Blue Shield Medicare Advantage Plan

65 Plus (HMO), Inspire, Trio  & Choice 

Blue Shield has  Medicare HMOs with a Medicare Advantage-Prescription Drug Plan MAPD contract.  MAPD  plans cover the same basic benefits as Original Medicare plus Part D prescription drug coverage.

See actual summary of benefits below  and evidence of coverage to make sure everything is up to date for 2021.

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Paper Application
MAPD Medicare Advantage

* Short Form - Transfers  65 Inspire, Plus, Choice & Trio

Medi Gap  Paper Application

Steve Video @ Blue Shield Headquarters

Forms

 

2020 Blue Shield Medicare Advantage HMO Change of Plan Form

Check your application status?

 

Summary of Benefits SOB
for Blue Shield Medicare Advantage Plans

  • 2021 Blue Shield Inspire (HMO) Los Angeles and Orange Counties (PDF, 619KB)
  • Inspire Highlights 2021 LA & Orange
  • 2021 Blue Shield Inspire (HMO) Alameda County (PDF, 311KB)
  • 2021 Blue Shield Inspire (PPO) Alameda County (PDF, 765KB)
  • 2021 Blue Shield Inspire (HMO) San Mateo County (PDF, 321KB)
  • 2021 Blue Shield Inspire (HMO) Fresno and Madera Counties (PDF, 297KB)
  • 2021 Blue Shield Inspire (HMO) Sacramento County (PDF, 304KB)
  • 2021 Blue Shield Inspire (HMO) Santa Clara County (PDF, 303KB)
  • 2021 Blue Shield Inspire (HMO) San Joaquin, Stanislaus & Merced counties (PDF, 565KB)
  •  
  • 2021 Blue Shield Vital (HMO) Los Angeles and Orange counties (PDF, 320KB)
  • 2021 Blue Shield Vital (HMO) Riverside and San Bernardino counties (PDF, 586KB)
  •  
  • 2021 Blue Shield 65 Plus (HMO) Los Angeles and Orange counties (PDF, 387KB)
  • 2021 Blue Shield 65 Plus (HMO) San Bernardino County (PDF, 351KB)
  • 2021 Blue Shield 65 Plus (HMO) Riverside County (PDF, 599KB)
  • 2021 Blue Shield 65 Plus Plan 2 (HMO) Los Angeles and Orange counties (PDF, 389KB)
  • 2021 Blue Shield 65 Plus Choice Plan (HMO) Riverside and San Bernardino counties (PDF, 648KB)
  • 2021 Blue Shield 65 Plus (HMO) San Diego County (PDF, 406KB)
  • 2021 Blue Shield 65 Plus (HMO) Ventura County (PDF, 466KB)
  • 2021 Blue Shield 65 Plus (HMO) Kern County (PDF, 394KB)
  • 2021 Blue Shield 65 Plus (HMO) San Luis Obispo and Santa Barbara counties (PDF, 295KB)
  •  
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) Los Angeles & Orange counties (PDF, 256KB)
  • 2021 Blue Shield AdvantageOptimum Plan 1 (HMO) San Diego County (PDF, 258KB)
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) Santa Clara County (PDF, 256KB)
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) Fresno County (PDF, 252KB)
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) Merced County (PDF, 442KB)
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) Stanislaus County (PDF, 252KB)
  • 2021 Blue Shield AdvantageOptimum Plan (HMO) San Joaquin County (PDF, 464KB)
  • 2021 Blue Shield AdvantageOptimum Plan 2 (HMO) San Diego County (PDF, 259KB)
  •  
  • 2021 Blue Shield TotalDual Plan (HMO D-SNP) Los Angeles, Orange, San Bernardino & San Diego counties (PDF, 423KB)
  • 2021 Blue Shield Inspire (HMO D-SNP) Fresno, San Joaquin & Stanislaus counties (PDF, 254KB)
  • 2021 Blue Shield Coordinated Choice Plan (HMO) Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus counties (PDF, 244KB)

