Find all the resources you need to manage and understand Medicare plans including your rights and responsibilities as a member, what you will pay as a member of a plan, the process for coverage decisions and making appeals, Medicare formulary, and much more.
The Evidence of Coverage booklet tells members how to get their Medicare medical care and prescription drugs (if applicable) through our plan, a Medicare Advantage Plan. The Evidence of Coverage booklet explains member’s rights and responsibilities, what is covered, and what you will pay as a member of the plan.
Compare our Medicare Advantage plans and the Original Medicare Plan using the Summary of Benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. View the Plan Ratings for our Medicare Advantage plans to compare our plans’ performance to other plans
When you have multiple medical needs, coordinating everything you need can be exhausting.
At BlueShield of Northeastern New York, we want to help you have less to worry about.
We are committed to helping our members take an active role in their good health. Through our Health and Wellness programs and benefits, you can enjoy the advantages of learning from healthcare professionals throughout the area and exclusive member discounts.
Understand the process for coverage decisions, how to request an appeal, and who to contact with questions related to benefits and coverage for medical services and prescription drugs.
Our Medicare Advantage plans are offered with or without a prescription drug benefit. View the Medicare Formulary or search for a network pharmacy. Review the Transition, Prior Authorization, Quantity Limits, Step Therapy, and Medication Therapy Management guidelines. Also, see if you qualify for help with your prescription drug costs and more.
Our Star Rating:
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Out-of-network/non-contracted providers are under no obligation to treat BlueShield of Northeastern New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.
Content Last Updated December 15, 2016