Overview of Medicaid with Healthy Blue® and Medicare Advantage with Healthy Blue + Medicare (HMO D-SNP)
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
With the implementation of Healthy Blue Medicaid Managed Care plan on July 1, 2021, and Healthy Blue + Medicare on January 1, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has developed an overview highlighting key points about each product which provides clarity for both Healthy Blue and Healthy Blue + Medicare. It is important for all participating providers to understand the differences between each plan to ensure that members are identified appropriately and to ensure you do not experience any delays when filing your claims. As a reminder, all claims must be filed to Availity. Please view the full overview of the Healthy Blue Medicaid and Healthy Blue + Medicare comparison flyer (PDF).
| Healthy Blue | Healthy Blue + Medicare | |
|---|---|---|
| Plan type | Medicaid Managed Care Prepaid Health Plan | Medicare Advantage HMO Dual-Eligible Special Needs Plan (HMO D-SNP) |
| Number of plan designs offered | Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers one Medicaid managed care plan, with benefits designed by the North Carolina Department of Health and Human Services (NC DHHS). The plan is administered by Blue Cross NC under a contract with NC DHHS. Blue Cross NC offers value-added services (VAS) to differentiate us in the market. | Blue Cross NC offers one D-SNP plan design with a $0 premium. The plan is offered by Blue Cross NC under a contract with CMS. Blue Cross NC offers supplemental benefits to be competitive in the market. |
| Go-live date | July 1, 2021 | January 1, 2021 |
| Service area | Statewide, all 100 counties | For 2021, 18 counties (primarily the Triangle and Triad areas, plus Charlotte and Asheville) For 2022, 90 counties |
| Member cost sharing | $0 premium, $0 for most services | $0 premium, $0 for many services |
| Contract/network | Custom provider network, specifically for Healthy Blue members | Same provider network as Blue Cross NC’s other Medicare Advantage plans |
| Claims filing | Claims are filed to Availity | Claims are filed to Availity |
Note: Availity, LLC is an independent company providing administrative support services for Healthy Blue + Medicare providers on behalf of Blue Cross and Blue Shield of North Carolina.
For more information, visit Healthy Blue + Medicare
BNCCARE-0184-21 August 2021 519259NCPENBNC
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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