Medicare Advantage Plans

 

 

Our Medicare Advantage plans have a 50-year tradition of being highly rated by the Centers for Medicare & Medicaid Services (CMS) and for meeting the needs of our over 6.5 million Medicare members nationwide. Enroll today, and see why we are the most selected Medicare plan in Massachusetts and a national leader in member service and care management.

Our plans provide everything that Original Medicare covers, and more, including:

  • Prescription drug coverage
  • Vision and hearing checkups on most plans
  • Routine dental care 

Medicare HMO Blue ValueRx

Overall Plan Rating 

As a member of HMO Blue ValueRx, you'll need to choose a primary care provider. Except for emergencies, you must receive care from doctors and hospitals in your plan’s network.

Ready to Enroll

Select any of the Enroll Now buttons throughout this site to see information on how to enroll online, by mail, or via phone or fax.

Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance
Medicare HMO BlueSM Value Rx

Monthly Plan  Premium

Enter your Zip Code above to see plan prices

Plan Information

Medical

Doctor Office Visits

$20 copay per visit

Specialist Office Visits

$40 copay per visit

Medicare Preventive Services

$0 copay per visit

Annual Medical Out-of-Pocket Maximum

$4,900 for Medicare-covered services

Days 1-5: $275 copay per day

$250 copay per visit

Diagnostic Procedures, Tests, and Lab Services

$30 copay per day for labs and other diagnostic tests; $250 copay per day for certain high-tech imaging; $0 copay for therapeutic radiological services

X-rays

$20 copay per day

Emergency Care

$75 copay per visit

Other Preventive Services

Preventive Dental

$40 copay per visit, once every six months

Annual Routine Vision Exam

$40 copay for one routine test per year

Eyeglasses Benefit

$150 limit for routine eyewear every two years

Annual Physical Exam

$0 copay

Annual Routine Hearing Exam

$20-$40 copay for one routine test per year

Hearing Aid Benefit

Not covered

Annual Fitness Benefit

Up to $150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®'' or hospital-based weight loss programs per year

  • $0 for Tiers 1 and 2

  • $320 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$3 copay

$8 copay

$3 copay

Tier 2: Generic

$7 copay

$12 copay

$14 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000 you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Additional Benefits

As a Medicare HMO Blue ValueRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Coverage for routine hearing exams and vision care

  • Allowances toward eyewear

  • Routine preventive dental care

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

 

Prescription Drug Coverage

Medicare HMO Blue ValueRx also offers Medicare Part D prescription drug coverage—making it easy for you to get your medical and prescription benefits from one plan.

 

Summary of Benefits and Evidence of Coverage
Access to Doctors and Hospitals

If you choose Medicare HMO Blue ValueRx, you'll pick a primary care provider from our Medicare HMO Blue network. Your primary care provider will coordinate your care and refer you to any in-network specialists you may need. Our list of network providers shows you the number and type of providers in our network.

You must use in-network providers except in the following circumstances:

  • Emergency services

  • Urgently needed care from out-of-network providers when network providers are temporarily unavailable or inaccessible

  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan's service area

Services received from out-of-network providers and hospitals may not be covered/paid for by Blue Cross Blue Shield of Massachusetts.

For more information, please refer to the plan Evidence of Coverage (EOC).

 

Is my doctor in the network?

Find out if your doctor is part of our network by choosing one of the following actions:

  • Visiting Find a Doctor 

  • Calling 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET.

    • October 1-February 14: 7 days a week.

    • February 15-September 30: Monday through Friday.

If you would like a Provider Directory mailed to you, you can call Member Service at the number above.

Looking for a new doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Using our Find a Doctor tool

  • Calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You can also request to have the Provider Directory mailed to you.

  • Requesting a Provider Director be mailed to you by calling Member Service using the number above

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

 

Prescription Drug Coverage
Prescription Drug Coverage Summary
  • $0 for Tiers 1 and 2

  • $320 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$3 copay

$8 copay

$3 copay

Tier 2: Generic

$7 copay

$12 copay

$14 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000 you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

 

Find a Pharmacy Near You

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

 

Learn More

View Medicare Advantage Network and Formulary

You are eligible to enroll if you meet all of the following requirements:
  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.

