Blue Shield Medicare Advantage Plan

65 Plus (HMO), Inspire, Trio  & Choice 

Blue Shield MAPD Introduction 

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 Enrollment Kits including summary of benefits below  and evidence of coverage to make sure everything is up to date for 2022.

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Summary of Benefits #SOB

Enrollment Kits

for Blue Shield Medicare Advantage Plans

  • Los Angeles County & Orange County
    • Blue Shield Inspire (HMO) 2022 Enrollment Kit
    • Blue Shield 65 Plus (HMO) 2022 Enrollment Kit
    • Blue Shield 65 Plus Plan 2 (HMO) 2022 Enrollment Kit
    • Blue Shield Advantage Optimum Plan (HMO) 2022 Enrollment Kit
  • Blue Shield Total Dual Plan (HMO D-SNP) Los Angeles, Orange, San Bernardino & San Diego Counties 2022 Enrollment Kit
  • Blue Shield Coordinated Choice Plan (HMO) Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus 2022 Enrollment Kit

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

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Forms

 

2020 Blue Shield Medicare Advantage HMO Change of Plan Form

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Blue Shield Provider #Finder -
Dentists, Doctors & Hospitals

Blue Shield Provider Finder - Dentists

VIDEOS

Blue Shield Videos On Medicare 

you tube videos

“Medicare Enlightenment” video series out now!

#Evidence of Coverage

2022 

2022 Blue Shield Inspire (HMO) – Los Angeles and Orange counties, English
2022 Blue Shield Inspire (HMO) – Alameda and San Mateo counties, English
2022 Blue Shield Inspire (PPO) – Alameda County, English
2022 Blue Shield Inspire (HMO) – Fresno and Madera counties, English
2022 Blue Shield Inspire (HMO) – Sacramento County, English
2022 Blue Shield Inspire (HMO) – Santa Clara County, English
2022 Blue Shield Inspire (HMO) – San Joaquin, Stanislaus and Merced counties, English

2022 Blue Shield Vital (HMO) – Los Angeles, Orange, Riverside and San Bernardino counties, English

2022 Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties, English
2022 Blue Shield 65 Plus (HMO) – San Bernardino County, English
2022 Blue Shield 65 Plus (HMO) – Riverside County, English

2022 Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties, English

2022 Blue Shield 65 Plus Choice Plan (HMO) – Riverside and San Bernardino counties, English

2022 Blue Shield 65 Plus (HMO) – San Diego County, English
2022 Blue Shield 65 Plus (HMO) – Ventura County, English
2022 Blue Shield 65 Plus (HMO) – Kern County, English
2022 Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties, English

2022 Blue Shield Balance (HMO) – Los Angeles County, English

2022 Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties, English
2022 Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County, English
2022 Blue Shield AdvantageOptimum Plan (HMO) – Fresno County, English
2022 Blue Shield AdvantageOptimum Plan (HMO) – Merced and Santa Clara Counties, English
2022 Blue Shield AdvantageOptimum Plan (HMO) – Stanislaus County, English
2022 Blue Shield AdvantageOptimum Plan (HMO) – San Joaquin County, English
2022 Blue Shield AdvantageOptimum Plan 2 (HMO) – San Diego County, English

2022 Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles, Orange, San Bernardino & San Diego counties, English

2022 Blue Shield Inspire (HMO D-SNP) – Fresno, Merced, San Joaquin & Stanislaus counties, English

2022 Blue Shield CoordinatedChoice Plan (HMO) – Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus counties, English

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Video

Video understanding medicare advantage mapd

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.  MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

Blue Shield Medicare
Resources & Links

Member Services 800.766.4466 

Medicare Advantage Prescription Drug (MA-PD) Plan Customer Care: (800) 776-4466 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, year-round -Effective 10/01/2021

Blue Shield Balance: (888) 802-4423 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, year round

Individual Medicare Prescription Drug Plan (PDP): 888) 239-6469 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, year round

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.

 

Broker ONLY Forms

Formularies & Rx Prescription Drug Resources

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Formularies

Pharmacy Directory

2022

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 AdvantageOptimum Plan 1 (HMO), Blue Shield AdvantageOptimum Plan 2 (HMO), Blue Shield Inspire (HMO), Blue Shield Inspire (PPO), and Blue Shield Vital (HMO)

Blue Shield Balance (HMO)

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

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

 

Agent log in

#Dental?

Blue Shield offers two optional supplemental dental plans to Blue Shield of California Medicare Advantage Prescription Drug plan  members. Members can choose between an

Optional

These plans offer a wide range of dental benefits, including many diagnostic and preventive services at no charge to you.

Be Sure to email your completed application to us [email protected] so that we are coded as your broker.  No extra charge.

