Blue Medicare Supplement benefits can be used anywhere in the country with any provider or facility that accepts Medicare.

Dual Special Needs Plans (D-SNP) cover individuals who have both Medicare and medical assistance from a state plan under Medicaid. 

Medicare Part C is provided by private insurance companies, like Blue Cross NC. It covers the same types of care as Medicare Parts A and B but may lower your share of the costs when you use doctors and hospitals that are part of the plan’s network.

In addition, most Medicare Advantage plans offer prescription drug coverage and supplemental benefits such as gym memberships, vision coverage, dental coverage, and more.

Medicare Part D is prescription drug coverage for those enrolled in Original Medicare (Parts A and/or B). Plans are also available from private insurers, like Blue Cross NC.

If you are enrolled in a Medicare Advantage plan, you are not eligible for this standalone prescription drug coverage. If you are interested in a Medicare Advantage plan and need drug coverage, be sure to choose a Medicare Advantage plan that includes drug coverage.

Original Medicare is your Part A hospital benefits and Part B medical benefits. It is administered by the federal government.

Original Medicare covers many preventive services, such as flu shots and pneumonia shots.

Both Original Medicare and Medicare Advantage cover pre-existing conditions. Medicare Supplement plans may be subject to a waiting period.

Yes. Medicare Part B covers one flu/influenza shot (or vaccine) per flu/influenza season in the fall and winter, with additional flu/influenza shots (or vaccines) if medically necessary.

Medicare Part B covers flu, COVID-19, pneumonia, and Hepatitis B vaccines.

Medicare Part D covers RSV, shingles, and Tdap vaccines.

Medicare Advantage plans may include dental, hearing and vision benefits and/or allowances. Original Medicare and some Medicare Supplement plans do not cover dental, hearing and vision services that are not medically necessary, but you can purchase dental or vision plans separately.

Expenses for long-term care facilities, such as nursing homes, are not covered. However, Medicare does include benefits for a skilled nursing facility for rehabilitation and medical treatment (from a surgery or other significant inpatient medical procedure).

With Original Medicare and Medicare Supplement, you can see any doctor or visit any hospital that accepts Medicare. Some plans also offer coverage for foreign travel and foreign emergency care. With Medicare Advantage PPO plans, you may use your out-of-network benefits when traveling outside the service area. Medicare Advantage HMO plans require you stay in the network for your medical care, however, in the event of an emergency, you’re covered.

Some medications may be covered under Original Medicare's Part B benefits. For more robust coverage, you may purchase a Medicare Rx (Part D) plan to add to Original Medicare or purchase a Medicare Advantage plan that includes prescription drug (Part D) coverage.

Original Medicare and Medicare Supplement provide coverage at any Medicare-participating doctor or hospital in the country. Medicare Advantage plans are coordinated care plans, which means they are built around a network of doctors and hospitals working together to provide your care. 

Yes. You can lose your Medicare Part B, Medicare Supplement or Medicare Advantage coverage if you don’t pay your Part B or plan premium. To maintain your Medicare coverage, you must pay your premium each month.

You can begin your Medicare enrollment at ssa.gov. If you'd like to purchase a Medicare Advantage plan, Medicare Supplement plan or Medicare Prescription Drug plan (PDP), you need to enroll in Parts A and/or B before purchasing those plans.

Some people get Medicare Part A and Medicare Part B automatically, and other people have to sign up. In most cases, it depends on whether you're getting Social Security benefits. You can learn more at Medicare.gov.

Medicare Part A is usually available at no cost if you or your spouse made payroll contributions to Social Security for at least 10 years. Medicare Part B comes with a monthly premium based on your income. Some Medicare Advantage (Part C) plans, Medicare Supplement and Medicare Rx (Part D) also come with a monthly premium.

You still qualify for Medicare at age 65, but it may or may not make sense to enroll. Check with your employer's human resources manager, benefits specialist, or a Blue Cross NC agent to learn about your options.

In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more. 

