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Member Support & Assistance Program

To better serve our members and make the care and services you need more accessible, we offer a suite of integrated member assistance programs at no additional cost.

In-home Health Assessments with Signify Health^®´

Your Medicare Advantage membership gives you access to in-home and virtual health evaluations with licensed providers at no additional cost. The evaluations allow you to spend extra time with a provider to talk about health issues that you might not have discussed during a regular doctor visit.

The service is offered through Signify Health, an independent health care management company that works on our behalf.

What to Expect From the Signify Health Program

A licensed health care provider conveniently comes to your home to talk one-on-one with you about your health.
During each 45-minute visit, the provider performs a brief physical exam, reviews your medical history, and provides a comprehensive assessment of your health.
After your evaluation, the provider shares the information with your doctor to help coordinate care.
In-home evaluations don’t replace existing appointments, advice, or medical care, but they can help improve the care you already get from your doctor.

Sign Up Today

To sign up, call Signify Health at 1-844-857-3937 (TTY: 711).

Once you complete your health assessment, we’ll send you a $25 gift card.

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Personalized Support for Disease Management

Managing chronic and serious conditions can be a lot of work, but it’s essential to staying on top of your health. That’s why we offer specialized programs to help our members who have diabetes, congestive heart failure, and kidney disease.

Diabetic Testing Supplies & Personalized Support

If you have type 1 or type 2 diabetes, your plan benefits will cover the cost to buy certain medically necessary diabetic testing supplies. See below to understand how diabetic test strips and monitors are covered under your plan. Also, Medex plans with the Syringes and Needles rider have no cost for needles and syringes. Plus, Medicare Advantage members have access to a highly-trained team of Diabetes Navigators from Team Blue who will use their specific skills and knowledge to help guide and support you.

Getting your medically necessary testing supplies at no-cost is easy. Based on your plan type, you may be eligible for a no-cost purchase at the pharmacy, or mailed reimbursement with your receipt. See the chart below for coverage on testing supplies, insulin, and syringes.

Medicare Advantage Members

Coverage For:	You Pay:
Insulin and syringes Freestyle and OneTouch^®´ brand test strips and glucose monitors Lancets and Lancet Devices	Your Tier 3 cost-share (after meeting deductible if applicable) for insulin and syringes. Nothing for the One Touch blood glucose test strips and blood glucose monitors purchased at participating retail or mail-order pharmacies. Nothing for lancet devices and lancets

Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible (if applicable).

One-on-One Help From a Diabetes Expert

The Diabetes Navigator Program is a specialized program designed to provide tailored support and resources to our Medicare Advantage members with diabetes or prediabetes. The Team Blue Navigators are trusted advocates that are on-hand to encourage and support your journey when managing this chronic condition. The goal is to:

Motivate you to make critical lifestyle changes through an awareness of barriers such as cost, resources, transportation, and benefit understanding
Offer extensive knowledge, awareness, and support

To talk to a Diabetes Navigator, call 1-800-200-4255 (TTY: 711), 8:00 a.m. to 5:00 p.m. ET, Monday through Friday.

Medex Members with No Prescription Drug Coverage

Coverage For:	You Pay:
Needles and syringes¹ Medicare-approved diabetic testing supplies Insulin for insulin pump: covered by Medicare as primary insurance Lancet devices, lancets and glucometers	The full cost when buying the needles and syringes, then submit the receipt with the Medex Claim Form.^1,2 Medicare deductible at point of sale for testing supplies; pharmacy reimburses once plan pays (if applicable). Insulin for pump: Part B deductible and/or coinsurance per benefit structure. Medicare Part B (Medical Insurance) covers lancet devices, lancets and glucometers as supplies used with durable medical equipment (DME); Medex covers Part B deductible and/or coinsurance per benefit structure.

Coverage For:

You Pay:

Needles and syringes¹
Medicare-approved diabetic testing supplies
Insulin for insulin pump: covered by Medicare as primary insurance
Lancet devices, lancets and glucometers

The full cost when buying the needles and syringes, then submit the receipt with the Medex Claim Form.^1,2
Medicare deductible at point of sale for testing supplies; pharmacy reimburses once plan pays (if applicable).
Insulin for pump: Part B deductible and/or coinsurance per benefit structure.
Medicare Part B (Medical Insurance) covers lancet devices, lancets and glucometers as supplies used with durable medical equipment (DME); Medex covers Part B deductible and/or coinsurance per benefit structure.

Questions?

Call us at 1-800-258-2226 (TTY: 711)
8:00 a.m. to 6:00 p.m. ET, Monday through Friday.

