Blue Cross Blue Shield With Medicaid

Date:

Available Beginning July 1 2019

Independence Blue Cross and BCBSM Announce Partnership to Expand Medicaid Services
  • Assertive Community Treatment – A comprehensive and integrated set of psychiatric, psychosocial rehabilitation, case management, and support services for individuals 18 and older. Services are provided by a mobile multi-disciplinary mental health treatment program mainly in the clients residence or other community locations.
  • Personalized Recovery Oriented Services – A comprehensive recovery program for individuals 18 and older with severe mental illness. The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individuals recovery.
  • Continuing Day Treatment – A program that provides individuals 18 and older with mental illness the skills and supports necessary to remain in the community and/or work toward a more independent level of functioning. Participants often attend several days per week with visits lasting more than an hour.
  • Partial Hospitalization – A program that provides active treatment designed to stabilize or reduce acute symptoms in a person who would otherwise need hospitalization.
  • Comprehensive Psychiatric Emergency Program – A hospital-based emergency program that offers/provides access to crisis outreach, intervention, and residential services and/or provides beds for the extended observation to adults who need emergency mental health services.

How Efficient Is Medicaid

Medicaids costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per-beneficiary costs under private employer coverage.

Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status. For example, adults on Medicaid cost about 22 percent less than if they were covered by private insurance, Urban Institute research shows.

Over the past 30 years, Medicaid costs per beneficiary have essentially tracked costs in the health care system as a whole, public and private. In fact, costs per beneficiary grew more slowly for Medicaid than for private insurance between 1987 and 2017, and are expected to continue growing more slowly than for private insurance in coming years, according to the Medicaid and CHIP Payment and Access Commission.

Moreover, the Centers for Medicare & Medicaid Services , which projected in 2010 before enactment of the Affordable Care Act that Medicaid spending would total $794 billion by 2019, has lowered its projection for 2019 by 21.5 percent to $623 billion, even with the ACAs coverage expansions.

Available Part D Prescription Drug Plans

While many of Blue Cross Blue Shields Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans, also known as PDPs. These plans, which are meant to accompany Medicare Part A and Medicare Part B, don’t provide medical coverage.

All states offering a stand-alone prescription drug plan have both a basic and an enhanced option. For instance, if you live in Grand Rapids, Michigan, you have the option of the following two PDPs from Blue Cross Blue Shield of Michigan:

  • Prescription Blue PDP Select.

Heres an example of how they compare:

Plan feature

$35.

$40.

*For a one-month supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

These plans differ by premium, by the drugs they cover, by the costs associated with each tier of drugs and by the pharmacies that are in their network of preferred retailers. To find the best drug plan for you, consider plans that offer the lowest costs for your regular prescriptions and preferred pharmacies.

Read Also: Can I Get A Replacement Medicaid Card Online

Aim Specialty Health Prior Authorization Program

Blue Cross and Blue Shield of New Mexico has contracted with AIM to provide certain utilization management prior authorization services for certain Commercial, Retail and ASO members and Blue Cross Community Centennial Members. Services requiring prior authorization through AIM are outlined below. AIM is an independent company that provides specialty medical benefits management for BCBSNM.

Use the AIM ProviderPortal for Pre & Post-Service Reviews

Use the AIM ProviderPortal to request prior authorization and respond to post-service review requests by AIM. Do not submit medical records to BCBSNM for prior authorization or post-service reviews for the care categories managed by AIM. Medical records may or may not be needed for pre or post service reviews using the AIM portal due to the smart clinical algorithms within the portal.

