About Blue Cross Blue Shield of Illinois health insuranceBlue Cross Blue Shield of Illinois is the largest health insurer in Illinois, offering group and individual health insurance coverage, managed care products, Medicare supplement coverage, and prescription drug coverage to over 7 million members. The BCBSIL network includes over 92% of hospitals in Illinois, over 91% of PCP’s in Illinois and over 87% of specialists in Illinois. Blue Cross Blue Shield of Illinois is committed to promoting the health and wellness of its members and Illinois communities through accessible, cost-effective, quality health care. Show
Blue MedicareRx Plans
Blue MedicareRx offers 3 plan designs: Basic, Value, and Plus. Below is an overview of each plan. Blue MedicareRx Plans Comparison
Medicare Part D EligibilityBefore picking a plan, you need to be sure you are eligible for Blue MedicareRx. To be eligible, you must:
If you are enrolled in a Medicare Advantage HMO, PPO, or POS plan, you may only receive your Medicare prescription drug benefits through that Medicare Advantage plan. You can also enroll if you have Original Medicare or have a Medigap policy in addition to a prescription drug plan. You may not enroll in any Medicare-approved prescription drug plan unless you have a Medicare services account (MSA) or a private fee-for-service (PFFS) Medicare Advantage plan that does not provide Medicare prescription drug coverage. If you are eligible and live where Blue MedicareRx is available, you should decide which enrollment period is right for you. Enrollment PeriodsAnnual Enrollment Period*
*Dates subject to change after January 1, 2017 Initial Enrollment PeriodThe Initial Enrollment Period (IEP) is the period of time when a Medicare beneficiary is first eligible to enroll in Blue MedicareRx. Instances of IEP include:
The effective date is generally the first day of the month after Blue MedicareRx receives the completed enrollment request. Special Enrollment PeriodThere may be select circumstances when you can enroll outside of the initial and annual enrollment periods. Below is a list of some, but not all, of those circumstances:
To obtain more detailed information on a Special Enrollment Period, including enrollment and effective dates, please contact a Blue MedicareRx Product Specialist. Late Enrollment PenaltyPart D Penalty – If you do not or did not join a Medicare drug plan when you first became eligible and didn’t have other creditable prescription drug coverage**, you may have to pay a late enrollment penalty of 1% for every month that you were eligible for Medicare but did not have creditable prescription drug coverage. This penalty would be added to your Part D plan premium, and the penalty amount could increase every year. You may also have to pay a penalty if you had a break in your Medicare drug coverage or other creditable drug coverage for at least 63 days in a row.
*The Initial Enrollment Period for Part B consists of the month of your 65th birthday, the three months before, and the three months after the month you turn 65. **Creditable prescription drug coverage is coverage that is expected to pay on average at least as much as Medicare’s standard prescription drug coverage (eg. coverage from an employer or union). Please visit the Social Security Administration website for more information. After You EnrollAfter EnrollmentAfter receiving your completed enrollment form, Blue MedicareRx will send you:
Evidence of CoverageThe evidence of coverage (EOC) is a detailed document that explains the plan rules associated with Blue MedicareRx. This document, together with your enrollment form, riders, coverage and the amendments that we may send to you, is our contract with you. The EOC explains:
Evidence of Coverage: Basic Plan Evidence of Coverage: Value Plan Evidence of Coverage: Plus Plan Medicare Part D Financial HelpPeople with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for up to 100 percent of drug costs, including monthly prescription drug premiums, annual deductibles and copays/coinsurance. (An enrollee’s premium will generally be lower once he or she receives extra help from Medicare.) Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it. Best Available Evidence PolicyGet more information from the Centers for Medicare & Medicaid Services about the policy for applying for extra help and the documentation required Low Income Subsidy PremiumThe premiums listed do not include the amount you pay for your Medicare Part B premium.
