Blue Medicare Advantage (HMO) Summary of Benefits (PDF)
Blue Medicare Advantage (PPO) Summary of Benefits (PDF)
Blue Medicare Freedom+ (PPO) Summary of Benefits (PDF)
Healthy Blue + Medicare (HMO-POS) (D-SNP) Summary of Benefits (PDF)
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2025 EOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)
2025 EOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)
2025 EOC Blue Medicare Freedom Plus (PPO) 004 (PDF)
2025 EOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)
2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)
2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)
2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)
2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)
2025 EOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)
2025 EOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)
2025 EOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)
2025 EOC Blue Medicare Choice (HMO) 026 (PDF)
2025 EOC Blue Medicare Essential (HMO) 027-001 (PDF)
2025 EOC Blue Medicare Essential (HMO) 027-002 (PDF)
2025 EOC Blue Medicare Rx Standard (PDP) 002 (PDF)
2025 ANOC Blue Medicare Choice (HMO) 026-000 (PDF)
2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)
2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)
2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)
2025 ANOC Blue Medicare Essential (HMO) 027-001 (PDF)
2025 ANOC Blue Medicare Essential (HMO) 027-002 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 to 004 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 to 005 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)
2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)
2025 ANOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)
2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)
2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)
2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 to 001 (PDF)
2025 ANOC Blue Medicare PPO Freedom Plus (PPO) 004 (PDF)
2025 ANOC Blue Medicare Rx Enhanced (PDP) 004 (PDF)
The list of drugs covered on each plan, along with any restrictions for those drugs, can be found in the formulary.
- Log in to Blue Connect and select "Find a Medication" to view estimated costs, drug limitations or requirements, and other covered drugs.
Blue Medicare Choice (HMO) (PDF)
Blue Medicare Enhanced (HMO-POS) (PDF)
Blue Medicare Essential (HMO) (PDF)
Blue Medicare Essential Plus (HMO-POS) (PDF)
Blue Medicare PPO Enhanced (PPO) (PDF)
Blue Medicare Rx Enhanced (PDP) (PDF)
Blue Medicare Rx Standard (PDP) (PDF)
Blue Medicare HMO EGWP MAPD (PDF)
Blue Medicare HMO EGWP MAPD (plans with deductible) (PDF)
Blue Medicare PPO EGWP MAPD (PDF)
Blue Medicare PPO EGWP Complete (PDF)
The Pharmacy Directory lists our network pharmacies. To locate a pharmacy in your area, log in to Blue Connect or select your plan's Pharmacy Directory PDF.
- Medicare Medical Claim Form (PDF) Or, submit your Medical Claim online through your Blue Connect℠ member portal.
- Medicare Prescription Drug Claim Form (PDF)
- Liberty Dental Claim Form (PDF)
- PHI Authorization Request Form (PDF) Or, submit your request through your Blue Connect℠ member portal.
Members with Blue Medicare Choice℠, Blue Medicare Essential℠, Blue Medicare Essential Plus℠, Blue Medicare Enhanced℠, and Blue Medicare PPO Enhanced℠ can take advantage of $0 copays for select care drugs at preferred retail and mail order pharmacies, or with a low copay at standard pharmacies.
Learn more about your pharmacy network.
The Formulary Tier 6 Select Care drug list below includes a wide range of commonly prescribed generic drugs used for high blood pressure, high cholesterol, and diabetes. Talk with your doctor to determine if a Formulary Tier 6 Select Care drug is appropriate to treat your condition so you get the best value from your pharmacy benefits.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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