We're the only Medicare Advantage provider based in South Carolina, and we've been covering South Carolinians for over 75 years. Our local and experienced agents are here to help you navigate your Medicare options. Browse our affordable plans, and give us a call if you have questions.
A message from BlueCross BlueShield of South Carolina Medicare Advantage
Have Questions?
Discuss your Medicare Advantage plan options with an agent today at 1-800-930-2836 (TTY 711). Or click here to sign up for a BlueCross Medicare Advantage Sales Seminar in your area.
Find a Licensed Agent
Choose an SC Agent or request a call whenever it’s convenient for you.
Medication Therapy Management (MTM) Program
Prescription Drug Coverage
Unlike Original Medicare, our plans include coverage for Medicare Part D prescription drugs. You're also eligible for our free therapy management program designed to help you keep your medications on the right track by:
- Making sure all your medications are the right choice for your medical conditions.
- Teaching you how to get the most from your medications.
- Lowering your risk for potential harmful drug reactions and side effects.
- Teaching you why it’s important to take your medications on time.
- Helping you potentially find ways to save money.
Extra Benefits With Medicare Advantage
Fitness Membership
Access online programs, no-cost fitness center memberships and home fitness programs through our FitOn® program.
E-Shop for Your Health
You receive $51 - $100 per quarter in Over-the-Counter items with free shipping. Order placed once per quarter via phone, catalog, or vendor website. You can use an OTC Benefits Card to purchase food in addition to OTC products. See EOC for details.
Vision, Hearing & Dental
Get excellent eye care and eyewear with BlueCross BlueShield of South Carolina and EyeMed Vision care.
Care Support
A dedicated nurse is available to help you manage chronic conditions and coordinate your care.
Already a Member?
Forms & Policies
Forms & Policies
Review forms and policies, review coverage decisions, submit an appeal or file a grievance associated with your plan.
Frequently Asked Questions
General Plan Coverage
- Do I have to choose a network primary care provider (PCP)?
If you have a Total, Total Value, or Blue Basic PPO plan, it's not required.
As a member of BlueCross Total, Total Value, Blue Basic you do not have to choose a network primary care provider (PCP). However, we strongly encourage you to choose a PCP and let us know whom you have chosen. Your PCP can help you stay healthy, treat illnesses and coordinate your care with other health care providers. You do not need a referral to visit a specialist.
- How can I find a list of in-network doctors?
You can find an up-to-date list of primary care providers, specialists, durable medical equipment suppliers and hospitals in our network using our online finder tools.
Download Total/Total Value/Blue BasicSM (PPO) Provider Directory
- How do I compare plans and enroll?
Comparison & Enrollment Tools
It's easy to shop and compare plans using our online enrollment tools.
Review Documents
You can also take a look at our resources based on your plan of interest:
Total PPO:
- You can compare BlueCross TotalSM to other plans using our Summary of Benefits. Please note the Summary of Benefits does not list every service that we cover or list every limitation or exclusion.
- To get a complete list of our benefits, please review the Annual Notice of Changes (ANOC): BlueCross Total Upstate ANOC, BlueCross Total Midlands/Coastal ANOC or BlueCross Total Lowcountry ANOC.
- Also review the annual Evidence of Coverage (EOC) for you plan: BlueCross Total Upstate EOC, BlueCross Total Midlands/Coastal EOC or BlueCross Total Lowcountry EOC.
Total Value PPO:
- You can compare BlueCross Total ValueSM to other plans using our Summary of Benefits. Please note the Summary of Benefits does not list every service that we cover or list every limitation or exclusion.
- To get a complete list of our benefits, please review the Annual Notice of Changes (ANOC): BlueCross Total Value Upstate ANOC, BlueCross Total Value Midlands/Coastal ANOC, BlueCross Total Value Lowcountry ANOC.
- To get a complete list of our benefits, please review the Evidence of Coverage (EOC) for your plan: BlueCross Total Value Upstate EOC, BlueCross Total Value Midlands/Coastal EOC or BlueCross Total Value Lowcountry EOC.
Blue Basic:
- You can compare BlueCross Blue BasicSM to other plans using our Summary of Benefits. Please note the Summary of Benefits does not list every service that we cover or list every limitation or exclusion.
- To get a complete list of our benefits, please review the Annual Notice of Changes (ANOC): BlueCross Blue Basic ANOC.
- To get a complete list of our benefits, please review the BlueCross Blue Basic Evidence of Coverage for your plan.
