Monday - Friday | 8 a.m. - 8 p.m.
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:
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.
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
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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.
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
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.
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).
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.
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
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.
$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.
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.
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.
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.
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.
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.
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.
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
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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
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
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.
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
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.
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).
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.
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.
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.
2018 Medicare HMO Blue FlexRx Formulary
Updated 8/1/2018
Request for Medicare Advantage Prescription Drug Coverage Determination
$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.
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.
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.
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.
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.
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.
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
Benefits at a Glance
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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
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
$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.
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
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).
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.
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.
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
$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.
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.
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.
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.
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.
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.
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
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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
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
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.
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
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.
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:
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.
The list of network providers shows you the number and type of providers in our network.
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.
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.
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.
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
$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.
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.
(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.
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.
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.
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.
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
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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.
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
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.
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
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.
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.
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.
The list of network providers shows you the number and type of providers in our network.
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.
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.
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.
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.
$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.
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.
(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.
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.
With Medicare PPO 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.
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.
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
Monthly Plan Premium
Enter your Zip Code above to see plan prices
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
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
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.
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
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.
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.
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.
This list of network providers shows you the number and type of providers in our network.
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.
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.
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.
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.
$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.
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.
(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.
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
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.
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.
Max. Out-of-Pocket Cost: $4,900
Max. Out-of-Pocket Cost
In-Network: $3,900
Max. Out-of-Pocket Cost
Out-of-Network: $9,900
Max. Out-of-Pocket Cost: $3,400
Max. Out-of-Pocket Cost
In- and Out-of Network Combined:
$6,700
Max. Out-of-Pocket Cost
In- and Out-of Network Combined:
$4,900
Max. Out-of-Pocket Cost
In-Network: $3,400
Max. Out-of-Pocket Cost
In- and Out-of Network Combined:
$5,100
Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. You must continue to pay your Medicare Part B Premium.