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Blue Shield of California Medicare Advantage Plan

 

65 Plus (HMO), Inspire, Trio  & Choice 

Blue Shield of California MAPD Introduction 

Blue Shield offers Medicare HMOs Medicare Advantage-Prescription Drug Plan MAPD.   MAPD  plans are mandated to cover the same basic benefits as Original Medicare plus Part D prescription drug coverage.

We offer Blue Shield Medicare Advantage plans in Los Angeles, Orange, San Bernardino, San Diego  Counties  and throughout California.

See actual Enrollment Kits including summary of benefits below  and evidence of coverage to make sure everything is up to date 

2025 Blue Shield Medicare Enrollment & FULL information & Details

Blue Shield Medicare Enrollment & Details

Summary of Benefits #SOB

Enrollment Kits

for Blue Shield Medicare Advantage Plans

  • Los Angeles County & Orange County
    • “optimum plan adobe.com 
    • “Enhanced  adobe.com 
    • Inspire adobe.com 
    • “65 Plus   adobe.com 
    • “65 Plus Plan 2  adobe.com 
    • Blue Shield Inspire (HMO)  2023  Enrollment Kit
    • Blue Shield 65 Plus (HMO)
    • Blue Shield 65 Plus Plan 2 (HMO) 
    • Blue Shield Advantage Optimum Plan (HMO)
  • Blue Shield Total Dual Plan (HMO D-SNP)
    • Los Angeles, Orange, San Bernardino & San Diego Counties
  • Blue Shield Coordinated Choice Plan (HMO)
    • Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus 2022 Enrollment Kit
  • See the Full Evidence of Coverage,
  • MORE…  If password is required – Email us at [email protected]
  • Permission to have a Zoom, Phone or Skype Meeting – Scope of Appointment – English
Ask us a Question? FAQ's?

Blue Shield Videos On Medicare 

you tube videos

“Medicare Enlightenment” video series out now!

Schedule a Zoom or Phone Meeting

Calendar Set a Meeting

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Medicare booklet on understanding mapd Medicare advantage plans

 

  • MAPD Plans look like a great deal, as the "premium" is paid by fee from the Federal Government, on average $2k/year.Kff *  MAPD Plans must cover all A & B services Medicare.Gov * generally they also cover Part D Rx.
  • That's why the premium is very low or ZERO!

Provider Finder

Blue Shield of California

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Provider #Finder -
Dentists, Doctors & Hospitals
All Plans - Medicare Advantage, Employer Group, Under 65 - Covered CA
Find a doctor near you
Blue Shield Provider Finder - Dentists

VIDEOS

FAQ Provider Finder

  • Question I moved from Orange County to Redlands in San Bernardino County. Since there is a change in residency, I have to change plans and have a special enrollment period to do so.
    • My question is, can I keep my same MD:
    • Norman J Rosen M.D. 2501 Chapman Ave, Orange, CA
  • Answer IMHO the simplest is to call your MD and ask.  Then double check by calling the Insurance Company or check the provider directory. ONLINE is best, as the printed directories get outdated quickly.
    • Here’s the Blue Shield provider directory. It’s also listed above.
    • We do find Dr. Rosen listed, see below. There is a rule somewhere about a doctor having to be within 20 miles. Let me check that.
    • Primary care network providers must be within 30 minutes or 15 miles of each covered person’s residence or workplace. insurance.ca.gov
    • If you really want Dr. Rosen, you do have a guaranteed right to get a Medi Gap plan. We can help you with that.
    • Review our page on continuity of care SB 133. Double check if it applies to MAPD. Even if it doesn’t specifically, there must be similar legislation for MAPD plans.
    • Review the appeals procedures in the evidence of coverage.
      • Review the appeals procedure on our website.
    • When you appoint us as your broker, no charge, we can help you with this.
  • If the appeal fails, what if I just go outside of the Insurance and pay cash?
    • Right, you would have to pay cash, as the Insurance since you have a MAPD plan would not pay anything. Medicare would not pay, as they are paying your MAPD plan to take care of you. You basically trade in your Medicare Card for a MAPD plan. There are certain times that you can get out of an MAPD plan and get regular Medicare. You would also have an enrollment period into a Part D Rx plan.
    •  
  •  
  • What is my deadline to change plans after a move?
    • If you drop the MAPD plan because of the move, you can do that now. You wouldn’t have to wait till MAPD open enrollment. At  open enrollment you could select a new MAPD plan. As we said above, you can get a Medi Gap plan now, to pay what Medicare doesn’t pay. You can also get an Rx plan now, during special enrollment.
Ask us a Question? FAQ's?