- Can I change plans after I enroll?
Enrollment in this plan is generally for the entire year. You may leave this plan or make changes during the Annual Election Period from Oct. 15 to Dec. 7. The Medicare Advantage Open Enrollment Period (OEP) occurs each year between Jan. 1 and Mar. 31. If you are enrolled in a Medicare Advantage plan, you can leave your plan and switch to Original Medicare or join another Medicare Advantage plan. Medicare may also allow you to change plans under special circumstances, such as
- If you permanently move out of your plan’s service area.
- If you get help from your state Medicaid program paying Medicare premiums or cost-sharing.
- If you qualify for extra help paying for prescription drugs.
- If you enter, live in or leave a nursing home.
The Medicare program rates how well health plans perform in different categories (for example, ratings in customer service and detecting and preventing illnesses). By visiting the website www.Medicare.gov* you can compare the ratings for plans in your area by selecting “Find Health and Drug Plans.” You can also get a copy of our plans' ratings by calling us at 1-855-204-2744 (TTY 711), from 8 a.m. to 8 p.m., seven days a week.
*This link leads to a third-party site. That party is solely responsible for the privacy policy and contents of its site.
Prescription Drug Coverage
- Where can I get my prescriptions?
BlueCross has formed a network of pharmacies that you must use to receive prescription drug benefits. In general, you must use network pharmacies to access your prescription drug benefit, except in special circumstances.
The pharmacy network may change at any time. You will receive notice when necessary. For an up-to-date list of the pharmacies in our network, see your plan's Pharmacy Directory on the Forms & Policies page, or search by pharmacy name or location using the Pharmacy Locator. If you would like a Pharmacy Directory mailed to you, please call Customer Service at 1-855-204-2744.
- Which prescriptions are covered?
BlueCross has a list of Covered Prescription Drugs (formulary). The formulary may change at any time. You will receive notice when necessary. For the most current information, see our Comprehensive Total Formulary or Total Value Formulary or our drug search tools: Total Drug Search and Total Value Drug Search.* Restrictions may apply. For a list of upcoming changes, see the Formulary Change Notice. For information about our preferred vendor for blood glucose test strips, see our Preferred Test Strips Vendor Notice.
- Do certain drugs have additional requirements?
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include prior authorization, quantity limits or step therapy. You can find links to our plan's prior authorization and step therapy criteria here:
- Prior authorization: requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval before you fill your prescriptions. If you don’t get approval, the plan may not cover the drug.
- Secure HMO/Total Value (PPO)
- Total Value (PPO)
- Quantity limits: For certain drugs, the plan limits the amount of the drug that will be covered.
- Step therapy: In some cases, the plan requires you to first try certain drugs to treat your medical condition before another drug will be covered for that condition.
- Secure HMO/Total (PPO)
- Total Value (PPO)
- Prior authorization: requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval before you fill your prescriptions. If you don’t get approval, the plan may not cover the drug.
- Do I qualify for subsidized prescription drug coverage?
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week.
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- Your state Medicaid office.
Learn about the Medicare Extra Help program here. This program provides additional help for people with limited income. You can also view the Centers for Medicare & Medicaid Services (CMS)* Best Available Evidence (BAE) policy.
*CMS is an independent organization with health information you may find helpful.
- How do I enroll in the Medication Therapy Management (MTM) program?
It’s easy to get started in the MTM program. If you are eligible, you are automatically enrolled, and you will receive a letter in the mail inviting you to participate. There is no added cost for participating, and you may decline individual services or opt-out of the program at any time. Learn more about the MTM program here.
Have More Questions?
Use our online enrollment and comparison tools to shop for plans.
Note: This link will direct you to another site and prompt you to share your ZIP code for plan information.
New for 2025: Medicare Prescription Payment Plan
This is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year.
Disclaimer
- » Submit feedback to Medicare about your BlueCross plan
- » Find out how the Medicare Beneficiary Ombudsman works for you
- » How to Report Fraud
Last Updated: October 9, 2024
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BlueCross BlueShield of South Carolina is a Medicare Advantage PPO plan with a Medicare contract. BlueCross Rx Value is a stand-alone prescription drug plan with a Medicare contract. Enrollment in BlueCross Total, BlueCross Total Value, BlueCross Blue Basic, or BlueCross Rx Value depends on contract renewal.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.
Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of South Carolina Medicare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call Customer Service or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English.