Understanding Medicare can feel complicated – but we’re here to help. Our frequently asked questions (FAQs) can help you understand your options and feel more confident in your coverage. Learn more about Medicare Advantage Plans (MA-PD) and Medicare Supplement plans. Discover how a Medicare Prescription Drug Plan (PDP) works and how to get the most out of your prescription drug coverage. You’ll also find information about our Dual Eligible Special Needs Plan (HMO D-SNP) and emergency care.
What types of plans for Medicare beneficiaries does Blue Shield offer?
We have four different plans to meet your needs: Medicare Advantage Prescription Drug Plans, Medicare Supplement plans, Medicare Prescription Drug Plans, and a Dual Eligible Special Needs Plan. Learn more about our plans or call (800) 260-9607 (TTY: 711)*.
How do you know what your medical or prescription drug costs will be?
To understand your costs, reach out to your Blue Shield Medicare Adviser, or if you are a Blue Shield of California member, please call Customer Service at the number on your Blue Shield member ID card. You can also log in to your online account to get this information.
How do you get medical equipment and is it covered?
Durable medical equipment (DME) is a type of medical equipment that your doctor orders for medical reasons. Examples of DME are walkers, wheelchairs, and hospital beds. DME is covered by Medicare. A member’s out-of-pocket costs may vary. This is covered in our Medicare Advantage Prescription Drug Plans. If you are enrolled in a Dual Eligible Special Needs Plan, Medi-Cal will cover additional DME that is not covered by Medicare. A prior authorization is needed for DME. This means your doctor or supplier must get approval from Blue Shield before you receive the equipment. Check your Summary of Benefits (SOB) or Evidence of Coverage (EOC) or for Dual Eligible Special Needs Plan members, your member handbook, for details.
For Medicare Supplement plans, Original Medicare Part B covers medically necessary DME coverage. To understand Original Medicare benefits, please refer to the “Medicare and You” handbook. Please see your SOB for specific Medicare Supplement plan coverage for out-of-pocket costs associated with Medicare Part B deductible/cost share details.
Is emergency care covered?
For our Medicare Advantage Prescription Drug Plan and our Dual Eligible Special Needs Plan , emergency care is covered. Medicare Advantage Prescription Drug Plan members, please see your EOC for details. Dual Eligible Special Needs Plan members, please see your member handbook.
For Medicare Supplement plans, Original Medicare Part B usually covers emergency department services. To understand Original Medicare benefits, please refer to the “Medicare and You” handbook. Please see your SOB for specific Medicare Supplement plan coverage for out-of-pocket costs associated with Medicare Part B deductible/cost share details.
What is catastrophic coverage?
Catastrophic coverage is the drug payment stage in the Part D Drug Benefit that begins when you (or other qualified parties on your behalf) have spent $2,100 for Part D covered drugs during the year. During this payment stage, you pay nothing for your covered Part D drugs.
Please note this does not apply to Medicare Supplement plans.
Am I covered when outside of my plan’s service area?
Our Medicare Advantage Plans and our Dual Eligible Special Needs Plan cover emergency care or urgently needed services outside your service area. Please refer to your plan EOC/Member Handbook for additional information, specifically in the Emergency care and Urgently needed services section in the Medical Benefits Chart. Examples of urgently needed services are unforeseen medical illnesses and injuries, or unexpected flare-ups of existing conditions. However, medically necessary routine provider visits, such as annual checkups, are not considered urgently needed even if you are outside the plan’s service area or the plan network is temporarily unavailable. Our plans cover worldwide emergency care and urgently needed services outside the United States and its territories. Please see the Emergency care and Urgently needed services section in the Medical Benefits Chart of your plan EOC/Member Handbook for more information on how much you pay and annual limits.
Select Medicare Supplement plans members have some coverage for some medically necessary emergency care outside of California. Please reference your SOB for more information.
Still have questions? Contact Blue Shield Customer Service.
More resources
Blue Shield of California is an HMO, HMO D-SNP, and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.
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Page last updated: 10/1/2025