FAQ  MAPD PPO

 

 

  • 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.
  • Blue Shield Medi Gap Plans are PPO or even better as you can use ANY Medicare Provider! Blue Shield often has UNDERWRITING HOLIDAY, so you can enroll now, without doing Health Questions Use the logo above to get quotes or use the rate sheet above.

FAQ’s

  • Where do I find a list of providers that are endodontic dentists in or near Fullerton ca 92835 and accept the blue shield 65 plus choice co pay listed in the  benefits listing
    .
  • Question 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 my husband 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
    • This seems odd to me but need your take on this.
      .
  • Answer  This is an interesting question as it’s the first time it’s come up for me for someone who has lived in the USA all their life. The answer is simply to pay for Part A $426, click here for more detail and reasoning.  What is the deadline to enroll when someone ages into Medicare, age 65?
    • The Initial Enrollment Period for someone turning 65 to sign up for Medicare A Hospital B Doctor Visits and for a Medicare Advantage Plan is 3 months before you turn 65 and 3 months after the month that you turn 65.
    • Learn More Medicare & You  ======== Medicare Publication 11219 Page 3 Thus someone turning 65 last December has till the end of March to complete a MAPD Application and get coverage for April 1st

      .

  • Question 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.
    .
  • Answer No! In fact it’s illegal to sell extra coverage.  Blue Shield formulary  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.

    .

  • Question Is this a Medicare Plan C  [MAPD Medicare Advantage] which includes outpatient, inpatient and prescription drug coverage provided on an HMO basis by Beaver Medical Group? What is the monthly cost if Jackie enrolls in this plan?
    .
  • .
    .
  • 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?
    .
  • Someone just asked that exact same question yesterday. I responded on the dental page.
    .
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  • 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 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.

FAQ’s Provider Directories, Search #Tools & Instructions

  • Question 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.
    • I 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?
  • Answer  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.
    • It often seems that Medicare Advantage rules are there, just so that agents can go to jail at the Federal Governments whim.
    • We do see Blue Shield 65 Plus, Vital & Inspire on UCLA’s list of accepted Health Plans, but don’t know if that’s for 2021.
    • Which facility are you using?
    • When using Blue Shield Provider Finder
      blueshieldca.com/fad   you can set the filter to which MD’s accept Blue Shield
    • Working “backwards” UCLA shows Dr. Donin MD as accepting Blue Shield. Give me a couple of days to see why he doesn’t show on Blue Shield’s provider finder.
    • He does show in their print directory on page 640
    • uclahealth.org/nicholas-donin
    • Is it Malcolm Smith you’re going to?
    • uclahealth.org/malcolm-smith
    • He’s on page 632 of the pdf directory
      • 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.
      • 2nd reply from Blue Shield broker services:
        • [we will] request for the Find a Provider page to be updated.
      • 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]
  • Question I have no changes planned for my supplement (F extra) so  will it automatically renew?
  • Answer 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. Email us for the form to appoint us. How much time did we spend helping you?
    • 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 current  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.

