Blue Review
A newsletter for contracting institutional and professional providers

November 2019

New Names and ID Cards for Some Medicare Plans

Beginning Jan. 1, 2020, you may notice new names and ID cards for some of our Medicare plans. In addition to Blue Cross Medicare AdvantageSM plans, you may see the following new names for group plans offered by our members’ benefit administrators. While some plan names have changed, your experience as a provider will be the same and members’ benefits will not change.

The new member ID cards will include a Customer Service number for providers and the new plan names.

  • Blue Cross Group Medicare Advantage (HMO)SM is the new name of Blue Cross Medicare Advantage (HMO)SM for group Medicare members. This plan provides members access to providers within a defined network, with no out-of-network benefit.
  • Blue Cross Group Medicare Advantage (PPO)SM is the new name of Blue Cross Medicare Advantage (PPO)SM for group Medicare members. This traditional PPO allows members to seek care in network and out of network, typically providing cost savings for in-network care.
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM is the new name of Blue Cross Medicare Advantage (PPO) Employer GroupSM. This plan offers members access to providers nationwide who accept assignments from Medicare and are willing to bill Blue Cross and Blue Shield of Illinois (BCBSIL). Because there are no network restrictions, coverage levels are the same for all care regardless of provider network affiliation.
  • Blue Cross Group MedicareRxSM is the new name of Blue Cross MedicareRx (PDP)SM. It provides Medicare Part D prescription drug coverage.

The name of the BlueSecureSM retiree group plan isn’t changing. BlueSecure helps members cover some costs beyond what is covered by original Medicare. BlueSecure members can see providers who accept Medicare assignments and are willing to bill BCBSIL.

It’s important to check eligibility and benefits for each patient before every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status and applicable copayment, coinsurance and deductible amounts. The benefit quote may also include information on applicable benefit preauthorization requirements. Ask to see the member’s BCBSIL ID card and a driver’s license or other photo ID to help guard against medical identity theft.

Checking eligibility and benefits and/or obtaining benefit preauthorization/pre-notification or predetermination of benefits is not a guarantee that benefits will be paid. Payment is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations and exclusions set forth in your patient’s policy certificate and/or benefits booklet and/or summary plan description. Regardless of any benefit determination, the final decision regarding any treatment or service is between you and your patient. If you have any questions, please call the number on the member’s ID card.