Mystical Magical BlueCard

[somarco]

For years I have read about agents proclaiming that clients/policyholders can go anywhere with the BlueCard. I am not really sure what it is, but it seems to be a national PPO for certain BX plans. It seems to extend the EGH network access as well as SOME MA plans.

A prospect that has the state plan for teachers is retiring the end of this month and weighing her option of continuing with the state plan as a retiree, or changing to OM + Medigap.

She was also told (by HR) the BlueCard allows her access to any provider that accepts BX insurance.

Digging, I found a BlueCard manual (100+ pages) for a handful of BX plans. This summary appears below . . .


No, you generally cannot use your BlueCard with Medicare Advantage, as Medicare Advantage is considered a separate program from the BlueCard network and is usually not included in its benefits; meaning you would need to use the specific membership card provided by your Medicare Advantage plan when seeking care.

Key points to remember:
Separate programs: Medicare Advantage operates independently from the BlueCard network.

Specific plan card: When enrolled in Medicare Advantage, you will use the ID card provided by your chosen plan, not your BlueCard.

Check with your plan: While most BlueCard plans exclude Medicare Advantage, it's always best to verify with your specific Blue Cross Blue Shield provider to confirm coverage details

This link takes you to one of the BlueCard manuals. Looking at a few of these, the manual appears to be identical except for the BX underlying plan. In this case it is Premera.

https://www.premera.com/documents/014206.pdf

I really hate to toss this to the jackals on the forum but I am curious to see the responses.

 

[Fisher]

What's the question?

 

[costrand]

Is the company offering an HMO or PPO Group MA plan?

The excluded MA plans from the BlueCard Medicare Advantage PPO network would be all HMOs and any PPOs in the 2 states not listed on page 33 (one is Alaska which doesn't offer a BCBS MA plan).

Most MA plans are HMOs so that is why they have the disclaimers about "Most" MA plans being separate from BlueCard.

 

[somarco]

Is the company offering an HMO or PPO Group MA plan?

Government entity with self funded MAPD for active employees and a separate plan for retirees. Actives can pick BX or UHC as the plan administrator TPA . . . different benefits, different premiums.

If you want the retiree benefit and you are on the BX plan now that is what you get when you retire.

Every few years the agency that oversees this state plan "shops" coverage and may drop or add a TPA. A few years ago BX was the only choice, they got booted and allowed UHC to run the show. BIG mistake. Almost everyone was mad, so much so that the agency had to change the plan design RETROACTIVE to 1/1. This took place in May as I recall.

Claims had to be readjudicated with refunds in some cases, ask for additional money in others. A huge mess that only a government entity could create.

Making matters worse, the plan has higher premiums than commercial MAPD plans. The only positive is the MOOP is about half of what commercial plans offer in the state.

BlueCard or not, there are some hospitals and specialty providers who do not participate in the retiree MAPD BX network and won't accept the BlueCard either.

And the state plan for retirees is a PPO . . .

 

[bluediamond]

Bluecard is for under PPO 65 products and is only for PPO networks and if a doc in Kansas is a contracted provider for the Blue PPO in Kansas he would be considered in network. The insured person always is directed to call the member services number on back of card to see if doc so and so is in network and if the answer is yes then the client is directed to call that doc to make sure as networks can change.

MAPD PPO plans are not bluecard but if a doc or provider in Kansas is a contracted provider for the blues in Kansas BlueMedicare PPO plan he is in network, but same rules apply by calling back of card. There are BlueMedicare PPO plans in 49 states and Puerto Rico.