The Medex Choice benefit design requires a primary care provider (PCP) selection from the HMO Blue network. Members who select a Choice PCP (a sub-set of the HMO Blue network), will receive enhanced benefits, such as:
- Coverage for 100% of the Medicare Part A and Part B deductibles and the co-insurance for days 21-100 for Medicare–covered admissions in a skilled nursing facility.
If a member does not select a Choice PCP and selects another HMO Blue PCP, they will not receive coverage for the Medicare Part A and Part B deductibles or co-insurance for skilled nursing facilities. The member will continue to receive coverage for the 20% Medicare Part B co-insurance after Original Medicare processes and pays the claim.
This plan includes the following key features, plus more:
- Care is coordinated by a primary care provider (PCP)
- Choice of any PCP or other providers in the HMO Blue network
- Benefits received outside of the HMO Blue network are not covered under Medex Choice but are covered by Original Medicare, except for emergencies and urgent care
- It can be combined with a Blue MedicareRx (PDP) prescription drug plan, or a Dental Blue 65 plan
Visit the Enroll section for information on how to enroll via phone, mail or fax.
Online enrollment in Medex Choice is currently unavailable.
When a member needs specialty care, the member must get a referral to an HMO Blue specialist from the PCP before seeing the specialist, otherwise the Medex Choice plan may not provide coverage for the specialist care.
For more information, Download our Medex Choice Brochure.
- You must continue to pay your Medicare Part B premium.
*Medex®' Choice is a Medicare supplement plan from Blue Cross Blue Shield of Massachusetts HMO Blue, a wholly controlled subsidiary of Blue Cross and Blue Shield of Massachusetts. Primary care providers (PCPs) are part of the Blue Cross Blue Shield of Massachusetts HMO Blue® provider network. When you need specialized care, your PCP will work with you to identify the best doctor for your care and provide a referral, most often to doctors and hospitals with whom they are affiliated in the HMO Blue® provider Network.
The Medicare costs and dollar values represented in this table are the 2019 rates.