Blue Cross Medicare Advantage
Dual Care (HMO SNP)SM

Blue Cross Medicare Advantage

A Dual-Eligible Special Needs Plan is a Medicare Advantage plan that is offered to beneficiaries who qualify both for Medicare and Medicaid. A Medicare Advantage Plan (like an HMO or PPO)* is sometimes called "Part C" or "an MA Plan," and is offered by private insurance companies approved by Medicare.

Blue Cross Medicare AdvantageSM offers all of the coverage of Original Medicare — plus more.

Whether you're new to Medicare or thinking about switching plans, here are some important things to consider before choosing Blue Cross Medicare Advantage.

  • Be sure you are eligible for Medicare. Your primary residence must be in Bernalillo, Sandoval, Torrance, and Valencia counties to enroll in Blue Cross Medicare Advantage.
  • Depending on your level of Medicaid eligibility, you may not have any cost-sharing responsibility for Original Medicare services, including premium.
  • Review the 2014 Blue Cross Medicare Advantage plan benefits and built-in drug coverage below.
  • If you'd like to enroll in a Medicare Advantage plan, make sure you're aware of enrollment periods. Members may enroll in the plan only during specific times of the year.
  • Be eligible for Medicaid benefits with the State of New Mexico and be enrolled in Blue Cross Blue Shield of New Mexico's (BCBSNM) Medicaid plan, Blue Cross Community CentennialSM.

2014 Blue Cross Medicare Advantage Dual Care (HMO SNP) plan benefits:

Benefit In-Network
Monthly premium $12.60
Doctor office visits 0% or 20%
Inpatient hospital care $0 copay or $1,184 deductible (Days 1-60);
$296/day (Days 61-90);
$592/day (Days 91-150)**
Emergency care 0% or 20%

2014 Blue Cross Medicare Advantage Dual Care (HMO SNP) built-in drug coverage:

Prescription deductible $0.00
Copay Tier 1 Preferred Generic Drugs $0 copay;
or a $1.15 copay;
or a $2.55 copay
Copay Tier 2 Non-preferred Generic Drugs $0 copay;
or a $1.15 copay;
or a $2.55 copay
Copay Tier 3 Preferred Brand Drugs $0 copay;
or a $3.50 copay;
or a $6.35 copay
Copay Tier 4 Non-preferred Brand Drugs $0 copay;
or a $3.50 copay;
or a $6.35 copay
Coinsurance Tier 5 Specialty Drugs For generic drugs: $0 copay;
or a $1.15 copay;
or a $2.55 copay;
For brand drugs: $0 copay;
or a $3.50 copay;
or a $6.35 copay

Evidence of Coverage
Y0096_BEN_TMP_MAEOCCVR14 Approved 08222013

Evidence of Coverage en Espanol
Y0096_BEN_NM_HMOSNPEOC_2014aSPA Accepted 10312013.pdf

Summary of Benefits
Y0096_BEN_NM_DSNPSB14b Accepted 02052014

Summary of Benefits en Espanol
Y0096_BEN_NM_DSNPSB14bSPA Accepted 02052014

* HMO — Health Maintenance Organization; you must use the doctors, specialists, or hospitals in the plan’s network of providers. The HMO may require you to get a referral from your primary care physician.
PPO — Preferred Provider Organization; you pay less when you use health care providers in the plan’s network. You can use providers from outside of the network, but may have to pay more.

** These amounts may change for 2014.

You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form  or contact the Office of the Medicare Ombudsman .

This plan is available to anyone who has both Medical Assistance from the State and Medicare.