Blue Shield 65 Plus (HMO) Plan
Welcome to Blue Shield 65 Plus. We are excited to have you as a member of our health plan. Before we get started with how to use your plan, here are some things to remember about Blue Shield:
- We’ve been serving Californians for over 75 years
- As a nonprofit, we put care first
- Our Member Services team is located right here in California
With Blue Shield 65 Plus you will only need one ID card to access medical services and to fill prescriptions. There's less paperwork for you, because we do all the coordination with Medicare.
Four things you should do now that you have Blue Shield 65 Plus
Now that you are enrolled in Blue Shield 65 Plus, be sure to complete the steps below to take full advantage of your new plan!
If you are new to Medicare, schedule your Welcome to Medicare visit, and established members should schedule their Annual Wellness visit.
Sign up for the Mail Service Pharmacy program to fill maintenance medications. See the Pharmacy section below.
Register on the Blue Shield of California website. Find a network provider, search our formulary, access prescription drug information and much more.
Sign up for mywellvolution for tips and tricks on including healthy activities in even the busiest lifestyle.
Access to a broad range of network providers
When you enrolled in Blue Shield 65 Plus, you chose a primary care physician for you and your enrolled dependents. Did you know you can choose a different primary care physician at any time? To find a Blue Shield 65 Plus primary care physician, search for a Blue Shield 65 Plus Group physician, log in and select your plan. If you’d like to change your primary care physician, just call Blue Shield 65 Plus Member Services at (800) 776-4466 [TTY: 711].
Comprehensive benefits and coverage
- $10 copay for primary care physician and specialist visits
- $0 copay for ambulance services
- $0 copay for diagnostic tests, like outpatient X-rays and lab services
- $0 copay for inpatient hospital care
- Routine chiropractic coverage
Part D prescription drug coverage
As a Blue Shield 65 Plus member, you can fill or refill your prescription drugs at a Blue Shield 65 Plus network pharmacy or use the convenient mail service pharmacy.
Network pharmacies are conveniently located in many areas and include most major retail chains. For assistance in finding a network pharmacy or to learn more about the mail service pharmacy, call your dedicated Member Services team at (800) 776-4466 [TTY: 711], or search for pharmacies online.
You may pay less when you visit one of our network pharmacies that offer you preferred cost-sharing:
- CVS/pharmacy (including CVS Pharmacy at Target)
- Safeway and Vons pharmacies
And many more!
Pharmacies that offer preferred cost-sharing offer a 90-day supply of covered prescription drugs at the cost of two 30-day supplies. You may still receive an extended supply of drugs at pharmacies that offer standard cost-sharing; however, you may not receive the discounted price. Not all drugs may be available in a 90-day supply, depending on the plan. Please see the plan's Formulary for details.
Our mail service pharmacy
Use Blue Shield's mail service pharmacy to fill maintenance medications with stabilized dosages for the treatment of long-term conditions such as high blood pressure.
Before you fill or refill your prescription, check to ensure your drug is on the Blue Shield 65 Plus (HMO) Group Plan Formulary. Call Blue Shield 65 Plus Member Services at (800) 776-4466 [TTY: 711] for assistance.
Condition management programs – These programs offer nurse support as well as education and self-management tools for members with asthma, diabetes, coronary artery disease, heart failure, and chronic obstructive pulmonary disease. These programs are personal, confidential, and available to members at no additional cost. To learn more or to get started, please call (866) 954-4567.
NurseHelp 24/7 – Speak with registered nurses anytime, day or night, and get answers to your health-related questions, or go online to have a one-on-one personal chat with a registered nurse anytime. Just call (877) 304-0504 anytime [TTY: 711]. The NurseHelp 24/7SM phone number is also conveniently located on the back of your member ID card.
LifeReferrals 24/7 – Call anytime to talk with a team of experienced professionals ready to assist you with personal, family, and work issues. Get referrals for three face-to-face visits (in a six-month period) with a licensed therapist at no cost to you (available only in California). Telephonic counseling sessions with a licensed therapist are available for members outside of California. Just call (800) 985-2405 anytime. The LifeReferrals 24/7SM phone number is also located on the back of your member ID card.
The products and services described below are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Blue Shield 65 Plus grievance process. Should a problem arise with any value-added item or service, please call the Blue Shield 65 Plus Member Services department at (800) 776-4466 [TTY: 711].
Hearing Aids Discounts – As a Blue Shield 65 Plus member, you are eligible for:
- 30-60% discount off the manufacturer's suggested retail price on hearing aids, which come with:
- Unlimited adaptation and counseling visits
- Three-year extended warranty, covering loss, damage, and servicing
- Two-year supply of batteries per hearing aid purchased; and in-office servicing for three years
- $0 charge for office visit (includes hearing-aid evaluation, cleaning and adjustment) when hearing aid is purchased through this program
Call our contracted provider, EPIC Hearing at (866) 956-5400 [TTY: 711], Monday to Friday, 6 a.m. to 6 p.m., to find a location, schedule an appointment and for more information on discounts offered.
NOTE: Authorization must be obtained from your primary care physician for Medicare-covered hearing exams.
Wellness Discount Program – To learn about Blue Shield’s wellness discount program, visit the Wellness Discounts page.
Blue Shield of California is an HMO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Blue Shield 65 Plus offers individual and employer group retiree plans to Medicare beneficiaries who have Part A and Part B. Individual plans are open to all Medicare beneficiaries who reside within a plan’s specific service area. Employer group retiree plans are open only to Medicare beneficiaries who are eligible group retirees and who reside within a plan’s specific service area. Blue Shield 65 Plus individual and employer group retiree plans have different service areas, benefits and provider networks. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on July 1 of each year.