Benefits of the AIM ProviderPortal for Pre & Post-Service Reviews

  • Medical records for pre or post-service reviews are not necessary unless specifically requested by AIM.
  • offers self-service, smart clinical algorithms and in many instances real-time determinations
  • Check prior authorization status on the AIM ProviderPortal
  • Increase payment certainty
  • Faster pre-service decision turnaround times than post service reviews
  • Services requiring prior authorization through AIM:

    • Molecular and Genomic Tests
    • Joint Surgery
    • Spine Surgery
  • Sleep Studies .
  • Select Outpatient Procedures
  • Use the AIM ProviderPortal for Pre & Post-Service Reviews

    AIM Contact Information

    Blue Cross And Blue Shield Of Nebraska To Offer New Individual Health Care Plan

    Medicaid: A primer on Americas biggest health insurance program
    • Fremont Tribune staff

    Blue Cross and Blue Shield of Nebraska will introduce a new individual health care plan called Nebraska HeartlandBlue on the governments ACA Marketplace for 2023, providing Nebraskans and their families not covered under an employers health plan with more choices in coverage.

    We exist to serve the people of Nebraska, to provide them with security and peace of mind about the cost of medical care for themselves and their families, said Ron Rowe, BCBSNE executive vice president. We want to give people looking for coverage on the ACA Marketplace more choice. Nebraska HeartlandBlue offers individuals affordable health care coverage and strong provider networks.

    Nebraska HeartlandBlue will include gold, silver and bronze plans, which provide customers with the ability to choose the option that best fits their coverage needs and budgets. The plans will use BCBSNEs existing provider networks in the state, enabling Nebraskans to tap into the strong, established relationships the insurer has with health care providers across the state.

    Recommended Reading: How To Renew Medicaid Nc

    Youre Our First Priorityevery Time

    We believe everyone should be able to make financial decisions with confidence. And while our site doesnt feature every company or financial product available on the market, were proud that the guidance we offer, the information we provide and the tools we create are objective, independent, straightforward and free.

    So how do we make money? Our partners compensate us. This may influence which products we review and write about , but it in no way affects our recommendations or advice, which are grounded in thousands of hours of research. Our partners cannot pay us to guarantee favorable reviews of their products or services.Here is a list of our partners.

    Advocacy Organizations/volunteer Opportunities/support Services/community Forums:

    There are many opportunities available for members and their families to get involved in volunteer activities, committees, work groups, community forums and connect with advocacy services. Listed are some of the community organizations that are available to our members and their families for support, guidance and advocacy.

    We also offer Behavioral Health Case Management services to our members and their families. Our Behavioral Health Case Managers can assist you with understanding your insurance benefits, understanding your treatment options, locating and connecting with area treatment providers for mental health and substance use treatment and much more. If you or a loved one have questions or need assistance please reach out to one of our Behavioral Health Case Managers who can be reached at . A Behavioral Health Case Manager will be able to assist you during our normal business hours. If calling after hours you will be connected with a live nurse through Fonemed.

    We also offer Behavioral Health Advocacy services to our members and providers when a request for treatment has been denied. Our Behavioral Health Advocate is available to assist you and your provider in understanding the denial decision as well as with the process for pursuing appeals, and in identifying participating providers. Our Behavioral Health Advocate can be reached at .

    Mental Health Association offers listings of services and support groups for Monroe, Livingston and Wyoming Counties.

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    Does Blue Cross Blue Shield Of Georgia Offer Medicare Supplement Insurance

    Medicare Supplement Plans A, F*, G, and N may be available to help with certain out-of-pocket costs that Original Medicare doesnât cover. Depending on the plan, you may be able to get help with expenses like deductibles, copayments and/or coinsurance, and emergency health care when youâre traveling out of the country. These plans only work with Original Medicare and canât be used to pay for plan costs you may have if youâre enrolled in a Medicare Advantage plan.

    There are up to 10 plans available in most states, including Georgia, with each plan type labeled with a letter A through N . BCBS of Georgia might offer Medicare Supplement Plans A, F*, G, and N. Benefits for Medigap plans are standardized across plans of the same letter type. Depending on where you live, you may be eligible to enroll in a Medigap plan from Blue Cross Blue Shield of Georgia if youâre currently enrolled in Original Medicare, Part A and Part B. Not all plans may be available in all areas and your plan premium may vary depending on where you live.

