Medical Benefits

Blue Cross Community MMAI (Medicare-Medicaid Plan)SM covers many of your health care needs. You pay nothing ($0) when you go to a doctor or health care provider in the plan's network.

Services must be medically necessary. Some services need approval from your health plan before you get treated. This approval is called "prior authorization." Your doctor should know which services need approval and can help with the details.

What Is Covered?

Here are just some of the services covered under this plan:

Services You May Need Your Cost for In-Network Providers Rules About Benefits
Ambulance Service
$0

Your condition must be serious enough that other ways of getting to a place of care could risk your life or health. Ambulance services for other cases must be approved by the plan.

In cases that are not emergencies, the plan may pay for an ambulance.

Care to keep you from getting sick, such as flu shots
$0
Prior authorization is not required for services provided by in-network providers.

Doctor Visits:

  • To treat an injury or illness
  • Specialist care
  • Wellness visits, such as an annual physical
$0
Prior authorization is not required for services provided by in-network providers.
Durable Medical Equipment
(including Oxygen)
$0
Prior authorization rules may apply. See in-network providers.
Emergency Room Service
$0

Prior authorization is not required.

Not covered outside the U.S. and its territories, except under limited circumstances. Contact plan for details.

You may go to any emergency room if you reasonably believe you need emergency care.

Hearing Screenings and Hearing Aids
$0

Prior authorization rules may apply.

You must use in-network providers.

Hearing aids and fitting/evaluation: allowed 1 per ear every 3 years.

Home Health Care
$0

Prior authorization rules may apply.

You must use in-network providers.

Hospital Stay
$0

Prior authorization rules may apply, except in an emergency. Your doctor must tell the health plan that you are going to be admitted to the hospital.

You must use in-network hospitals when not an emergency.

Medical Tests:

  • Lab Tests, such as blood work
  • Screening Tests, such as tests to check for cancer
  • X-rays or other pictures, such as CAT scans
$0

Prior authorization rules may apply.

You must use in-network providers.

Mental or Behavioral Health Sevices
$0

Prior authorization may be required. For a detailed list of services that require a prior authorization, please Contact Us.

You must use in-network providers.

Transportation to a doctor's office
$0

Prior authorization rules may apply.

You must use in-network providers.

Urgent Care
$0

Prior authorization is not required.

Urgent care is not covered outside of the United States and its territories.

If you require urgently needed care, you should first try to get it from a network provider or call our 24/7 Nurseline. However, you can use out-of network providers when you cannot get to a network provider.

To view your plan's documents, including the Annual Notice of Changes (ANOC), visit the Forms & Documents page.

Coverage Decisions

Blue Cross Community MMAI has strict rules about how decisions are made about your care. Our doctors and staff make decisions about your care based only on need and benefits. There are no rewards to deny or promote care. Your plan does not encourage doctors to give less care than you need. Doctors are not paid to deny care.

If you want to know more about the utilization management process or how decisions are made about your care, Contact Us.