Get Healthy Discounts & Programs

With Medicare HMO Blue ValueRx, you get access to information, support, tools, and discounts to help you be your healthiest.

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Medicare HMO Blue FlexRx

Overall Plan Rating 

As a member of HMO Blue FlexRx, you get routine care from an in-network primary care provider. In-network services may require referrals and/or prior authorization. You may get care from doctors, hospitals, and other providers that are out-of-network, but you may pay more for these services.

Ready to Enroll

Select any of the Enroll Now buttons throughout this site to see information on how to enroll online, by mail, or via phone or fax.

Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center.

For benefit details, click on the sections listed below.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance

Monthly Plan  Premium 

Enter your Zip Code above to see plan prices

Plan Information
Medical

Doctor Office Visits

$15 copay per visit

$65 copay per visit

Specialist Office Visits

$35 copay per visit

$65 copay per visit

Medicare Preventive Services

$0 copay per visit

$65 copay or 20% of the cost per visit depending on the service

Annual Medical Out-of-Pocket Maximum

$3,900 for Medicare-covered services

$9,900 for Medicare-covered services

Days 1-5: $200 copay per day

20% of the cost

$200 copay per visit

20% of the cost

Diagnostic Procedures, Tests, and Lab Services

$15 copay per day for lab, X-rays, and other diagnostic tests; $200 copay per day for certain high-tech imaging

20% of the cost for lab, X-rays, and other diagnostic tests; 40% of the cost for high-tech imaging

Emergency Care

$75 copay per visit

$75 copay per visit

Other Preventive Services

Preventive Dental

$35 copay per visit, once every six months

$45 copay per visit, once every six months

Annual Routine Vision Exam

$35 copay for one routine test per year

No Coverage

Eyeglasses Benefit

$150 limit for routine eyewear every two years

No Coverage

Annual Physical Exam

$0 copay

$65 copay

Annual Routine Hearing Exam

$15-$35 copay for one routine test per year

$45 copay for one routine test per year

Hearing Aid Benefit

Up to $400 limit every three years for In-Network and Out-Of-Network combined

Annual Fitness Benefit

$150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®" or hospital-based weight loss programs per year

  • $0 for Tiers 1 and 2

  • $260 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or brand drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

 

Additional Benefits

As a Medicare HMO Blue FlexRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Coverage for routine hearing exams and vision care

  • Allowances toward eyewear

  • Routine preventive dental care

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

 

Prescription Drug Coverage

Medicare HMO Blue FlexRx also offers Medicare Part D prescription drug coverage. This makes it easy for you to get your medical and prescription benefits from one plan.

 

Summary of Benefits and Evidence of Coverage

Access to Doctors and Hospitals

If you choose Medicare HMO Blue FlexRx, you'll pick a primary care provider from our Medicare HMO Blue network. Your primary care provider will coordinate your care and refer you to any in-network specialists you may need. Our list of network providers shows you the number and type of providers in our network.

Medicare HMO Blue FlexRx also provides you with the flexibility to use Out-of-Network providers as well. You may go to doctors, hospitals, or other providers in- or out-of- network. In-network services may require referrals and/or prior authorization. You may pay more for the services you receive outside the network.

For more information, please refer to the plan Evidence of Coverage (EOC).

 

Is my doctor in the network?

If you already have a primary care provider and want to learn whether he or she is already a part of our network, just visit Find a Doctor or call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET.

  • October 1-February 14: 7 days a week

  • February 15-September 30: Monday through Friday

If you would like a Provider Directory mailed to you, you can call Member Service at the number above.

 

Looking for a new doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Using our Find a Doctor feature

  • Calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You can also request to have the Provider Directory mailed to you.

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

 

Prescription Drug Coverage

 

Prescription Drug Coverage Summary

  • $0 for Tiers 1 and 2

  • $260 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or brand drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

Find a Pharmacy Near You

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

Learn More

View Medicare Advantage Network and Formulary

 

You are eligible to enroll if you meet all of the following requirements:

  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.

Get Healthy Discounts & Programs

With Medicare HMO Blue FlexRx, you get access to information, support, tools, and discounts to help you be your healthiest.

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.