    *Medicare Supplement Plans F and C are being phased out. They are no longer available to people new to Medicare as of January 1,2020 and later. However, Plan C has most of the same benefits as Plan F.

    Y0114_17_32859_U Anthem Articles_ Accepted

    A Medicaid And Healthy Michigan Planmanaged Care Health Plan

    The ABCs of Medicare | Blue Cross and Blue Shield of Nebraska

    Blue Cross Complete of Michigan is a managed care health plan contracted by the state of Michigan. We help Medicaid members get the health care they need in 32 Michigan counties across the state.

    We provide members with the care they need, when they need it. This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. We also offer pharmacy, maternity care and integrated care management benefits.

    The Healthy Michigan Plan is a health care program from the Michigan Department of Health and Human Services. Blue Cross Complete administers Healthy Michigan Plan benefits to eligible beneficiaries.

    Read Also: How To Obtain Medicaid In Florida

    Available Medicare Advantage Plans

    Blue Cross Blue Shield offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Availability of specific plan types varies by location.

    Blue Cross Blue Shield offers Medicare Advantage Prescription Drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage.

    Plan offerings include the following types:

    A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

    HMO point of service, or POS, plans are HMO plans that allow members to get some out-of-network services, but youll pay more for those services.

    Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you dont need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

    Blue Cross Blue Shields private fee-for-service, or PFFS, plans allow you to see any Medicare-approved provider who accepts your Blue Cross Blue Shield plan. You wont have to pick a primary doctor, and you wont need a referral to see a specialist.

    Childrens Home And Community Based Services :

    Some benefits listed below require providers to authorize services. For more information, please call .Childrens HCBS benefits are designed to offer support and services to children in non-institutionalized settings that enable them to remain at home and in the community. These services are intended to assist children in being successful at home, in school and other environments to help maintain them in their community and avoid higher levels of care .Medicaid Managed Care children must be under 21 years old and determined eligible to receive HCBS services through clinical evaluation and documentation of need in a personalized plan of care

    Don’t Miss: Get A Copy Of Medicaid Card

    Assistance Programs For Eligible Individuals

    My Advocate® Program

    Blue Cross NC collaborates with Change Healthcares My Advocate program® to help find out if youre eligible for government programs and Extra Help on your healthcare costs. By working with an advocate, youll receive personalized assistance, eligibility information, and help through the application process if you qualify.

    In order to make the assessment, My Advocate will gather personal financial information necessary to make a determination, so be prepared for questions regarding your finances. Rest assured that Change Healthcare does not share this information with any company or agency other than government agencies that require it should you qualify. The Blue Cross NC contract with Change Healthcare requires that your information be protected. Blue Cross NC does not receive the information that Change Healthcare gathers.

    Dual Enrollment AdvocateTM

    My Advocate will perform an individual screening to determine your eligibility for Medicaid services and Medicare Savings Programs that can help with some of your Medicare costs based on your income and financial asset level. If eligible, an advocate will help you through the enrollment process.

    Extra Help Program

    My Advocate can also help identify qualifying seniors and others who are eligible to receive Extra Help to pay for prescription medication and help assist with completing the program application.

    Low Income Subsidy and Best Available Evidence

    2022 Blue Medicare HMO & PPO LIS Table

    True Blue Special Needs Plan

    Medicaid: A primer on Americas biggest health insurance program

    True Blue Special Needs Plan is a plan that combines both Medicare and Medicaid services, all in one simple, but comprehensive plan. This plan offers the ease of a coordinated plan with additional benefits to support your wellness and daily life. A care coordinator is your personal connection to better care helping you navigate the healthcare process to get the services you need.

