Member Information
What You Should Know About Your Plan
Learn the basics of how your Blue Cross and Blue Shield of Oklahoma Blue Cross Medicare Advantage℠ plan works. Use these resources and tools to help you get the most from your plan.
Using Your Blue Cross Medicare Advantage℠ Plan
We want you to get the most from your new plan. In this section, you’ll find resources to help you get started, maximize your benefits, use online tools, learn about claims and more.
Call us before calling Medicare. Because Blue Cross Medicare Advantage is your Medicare plan, you should call us with all your questions. Our Member Services team will let you know if your question can be answered by Medicare. Call the customer service number on your member ID card.
Welcome To Your Plan
- Enrollment Confirmation: Before you can start using your plan, Medicare must approve your enrollment. This will take about 10 business days. You’ll get an acknowledgment letter and a confirmation letter once approved. Your member ID card will be mailed next.
- Welcome Kit: Includes your plan’s drug formulary, the Evidence of Coverage form and other helpful information. Learn more about the Welcome Kit
Finding a Provider
- Provider Search: To maximize benefits, use in-network providers. We can help you choose a primary care provider (PCP) in your plan's network. Search for a provider
- Set up your Annual Wellness Visit once coverage is active.
Coinsurance and Copays
- Understanding Costs: Coinsurance is a percentage of the bill you pay. Copays are a set amount you pay at the time of service.
Prescription Drug Coverage
- Drug Formulary and Pharmacy Search: You will have online access to a Drug Formulary, which is a list of drugs that are covered. You can share the formulary with your doctor and talk about the drugs you take now. Learn More
- Prior Authorization: Also, learn about how drugs are placed into tiers based on cost, prior authorization, quantity limits and more. Learn more about prior authorization
- Drug Plan Transition: If you’re new to our plan, find out how to get a limited supply of your medication that isn’t covered Learn more about drug plan transition
- Medication Therapy Management: Find out if the drug you take is safe, works well and fits your lifestyle at no additional cost to eligible members. Learn more about medication therapy management
- Medicare Prescription Payment Plan: This program can offer help with managing your out-of-pocket costs. Learn more about the Medicare Prescription Payment Plan
Quick Facts About Claims and More
- Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will receive an Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
- What is an EOB? The EOB is a statement, not a bill. It simply details what you have paid and indicates the level of benefits you’ve used.
- 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 the number on the back of your member ID card.
Annual Notice of Change
- You will get your Annual Notice of Change in October. This will tell you what changes will be made to your plan for the next year, starting January 1st. It will outline any expected premium or benefit changes.
How to Address Issues and Problems
If you have issues or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can address any Medicare coverage difficulties and concerns you may have via a complaint process.
For complaints about your Medicare plan related to medical care you have received:
Go to Medical Care Appeals and Grievances
For complaints about your Medicare plan related to prescription drugs:
Go to Medicare Coverage Determination, Appeals, and Grievances
If you would like to submit feedback directly to Medicare, you have two options:
Use the Medicare Complaint Form
Contact the Office of the Medicare Ombudsman