Using Your Plan

Learn About You Costs and Coverage

Coinsurance and Copays

• Understanding Costs: You may hear the terms "coinsurance" and "copay" while enrolled in a Blue Cross Medicare Advantage Dual Care plan. Coinsurance is a percentage of the bill you pay. Copays are a set amount you pay at the time of service.

Quick Facts About Claims and More

• Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will get a statement called the Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
• What is an EOB? The EOB is a statement, not a bill. It simply details what you have paid and indicates the level of benefits you’ve used.
• How to use an EOB: Review these to be sure they are correct. If you think there are errors on your EOB statement, or you think you are the victim of fraud, please call customer service.

Prescription Drug Coverage

Drugs covered by Blue Cross Medicare Advantage Dual Care plans are listed in formularies (drug lists). Each plan has its own drug list that includes generic and brand name drugs. The list also provides information about drug copays and limitations, such as prior authorization, quantity limit and step therapy.

Drug Formulary

You will have access to the Drug Formulary, which is a list of drugs that are covered, both as a document or online. You can share the formulary with your doctor to talk about your medication options. Drug lists can change, most often in the beginning of each year. Normally, any changes in the drug list are reflected in the list at the beginning of each year. To access your formulary online, use the Drug Finder Tool.

Medication List

The Medication List is used to record your current medications along with directions, prescriber, and any knock allergies. Bring your Medication List when you go to the doctor, hospital, or emergency room and share it with your family or caregivers.

How to Address Issues and Problems

At Blue Cross and Blue Shield of New Mexico, we are here to help guide you through your plan's coverage options. To ensure member safety, a prescribed drug or medical service may need review from our specialized teams. If at any time you have a question or experience any issues during these processes, our customer service team will be able to assist.

If you have issues or problems with your Medicare plan or the care you receive, you have the right to make a complaint. Because Blue Cross Medicare Advantage Dual Care is your Medicare plan, you should call us with all your questions. You can address any Medicare coverage difficulties and concerns you may have via a complaint process.

Contact Us for Help.

If you would like to submit feedback directly to Medicare, you have two options:

Use the Medicare Complaint Form
Contact the Office of the Medicare Ombudsman