To learn if you qualify for extra help, contact: Medicare Social Security Administration Your local Medicaid office Resources include savings and stocks, but not your home or car. Qualifications are established by the federal government and subject to change annually. Medicare Supplement Plan OverviewWhy You Need Medicare Supplement InsuranceMedicare is a federal program to help older Americans and some disabled Americans pay for the high cost of health care. However, Medicare was never intended to cover all your health care costs. So even if you’re covered by Medicare, you are still responsible for a large portion of your health care costs. Without Medicare Supplement insurance, your out-of-pocket costs could add up to more than $60,424 this year alone. What Medicare Doesn’t CoverMedicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses). Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:
By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. While the benefits must be the same, each company’s rates, reputation, membership features and quality of service can vary. With Blue Cross and Blue Shield of Illinois, you don’t have to sacrifice comprehensive benefits or freedom-of-choice for affordability. Their Medicare Supplement plans provide substantial benefits at rates that can save you money over other plans. Blue Cross Blue Shield of Illinois Member BenefitsAll Blue Cross and Blue Shield of Illinois Medicare Supplement plans give you:
Medicare Supplement Basic BenefitsBasic benefits included in all plans include:
*Plans K and L include benefits at different levels of cost sharing (see outline of coverage). Premier Plans
Budget-Conscious PlansHigh Deductible Plan F, Plan K, Plan L and Plan N include cost-sharing features that allow you to save on premiums while still receiving dependable coverage.
If you are seeking the most basic benefit plan with the lowest cost, BCBSIL offers Medicare Supplement Plan A. For more detailed explanations on all the available BCBSIL Medicare Supplement plans and benefits, you can Compare BCBSIL Medicare Supplement Plans. BCBSIL Medicare Supplement Plans – Quick Comparison Table
*Plan F also has an option called high deductible Plan F (HD-F). This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,490 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,490. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare Part A and Medicare Part B deductibles, but do not include the plan’s separate foreign travel emergency deductible. **Plans K and L provide for different cost-sharing than plans A-F. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You will be responsible for paying excess charges. Part B medical excess: Charges from your provider that exceed Medicare-approved amounts. Only Plan F, High Deductible Plan F, and Plan G cover these charges. For all other plans, you are responsible for paying excess charges. In no case can a provider charge more than 115% of the Medicare approved amount. Skilled nursing coinsurance: Medicare pays the first 20 days of treatment in a skilled nursing facility, and an annually adjusted per diem for the 21st through 100th day. Plans with this benefit pay an additional annually adjusted per diem for the 21st through 100th day. You are responsible for all charges after the 100th day. In order to receive any Skilled Nursing Facility benefits, you must meet Medicare’s requirements:
Foreign travel emergency: Medically necessary emergency care services beginning during the first 60 days of each trip outside of the United States. All plans offering this benefit require you to pay a foreign travel emergency deductible and a percent of costs after the deductible is met. Preventive care: Some annual physical and preventive tests and services administered or ordered by your doctor when not covered by Medicare. Reduced Premium Medicare Select OptionMed-Select OptionsPlan F, Plan G, Plan K, Plan L, and Plan N Med-Select options offer you the same solid benefits as the “standard” plans, but cost less. You save on premiums simply by agreeing to use any of the Med-Select participating hospitals for non-emergency elective admissions. If you do not use one of these hospitals for your non-emergency admissions, you pay the $1,556 Part A deductible. Med-Select is not an HMO. With Med-Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists. Med-Select is available in specific geographic areas only. You must live within a 30 mile radius of a Med-Select participating hospital. New Plan G Option: Plan G PlusBeginning February 1st, 2021 all three Blue Medicare Supplement Plan Gs (Standard, Select, and High Deductible) have Plus options. Medicare Supplement Plan G Plus plans have the same medical coverage and provider network as their regular versions as well as additional benefits and programs included so members can get more out of their Blue Medicare Supplement insurance plans. Additional benefits and programs include dental, vision, hearing, and fitness. BCBSIL Medicare Supplement – Plan G Plus Benefits
What pharmacy takes Blue Cross Blue Shield of Illinois?AllianceRx Walgreens Pharmacy, a central specialty and home delivery pharmacy, is contracted to provide mail pharmacy services to members of Blue Cross and Blue Shield of Illinois.
What is covered by Blue Cross Blue Shield of Illinois?As a Blue Cross Community Health Plans member, you have access to medical, dental, vision, behavioral health, prescription drug coverage and more. Some special benefits include: Zero co-pays: You pay nothing ($0) when you go to a doctor or health care provider in the plan's network.
What is Tier 1 prescription coverage?Tier 1 - Generic: All drugs in Tier 1 are generic and have the lowest possible copayment. A copayment is a fixed amount you pay when you get a prescription filled or receive other health care services. Drugs listed as Tier 1 are preferred because they offer the best combination of value and effectiveness.
What is the list of drugs covered by insurance called?A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
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Blue cross blue shield of illinois prescription coverage
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