    Also Check: Problems With Medicare And Medicaid

    Is Anything Being Done To Improve Patient Outcomes Or Reduce Medicaid Costs

    Medicaid beneficiaries have a much higher rate of chronic conditions than those covered by employers or through Medicare. One in ten adult Medicaid enrollees has diabetes, and nearly one in three has heart disease. More than a third suffer from a mental illness. With these more complex needs comes higher use of healthcare services, including emergency room, hospital and doctor visits, as well as prescription drugs.

    To meet the needs of their Medicaid populations, many states work closely with Medicaid managed care organizations to provide enrollees with better access to disease management, care coordination and mental health services. Some even provide tools to help with housing, education, job training and financial counseling. Approximately 70 percent of Medicaid enrollees participate in this type of care model.

    Through this transition, many states are achieving promising results. For instance, by reducing emergency room and hospital visits through better coordinated care and disease management, some states are yielding Medicaid cost savings of up to 20 percent.

    Blue Cross Blue Shield Medicare

    Blue Cross Blue Shield, one of the largest healthcare providers in America, offers a wide range of Medicare Supplement plans designed to fulfill your health insurance needs. Compare plans to find the best Medicare Supplement plan for you.

    by Christian Worstell | Published February 03, 2022 | Reviewed by John Krahnert

    Blue Cross Blue Shield is among the leading health insurance carriers in the U.S. and provides a wide selection of Medicare Supplement Insurance plans.

    Medicare Supplement Insurance plans can help cover of the out-of-pocket expenses that Original Medicare doesnt cover. These costs can include deductibles, coinsurance, copayments and more.

    Recommended Reading: Medicaid And Medicare Differ In That

    Blue Cross Blue Shield Medicare Advantage 2022 Review

    Many or all of the products featured here are from our partners who compensate us. This may influence which products we write about and where and how the product appears on a page. However, this does not influence our evaluations. Our opinions are our own. Here is a list ofour partnersandhere’s how we make money.

    Blue Cross Blue Shield is a collective of 34 independent companies, and together they were the third-largest provider of Medicare Advantage plans in 2021

    Although BCBS companies are all licensed by the Blue Cross Blue Shield Association, they’re locally owned and operated and may vary in terms of coverage, benefits and quality of plans. More than 8 in 10 BCBS customers are in a Medicare Advantage contract rated 4 or higher on the Medicare Star Rating scale as of June 2022.

    Heres what you should know about Blue Cross Blue Shield Medicare Advantage.

    About Blue Cross Blue Shield

    Provider Finder® for Blue Cross and Blue Shield of Illinois PPO members

    Blue Cross Blue Shield began as two companies Blue Cross and Blue Shield that offered affordable health care solutions in the early 1900s and started to come together in the 1940s. It was made official in 1982 when they formed the Blue Cross Blue Shield Association, which now includes 34 independent and locally operated companies across the country. Nationwide, it provides health care coverage to 110 million members in the U.S. and Puerto Rico.

    The Blue Cross Blue Shield Association has two main offices, in Chicago and Washington, D.C.

    • Blue Cross and Blue Shield of Alabama.

    • Premera Blue Cross and Blue Shield of Alaska.

    • Blue Cross Blue Shield of Arizona.

    • Arkansas Blue Cross and Blue Shield.

    • Anthem Blue Cross .

    Don’t Miss: How To Add A Baby To Medicaid

    People Are Also Reading

    Nebraska HeartlandBlue will be available in all 93 of Nebraskas counties. Customers can purchase coverage as soon as the 2023 Open Enrollment Period begins. OEP runs annually from Nov. 1 to Dec. 15.

    To purchase individual coverage, Nebraskans will visit HealthCare.Gov or NebraskaBlue.com during OEP or any other Special Enrollment Period for which theyre eligible.

    Customers can also consult a health insurance broker for assistance in determining which plan option best fits their needs. BCBSNE will have its sales agents available to help Nebraskans purchase coverage during OEP.

    For more information, visit NebraskaBlue.com.

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