Using Your Medicare Plan
Blue Cross and Blue Shield of New Mexico wants you to get the most from your plan. Understanding how it works and having the right resources can help. Learn the details of what’s covered in your Blue MedicareRx plan. Get the forms you need to order prescription drugs by mail, submit a claim, and more.
Understanding Your Claims
Your pharmacist will usually submit claims for prescriptions you received. Once the claim is filed, you will receive an Explanation of Benefits from us.
- Explanation of Benefits (EOB)
This notice gives you a summary of your prescription drug claims and costs. It is not a bill. It simply details what you have paid and the level of benefits you’ve used. How often you receive it depends on how often you fill your prescription. Review the details on your EOBs to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.
- Coinsurance and Copays
Some plans include coinsurance and/or copays when you receive care or prescriptions. These payments are your responsibility. Coinsurance and copays count toward your “Total Out-of-Pocket” expenses for the year.
- Coinsurance is the percentage of cost of the drug. For example, you may pay a 25% coinsurance for a prescription drug.
- Copays are a set amount you pay for all drugs on a tier. For example, you may have a $10 copay for a prescription drug. You may pay a lower copayment for generic drugs than brand-name drugs.
Medicare Coverage Determination, Appeals and Grievances
Blue Cross MedicareRx Plans have processes in place to address Medicare coverage issues, complaints and problems. If you have issues, complaints or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can find more information on the Drug Coverage, Appeals and Grievances page.
If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form or contact the Office of the Medicare Ombudsman.