Blue Cross Medicare Advantage Dual Care℠
Lo que debe saber sobre su cobertura
Learn the basics of how your Blue Cross and Blue Shield of Texas Blue Cross Medicare Advantage Dual Care plan works. Utilice estos recursos y herramientas para ayudarlo a aprovechar al máximo su cobertura.
Using Your Blue Cross Medicare Advantage Dual Care Plan
Queremos que aproveche al máximo su cobertura nueva. En esta sección, encontrará recursos que le ayudarán a comenzar, aprovechar al máximo sus beneficios, usar recursos en línea, aprender acerca de las reclamaciones y mucho más.
Helpful Documents
Once enrolled in a Blue Cross Medicare Advantage Dual Care plan with Blue Cross and Blue Shield of Texas, you will have access to documents that provide information you may need understand and use your plan. You can find your plan's specific documents by logging into your online account, Blue Access for Members℠.
You can also find them by going to the Formularios y documentos page, searching your Zip Code, and selecting your plan.
Aviso anual de cambios (ANOC, en inglés)
Usted recibirá el aviso anual de cambios en octubre. This document will tell you what changes will be made to your plan for the next year, starting January 1st. Se describirán los cambios previstos en las primas o beneficios.
Evidencia de Cobertura (EOC)
You will get your Evidence of Coverage in October. This document gives you a detailed description your plan benefits. It explains your rights and responsibilities, what is covered, what you pay as a member of the plan, and how to file a complaint if you are not satisfied with a decision or treatment.
Learn About You Costs and Coverage
Coseguros y copagos
- Understanding Costs: You may hear the terms "coinsurance" and "copay" while enrolled in a Blue Cross Medicare Options plan. Coinsurance is a percentage of the bill you pay. Los copagos son un monto fijo que usted paga al momento de recibir el servicio.
Reseña de las reclamaciones y más
- Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Una vez que se presente la reclamación, le enviaremos un estado de cuenta denominado Explicación de Beneficios (EOB, en inglés). La frecuencia con la que la reciba dependerá de la frecuencia con la que reciba atención o surta sus recetas.
- ¿Qué es una EOB? La EOB es un estado de cuenta, no una factura. Sencillamente, detalla lo que usted pagó e indica el nivel de beneficios que usó.
- How to use an EOB: Review these to be sure they are correct. If you think there are errors on your EOB statement, or you think you are the victim of fraud, please call customer service.
Cobertura de medicamentos con receta
Los medicamentos que tienen cobertura Blue Cross Medicare Advantage Dual Care se enumeran en los formularios (listas de medicamentos). Cada cobertura tiene su propia lista de medicamentos que incluye medicamentos genéricos y de marca. Esta lista también incluye información sobre los copagos y limitaciones de los medicamentos, como las autorizaciones previas, la cantidad límite y la terapia escalonada.
Lista de Medicamentos Preferidos
You will have access to the Drug Formulary, which is a list of drugs that are covered, both as a document or online. You can share the formulary with your doctor to talk about your medication options. Las listas de medicamentos pueden cambiar, con mayor frecuencia al comienzo de cada año. Por lo general, cualquier cambio en la lista de medicamentos se refleja en la lista al comienzo de cada año. To access your formulary online, .
Medication List
The Medication List is used to record your current medications along with directions, prescriber, and any knock allergies. Bring your Medication List when you go to the doctor, hospital, or emergency room and share it with your family or caregivers.
You can find your plan's specific documents by logging into your Blue Access for Members account.
You can also find them by going to the Formularios y documentos page, searching your Zip Code, and selecting your plan.
Prescription Drugs (Medicamentos con receta)
Prescription Drug Programs That Are Here to Help
- Pago de medicamento con receta de Medicare
- Manejo de terapias con medicamentos
- Cobertura de medicamentos para asegurados en transición
- Ayuda financiera adicional
Cómo abordar cuestiones y problemas
At Blue Cross and Blue Shield of Texas, we are here to help guide you through your plan's coverage options. To ensure member safety, a prescribed drug or medical service may need review from our specialized teams. If at any time you have a question or experience any issues during these processes, our customer service team will be able to assist.
Si tiene problemas con su cobertura Medicare o con la atención médica que recibe, tiene derecho a presentar una queja. Because Blue Cross Medicare Advantage Dual Care is your Medicare plan, you should call us with all your questions. Usted puede abordar cualquier dificultad e inquietud sobre la cobertura Medicare a través de un proceso de quejas.
Learn About Your Plan's Coverage Reviews
Autorización previa y terapia escalonada
Explore how drugs are placed into tiers, how prior authorization works, quantity limits and more.
Visit Prior AuthorizationDeterminaciones de cobertura
Want to understand how prescription drug coverage decisions are made and explore how to file a prescription drug appeal or grievance?
Visit Coverage DeterminationsApelaciones e inconformidades médicas
Learn how medical coverage decisions are made and how to use your rights to file a medical appeal or grievance.
Visite Apelaciones e inconformidades médicasGuías clínicas
BCBSTX uses Medicare and internal medical policies based on scientific and medical research to make sure you get the health care you need. These policies are available for review.
Visit Clinical Guidelines
