Blue Cross Medicare AdvantageSM Plans | Blue Cross and Blue Shield of Texas

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Welcome to Blue Cross Medicare Advantage

Whether you’re new to Medicare or just to your plan, here are some tips to make the transition smooth. Feeling a little nervous about your new plan? We understand. Your Medicare plan may be new to you now, but soon you’ll get to know and be comfortable with the plan. You may even like it better. We hope to answer your basic questions here.

If you need more information or just want a little help understanding your benefits or the Medicare rules, call the number listed on the back of your member ID card.

We Stay in Touch With You


Our goal is to help you manage your health. We’ll call to welcome you to the plan. We’d like to know if you have questions about your benefits or if you have other special needs that need immediate attention. During your welcome call:

✔ We’ll make sure you received your member ID card and Evidence of Coverage (EOC) in the mail. The EOC tells you how to get your medical care and prescription drugs covered through our plan. Review it and keep it in a safe place.

✔ We’ll ask you a few questions from a voluntary Health Questionnaire. The questions are easy to answer and will help us understand your needs. Based on your answers, we may reach out to you about your health to help you better manage it. We might suggest an in-home assessment with one of our care management professionals.

✔ We’ll help you schedule an Annual Wellness Exam.

✔ We’ll discuss the Healthy Actions Rewards Program.

You may have caller ID on your phone, and may not recognize that your plan is calling you. Remember we’ll be calling, so be sure to answer.

Email Alerts

We’d like to have your email address to send you communications about health plan benefits and programs throughout the year. We never share your email address outside the plan. You can always opt out or ask us to stop sending you emails.

Annual Notice of Change (ANOC)

You will receive an Annual Notice of Change. This notice outlines any expected premium/benefit changes for next year. These changes will begin January 1 of the following calendar year. Review this document carefully.

The Drug Formulary May Be Different

Blue Cross Medicare Advantage covers a broad range of prescription drugs. The formulary may be different from what you’re used to, and it is always available to view online. Share the formulary with your doctor and talk about the drugs you take now. You may find you can save money by choosing generic drugs. Ask if this is an option for you.

Drugs Are Placed Into Tiers

In Medicare Advantage plans, prescription drugs are placed into tiers. The costs for drugs in each tier are different. Tier 1 drugs will cost less than Tier 5 drugs. The tiers are:

  • Tier 1 Preferred Generic Drugs
  • Tier 2 Generic Drugs
  • Tier 3 Preferred Brand Drugs
  • Tier 4 Non-Preferred Brand Drugs
  • Tier 5 Specialty Drugs

Prior Authorization, Step Therapy and Quantity Limits

Before you can be covered for some medications, your doctor will need to get authorization from the plan. You may find you need to try other clinically appropriate or cost-effective drugs. Quantity limits may be set for some drugs for cost or safety reasons.

You Will Use a Provider From the Plan Network

To get the most from your benefits, you will use providers in our network. Your current doctors may be in the network. The network includes local primary care providers and a wide range of specialists. If you have an HMO plan, you must choose a primary care provider (PCP). In some cases, you may need care from a provider that is out of network, which may cost you more. If your current provider is not in the network, we can help you find a new one. Call customer service or search for a provider.

We’ll Work Closely With Your Provider to Deliver the Best Care

Certain high cost medical services that have more cost-effective alternatives need prior authorization from the plan before your provider can proceed. Our plans follow government guidelines in this area to make sure you receive the most appropriate, cost-effective care available.

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