 


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Medicare HMO Blue PlusRx

Overall Plan Rating 

As a member of HMO Blue PlusRx, you get routine care from an in-network primary care provider. Your primary care provider coordinates your care with specialists, hospitals, and other in-network providers.

Visit the Enroll Now section for information on how to enroll online, by mail, or via phone or fax. Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center. For benefit details, click on the sections listed below.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance

Medicare HMO BlueSM Plus Rx

Monthly Plan  Premium 

Enter your Zip Code above to see plan prices

Plan Information
Medical

Doctor Office Visits

$15 copay per visit

Specialist Office Visits

$35 copay per visit

Medicare Preventive Services

$0 copay per visit

Annual Medical Out-of-Pocket Maximum

$3,400 for Medicare-covered services

Days 1-5: $150 copay per day

$150 copay per visit

Diagnostic Procedures, Tests, X-rays and Lab Services

$10 copay per day for lab, X-rays, and other diagnostic tests; $150 copay per day for certain high-tech imaging, $0 copay for therapeutic radiological services

Emergency Care

$75 copay per visit

Other Preventive Services

Preventive Dental

$35 copay per visit, once every six months

Annual Routine Vision Exam

$35 copay for one routine test per year

Eyeglasses Benefit

$150 limit for routine eyewear every two years

Annual Physical Exam

$0 copay

Annual Routine Hearing Exam

$15-$35 copay for one routine test per year

Hearing Aid Benefit

Up to $400 limit every three years

Annual Fitness Benefit

Up to $150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®'' or hospital-based weight loss programs per year

Prescription Drug Coverage
  • $0 for Tiers 1 and 2

  • $200 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Additional Benefits

As a Medicare HMO Blue PlusRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Coverage for routine hearing exams and vision care

  • Allowances toward hearing aids and eyewear

  • Routine preventive dental care

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

Summary of Benefits and Evidence of Coverage
Access to Doctors and Hospitals

If you choose Medicare HMO Blue ValueRx, you'll pick a primary care provider from our Medicare HMO Blue network. Your primary care provider will coordinate your care and refer you to any in-network specialists you may need. Our list of network providers shows you the number and type of providers in our network.

Medicare HMO Blue PlusRx also provides you with the flexibility to use Out-of-Network providers as well. You may go to doctors, hospitals, or other providers in- or out-of- network. However, you still may require referrals and/or prior authorization for in-network services, and out-of-network service may cost more.

Services received from out-of-network providers and hospitals may not be covered/paid for by Blue Cross Blue Shield of Massachusetts.

For more information, please refer to the plan Evidence of Coverage (EOC).

 

Is my doctor in the network?

If you already have a primary care provider and want to learn whether he or she is already a part of our network, just visit Find a Doctor or call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET.

  • October 1-February 14: 7 days a week

  • February 15-September 30: Monday through Friday

If you would like a Provider Directory mailed to you, you can call Member Service at the number above.

 

Looking for a new doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Using our Find a Doctor tool

  • Calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You may also request to have the Provider Directory mailed to you.

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

Prescription Drug Coverage

Prescription Drug Coverage Summary
Prescription Drug Coverage
  • $0 for Tiers 1 and 2

  • $200 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

 

Find a Pharmacy Near You

Use our online pharmacy search tool.

Download the pharmacy directory: 2018 Medicare Advantage Pharmacy Directory

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

View Medicare Advantage Network and Formulary.

You are eligible to enroll if you meet all of the following requirements:
  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.

Get Healthy Discounts & Programs

With Medicare HMO Blue PlusRx, you get access to information, support, tools, and discounts to help you be your healthiest.

 

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Medicare PPO Blue SaverRx

Overall Plan Rating 

As a member of PPO Blue SaverRx, you have access to both in-network and out-of-network doctors, hospitals, and other providers with no referral requirements. Your costs for in- and out-of-network services will be the same in most cases. However, for some services, you may have higher out-of-pocket costs if you go outside the network.

Visit the Enroll section for information on how to enroll online, by mail, or via phone or fax. Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center.

