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TotalDual plan transition

TotalDual plan transition header

Blue Shield Promise Cal MediConnect members will soon transition to a Blue Shield TotalDual Plan (HMO D-SNP). This may seem like a big change. But the good news is that your new plan will have matching Medi-Cal coverage through Blue Shield of California Promise Health Plan. So you can expect the same care coordination and features as your current Cal MediConnect plan.

View the Frequently Asked Questions below to learn more about this transition.
You can also call Customer Care at (855) 905-3825 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.

To view information about all our current Medicare plans, including Blue Shield TotalDual Plan, visit our Medicare site.

Frequently Asked Questions

  • What is happening with Blue Shield Promise Cal MediConnect (“CMC”) Plan?

    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.

    Cal MediConnect counties

    2023 Crosswalk Plan

    Los Angeles
    and San Diego

    All CMC members will move to Blue Shield TotalDual Plan with “aligned” or matching Medi-Cal coverage through Blue Shield Promise.

  • Will I continue to get health services?

    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.

  • I like my current plan. What do I have to do to stay with the same 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.

  • Will there be a gap in coverage?

    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.

  • Will I get a new member ID card?

    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.

  • What will happen to any benefits, items, or services I am receiving before the transition?

    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.

  • When will I be notified that my plan is changing?

    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.

  • Can I keep my broker?

    Yes, you can.

  • What if I want to change coverage?

    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.
  • Will I be able to keep my doctor?

    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.

  • How will I get my prescription drugs?

    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.

  • Whom should I contact if I have more questions?

    If you want to:

    Contact:

    Ask questions about current Cal MediConnect services provided by Blue Shield Promise

    Call Blue Shield Promise Cal MediConnect’s Customer Care at (855) 905-3825, or visit the Promise Health Plan website.

    Ask a question about Medicare

    Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1‐877‐486‐2048.

    Talk to a health insurance counselor for free about these changes and your choices

    California Health Insurance Counseling & Advocacy Program (HICAP) at 1‐800‐434‐0222. TTY users should call 711.

    Ask a question about Medi-Cal or Medi-Cal plan choices

     

    • Health Care Options: (844) 580‐7272. TTY users should call 1‐800‐430‐7077.
    • Call the Medi-Cal Helpline at (800) 541-5555, 8 a.m. to 5 p.m., Monday through Friday, except national holidays.
    • Call the Department of Health Care Services (DHCS), Office of the Ombudsman at (888) 452-8609 (TTY: 711), 8 a.m. to 5 p.m., Monday through Friday, excluding state holidays.

     

    Learn more about Medicare and Medi-Cal plan options

     

    • Visit Medicare.gov or refer to your Medicare & You handbook for a list of all Medicare health and prescription drug plans in your area.
    • Visit MyCareMyChoice.org to compare different Medicare options. It’s a tool just for people with Medicare and Medi-Cal.

     

Blue Shield of California Promise Health Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at (855) 905-3825 (TTY: 711) and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you.

If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number ((888) 466-2219) and a TDD line ((877) 688-9891)) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.

 

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Page last updated: 8/3/22

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Medicare has neither reviewed nor endorsed this information. Blue Shield of California Promise Health Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

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