Rather than posting the Summary of Benefits, we are posting the Full Evidence of Coverage, which includes that information.  If you would like the SOB  Email us

Permission to have a Zoom, Phone or Skype Meeting – Scope of Appointment – English

Evidences of Coverage

2021 Blue Shield Inspire (HMO) – Los Angeles and Orange counties 
2021 Blue Shield Inspire (HMO)- Alameda County
2021 Blue Shield Inspire (PPO) – Alameda County
2021 Blue Shield Inspire (HMO) – San Mateo County
2021 Blue Shield Inspire (HMO) Fresno and Madera counties
2021 Blue Shield Inspire (HMO) – Sacramento County
2021 Blue Shield Inspire (HMO) Santa Clara County
2021 Blue Shield Inspire (HMO) San Joaquin, Stanislaus & Merced counties

2021 Blue Shield Vital (HMO) – Los Angeles and Orange counties
2021 Blue Shield Vital (HMO) – Riverside and San Bernardino counties

2021 Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties
2021 Blue Shield 65 Plus (HMO) – San Bernardino County
2021 Blue Shield 65 Plus (HMO)- Riverside County
2021 Blue Shield 65 Plus Plan 2 (HMO) Los Angeles and Orange counties
2021 Blue Shield 65 Plus Choice Plan (HMO) Riverside and San Bernardino counties
2021 Blue Shield 65 Plus (HMO) San Diego County
2021 Blue Shield 65 Plus (HMO) Ventura County
2021 Blue Shield 65 Plus (HMO) – Kern County
2021 Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties

2021 Blue Shield AdvantageOptimum Plan (HMO) Los Angeles & Orange counties
2021 Blue Shield AdvantageOptimum Plan 1 (HMO) San Diego County
2021 Blue Shield AdvantageOptimum Plan (HMO) Santa Clara County
2021 Blue Shield AdvantageOptimum Plan (HMO) Fresno County
2021 Blue Shield AdvantageOptimum Plan (HMO) Merced County
2021 Blue Shield AdvantageOptimum Plan (HMO) Stanislaus County
2021 Blue Shield AdvantageOptimum Plan (HMO) San Joaquin County
2021 Blue Shield AdvantageOptimum Plan 2 (HMO) San Diego County

2021 Blue Shield TotalDual Plan (HMO D-SNP) Los Angeles, Orange, San Bernardino & San Diego counties
2021 Blue Shield Inspire (HMO D-SNP) Fresno, San Joaquin & Stanislaus counties
2021 Blue Shield CoordinatedChoice Plan (HMO) Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus counties

Resources & Links

Member Services 800.766.4466   [TTY 711]. Available 7 a.m. to 8 p.m., seven days a week, from October 1 through February 14. However, after February 14, calls are handled by an automated phone system on weekends and holidays.

Blue Shield Financial Strength

More on financials & Mission Statement on our Individual Site

Silver Sneakers.com

Wellness Tools

Blue Shield Fraud Hotline

 

Blue Shield of California is an HMO and PDP plan with a Medicare contract.   Enrollment in Blue Shield of California depends on contract renewal.

Formularies & Rx Prescription Drug Resources

View formularies

Formularies

2021

2021 Pharmacy List 

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield AdvantageOptimum Plan (HMO), Blue Shield AdvantagOptimum Plan 1 (HMO), Blue Shield Advantage Optimum Plan 2 (HMO), Blue Shield Inspire (HMO), Blue Shield Inspire (PPO), and Blue Shield Vital (HMO)

Blue Shield Coordinated Choice Plan (HMO), Blue Shield Inspire (HMO D-SNP), and Blue Shield TotalDual Plan (HMO D-SNP)

*Available only in certain ZIP codes. See the Evidence of Coverage or Summary of Benefits for details.