Subject to plans with Syringes and Needles rider
You have two (2) years from the date of purchase to submit a claim form for reimbursement.
Please send your receipt and claim form to: BCBSMA P.O. Box 986030 Boston, MA 02298

Medex Members with Prescription Drug Coverage

Coverage For:	You Pay:
Needles and syringes Medicare-approved diabetic testing supplies Insulin for insulin pump: covered by Medicare as primary insurance• Insulin (all other forms); refer to your prescription drug benefit or Medicare Part D prescription drug plan Lancet devices, lancets and glucometers	Your member copay or cost-share for needles and syringes, then submit the receipt with a Medex Claim Form.^1,2 Medicare deductible at point of sale for testing supplies; pharmacy reimburses once plan pays (if applicable). Insulin for pump: Part B deductible and/or coinsurance per benefit structure. Insulin (all other forms): Your cost-share per pharmacy benefit structure; you are responsible for paying your Part D cost-share. Medicare Part B (Medical Insurance) covers lancet devices, lancets and glucometers as supplies used with durable medical equipment (DME); Medex covers Part B deductible and/or coinsurance per benefit structure.

Coverage For:

You Pay:

Needles and syringes
Medicare-approved diabetic testing supplies
Insulin for insulin pump: covered by Medicare as primary insurance• Insulin (all other forms); refer to your prescription drug benefit or Medicare Part D prescription drug plan
Lancet devices, lancets and glucometers

Your member copay or cost-share for needles and syringes, then submit the receipt with a Medex Claim Form.^1,2
Medicare deductible at point of sale for testing supplies; pharmacy reimburses once plan pays (if applicable).
Insulin for pump: Part B deductible and/or coinsurance per benefit structure.
Insulin (all other forms): Your cost-share per pharmacy benefit structure; you are responsible for paying your Part D cost-share.
Medicare Part B (Medical Insurance) covers lancet devices, lancets and glucometers as supplies used with durable medical equipment (DME); Medex covers Part B deductible and/or coinsurance per benefit structure.

Questions?

Call us at 1-800-258-2226 (TTY: 711)
8:00 a.m. to 6:00 p.m. ET, Monday through Friday.

Subject to plans with Syringes and Needles rider
You have two (2) years from the date of purchase to submit a claim form for reimbursement.
Please send your receipt and claim form to: BCBSMA P.O. Box 986030 Boston, MA 02298

Better Support for Members with Chronic Kidney Disease

We want to support our members on their health journeys by making sure they get the help they need, when they need it. That’s why we’ve teamed up with Square Knot Health, an independent company specializing in kidney disease management, to support the care of our members managing chronic kidney disease (CKD).

If you qualify, Square Knot will pair you with a specially trained kidney disease navigator who will:

Assess your current kidney disease status and overall health
Partner with your nephrologist and primary care provider to support you and develop a plan specific to your needs
Be a readily available resource for questions related to your kidney health

For more information on the program, visit squareknothealth.com. To see if you’re eligible, call Team Blue at 1-800-392-0098 (TTY: 711) and press 1, Monday through Friday, 8:30 a.m. to 4:30 p.m. ET.

Quality Optimizer

A lot goes into managing your health. That’s why we’re partnering with CVS Caremark^®, to offer Quality Optimizer to our Medicare Advantage members. For eligible members, this program helps you stay on track with your medicine. This makes it easier to manage your health condition, like diabetes or high blood pressure.

Personalized care and support

We want to make sure you know how to take your medicine correctly and how it works in your body. And we can offer education on why it’s important to stay on track with your medicine.

We’ll reach out to you if:

It is your first time filling a medicine
You’re not taking a medicine that may help you better manage your health condition
You missed a refill
You’re due for a routine screening, like an eye exam or mammogram

We’re also here to help and support you. If you have any questions call us anytime at 1-877-817-0493 (TTY: 711) to get answers from CVS Customer Care.

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Additional Programs

We are proud to offer a wide range of additional member support and assistance programs. To see if you are eligible for any of the programs below, call our dedicated care management team: 1-800-392-0098 (TTY: 711) 8:30 am to 4:30 pm ET, Monday – Friday.

Safe Returns Program

Before an elective hip or knee replacement, a care manager will call to offer you information about your surgery and expected recovery period.

Aftercare Program

After your hospital discharge, you may receive a call on your transition back home. Topics covered include discharge instructions, follow-up appointments, services and medications.

Nutritionist

A registered dietician can help with information on doctor-prescribed diets, healthy meals and appropriate portions

Alzheimer's Association

If you’re managing dementia or other memory complications, a Memory Care Specialist from the Alzheimer’s Association will contact you or your caregiver to provide tips on how to better manage your condition, as well as helpful resources and connections to support groups.