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Medicare coverage documents
- 2024 EOC Blue Medicare HMO Choice 026 (PDF)
- 2024 EOC Blue Medicare HMO Essential 027-001 (PDF)
- 2024 EOC Blue Medicare HMO Essential 027-002 (PDF)
- 2024 EOC Blue Medicare PPO Enhanced 003-001 (PDF)
- 2024 EOC Blue Medicare PPO Enhanced 003-002 (PDF)
- 2024 EOC Blue Medicare PPO Freedom+ 004 (PDF)
- 2024 EOC Enhanced HMO-POS 024-001 (PDF)
- 2024 EOC Enhanced HMO-POS 024-002 (PDF)
- 2024 EOC Enhanced HMO-POS 024-003 (PDF)
- 2024 EOC PDP Enhanced 004 (PDF)
- 2024 EOC Blue Medical Only HMO-POS 012 (PDF)
- 2024 EOC Blue Medicare Essential Plus HMO-POS 023-001 (PDF)
- 2024 EOC Blue Medicare Essential Plus HMO-POS 023-002 (PDF)
- 2024 EOC Blue Medicare Essential Plus HMO-POS 023-004 (PDF)
- 2024 EOC Blue Medicare Essential Plus HMO-POS 023-005 (PDF)
- 2024 EOC PDP Standard 002 (PDF)
- 2024 Healthy Blue + Medicare (HMO D-SNP) EOC (PDF)
- 2024 ANOC Blue Medicare Choice (HMO) (PDF)
- 2024 ANOC Blue Medicare Enhanced HMO 024-001 (PDF)
- 2024 ANOC Blue Medicare Enhanced HMO 024-002 (PDF)
- 2024 ANOC Blue Medicare Enhanced HMO 024-003 (PDF)
- 2024 ANOC Blue Medicare Enhanced HMO 024-003 to 002 (PDF)
- 2024 ANOC Blue Medicare Medical Only HMO-POS (PDF)
- 2024 ANOC HMO Essential H3449-027-001 (PDF)
- 2024 ANOC HMO Essential H3449-027-002 (PDF)
- 2024 ANOC HMO Essential H3449-027-002 to 001 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-001 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-002 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-004 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-005 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-004 to 002 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-004 to 001 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-005 to 001 (PDF)
- 2024 ANOC HMO Essential Plus H3449-023-005 to 002 (PDF)
- 2024 ANOC PDP Enhanced S5540 004 (PDF)
- 2024 ANOC PDP Enhanced S5540 002 (PDF)
- 2024 ANOC PPO Enhanced 003-001 (PDF)
- 2024 ANOC PPO Enhanced 003-002 (PDF)
- 2024 ANOC PPO Enhanced 003-002 to 001 (PDF)
- 2024 ANOC Blue Medicare Enhanced HMO 024-003 to 001 (PDF)
- 2024 ANOC Healthy Blue + Medicare (HMO D-SNP) (PDF)
- 2024 ANOC PPO Freedom+ 004 (PDF)
The list of drugs covered on each plan, along with any restrictions for those drugs, can be found in the formulary guide.
- Blue Medicare Choice (PDF)
- Blue Medicare Enhanced (PDF)
- Blue Medicare Essential (PDF)
- Blue Medicare Essential Plus (PDF)
- Blue Medicare PPO Enhanced (PDF)
- Blue Medicare Rx Enhanced (PDF)
- Blue Medicare Rx Standard (PDF)
- Blue Medicare HMO EGWP MAPD (PDF)
- Blue Medicare HMO EGWP MAPD (plans with deductible) (PDF)
- Blue Medicare PPO EGWP MAPD (PDF)
- Blue Medicare Rx EGWP HCE (PDF)
- Blue Medicare PPO EGWP Complete (PDF)
- Blue Medicare Rx EGWP Complete (PDF)
- Healthy Blue + Medicare (HMO D-SNP) (PDF)
Medicare plan forms
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 during the deductible, initial coverage and coverage gap phases 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, diabetes, osteoporosis, and rheumatoid arthritis. 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.
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.
Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.
Current as of 07/12/2024 | Y0079_12318_M CMS Accepted 08282024 | 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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