Using Your Medicare Plan

Blue Cross and Blue Shield of Illinois wants you to get the most from your plan. Understanding how it works and having the right resources can help. In this section you can find out what's covered, how to file an appeal or grievance, download the formulary 9 (or drug list), search for a pharmacy, and more.

Is It Covered

It's easy to ask questions or voice concerns about your coverage. If you have questions about what your plan covers, you can:

• Read your Evidence of Coverage. This important notice is in the welcome kit you received in the mail shortly after you enrolled. It details what the plan covers, how much you pay, and more. You can also find it on the Plan Documents page by selecting your plan.
• Call the Customer Service number listed on your member ID card, and a representative can help you understand your benefits.

Medicare Coverage Determination, Appeals and Grievances

Blue Cross MedicareRx Plans have processes in place to address Medicare coverage issues, complaints and problems. If you have issues, complaints or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can find more information on the Medicare Coverage Determination, Appeals and Grievances page.

Prescription Drug Coverage Determination, Appeals and Grievances

Blue Cross MedicareRx plans have processes in place to address Medicare coverage issues, complaints and problems. You can find more information on the Drug Coverage, Appeals and Grievances page.

Drug Information

Drugs covered by Blue Cross MedicareRx plans are listed in formularies. Each plan has its own drug list that includes generic and brand name drugs. The list also provides information about drug copays and limitations, such as prior authorization, quantity limits and step therapy.

Drug lists can change. Normally, any changes in the drug list are reflected in the list at the beginning of each year. However, during the year, we might make other changes that are allowed by Medicare rules. We will provide you with advance notice of these changes.

Use the Drug Finder tool to find the most up-to-date list of medicines covered by each plan.

Download your formulary on our Prescription Drug Plan Documents page by selecting your plan.

If you need help with additional plan documents, please contact us.

Prior Authorization/Utilization Management

Drug Plan Transition

Pharmacy Information

Medication Therapy Management

If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form or contact the Office of the Medicare Ombudsman.