See the EOC’s Evidences of Coverage for details & pricing

 

Related & Child Blue Shield MAPD Pages

127 comments on “Blue Shield 65 Plus – Inspire HMO 2022

  1. 11 comments on “Provider Directories, Search Tools & Instructions”

    1. Neil R says:

      HI Steve:

      Why can’t I find my specialist doctors listed when I search Blue Shield 65 plus site?

      I do find primary care doctors at UCLA Health in Santa Clarita but not my specialists Donin (Urology) and Smith (Pulmonology) who I see at the UCLA Health Santa Clarita Primary and Specialty Care clinic.

      see them as a traditional Medicare patient, which I switched to from Blue Shield 65 plus because at the time UCLA would not accept Blue Shield 65 plus.

      I understand from your video that now they do.

      My concern is whether the primary care physician is going to direct me to see some other doctor at that clinic who also practices the same specialty but not the doctors I have been seeing because I am a ” UCLA Medicare Advantage” patient instead of a traditional medicare patient.

      What is your view about this?

      Thanks so much for your help, Steve.

      Neil R

      Reply
      • Please when stating facts, provide the screen shots, exact URL’s, etc. It takes us time to duplicate what you are referring to.

      • I’m surprised that you can search for 2021 MD’s, as it’s my understanding that 2021 information can’t be released to the public until October 1st. https://medicare.healthreformquotes.com/mapd/regulations/

        It often seems that Medicare Advantage rules are there, just so that agents can go to jail at the Federal Governments whim.

        2021  Blue Shield

        Reply
            • Reply from Blue Shield broker support

              I can confirm Dr. Nicholas Donin is constructed with 65 plus / Inspire under UCLA Medicare Advantage ( Medical Group).

              Practioner id showing contracted with UCLA Medicare Advantage & 65 Plus/Inspire : 100323139008.

              If your member’s Primary Care physician is attached to UCLA Medicare Advantage then the member can request this Urologist.

              If its not, I would recommend speaking with your member as for HMO Policies, most procedures and specialists need to be authorized by medical group and they always refer out from their own doctors.

              See page 42 of EOC for more details on getting referred to specialists.

              Reply
              • 2nd reply from Blue Shield broker services:

                [we will] request for the Find a Provider page to be updated.

                Reply
                • Anonymous says:

                  Thanks for the information.

                  After spending a lot of time talking to UCLA and Blue Shield, I decided that if I wanted someone else to manage my care and didn’t care about how they did or didn’t do that, I should go back to the Medicare Advantage plan I was on for 4 years before I switched to original Medicare! [Parts A Hospital & B Doctor Visits]

                  Thanks for your help.

                  I have no changes planned for my supplement (F extra) so it will automatically renew

                  Reply
                  • Did you see our video and pdf # 12026 on Understanding Advantage Plans on our Blue Shield Advantage Plan Page?

                    The Introduction to Medi Gap Publication # 02110on our Blue Shield Medi Gap Page?

                    IMHO those video’s and official Government brochures explain how Medicare Advantage tries to save $$$ by “managing” your care.

                    We are authorized Blue Shield Medi Gap brokers and can assist you with anything that comes up. When you appoint us as your Broker, Blue Shield compensates us at no additional charge to you, as it saves them time on the phone with you not having to call them. Here’s the form to appoint us. How much time did we spend helping you?

                    Reply
        • We can get you enrolled in Blue Shield Medicare Advantage starting on October 15th for a January 1st effective date.

          Informational Materials will be released to the public on October 1st. If an agent is able to see anything before that time, it’s more secret that anything else I know of.

          Check our Blue Shield MAPD webpage for 2021 information and enrollment then. There is no extra charge for our services. The Federal Government provides for agent compensation from the fees they pay the Insurance Companies to take care of you.

          Reply
  2. Steve,

    you have mentioned to me in my san mateo county, part c will be available to me with out any premium

    How about other neighboring counties like santa clara, alameda etc in bay area.

    How can I verify the same?

    I am thinking of moving to low cost counties.

  3. 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?

  4. 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.

  5. 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.
  6. 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.

  7. 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.

  8. 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).

        • 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).

  9. 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.

  10. The rules for picking a provider start on page 40 of the Evidence of Coverage. I don’t see any rule about 20 miles… However, the print edition of the San Bernardino doctor list for 2017 doesn’t show Dr. Rosen. So it may be that he’s not a provider for San Bernardino County. Let me check further.

    If you click enrollment links above, we can do the transfer for you and thus get paid for helping you.

  11. Here’s a screen shot showing the Dr. Rosen is listed. The Plus plan has more MD’s than the choice plan, so that stands to reason

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