Blue Advantage Notices

Patrius Health, Licensee of the Blue Cross and Blue Shield Association, has a contract with the Centers for Medicare & Medicaid Services (CMS) that is renewed annually, and availability of coverage beyond the end of the current contract year is not guaranteed.

You may only enroll in our Blue Advantage (PPO) plans during specific times of the year. For more information about enrollment periods, call us toll free at 1-888-832-0046 (TTY 711) Monday – Friday, 8 a.m. to 8 p.m., 7 days a week. From October 1 to March 31, the hours of operation are Monday – Sunday, 8 a.m. – 8 p.m. CST. You may be required to leave a message for calls made after hours, weekends and holidays. Calls will be returned the next business day.

You may be enrolled in only one Part D plan at a time. Medicare beneficiaries who are enrolled in an MA Private Fee-for-Service (PFFS) plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or MA PFFS plan if they enroll in a Prescription Drug Plan (PDP). Medicare beneficiaries enrolled in a PFFS that does not include Medicare prescription drug coverage, an MA Medical Savings Account (MSA) plan or an 1876 Cost plan may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or an 1876 Cost plan.

To qualify for enrollment in Blue Advantage, individuals must have both Medicare Part A and Part B, and live in the service area. You must continue to pay your Medicare Part B premium. If you request premiums withheld, elect to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for the change to take effect and you will be held responsible for those premiums.

Out-of-network/non-contracted providers are under no obligation to treat Blue Advantage (PPO) members, except in emergency situations. Please call our member services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Every year, Medicare evaluates plans based on a 5-star rating system.

Blue Advantage (PPO) members: call 1-888-950-0705 (TTY 711), Monday – Friday, 8 a.m. to 8 p.m., seven (7) days a week. From October 1 to March 31, the hours of operation are Monday – Sunday, 8 a.m. – 8 p.m. CST. You may be required to leave a message for calls made after hours, weekends and holidays. Calls will be returned the next business day.

This information is not a complete description of benefits.  Call 1-888-950-0705 (TTY 711) for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. To the extent of any discrepancy between this web site and your Evidence of Coverage/Contract Booklet, your Evidence of Coverage/Contract Booklet takes priority.