You can discontinue your Medicare coverage to enroll under an employer plan. When you're ready for Medicare again, you'll still be eligible under a Special Enrollment Period.

Check with your human resources manager or benefits specialist to see your options. In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more.

If you enroll in Parts A, B or D after 3 months from your eligibility date, you may have to pay a higher premium for Parts B and D. This penalty is required by the federal government. For more information about late enrollment, visit Medicare.gov.

Yes. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

If you have Medicare and Medicaid, you already qualify for low-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. The amount of assistance will depend on your income and resources and will be applied to the cost of the Medicare prescription drug coverage portion of your Blue Medicare Advantage or Medicare Prescription Drug plan.

There are two opportunities for Medicare-eligible people to switch plans: the Annual Enrollment Period (AEP) October 15 to December 7 and the Open Enrollment Period (OEP) January 1 to March 31.

For example, if you enroll or switch plans in the fall but decide you don't like the plan once your coverage begins in January, you can switch back to Original Medicare or another Medicare Advantage plan before March 31.

You can also change plans anytime you qualify for a Special Enrollment Period. 

You can check your eligibility at Medicare.gov.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans

You can only make partial payments by mail. You cannot make partial payments online or by phone. Please keep in mind that if you mail in a partial payment, there is no guarantee that your claims will be paid, or your policy will remain active if the full amount is not received by the payment due date. This applies to all Blue Medicare^℠ plans. If you would prefer to mail your payment, please use the return envelope provided to avoid processing delays.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans

No. Business checks are not accepted for individual premium payments. If you would prefer to mail your payment, please use the return envelope provided to avoid processing delays.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans 

Yes. However, you can only submit a money order payment by mail. Be sure to include your Blue Cross NC member ID number on the money order to ensure your payment posts to your account on time. Please use the return envelope provided to avoid processing delays.

Yes. You can make a one-time payment online and by phone.

To pay online, log in to the Blue Cross NC member portal. Go to Billing & Payments, then select Pay Now under the plan you would like to pay. Follow the prompts to finish paying. Available payment methods online include debit cards, credit cards, or bank draft.

To pay by phone, call 844-395-4535 (TTY 711). Available payment methods by phone include debit cards, credit cards, or bank draft.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans 

Yes. We accept payments made through your bank’s online bill pay service or other third-party bill pay vendors. Be sure to include your Blue Cross NC member ID with each payment to ensure your payment posts to your account on time.

Blue Medicare Advantage^℠ and Blue Medicare Rx^℠ 

To reinstate your policy, log in to the Blue Cross NC member portal account. Send us a secure message or chat and we’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card. 

Blue Medicare Supplement^℠ 

To reinstate your policy, you’ll need to first pay the outstanding balance. To do that, log in to the member portal. Go to Account/Profile and select Manage Billing and Payment. Then, select Pay Now under the plan you would like to pay and follow the prompts. 

Once your account is paid, send us a secure message or chat, and we’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card. 

To set up autopay, log in to the Blue Cross NC member portal. Go to Billing and Payments, then click Set Up Autopay. Follow the prompts to complete your setup. Recurring payments (autopay) are only available using a bank draft. 

Blue Medicare Advantage^℠ and Blue Medicare Rx^℠ 

To reinstate your policy, log in to the Blue Cross NC member portal. You can log in to your member portal account to send us a secure message or chat and we’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card. 

Blue Medicare Supplement^℠ 

To reinstate your policy, you’ll need to first pay the outstanding balance. To do that, log in to the member portal. Go to Account / Profile and select Manage Billing and Payment. Then, select Pay Now under the plan you would like to pay and follow the prompts. 

Once your account is paid, send us a secure message or chat, and we’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans 

You can log in to the Blue Cross NC member portal to send us a secure message or chat. We’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card.

Blue Medicare Advantage^℠, Blue Medicare Supplement^℠, and Blue Medicare Rx^℠ plans 

We create and send invoices between the 5th and 10th of each month. It takes about 7–10 business days before you’ll receive your invoice by mail. It’s likely that the late notice was mailed before we received your payment. You can always log in to the Blue Cross NC member portal to check the status of your payment. 