FAQ

 

 

  • Shall I change to HMO  MAPD from Medicare Supplement?
    • My doctors all in UCLA Medical Group. Next year UCLA accept MAPD
    • If I want to switch back from MAPD to Medi Gap plan, can I do that?
  • Here’s the summary of benefits for Blue Shield Medi Gap Plans  –
    • Our webpage on Plan F Extra & Plan G
    • Here’s our webpage on what plans major hospitals and medical groups accept.
    • The difference between HMO Medicare Advantage and Medicare Supplement is, I’m not sure of the right word, but it’s the main decision to make, once one has Medicare Parts A & B. Here’s our webpage on which way to go.
    • If you decide to remain on your Medi Gap plan, ask use for the form to appoint us as your agent, no extra charge and allows us to get paid for helping you.
    • Yes, you can change back to Medi Gap under certain circumstances. See our webpage on guaranteed issue times for Medi Gap.
    • you can get Part D Rx separately.
    • video about your Medicare Choices.  MAPD, Medi Gap Original Medicare ONLY
    • See Blue Shield MAPD Summary of Benefits above  – shows that you pay NO EXTRA premium for the plan! It also shows, what you pay for various services. What it doesn’t show… is what you would pay, if you didn’t have a plan. See the screen shot’s below. The first is the MAPD inspire plan. The 2nd is a Medi Gap plan, which does have a premium and then you will also need a Part D Rx plan.
    • Here’s the provider finder
    • So, the choices are,
      • pay for a separate Part D plan,
      • premium for a Medi Gap plan that allows you to see ANY Medicare MD and will even pay the part that Medicare doesn’t if your MD charges more – see details in the evidence of coverage or our assignment page.
      • or pay out of pocket what Medicare doesn’t pay… don’t forget the 80% never ends. There is NO OOP Out of Pocket Maximum

Forms & Resources 

Chiropractic Coverage?

#Formularies & Rx Prescription Drug Resources

Formularies

Pharmacy Directory

 

 

Agent log in

Forms – Application Status

  • Email us [email protected]  for  any forms you need
  • You can also get it though our Blue Shield affiliate website 
  • Check your application status?

 

FAQ  Over the Counter Items

 

  • On your Inspire program, what are considered “over-the-counter” items?
    • Does it include vitamins?
      • Do you have to have a doctors note to buy the vitamins?
    • Where can I find the on-line catalog for over-the-counter meds, supplements, etc?
      • And how do I place an order?
  • Yes, Vitamins & Minerals are included
    • Page 83 of evidence of coverage
    • FDA’s definition:
      • Over-the-counter medicine is also known as OTC or nonprescription medicine. All these terms refer to medicine that you can buy without a prescription. They are safe and effective when you follow the directions on the label and as directed by your health care professional.
    • How about appointing us as your agent, no extra charge whenever you might make a change to your program?

Appoint us as your Blue Shield broker 

No extra charge

15 reasons why we are a excellent choice 

 

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Silver #Sneakers  

 

Blue Shield Medicare
Resources & Links

Evidence of Coverage 

#Evidence of Coverage

Specimen Individual Policy #EOC with Definitions

Employer Group Sample Policy

It's often so much easier and simpler to just read your Evidence of Coverage EOC-policy, then look all over for the codes, laws, regulations etc!  Plus, EOC's are mandated to be written in PLAIN ENGLISH!

Specimen Policy with Definitions

VIDEO Steve Explains how to read EOC

Videos by Steve Shorr

Guide to #Contract Interpretation 

#Plain Meaning Rule
How to read a policy

How to read and figure out the law or Insurance Policy Provisions - Evidence of Coverage

  • Read the Statute – Policy
  • Read the Statute – Policy
  • Read the Statute – Policy

guide to contract interpretation

  • Tools to Read a Statute VIDEO
  • Contract Interpretation in California: Plain Meaning, Parol Evidence and Use of the Just Result Principle

  • More on How to read a contract - Insurance Policy 

  •  

     
    The language of the text of the statute or  Evidence of Coverage EOC  should serve as the starting point for any inquiry into its meaning.    To properly understand and interpret a statute, [first] you must read the text closely, keeping in mind that your initial understanding of the text may not be the only plausible interpretation of the statute or even the correct one, per Justice Felix Frankfurter . Guide to Reading & Interpreting  *  American Society of Healthcare Risk Management    and * Wikipedia.
  •  

    The starting point in statutory construction is the language of the statute - Evidence of Coverage itself. The Supreme Court often recites the “plain meaning rule,”  as in, King vs Burwell Subsidies in Health Care.Gov upheld, that, if the language of the statute is clear, there is no need to look outside the statute to its legislative history in order to ascertain the statute’s meaning.