For benefit details, click on the sections listed below.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance

Monthly Plan Premium 

Enter your Zip Code above to see plan prices

Plan Information
Medical

Doctor Office Visits

$25 copay per visit

$25 copay per visit

Specialist Office Visits

$45 copay per visit

$45 copay per visit

Medicare Preventive Services

$0 copay per visit

$0 copay per visit

Annual Medical Out-of-Pocket Maximum

  • $6,700 for Medicare-covered services In-Network and Out-of-Network combined

Days 1-5: $350 copay per day

Days 1-5: $350 copay per day

$300 copay per visit

$300 copay per visit

Diagnostic Procedures, Tests, X-rays, and Lab Services

  • $30 copay per day for lab and other diagnostic tests

  • $30 per day for X-rays

  • $325 copay per day for certain high-tech imaging

  • $30 copay per day for lab and other diagnostic tests

  • $30 per day for X-rays

  • $325 copay per day for certain high-tech imaging

Emergency Care

$80 copay per visit

$80 copay per visit

Other Preventive Services

Preventive Dental

$60 copay per visit, once every six months

Annual Routine Vision Exam

No Coverage

Eyeglasses Benefit

No Coverage

Annual Physical Exam

$0 copay

Annual Routine Hearing Exam

No coverage

Hearing Aid Benefit

No coverage

Annual Fitness Benefit

Up to $150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®'' or hospital-based weight loss programs per year

  • $0 for Tiers 1 and 2

  • $405 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$5 copay

$10 copay

$5 copay

Tier 2: Generic

$11 copay

$16 copay

$22 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs.

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Additional Benefits

As a Medicare PPO Blue SaverRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Preventive dental

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

 

Prescription Drug Coverage

Medicare PPO Blue SaverRx also offers Medicare Part D prescription drug coverage. This makes it easy for you to get your medical and prescription benefits from one plan. See Medicare Advantage Prescription Drug Coverage for more information.

 

Visitor/Travel Program

Medicare PPO Blue SaverRx offers a Visitor/Travel Program that includes in-network benefits and cost sharing when you receive treatment for covered services from participating Blue Medicare Advantage PPO network providers outside of Massachusetts, in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia. 

Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program, you may remain in the plan while out of our service area for up to twelve (12) months.

In some cases, network providers are available in select areas of the state.

To locate a participating network provider:

  • Call the Member Service phone line during regular business hours, or
  • Call 1-800-810-BLUE to find a Blue Medicare Advantage PPO provider, or
  • Visit the Doctor Hospital Finder to find a Blue Medicare Advantage PPO provider.

 

Summary of Benefits and Evidence of Coverage
Access to Doctors and Hospitals with Medicare PPO Blue SaverRx

Medicare PPO Blue SaverRx uses a network of doctors, specialists, and hospitals. You can choose any doctor in our network to be your provider of choice responsible for helping you coordinate your care. However, you may also see any Medicare-participating providers outside the network. Your cost share for in- and out-of-network covered services is the same in most cases.

 

See List of In-Network Doctors

The list of network providers shows you the number and type of providers in our network.

 

Out-of-Network Coverage and Care

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Blue Shield of Massachusetts Medicare PPO Blue members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Service number on your ID card or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

 

Is my doctor in the network?

If you already have a primary care provider and want to learn whether he or she is already a part of our network, just visit or call 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET.  October 1 through February 14, 7 days a week, February 15 through September 30, or Monday through Friday.

If you would like a Provider Directory mailed to you, you can call Member Service at the number above.

 

Looking for a new doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Using our Find a Doctor tool or

  • Calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You may also request to have the Provider Directory mailed to you.

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

Prescription Drug Coverage

Prescription Drug Coverage Summary
  • $0 for Tiers 1 and 2

  • $405 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$5 copay

$10 copay

$5 copay

Tier 2: Generic

$11 copay

$16 copay

$22 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs.

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

 

Find a Pharmacy Near You

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET as follows: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

 

Learn More

View Medicare Advantage Network and Formulary

You are eligible to enroll if you meet all of the following requirements:
  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.

Get Healthy Discounts & Programs

With Medicare PPO Blue SaverRX, you get access to information, support, tools, and discounts to help you be your healthiest.

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®" or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Medicare PPO Blue ValueRx

Overall Plan Rating 

As a member of PPO Blue ValueRx, you have access to both in-network and out-of-network doctors, hospitals, and other providers with no referral requirements. Your costs for in- and out-of-network services will be the same in most cases. However, for some services, you may have higher out-of-pocket costs if you go outside the network.

