Coordinated Choice plan change

The Centers for Medicare & Medicaid Services (CMS) is requiring all Dual Eligible Special Needs Plan (D-SNP) Look-Alikes with 80% or more duals enrolled to close. Blue Shield Coordinated Choice Plan is a HMO D-SNP Look-Alike with more than 90% duals enrolled, so we are required to end the plan effective December 31, 2022. As a result, we will be transitioning all Coordinated Choice members to another Blue Shield plan effective January 1, 2023.

A D-SNP Look-Alike plan is an Individual Medicare Advantage HMO plan designed to look like a D-SNP. Your current Blue Shield Coordinated Choice Plan is a D-SNP Look-Alike plan. Unlike D-SNP plans, Look-Alike plans are not subject to the same requirements set forth by state and federal regulators to coordinate a member’s Medicare and Medi-Cal benefits. As a result, full dual members in Look-Alike plans do not have the same care coordination support or member experience that they would in a true D-SNP. Partial dual and non-dual members in these plans may also pay higher coinsurance and deductibles than they would in other Medicare Advantage HMO plans.

You will be automatically transitioned into a compatible Blue Shield HMO D-SNP or Blue Shield Medicare Advantage HMO plan. Minus a few exceptions, most full dual beneficiaries will move to one of our Blue Shield HMO D-SNP plans, while partial dual and non-dual beneficiaries will move to a Blue Shield Medicare Advantage HMO plan available in your county that offers lower copayments while maintaining rich benefits.

You will receive services through Blue Shield Coordinated Choice Plan (HMO) until December 31, 2022. Then on January 1, 2023, you will receive services through your new Blue Shield plan without a gap in coverage between the two plans. You do not need to do anything. Blue Shield will work with CMS to transition you from your current plan to your new plan.

Nothing if you would like to stay with Blue Shield and move into the plan we’ve selected for you.

Yes, you can opt out of the plan we’ve selected for you and enroll into any of Blue Shield’s Medicare Advantage plan, Medicare Supplement plan, or Prescription Drug Plan offerings. However, if a HMO D-SNP is offered in your county and you are fully dual eligible, the HMO D-SNP is the best option available for you. If you would like to explore other Blue Shield plans, you can call our Blue Shield Direct Sales team at (800) 488-8000 (TTY: 711) seven days a week 8am-8pm from October 1 through March 31 and 8am-8pm weekdays (8am-5pm Saturdays and Sundays) from April 1 through September 30.

We recommend staying with Blue Shield to avoid disruption and member service issues. But if you want to explore your plan options with other carriers, you can call 1-800-Medicare (TTY: (877) 486-2048) or speak with a health insurance counselor at the California Health Insurance Counseling & Advocacy Program (HICAP) at (800) 434-0222 (TTY: 711).

Blue Shield will copy all your active authorizations under your current plan to your new plan to ensure continuity and access to care remains intact throughout the transition.

Blue Shield will send letters informing you of the transition at least 90 days prior to your plan ending on December 31, 2022.

Yes, you can call your current plan’s Customer Care phone number located on your Blue Shield member ID card.

The Blue Shield Medicare Advantage HMO or HMO D-SNP plan members transition into will include most of the same providers as Blue Shield Coordinated Choice Plan. In the unlikely event that you are unable to keep your provider, you will be notified 60 days prior to the transition, and Blue Shield will help you find a network provider that meets your needs.

Yes, you will receive your new member ID card prior to the January 1, 2023, effective date and there will be no gap in coverage. You will also be able to keep your existing Subscriber ID as you move to your new Blue Shield Medicare plan.

Yes.