Blue Shield 65 Plus Choice Plan (HMO)
Summary of Benefits

2018   Email us [email protected] for 2019 Blue Shield 65 Plus Choice Plan (HMO) Summary of Benefits

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.

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

Blue Shield Medicare Advantage Plan

65 Plus (HMO), Inspire, Trio  & Choice 

Blue Shield 65 PlusSM (HMO),  Inspire, Blue Shield 65 PlusSM Choice Plan (HMO) and Blue Shield Trio Medicare (HMO)  are Medicare HMOs with a Medicare Advantage-Prescription Drug Plan contract. These  plans cover the same basic benefits as Original Medicare plus Part D prescription drug coverage.

Press Release for Inspire 

Blue Shield’s plans include*:

1. $0 monthly plan premium, depending on the plan and geographic area.
2. $0 copay for annual wellness visits
3. $0 copay for primary care physician and specialist office visits, depending on the plan
4. $0 copay for preferred generic drugs when purchased at Albertsons/Osco/Savon, Costco, CVS Pharmacy including CVS Pharmacy at Target), and Safeway, Vons, Walmart, Ralphs and many more pharmacies, and by mail service
5. $0 copay for SilverSneakers® fitness depending on the plan
6. Additional vision and hearing coverage
7. Optional supplement dental coverage with one of the state’s largest dentist networks
8. Personal Emergency Response System (PERS) and Hearing Aid benefits are available in Blue Shield 65 Plus Choice Plan offered in San Bernardino and Riverside counties and Blue Shield 65 Plus in Los Angeles, Orange and San Diego counties.

See actual summary of benefits below to make sure everything is up to date for 2020.

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Summary of Benefits
for Blue Shield Medicare Advantage Plans

  • 2020 Blue Shield Inspire (HMO) Los Angeles & Orange Counties 
  • 2020 Blue Shield Inspire (HMO) Alameda County
  • 2020 Blue Shield Inspire (HMO) San Mateo County
  •  
  • 2020 Blue Shield Medicare (PPO) Alameda County 
  •  
  • 2020 Blue Shield Vital (HMO) Los Angeles & Orange Counties 
  • 2020 Blue Shield Vital (HMO) Riverside & San Bernardino Counties
  •  
  • 2019 2020 Blue Shield 65 Plus (HMO) Los Angeles & Orange Counties 
  • 2019 2020 Blue Shield 65 Plus (HMO) San Bernardino County  
  • 2019 2020 Blue Shield 65 Plus (HMO) Riverside County 
  • 2019 2020 Blue Shield 65 Plus (HMO) San Diego County  
  • 2019 2020 Blue Shield 65 Plus (HMO) Ventura County  
  • 2019 2020 Blue Shield 65 Plus (HMO) San Luis Obispo and Santa Barbara Counties partial 
  • 2019 2020 Blue Shield 65 Plus (HMO) Fresno County  
  • 2019 2020 Blue Shield 65 Plus (HMO) Kern County 
  •  
  • 2019 2020 Blue Shield Trio Medicare (HMO)  Sacramento County
  •  
  • 2019 2020 Blue Shield 65 Plus Choice Plan (HMO) Los Angeles County (partial) & Orange County  
  • 2019 2020 Blue Shield 65 Plus Choice Plan (HMO) San Bernardino & Riverside 

For more information – Email us

Scope of Appointment – English

Evidences of Coverage

2020 Blue Shield Inspire (HMO) – Los Angeles* and Orange Counties 
2020 Blue Shield Inspire (HMO)- Alameda County  

2020 Blue Shield Medicare (PPO) – Alameda County  

2020 Blue Shield Inspire (HMO) – San Mateo County  

2020 Blue Shield Vital (HMO) – Los Angeles and Orange Counties 
2020 Blue Shield Vital (HMO) – Riverside and San Bernardino Counties 

2020 Blue Shield Medicare (PPO) – Alameda County

2019 2020 Blue Shield 65 Plus (HMO) – Los Angeles* and Orange Counties 
2019 2020 Blue Shield 65 Plus (HMO) – San Bernardino* County 
2019 2020 Blue Shield 65 Plus (HMO)- Riverside* County  
2019 2020 Blue Shield 65 Plus Choice Plan (HMO) Los Angeles* and Orange counties 
2019 2020 Blue Shield 65 Plus Choice Plan (HMO) Riverside and San Bernardino counties 
2019 2020 Blue Shield 65 Plus (HMO) San Diego County  
2019 2020 Blue Shield 65 Plus (HMO) Ventura* County  
2019 2020 Blue Shield 65 Plus (HMO) Fresno County

2019 2020 Blue Shield Trio Medicare (HMO) – Sacramento* County  

2019 2020 Blue Shield 65 Plus (HMO) – Kern County  
2019 2020 Blue Shield 65 Plus (HMO) – San Luis Obispo* and Santa Barbara* Counties  

Formularies & Rx Prescription Drug Resources

View formularies

2019 2020 Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Choice Plan, (HMO). Blue Shield Trio Medicare (HMO), Blue Shield Inspire (HMO), Blue Shield Vital (HMO) and Blue Shield Medicare (PPO) Formularies

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

 

Agent log in  

2019  Paper pdf Enrollment form

Steve Shorr @ Blue Shield HQ


Visit our Blue Shield Affiliate Website to learn more & enroll. No extra charge

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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Applications:

Blue Shield Medicare Advantage
HMO ONLINE Enrollment Form 

2020 Blue Shield Medicare Advantage HMO Change of Plan Form

2018 Medicare Plan Ratings Information for MAPD-English

2019 Optional Supplemental Dental form English and Spanish  (PDF, 1MB)

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24 comments on “Blue Shield 65 Plus – Inspire HMO 2020

        • 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).

  1. 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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