Visit the Enroll section for information on how to enroll online, by mail, or via phone or fax. Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center.

For benefits details, click on the sections listed below.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance

Monthly Plan  Premium 

Enter your Zip Code above to see plan prices

Plan Information
Medical

Doctor Office Visits

$20 copay per visit

$20 copay per visit

Specialist Office Visits

$40 copay per visit

$40 copay per visit

Medicare Preventive Services

$0 copay per visit

$0 copay per visit

Annual Medical Out-of-Pocket Maximum

$4,900 for Medicare-covered services In-Network and Out-Of-Network combined.

Days 1-5: $250 copay per day

Days 1-5: $250 copay per day

$225 copay per visit

$225 copay per visit

Diagnostic Procedures, Tests, X-rays, and Lab Services

$20 copay per day for lab, X-rays, and other diagnostic tests; $250 copay per day for certain high-tech imaging

$20 copay per day for lab, X-rays, and other diagnostic tests; $250 copay per day for certain high-tech imaging

Emergency Care

$75 copay per visit

$75 copay per visit

Other Preventive Services

Preventive Dental

$40 copay per visit, once every six months

Annual Routine Vision Exam

$40 copay for one routine test per year

Eyeglasses Benefit

$150 limit for routine eyewear every two years

Annual Routine Hearing Exam

$20-$40 copay for one routine test per year

Hearing Aid Benefit

Not covered

Annual Fitness Benefit

Up to $150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®'' or hospital-based weight loss programs per year

  • $0 for Tiers 1 and 2

  • $320 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$3 copay

$8 copay

$3 copay

Tier 2: Generic

$7 copay

$12 copay

$14 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Additional Benefits

As a Medicare PPO Blue ValueRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Coverage for routine hearing exams and vision care

  • Allowances toward eyewear

  • Routine preventive dental care

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

 

Prescription Drug Coverage

Medicare PPO Blue ValueRx also offers Medicare Part D prescription drug coverage. This makes it easy for you to get your medical and prescription benefits from one plan. See Medicare Advantage Prescription Drug Coverage for more information.

 

Visitor/Travel Program

Medicare PPO Blue ValueRx offers a Visitor/Travel Program that includes in-network benefits and cost sharing when you receive treatment for covered services from participating Blue Medicare Advantage PPO network providers outside of Massachusetts in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia. 

Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program, you may remain in the plan while out of our service area for up to twelve (12) months.

In some cases, network providers are available in select areas of the state.

To locate a participating network provider:

  • Call the Member Service phone line during regular business hours, or

  • Call 1-800-810-BLUE to find a Blue Medicare Advantage PPO provider, or

  • Visit the Doctor Hospital Finder to find a Blue Medicare Advantage PPO provider.

 

Summary of Benefits and Evidence of Coverage
Access to Doctors and Hospitals with Medicare PPO Blue ValueRx

Medicare PPO Blue ValueRx uses a network of doctors, specialists, and hospitals. You can choose any doctor in our network to be your provider of choice responsible for helping you coordinate your care. However, you may also see any Medicare-participating providers outside the network. Your cost share for in- and out-of-network covered services is the same in most cases.

 

See List of In-Network Doctors

 

Out-of-Network Coverage and Care

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Blue Shield of Massachusetts Medicare PPO Blue members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Service number on your ID card or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

 

Is my doctor in the network?

If you already have a primary care provider and want to learn whether he or she is already a part of our network, just visit Find a Doctor or call 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET. October 1 through February 14, 7 days a week, or February 15 through September 30, Monday through Friday.

If you would like a Provider Directory mailed to you, you may call Member Service at the number above.

 

Looking for a new doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • using our Find a Doctor feature or

  • calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You may also request to have the Provider Directory mailed to you.

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

 

Important Documents: Prescription Drug Coverage
Prescription Drug Coverage Summary
  • $0 for Tiers 1 and 2

  • $320 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$3 copay

$8 copay

$3 copay

Tier 2: Generic

$7 copay

$12 copay

$14 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

26% of the cost

26% of the cost

26% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

 

Find a Pharmacy Near You

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET as follows: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

 

Learn More

View Medicare Advantage Network and Formulary.

