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Using Your Medicare Plan

Blue Cross and Blue Shield of Illinois wants you to get the most from your plan. Understanding how it works and having the right resources can help. Learn the details of what’s covered in your Blue Cross Medicare Advantage plan. Get the forms you need to order a directory, submit a claim, and more.

Understanding Your Claims

Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will receive an Explanation of Benefits from us.

  • Explanation of Benefits (EOB)
    This is a statement of services rendered. It is not a bill. It simply details what you have paid and the level of benefits you’ve used. How often you receive an EOB depends on how often you fill your prescriptions or see your providers. Review the details on your EOBs to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.
  • Coinsurance and Copays
    Some plans include coinsurance and/or copays when you receive care or prescriptions. These payments are your responsibility. Coinsurance and copays count toward your total out-of-pocket expenses for the year.
    • Coinsurance is the percentage of the bill you pay. For example, your plan may include a 20% coinsurance for outpatient surgery. The provider may ask for this payment at the time of service or may send a bill afterward.
    • Copays are a set amount you pay for all drugs within a Tier. For example, a visit to a specialist in your network might include a $40 copay. Or, you may have a $10 copay for a prescription drug.

Medicare Coverage Determination, Appeals and Grievances

Blue Cross Medicare Advantage plans have processes in place to address Medicare coverage issues, complaints and problems. If you have issues, complaints or problems with your Medicare plan or the care you receive, you have the right to make a complaint. You can find more information on the Medical Care Determination, Appeals and Grievances page. More information about drug coverage determinations, appeals and grievances is on the Medicare Coverage Determination, Appeals and Grievances page.

If you would like to submit feedback directly to Medicare, please use the Medicare Complaint Form or contact the Office of the Medicare Ombudsman.

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Last Updated: Sept. 05, 2023