Get to know your Blue Shield Medicare (PPO) plan coverage

Beginning January 1, 2027

You will have a new Medicare plan with Blue Shield of California: the Blue Shield Medicare (PPO) plan. This is a Group Medicare Advantage Prescription Drug (GMAPD) Plan, and it will replace your current retiree plan. This plan lets you see any doctor who accepts Medicare, plus providers in the Blue Shield of California network at the same cost share. Plus, offers coverage for hospital services, medical services, and prescription drug coverage (Medicare Part D).

We have gathered some resources to help guide your transition to your new PPO plan, including how to find network providers, continuity of care, pharmacy benefits and more.

Here are some resources to help you once your new plan starts:

Dedicated Customer Service
Blue Shield provides one easy-to-use Customer Service phone number for both your medical and pharmacy benefits. You can contact them at (800) 370-8852 (TTY:711), 8 a.m. to 8 p.m. PT, seven days a week.
Find a doctor or specialist

Prior to your plan becoming effective, you can search for a PCP. Visit provider.bcbs.com to search for a PCP in the national BCBS PPO network and to view the latest listing of in-network providers, Medicare participating providers, specialists, mental health providers and more. When asked for a prefix, enter “XRT”.

You can also contact Customer Service to help you find doctors near you at (800) 370-8852 (TTY:711), 8 a.m. to 8 p.m. PT, seven days a week.

If your local doctors tell you that they do not accept Blue Shield of California because you are located outside of California, please call Customer Service and share your doctor’s information. They can reach out to your doctor to explain how the Blue Shield Medicare (PPO) plan works outside of California.

Get started with your pharmacy benefits

Below is helpful information to help you with your pharmacy benefits, including how to check the Blue Shield Drug Formulary for your medications and how to enroll in our prescriptions by home delivery service once your plan becomes effective.

Check the Blue Shield Drug Formulary - If you are currently taking a medication, you should check the Blue Shield Drug Formulary to see if your medication is in our list of preferred prescription drugs. You can also call Customer Service to confirm if your prescription is covered in the formulary.

Fill your current prescription(s) - Before transitioning to Blue Shield on January 1, 2027, work with your current provider to fill your current prescriptions.

Prescriptions through network retail pharmacies - With Blue Shield you have access to network retail pharmacies like Costco, CVS Pharmacy, Safeway, Vons, and more. To see if your preferred pharmacy is in the Blue Shield network, use our Pharmacy Locator. Once you become a member, you can fill your prescription by presenting your Blue Shield ID card at in-network pharmacies.

Prescriptions by mail - After January 1, 2027, if you take stabilized doses of covered long-term maintenance medications for conditions such as diabetes, you can order a home delivery refill of up to a 100-day supply for Tier 1-3 drugs through Amazon Pharmacy.

How to get the same prescription that your previous doctor prescribed - Blue Shield can work with your new doctor to provide a transitional 30-day supply of your current drug within the first 90 days of coverage if it is not on our drug formulary. Your new doctor will reevaluate if it is best to switch to a covered medication or request a formulary exception for the same drug.

Request prior authorization for any scheduled treatments

If you have a condition and have been scheduled for treatment that required authorization from your former health plan carrier, it is likely that this treatment will now need to be authorized by Blue Shield. For questions about prior authorization or to initiate authorization contact Customer Service.

You can also download and print the most commonly requested prior authorization fax forms for procedures, physician administered drugs and pharmacy outpatient drugs here.

Get 24/7 access to your health plan information

After your plan becomes effective on January 1, 2027, register for your Blue Shield online account. Registration allows members to quickly find doctors, view claims, and more. To get started, you’ll need either your:

  • Member ID

To get started click, here.

Once you create your account you can manage your health care from anywhere with our Blue Shield of California App. View your ID card, search for doctors, track your claim information, understand your benefits, and more. The Blue Shield app provides BSC members enhanced 24/7 service and ease-of-access to the information that matters most.