You are eligible to enroll if you meet all of the following requirements:
  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.

Get Healthy Discounts & Programs

With Medicare PPO Blue ValueRx, you get access to information, support, tools, and discounts to help you be your healthiest.

 

Benefits at a Glance

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Medicare PPO Blue PlusRx

Overall Plan Rating 

As a member of Medicare PPO Blue PlusRx, you have access to both in-network and out-of-network doctors, hospitals, and other providers with no referral requirements. Your costs for in- and out-of-network services will be the same in most cases. However, for some services you may have higher out-of-pocket costs if you go outside the network.

Visit the Enroll section for information on how to enroll online, by mail, or via phone or fax. Medicare beneficiaries may also enroll in this plan through the CMS Medicare Online Enrollment Center.

For benefit details, click on the sections listed below.

Enter your Zip Code above to see plan prices

Enroll Now

Benefits at a Glance

Monthly Plan Premium

Enter your Zip Code above to see plan prices

Plan Information
Medical

Doctor Office Visits

$15 copay per visit

$45 copay per visit

Specialist Office Visits

$35 copay per visit

$45 copay per visit

Medicare Preventive Services

$0 copay per visit

$45 copay or 20% of the cost per visit depending on the service

Annual Medical Out-of-Pocket Maximum

  • In-network: $3,400 for Medicare-covered services

  • Combined in- and out-of-network: $5,100 for Medicare-covered services

Days 1-5: $150 copay per day

20% of the cost

$150 copay per visit

20% of the cost

Diagnostic Procedures, Tests, X-rays, and Lab Services

  • $10 copay per day for lab, X-rays, and other diagnostic tests;

  • $150 copay per day for certain high-tech imaging

  • 20% of the cost for lab, X-rays, and other diagnostic tests;

  • 40% of the cost for high-tech imaging

Emergency Care

$75 copay per visit

$75 copay per visit

Other Preventive Services

Preventive Dental

$35 copay per visit, once every six months

$45 copay per visit, once every six months

Annual Routine Vision Exam

$35 copay for one routine test per year

$45 copay for one routine test per year

Eyeglasses Benefit

$150 limit for routine eyewear every two years

Annual Physical Exam

$0 Copay

$45 copay

Annual Routine Hearing Exam

$15-$35 copay for one routine test per year

$45 copay for one routine test per year

Hearing Aid Benefit

Up to $400 limit every 3 years for In-Network and Out-Of-Network combined

Annual Fitness Benefit

$150 toward fitness club membership per year

Weight Loss Benefit

Up to $150 toward fees paid for qualified Weight Watchers®" or hospital-based weight loss programs per year

  • $0 for Tiers 1 and 2;

  • $200 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Additional Benefits

As a Medicare PPO Blue PlusRx plan member, you get additional benefits beyond Original Medicare, such as:

  • Coverage for routine hearing exams and vision care

  • Allowances toward hearing aids and eyewear

  • Routine preventive dental care

  • Prevention and wellness programs

  • Worldwide coverage for emergency care

 

Prescription Drug Coverage

Medicare PPO Blue PlusRx also offers Medicare Part D prescription drug coverage. This makes it easy for you to get your medical and prescription benefits from one plan. See Medicare Advantage Prescription Drug Coverage for more information.

 

Visitor/Travel Program

Medicare PPO Blue PlusRx offers a Visitor/Travel Program that includes in-network benefits and cost-sharing when you receive treatment for covered services from participating Blue Medicare Advantage PPO network providers outside of Massachusetts in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia. 

Under Medicare Advantage rules, if you are absent from the service area for more than six (6) consecutive months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program, you may remain in the plan while out of our service area for up to twelve (12) months.

In some cases, network providers are available in select areas of the state.

To locate a participating network provider:

  • Call the Member Service phone line during regular business hours, or

  • Call 1-800-810-BLUE (TTY 711) to find a Blue Medicare Advantage PPO provider, or

  • Visit the Doctor Hospital Finder to find a Blue Medicare Advantage PPO provider.