2020

Blue Shield has a program that helps members with certain chronic conditions better manage their drug therapy.  Learn more about the program

Learn more about appeals and grievances

Find prior authorization request forms

Read FAQs

Learn about exceptions if you find our plan does not cover your medication and how you can ask us to make an exception to our coverage rules.  Learn more about coverage determinations

Medicare can help people with limited incomes pay for their prescription drug costs.  Find out how to get additional help

Pharmacy Directory

 2019  2020  Blue Shield 65 Plus HMO and Blue Shield 65 Plus Choice Plan HMO

 

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54 comments on “Blue Shield 65 Plus – Inspire HMO 2021

  1. tier one medication for ucla medical inspire hmo

    if there a charge for 90 days mail orders for my medicine

    zolpidem 5mg ,

    trazodone 50mg and

    lisinopril 2.5 mg ?

    what pharmacy will process orders?

  2. I’ve heard that Blue Shield has PPO here in Santa Barbara can you send me the link or info for these?

    I never liked HMO.

  3. FAQ’s from prior webpage

     

    1. Where do I find a list of providers that are endodonic dentists in or near fullerton ca 92835 and accept the blue shield 65 plus choice co pay listed in the 2016 benefits listing
    2. Hi Steve,

       

      I Just got off the phone with the Social Security Dept. as I needed clarification on some of the questions asked in the online application for Medicare.

      This woman “Tracy” states that I am not eligible as I don’t have enough credits and won’t be eligible until Bruce turns 62 this coming October, then apply under him as he does have the credits.

      She told me that I wouldn’t be able to apply until open enrollment, Jan-March 2017.

      This seems odd to me but need your take on this.

      Thanks,

      Jackie

    3. How soon can Jackie enroll and when will her Medicare coverage under this plan begin? Our monthly premium for March under our current Health Net HMO plan is due March 10th (I think). If Jackie enrolls and coverage under this plan begins before April 1st will the premiums for the two plans be pro-rated?
      • She can enroll 24/7 by using my Blue Shield Agent affiliate link above. Her coverage will begin April 1st. Coverage won’t start till then, so, just pay Health Net for March and this premium for April. I’m surprised that Health Net hasn’t dropped her….
    4. Is there any supplemental coverage (which I think is referred to as “gap” coverage) available for prescription drug expense which is not paid by this plan? If so, what does it cost per month and what does it cover? Jackie takes Uloric 40 mg and it is expensive.
      • No! In fact it’s illegal to sell extra coverage. I don’t find the Blue Shield formulary handy. Did you want me to request it from Blue Shield Agent Support? The Medicare.Gov shop & compare tool shows the cost of Ulric 40 mg 30 pills/month to be $2,800 without insurance. It appears from the tool that Ulric is available mail order and would be $240/year. I double checked this on the Blue Shield Affiliate Enrollment and Information site and they show $480. This might be that I picked the wrong pharmacy on the Medicare Site.
    5. Is this a Medicare Plan C which includes outpatient, inpatient and prescription drug coverage provided on an HMO basis by Beaver Medical Group (where Jackie and I currently have an HMO plan through Health Net)? What is the monthly cost if Jackie enrolls in this plan?
    6. I am starting anthem mediblue select.
      A yearly dental cleaning and exam is included. How do I get the list of in network dentists in Riverside County, CA?
    7. what is the difference in blue shield 65+ and blue shield 65+ choice medicare advantage plans? we now have the regular 65+ we live in huntington beach ca (orange county) 92649 thank you

       

      thank youJoan V

      • Thank you very much for asking your question in the comments section of our website. It allows more people to learn the answers and get general information. The Plus Plan is offered in Orange County and Portions of Los Angeles County. To see if your MD’s are on the list, use the search feature, check this directory or call your MD’s. The choice plan has slightly better benefits. Here’s a side by side comparison.
  4. Any notions about when the 2021 Medicare Advantage details and provider lists might be available?

    Thanks for a very informative website.

    Sorry that my PCP doesn’t take the Blue insurance so I could give you some business.

  5. I am signing up for medicare this month and want to know about doctors, in particular, urologists and GI doctors, in the Blue Shield Inspire Network.

    My family doc is already in this network.

    I live in the Redondo Beach/Torrance, CA 90277 area.

  6. On your Inspire program, what are considered “over-the-counter” items?

    Does it include vitamins?