  • Parol Evidence Rule Wikipedia - Contract stands by itself - can't bring up discussions or agreements that were prior to actually signing the written Contract

  • The plain meaning of the contract will be followed where the words used—whether written or oral—have a clear and unambiguous meaning. Words are given their ordinary meaning; technical terms are given their technical meaning; and local, cultural, or Trade Usage of terms are recognized as applicable. The circumstances surrounding the formation of the contract are also admissible to aid in the interpretation.  West’s Encyclopedia of American Law,

  • A cardinal rule of construction is that a statute should be read as a

    Harmonious Whole,

    with its various parts being interpreted within their broader statutory context in a manner that furthers statutory purposes.  A provision that may seem ambiguous in isolation is often clarified by the remainder of the statutory scheme — because the same terminology is used elsewhere in a context that makes its meaning clear, or because only one of the permissible meanings produces a substantive effect that is compatible with the rest of the law.”

  • In Edgar v. MITE Corp., 457 U.S. 624 (1982), the Supreme Court ruled: “A state statute is void to the extent that it actually conflicts with a valid Federal statute.” In effect, this means that a State law will be found to violate the supremacy clause when either of the following two conditions (or both) exist:[3]

    1. Compliance with both the Federal and State laws is impossible, or
    2. “…state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress…”

    Supreme Court - FINAL Ruling - Plain Meaning - No Jiggery Pokery 47 Pages, view our highlights, annotations & bookmarks

Our webpage on

Dental

Add #Dental to your coverage

Blue Shield of California Medicare Advantage plan  members can add dental benefits to their program. You can choose between:

Brother - Sister - Sibling Side Pages  Subpages 

View our website with your Desktop or Tablet for the most information 

Site Map

Plugin Codes

Broker ONLY

Medicare Supplement Plan Changes for April 1, 2024

 

With current market evaluation, we have made the decision to discontinue Medicare Supplement Plan G Inspire effective 4/1/24.

 

Plan G Inspire has been in the market for 3 years and was only offered in select Northern CA counties.  Agents and members will find Medicare Supplement Plan G Extra to be the same benefits and equal or less cost, without the AAA Roadside Driver program.

 

To help you navigate this change, we sent out a Producer Alert, and attached are PDF documents for Plan G Inspire FAQ, Plan G Extra, and Medicare Supplement Plan Comparisons (G, G Extra, F Extra).  All marketing materials with Plan G Inspire will be updated by 4/1/24, including new enrollment, transfer, enrollment kits, marketing flyers, online references. It is highly recommended you read the FAQ and your Producer Alert link .

 

Current Plan G Inspire members will be notified October 1, 2024 and will be given a Special Enrollment Period to move to another supplement plan with no underwriting.

 

Plan G Extra is sold statewide and offers these same extra benefits as Plan G Inspire:

  • Over The Counter (OTC) through CVS
  • Vision
  • Acupuncture & Chiropractic
  • Teladoc
  • Hearing Aids
  • SilverSneakers
  • NurseHelp

 

Additionally, Plan G Extra offers our popular Welcome to Medicare rate savings of $25 for the first year, Auto-payment savings, Household Savings, and Dental discount. 

74 comments on “Blue Shield 65 Plus – Inspire HMO 2025”

  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.

    Reply

  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?

    Reply

  5. call ASH American Specialty Health Network customer service at (800) 678-9133

    Verified with Blue Shield reference number 200270024298

    Reply

    • Online with our Blue Shield Affiliate Link – No extra charge for agent support Scroll to the top of the page.

      Transfer Application if you already have a Blue Shield Plan

      We can help you via Phone, Skype or Face to Face set a meeting

      Reply

  7. 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?

    Reply

  8. 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.

    Reply

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