 

Summary of Benefits and Evidence of Coverage
Access to Doctors and Hospitals with Medicare PPO Blue PlusRx

Medicare PPO Blue PlusRx uses a network of doctors, specialists, and hospitals.You can choose any doctor in our network to be your provider of choice responsible for helping you coordinate your care. However, you may also see any Medicare-participating providers outside the network. Your cost-share for in- and out-of-network covered services is the same in most cases.

 

See List of In-Network Doctors

This list of network providers  shows you the number and type of providers in our network.

 

Out-of-Network Coverage and Care

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Blue Shield of Massachusetts Medicare PPO Blue members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Service number on your ID Card or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

 

Is my doctor in the network?

If you already have a  primary care provider and want to learn whether he or she is already a part of our network, just call Member Service at the number listed below or visit Find a Doctor

  • October 1 - February 14: 7 days a week

  • February 15 - September 30: Monday through Friday

If you would like a Provider Directory mailed to you, you may call Member Service at the number above.

 

Looking for a new Doctor?

You can choose a doctor from our list of participating providers. Our network of doctors is subject to change, but you can keep up-to-date with the most complete list of current network doctors by:

  • Using our Find a Doctor tool or

  • Calling Member Service at 1-800-200-4255 (TTY: 711) from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, or October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. You may also request to have the Provider Directory mailed to you.

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

 

Important Documents: Prescription Drug Coverage
Prescription Drug Coverage Summary
  • $0 for Tiers 1 and 2;

  • $200 for Tiers 3, 4, and 5

Tier 1: Preferred Generic

$1 copay

$6 copay

$1 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Brand

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

25% of the cost

After your total yearly drug costs reach $3,750, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 44% of the plan's costs. For covered brand drugs, you pay no more than 35% of the plan's costs (excluding dispensing fees).

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of:

  • $3.35 copay for generics or drugs treated like generic drugs and a $8.35 copay for all other drugs; or

  • 5% of the cost

Preferred Retail Pharmacies include CVS, Kmart, Costco, Osco, Stop N Shop, and Tops.

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 67,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

 

Find a Pharmacy Near You

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET as follows: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

 

Learn More

View Medicare Advantage Network and Formulary

You are eligible to enroll if you meet all of the following requirements:
  • You are eligible for Medicare Part A and enrolled in Part B.

  • You permanently live in Barnstable, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, or Worcester counties in Massachusetts.

  • You do not currently have end-stage renal disease (ESRD). You may join this plan if you previously had ESRD but have recovered normal kidney function and no longer need regular dialysis. You may also join if you’ve had a successful kidney transplant or are currently a member of Blue Cross Blue Shield of Massachusetts. In addition, if you were a member of a Medicare Advantage plan that ended its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details

Get Healthy Discounts & Programs

With Medicare PPO Blue PlusRX, you get access to information, support, tools, and discounts to help you be your healthiest.

Get up to $150 per calendar year toward a qualified health club.

Get up to $150 per calendar year when you join a qualified Weight Watchers®'' or a hospital-based weight loss program.

Stay up-to-date in the world of health with articles, videos, health quizzes, and more.

Download the current issue of our quarterly newsletter for helpful health and wellness information.


  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Contact the plan 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. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


Compare Plans

HMO Plans

Medicare HMO BlueSM ValueRx
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Medical Deductible
$0

Max. Out-of-Pocket Cost: $4,900

Medicare HMO BlueSM FlexRx
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Medical Deductible
$0

Max. Out-of-Pocket Cost

In-Network: $3,900

Max. Out-of-Pocket Cost

Out-of-Network: $9,900

Medicare HMO BlueSM PlusRx
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Medical Deductible
$0

Max. Out-of-Pocket Cost: $3,400

PPO Plans

Medicare PPO BlueSM SaverRx
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Medical Deductible
$0

Max. Out-of-Pocket Cost

In- and Out-of Network Combined:
$6,700

Medicare PPO BlueSM ValueRx
Enter your Zip Code above to see plan prices
Medical Deductible
$0

Max. Out-of-Pocket Cost

In- and Out-of Network Combined:
$4,900

Medicare PPO BlueSM PlusRx
Enter your Zip Code above to see plan prices
Medical Deductible
$0

Max. Out-of-Pocket Cost

In-Network: $3,400

Max. Out-of-Pocket Cost

In- and Out-of Network Combined:
$5,100