Use the same login to manage your health care from anywhere with the Blue Shield mobile app – available to download on the App Store® or Google Play™.

Transportation services (non-Medicare covered)

Blue Shield provides transportation for plan members on an as-needed basis to facilitate non-emergent access to healthcare.

Arrangements for transportation within the United States or Puerto Rico or outside of California are managed by Call the car. Contact them at (855) 200-7544 (TTY: 711), 24 hours a day, seven days a week. Arrangements must be made at least 24 hours in advance.

Call the Car also offers a mobile application (CTC-Go) that can be used to coordinate your healthcare transportation. CTC-Go allows you to review upcoming or past reservations, rate your ride, track your driver, cancel an existing reservation, or schedule a new reservation. CTC-Go is available on iOS and Android. To learn more, visit here.

Transferring your medical records
Once you have selected a new provider, they may request a copy of your prior medical records. Check with your current provider on how to get a copy of your records.
How to request Continuity of Care

Blue Shield’s Continuity of Care program helps eligible members remain under the care of your current provider when a network change occurs.

If you are under the care of a provider who is not currently in the Blue Shield network, you can request continuity of your care. Continuity of care allows you to continue to see your current non-network provider during the course of your treatment while still receiving the network level of benefits from Blue Shield.

Examples of conditions that may qualify for continuity of care include:

  • An acute condition that has a limited duration
  • A serious, chronic condition
  • Pregnancy, including the immediate postpartum period
  • Care for a child, from newborn to 36 months of age
  • A surgery or other treatment that was previously recommended and documented by your doctor to take place within 180 days of the effective date of coverage
  • A terminal illness that has a high probability of causing death within one year or less, which is covered for the duration of the terminal illness

The program allows members to complete their care with your current healthcare provider in specific situations. To view the brochure and application for more information about the program and how to apply, visit here.

Look for your new member ID card
You should receive a new Blue Shield member ID card in the mail before your coverage becomes effective. Please review it carefully to make sure all the information is correct. You will use your new ID card whenever you get hospital and medical services covered by your plan, or prescription drugs at network pharmacies. We recommend you keep your Blue Shield ID card with you at all times.
Home health

If you have special needs and require in-home medications, infusions or care. Blue Shield offers Home Infusion providers that can send nurses in California and nationwide to your home to assist with in-home medications.

To learn more about additional home health services contact Customer Service.

SilverSneakers® Fitness

Blue Shield offers basic gym access through SilverSneakers® Fitness, to help you stay healthy - at no additional cost. They offer many participating fitness locations nationwide with thousands of participating national gyms or local community centers.

To find a location near you visit here.

View your Member health record
Once you become a member on January 1, 2027, you can access your health record. This shows your medical visits, medications, lab results, diagnoses, immunizations, claims and more in one secure place. You can also download and share this information with doctors and loved ones and view health reminders tailored to you. We provide near real-time updates to the health record.
Explore your new plan
To learn more about your new plan, visit blueshieldca.com/sfhss.
View your plan documents
To view your plan documents such as your Evidence of Coverage (EOC) or Summary of Benefits (SOB), click here.

Blue Shield of California’s pharmacy network includes limited lower-cost pharmacies with preferred cost sharing. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost pharmacies with preferred cost sharing in your area, please call Customer Service at (800) 370-8852 (TTY:711), 8 a.m. to 8 p.m. PT, seven days a week, or consult the online pharmacy directory at blueshieldca.com/medpharmacy2027.

Amazon Pharmacy is independent of Blue Shield of California and is contracted by Blue Shield to provide home delivery of prescription medications to Blue Shield members. Members are responsible for their share of cost, as stated in their benefit plan details.

Apple and the Apple logo are trademarks of Apple Inc. App Store is a service mark of Apple Inc.

Google Play is a trademark of Google LLC.

Blue Shield of California is a PPO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see the plan’s Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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Page Last Updated 08/26/2026