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Medicare Advantage coverage documents
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 plan forms
- 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.
Medicare prescription drug resources
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 copay drugs at preferred retail pharmacies and Express Scripts and Walgreens Mail Service mail-order pharmacies, or a low copay at standard pharmacies.
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 that you get the best value from your pharmacy benefits.
Disclosures:
Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.
Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
Blue Medicare Supplement plans offered: Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.
Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.
The federal government requires all Medicare Advantage members to continue paying their Part B premium each month.
Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Links marked with an external site icon indicate that you're leaving BlueCrossNC.com and Blue Cross and Blue Shield of North Carolina's plan information. The site you're going to is either a third-party vendor contracted with Blue Cross NC to provide services or an external website independent of Blue Cross NC.
To view PDF documents, you need to download and install Adobe Acrobat Reader on your computer.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.
Out-of-network / non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
The Blue FlexCard is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International. Stride Bank is an independent company offering debit card services and is solely responsible for its products.
Blue Cross NC contracts with independent companies to provide supplemental benefits. Those companies are responsible for the services they provide. They do not provide Blue Cross or Blue Shield products or services. Marks and trade names are property of their respective owners.
Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.
FitOn Health is an independent company providing health and fitness services on behalf of Blue Cross and Blue Shield of North Carolina.
CareLinx is an independent company providing in-home care solutions on behalf of Blue Cross and Blue Shield of North Carolina.
TruHearing is an independent company providing hearing health and hearing aids on behalf of Blue Cross and Blue Shield of North Carolina.
Current as of 07/12/2024 | Y0079_12997_M CMS Accepted 05052025 | U36079, 6/24
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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© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.