New Flexible Medicare Advantage PPO Plan
We’re offering certain Blue Cross Medicare AdvantageSM members a new way to access care. The Blue Cross Medicare Advantage Flex (PPO)SM Plan is an open access plan that allows members to see any provider accepting Medicare, including Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM contracted providers. Members can see providers inside or outside the plan service area or plan network, at no additional cost.
What This Means for You
- Starting Jan. 1, 2022, you can identify Flex Plan members by their member ID card. Look for the Flex Plan name on the front.
- You can see Flex Plan members if you accept Medicare and bill Blue Cross and Blue Shield of Texas (BCBSTX). Follow the billing instructions on the member ID card.
- If you are a Medicare Advantage-contracted provider with Blue Cross and Blue Shield (BCBS), you will be paid at your contracted rate.
- If you are not a Medicare Advantage-contracted provider with BCBS, you will receive the Medicare allowed amount for covered services. You may not balance bill the member for any difference in your charge and the allowance.
Value for Members
Flex Plan members’ coverage level is the same whether in or outside the plan service area nationwide. Services must meet medical necessity criteria to be covered. The Flex Plan includes:
- Prescription drug coverage
- MDLIVE® for telehealth and 24/7 Nurseline
- SilverSneakers® fitness program at no cost
- A traveler benefit for members leaving their service area for up to six months
Check Eligibility and Benefits First
Use the Availity® Provider Portal or your preferred vendor to verify members’ eligibility and benefits before every appointment. Eligibility and benefit quotes include:
- Membership verification
- Coverage status
- Prior authorization requirements
- Provider’s network status for the member’s policy
- Applicable copayment, coinsurance, and deductible amounts
Ask to see the member’s ID card and a photo ID to help guard against medical identity theft. If services may not be covered, members should be notified that they may be billed directly.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
MDLIVE is a separate company that has contracted with BCBSTX to provide virtual visit services for members with coverage through BCBSTX. MDLIVE is solely responsible for its operations and for those of its contracted providers. Virtual visits may not be available to all BCBSTX members.
SilverSneakers is a wellness program owned and operated by Tivity Health, Inc., an independent company. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. If you have any questions about the products or services provided by the vendor, you should contact the vendor directly.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, and the terms of the member’s certificate of coverage applicable on the date services were rendered.