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My Advocate® program
Blue Cross NC collaborates with Change Healthcare’s My Advocate program® to help find out if you’re eligible for government programs and Extra Help on your healthcare costs. By working with an advocate, you’ll receive personalized assistance, eligibility information, and help through the application process if you qualify.
In order to make the assessment, My Advocate will gather personal financial information necessary to make a determination, so be prepared for questions regarding your finances. Rest assured that Change Healthcare does not share this information with any company or agency other than government agencies that require it should you qualify. The Blue Cross NC contract with Change Healthcare requires that your information be protected. Blue Cross NC does not receive the information that Change Healthcare gathers.
Dual Enrollment Advocate™
My Advocate will perform an individual screening to determine your eligibility for Medicaid services and Medicare Savings Programs that can help with some of your Medicare costs based on your income and financial asset level. If eligible, an advocate will help you through the enrollment process.
Extra Help (Part D Complete™) program
My Advocate can also help identify qualifying seniors and others who are eligible to receive Extra Help to pay for prescription medication and help assist with completing the program application.
Low income subsidy and best available evidence
If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our Plan.
These tables show you what your monthly plan premium will be if you get Extra Help.
2023 Blue Medicare HMO & PPO LIS table
| Monthly Premium for Blue Medicare | 100% Extra Help | 75% Extra Help | 50% Extra Help | 25% Extra Help |
|---|---|---|---|---|
PPO Enhanced (H3404-003-001)* | $0.00 | $7.20 | $14.50 | $21.70 |
PPO Enhanced (H3404-003-002)* | $10.60 | $20.20 | $29.80 | $39.40 |
Essential Plus (HMO) (H3449-023-001)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential Plus (HMO) (H3449-023-002)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential Plus (HMO) (H3449-023-004)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential Plus (HMO) (H3449-023-005)* | $0.00 | $0.00 | $0.00 | $0.00 |
Enhanced (HMO) (H3449-024-001)* | $0.00 | $4.70 | $9.50 | $14.20 |
Enhanced (HMO) (H3449-024-002)* | $0.00 | $8.50 | $17.00 | $25.50 |
Enhanced (HMO) (H3449-024-003)* | $10.60 | $20.20 | $29.80 | $39.40 |
Choice (HMO) (H3449-026-000)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential (HMO) (H3449-027-001)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential (HMO) (H3449-027-002)* | $0.00 | $0.00 | $0.00 | $0.00 |
Healthy Blue + Medicare (HMO) (H9147-001-000) | $0.00 | $9.60 | $19.20 | $28.80 |
Rx Standard (S5540-002-000) | $63.10 | $72.70 | $82.30 | $91.90 |
Rx Enhanced (S5540-004-000) | $94.10 | $103.70 | $113.30 | $122.90 |
2022 Blue Medicare HMO & PPO LIS table
| Monthly Premium For Blue Medicare | 100% Extra Help | 75% Extra Help | 50% Extra Help | 25% Extra Help |
|---|---|---|---|---|
PPO Enhanced (H3404-003-001)* | $0.00 | $7.20 | $14.50 | $21.70 |
PPO Enhanced (H3404-003-002)* | $13.20 | $22.10 | $31.10 | $40.00 |
Essential Plus (HMO) (H3449-023-001)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential Plus (HMO) (H3449-023-002)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential Plus (HMO) (H3449-023-004)* | $0.00 | $2.50 | $5.00 | $7.50 |
Essential Plus (HMO) (H3449-023-005)* | $1.20 | $7.40 | $13.60 | $19.80 |
Enhanced (HMO) (H3449-024-001)* | $0.00 | $4.70 | $9.50 | $14.20 |
Enhanced (HMO) (H3449-024-002)* | $0.00 | $8.50 | $17.00 | $25.50 |
Enhanced (HMO) (H3449-024-003)* | $13.20 | $22.10 | $31.10 | $40.00 |
Choice (HMO) (H3449-026-000)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential (HMO) (H3449-027-001)* | $0.00 | $0.00 | $0.00 | $0.00 |
Essential (HMO) (H3449-027-002)* | $0.00 | $0.00 | $0.00 | $0.00 |
Rx Standard (S5540-002-000) | $58.60 | $67.50 | $76.50 | $85.40 |
Rx Enhanced (S5540-004-000) | $84.60 | $93.50 | $102.50 | $111.40 |
This does not include any Medicare Part B premium you may have to pay.
Blue Medicare HMO's and Blue Medicare PPO's premium includes coverage for both medical services and prescription drug coverage.
If you aren't getting Extra Help, you can see if you qualify by calling:
Your State Medicaid Office, or The Social Security Administration at 800-772-1213. TTY users should call 800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call Customer Service at 888-310-4110 for HMO, 877-494-7647 for PPO, (TTY: 711). We are available for phone calls 8 a.m. to 8 p.m. daily. Calls to these numbers are free.
In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.
To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.
Please visit the CMS website for materials related to the CMS Best Available Evidence (BAE) policy.
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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, 2/22, Plan G: BMS G, 2/22, Plan HI DED G: BMS HDG, 2/22, Plan K: BMS K, 2/22, Plan N: BMS N, 2/22.]
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.
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The information on this page is current as of 10092022 | Y0079_11785_M CMS Accepted 10092022 | U36079, 092020
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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