If you would prefer to mail your payment, please use the return envelope provided to avoid processing delays.

Original Medicare is Medicare Parts A and B. It is administered by the federal government. 

Medicare Advantage (Part C) is provided by private insurance companies, like Blue Cross NC. It covers the same types of care as Medicare Parts A and B but may lower your share of the costs when you use doctors and hospitals that are part of the plan’s network. 

In addition, most Medicare Advantage plans offer prescription drug coverage (Part D) and supplemental benefits such as gym memberships, vision coverage, dental coverage, and more.

Yes. You'll need to be enrolled in Original Medicare (Parts A and B) to be eligible for a Medicare Advantage plan.

Once you become a Blue Medicare HMO or Blue Medicare PPO member, you transfer the administration of your Medicare benefits to the plan. This means you maintain your status as a Medicare beneficiary, plus gain the enhanced coverage available through your health plan. You will receive a member ID card that you will present when using your benefits. You should present this card when using your pharmacy benefits as well. Pharmacy benefits are not available on all plans.

You are still responsible for paying your Medicare Part B premium.

Yes. If you join Blue Medicare HMO or Blue Medicare PPO, you can keep your military benefits.

Yes. Starting in plan year 2021, people with End Stage Renal Disease can enroll in Medicare Advantage.

You can search for doctors in the Blue Cross NC network using our Find a Doctor tool. You can also use the tool to search for in-network pharmacies and medical facilities.

As a Medicare Advantage member, you are entitled to receive a one-time Welcome to Medicare exam within the first 12 months of enrollment in Medicare Part B. The Welcome to Medicare exam offers an opportunity for your doctor to review your medical and personal history, conduct several simple measurements and screenings related to your well-being, and outline a plan for future preventive services.

One annual routine physical exam is covered at no cost to you. This includes baseline measurements such as blood pressure, height and weight, review of risk factors, and certain diagnostic tests that include complete blood count and urinalysis. 

If you have been enrolled in Medicare Part B for more than 12 months, you will want to schedule this as an Annual Wellness Visit. It's important to schedule the correct visit so it can be covered correctly.

Blue Medicare HMO and Blue Medicare PPO plans cover eligible emergency services for you in or out of the service area. If you have a medical emergency, go to the nearest medical facility or call 911. Emergency services require a copayment, but it will be waived if you are admitted to the hospital on an inpatient basis within 48 hours.

If you have a PPO plan, you can use your out-of-network benefits for your doctor and may pay more. Otherwise, your plan will notify you if your doctor leaves the plan network, and you'll be able to choose a new doctor.

If you plan to move out your plan’s service area in North Carolina, you can't remain a member of the plan. Contact Customer Service to see if we have a plan in your new area. If you move to another state, you can't remain a member of the plan.

When you move, you will have a Special Enrollment Period that will allow you to switch to Original Medicare or enroll in a Medicare Advantage health or drug plan that is available in your new location.

Medicare Part C is provided by private insurance companies, like Blue Cross NC. It covers the same types of care as Medicare Parts A and B but may lower your share of the costs when you use doctors and hospitals that are part of the plan’s network.

In addition, most Medicare Advantage plans offer prescription drug coverage and supplemental benefits such as gym memberships, vision coverage, dental coverage, and more.

You'll need to be enrolled in Original Medicare (Parts A and B) to be eligible for a Medicare Supplement plan.

Supplement plans help cover costs not covered by Original Medicare, such as coinsurance, copays and deductibles. 

Blue Medicare Supplement benefits can be used anywhere in the country with any provider or facility that accepts Medicare.

If your Medicare Supplement plan is from Blue Cross NC you can keep your plan if you move to a different state.

Medicare Part B covers a limited number of outpatient prescription drugs under limited conditions. Drugs covered under Part B are drugs you'd have administered in a doctor's office or hospital outpatient setting, such as a flu vaccine. You can view a list of these drugs at Medicare.gov.

