TotalDual plan transition

On December 31, 2022, CMC plans will end. All CMC members will move into an Exclusively Aligned Enrollment Dual Special Needs Plan with a matching Medi-Cal plan. These are provided by both Blue Shield of California and Blue Shield Promise. An Exclusively Aligned Enrollment Dual Eligible Special Needs Plan (EAE-DSNP) is designed to coordinate care for full dual eligible members with both Medicare and Medi-Cal. The coverage will look and feel like a CMC plan.

• You will receive integrated materials with Medicare and Medi-Cal benefit information. This includes a single member ID card, Member Handbook, Directory, Formulary, Summary of Benefits, and Annual Notice of Change.
• You will continue to have access to a provider network that includes many of the same doctors as your CMC plan.
• You will not pay a copay or deductible when you get covered Medicare or Medi-Cal services from a doctor in our provider network.

You will receive services through your CMC plan until December 31, 2022. Then, on January 1, 2023, you will receive services through Blue Shield TotalDual Plan and your matching Blue Shield Promise Medi-Cal Plan. You do NOT need to do anything to enroll into your new 2023 plan.

You do not have to do anything. You will continue to have similar healthcare benefits and access to a provider network that includes many of the same doctors as your CMC plan. Like the support you receive with CMC, you will also have a dedicated team of care coordinators. This team can help you manage your appointments, benefits, and services. Blue Shield TotalDual Plan will also coordinate long-term services and supports, mental health services, and access to other services like transportation.

As a CMC member, your plan will automatically change to Blue Shield TotalDual Plan and its matching Blue Shield Promise Medi-Cal plan on January 1, 2023.

No, you will be automatically enrolled into Blue Shield TotalDual Plan and its matching Blue Shield Promise Medi-Cal Managed Care Plan (“MCP”) effective January 1, 2023.

Yes, you will receive a new single ID card prior to your January 1, 2023, effective date. This card works for both Blue Shield TotalDual Plan and Blue Shield Promise Medi-Cal covered services.

Blue Shield will copy all your open authorizations for services and benefits under Cal MediConnect to your new Blue Shield TotalDual Plan. This will help you continue to access your care throughout the transition and after.

Blue Shield will send letters informing you of the transition 90 days and 45 days before your plan ends on December 31, 2022. This will help remind you that your plan is ending, and that you will automatically be moved into Blue Shield TotalDual Plan with a matching Blue Shield Promise Medi-Cal coverage effective January 1, 2023.

Yes, you can.

Blue Shield will ensure a seamless transition experience for you. We recommend you stay with Blue Shield to avoid disruptions to your care. If you do want to change plans, the following options are available.

• Option 1: Join an Exclusively Aligned Enrollment D-SNP offered by another carrier during the Annual Enrollment Period (October 15, 2022 – December 7, 2022).
• Option 2: Join a different Medicare Advantage health plan that is not a Special Needs Plan. If a matching Medi-Cal plan is available, the Medi-Cal plan will be updated to match.
• Option 3: Change to Original Medicare, Fee-For-Service coverage managed by the Federal Government. Your Medi-Cal coverage will remain with Blue Shield Promise unless you pick another Medi-Cal plan.
• Option 4: Enroll in a Program of All-Inclusive Care for the Elderly (PACE) – pending eligibility.

Blue Shield TotalDual Plan will include most of the same doctors as your current CMC plan. In the unlikely event that you are unable to keep your doctor, you will be notified at least 60 days before your CMC plan ends. Blue Shield will also help you find a doctor that meets your needs.

Most pharmacy benefits and services are covered by Medicare Part D. These will be administered by your Blue Shield TotalDual Plan. However, Medi-Cal pharmacy benefits and services are now covered by Medi-Cal Rx. Blue Shield will work with you to access any needed prescriptions through Blue Shield TotalDual Plan or items under Medi-Cal Rx. For more information on Medi-Cal Rx, prescription drug coverage, and pharmacies that take Medi-Cal, call the Medi-Cal Rx Customer Service Center at (800) 977-2273. TTY users can dial 711 for the California State Relay. You can also visit medi-calrx.dhcs.ca.gov.