  7. Please explain Blue Shield inspire 2020 to me.

    I had Medicare Supplement Blue Shield extra F Plan 2019,

    My doctors all in UCLA Medical Group. Next year UCLA accept Blue Shield Inspire HMO.

    Shall I change to HMO from Medicare Supplement?

        • I’ve cut and pasted this from the Evidence of Coverage

          Section 2.2 What kinds of medical care can you get without getting approval in advance from your PCP?

          You can get the services listed below without getting approval in advance from your PCP.

           Routine women’s health care, which includes breast exams, screening mammograms (xrays of the breast), Pap tests, and pelvic exams as long as you get them from a network provider.

           Flu shots, Hepatitis B vaccinations, and pneumonia vaccinations as long as you get them from a network provider.  Emergency services from network providers or from out-of-network providers.

           Urgently needed services from network providers or from out-of-network providers when network providers are temporarily unavailable or inaccessible (e.g., when you are temporarily outside of the plan’s service area).

           Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area. (If possible, please call Member Services before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away. Phone numbers for Member Services are printed on the back cover of this booklet.)

          Section 2.3 How to get care from specialists and other network providers

          A specialist is a doctor who provides health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:

           Oncologists care for patients with cancer.

           Cardiologists care for patients with heart conditions.

           Orthopedists care for patients with certain bone, joint, or muscle conditions.

          When your PCP thinks that you need specialized treatment, they will request a referral (approval in advance) to see a plan specialist or certain other providers. For some types of referrals, your PCP may need to get approval in advance from our plan (this is called getting “prior authorization”). For more information about which services require prior authorization, see Chapter 4, Section 2.1 of this booklet.

          It is very important to get a referral (approval in advance) from your PCP before you see a plan specialist or certain other providers (there are a few exceptions, including routine women’s health care that we explain later in this section). If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself.

          If the specialist wants you to come back for more care, check first to be sure that the referral (approval in advance) you got from your PCP for the first visit covers more visits to the specialist.

          When you choose your PCP, you are also choosing the hospital and specialty network associated with your PCP.

          If there are specific specialists you want to use, find out whether your PCP sends patients to these specialists. Each network PCP has certain plan specialists they use for referrals. This means that the PCP you select may determine the specialists you may see. You may generally change your PCP at any time if you want to see a plan specialist that your current PCP can’t refer you to. Earlier in this chapter, in Section 2.1 under “Changing your PCP”, we tell you how to change your PCP. If there are specific hospitals you want to use, you must first find out whether your PCP uses these hospitals. Note that changing your PCP may result in being limited to specific specialists or hospitals to which that PCP refers (i.e., sub-networks, referral circles).

  8. I live in Orange County and have Blue Shield 65 Plus.

    I got an outpatient X-ray done at my doctor’s, St Jude Heritage.

    On my summary of benefits
    https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=2019_MAPD-LAOR-SOB.pdf

    it clearly states that I pay nothing.

    However, Blue Shield is telling me that because my doctor ordered 2 views it now becomes a “complex X-ray” to quote them and therefore I have to pay a $40 co-pay as if it was a ct scan etc,

    What is going on?

    • Here’s some thoughts & suggestions:

      Medicare Advantage offers Part D Rx at no additional charge

      You might just pay cash for the entire MD visit, Medicare wouldn’t pay, as when you have Medicare Advantage, the Insurance Company takes care of everything.

      See our webpage on the pros & cons of Medi Gap vs Medicare Advantage and what’s best for each person.

      Just get a Part D plan and leave what Medicare doesn’t pay as something you pay out of pocket, like you’re doing now. Note, if you didn’t buy Part D when first eligible, there might be a late enrollment penalty.

      Get a Medi Gap plan. Look at High F from Blue Shield, sure it has a deductible, but that doesn’t stop Medicare from paying first. The price is right. Here’s where we explained to another web visitor how to figure out the rate chart. Or, just send an email, with zip code and date of birth and we can send you your specific rate.

      If you want to discuss this on the phone, face to face, video conference, etc. see above for our appointment scheduler.

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