For medications you'd administer yourself, including maintenance medications and drugs prescribed by a doctor to take at home, you'd want to consider a Medicare Rx (Part D) plan or a Medicare Advantage plan that includes prescription drug coverage.

You'll need to be enrolled in either Part A or Part B of Original Medicare to be eligible for a Medicare Rx (Part D) plan.

If you're enrolled in Medicare Advantage without prescription coverage, you cannot enroll in a standalone Medicare Rx plan. If you'd like a Medicare Advantage plan plus drug coverage, be sure to choose a Medicare Advantage plan that includes drug coverage.

Medicare has established a "standard benefit" for prescription drug coverage, which consists of three stages. Private companies, such as Blue Cross NC, can offer enhanced prescription drug plans. However, these plans must provide a standard benefit package that is, at a minimum, equal in value to Medicare's standard benefit.

For 2026, this defined standard benefit is:

Deductible Stage: You will be responsible for 100% of the first $615 in total prescription drug costs in each calendar year before your prescription drug benefit begins.

Initial Coverage Stage: After the first $615, you will be responsible for 25% of the total cost of your prescription drugs. The plan will pay 75% of your total drug costs until they reach a total of $2,100.

Catastrophic Coverage Stage: After your total out-of-pocket costs reach $2,100, you will pay nothing for your covered prescription drugs.

Each plan establishes its own formulary, or list of covered drugs.* Formularies may differ by plan, but are all required to meet certain requirements set by Medicare.

Medicare prescription drug coverage covers drugs that meet the following criteria:

• They must be available only by prescription.
• They must be approved by the Food and Drug Administration.
• They must be used and sold in the United States.
• They must be used for a medically necessary indication.

Specifically, coverage will include:

• Prescription drugs
• Vaccines
• Insulin
• Certain medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze)

Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over-the-counter medicines or drugs used exclusively for weight loss.

Drugs that are covered by our Blue Cross NC Medicare Advantage Prescription Drug (MAPD) plans or our standalone Prescription Drug Plans (PDP), can be found on our formularies.

*Formulary and pharmacy network may change at any time. You will receive notice when necessary.

Yes. You have the convenience of ordering your prescriptions from one of our mail order pharmacies. For most drugs, you can fill up to a 90-day supply through mail order, and your medications will be delivered directly to your home with free shipping. Depending on your plan, there may be savings available if you use Amazon, our preferred mail order pharmacy.

Only drugs purchased in the United States or its territories are eligible for Medicare prescription drug coverage.

Members can fill their prescriptions at any in-network pharmacy, even outside of the covered service area. International pharmacies are not eligible for Medicare prescription drug coverage. If you have upcoming travel plans, speak with your pharmacy to ensure you have enough medication on hand while you are away from home.

If you plan to move out your plan’s service area in North Carolina, you can't remain a member of the plan. Contact Customer Service to see if we have a plan in your new area. If you move to another state, you can't remain a member of the plan.

When you move, you will have a Special Enrollment Period that will allow you to switch to Original Medicare or enroll in a Medicare Advantage health or drug plan that is available in your new location.

Congress designed Medicare prescription drug coverage on an annual enrollment cycle. This means that each year, you will have the option to re-enroll in your existing Medicare prescription drug coverage plan or change plans between October 15 and December 7 each year.

If you qualify for a Special Enrollment Period (SEP), you can change your Medicare Rx plan.

You may also have another opportunity during the year to switch plans, under limited circumstances. For example, if you move out of your plan's service area, you'll have an opportunity to choose another plan that serves your new area.

Medicare Part D is prescription drug coverage for those enrolled in Original Medicare (Parts A and/or B). Plans are also available from private insurers, like Blue Cross NC.

If you are enrolled in a Medicare Advantage plan, you are not eligible for this standalone prescription drug coverage. If you are interested in a Medicare Advantage plan and need drug coverage, be sure to choose a Medicare Advantage plan that includes drug coverage.