there are resources and tools to help you get the most from your plan.
Using Your Blue Cross Medicare Advantage℠ Plan
Queremos que aproveche al máximo su cobertura nueva. En esta sección, encontrará recursos que le ayudarán a comenzar, aprovechar al máximo sus beneficios, usar recursos en línea, aprender acerca de las reclamaciones y mucho más.
Llámenos antes de llamar a Medicare. Debido a que Blue Cross Medicare Advantage es su cobertura Medicare, debe llamarnos si tiene alguna pregunta. Our Member Services team will let you know if your question can be answered by Medicare. Llame a Servicio al Cliente al número que figura en su tarjeta de asegurado.
Bienvenido a su cobertura
- Enrollment Confirmation: Before you can start using your plan, Medicare must approve your enrollment. This will take about 10 business days. You’ll get an acknowledgment letter and a confirmation letter once approved. A continuación, le enviaremos su tarjeta de asegurado.
- Welcome Kit: Includes your plan’s drug formulary, the Evidence of Coverage form and other helpful information. Learn more about the Welcome Kit
Buscar un profesional
- Provider Finder®: To maximize benefits, use in-network providers. We can help you choose a primary care provider (PCP) in your plan's network. Buscar un profesional médico
- Set up your Annual Wellness Visit once coverage is active.
Coseguros y copagos
- Understanding Costs: Coinsurance is a percentage of the bill you pay. Los copagos son un monto fijo que usted paga al momento de recibir el servicio.
Cobertura de medicamentos con receta
- Drug Formulary and Pharmacy Search: You will have online access to a Drug Formulary, which is a list of drugs that are covered. You can share the formulary with your doctor and talk about the drugs you take now. Más información
- Prior Authorization: Also, learn about how drugs are placed into tiers based on cost, prior authorization, quantity limits and more. Más información sobre autorización previa
- Drug Plan Transition: If you’re new to our plan, find out how to get a limited supply of your medication that isn’t covered Learn more about drug plan transition
- Medication Therapy Management: Find out if the drug you take is safe, works well and fits your lifestyle at no additional cost to eligible members. Más información sobre medication therapy management
- Medicare Prescription Payment Plan: This program can offer help with managing your out-of-pocket costs. Averigüe más acerca de la Pago de medicamento con receta de Medicare
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 receive an Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
- ¿Qué es una EOB? The EOB is a statement, not a bill. Sencillamente, detalla lo que usted pagó e indica el nivel de beneficios que usó.
- 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 the number on the back of your member ID card.
Aviso anual de cambios
- You will get your Annual Notice of Change in October. This 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.
How to Address Issues and Problems
If you have issues or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can address any Medicare coverage difficulties and concerns you may have via a complaint process.
For complaints about your Medicare plan related to medical care you have received:
Go to Medical Care Appeals and Grievances
For complaints about your Medicare plan related to prescription drugs:
Go to Medicare Coverage Determination, Appeals, and Grievances
If you would like to submit feedback directly to Medicare, you have two options: