Using Your Medicare Plan

If you choose a Medicare Advantage plan from Blue Cross and Blue Shield of Illinois, we’ll make sure you have the right resources to help you get the most from your plan. This section details how to: find out what's covered in the plan, file an appeal or grievance, download the the formulary, search for a pharmacy, and more.

It’s easy to ask questions or voice concerns about Medicare Advantage coverage. If you have questions about what the plan covers, you can:

• Read the Evidence of Coverage – This important notice is in the welcome kit we mail you shortly after you enroll. It details what the plan covers, how much you pay, and more. You can also find it on the Plan Documents page by selecting your plan.
• Call the Customer Service number listed on your member ID card, and a representative can help you understand the plan benefits.

Medical Care Appeals and Grievances

Drug Coverage, Appeals and Grievances

Blue Cross Medicare Advantage plans have processes in place to address Medicare coverage issues, complaints and problems. If you have an issue, complaint or problem with your Medicare plan or the care you receive, you have the right to file a complaint. You can find more information on the Medical Care Appeals and Grievances page and on the Drug Coverage, Appeals and Grievances page.

Drugs covered by Blue Cross Medicare Advantage are listed in formularies (drug lists). Each plan has its own drug list that includes generic and brand name drugs. The list also provides information about drug copays and limitations, such as prior authorization, quantity limit and step therapy.

Drug lists can change. Normally, any changes in the drug list are reflected in the list at the beginning of each year. However, during the year, we might make other changes that are allowed by Medicare rules.

Use the Drug Finder tool to find the most up-to-date list of medicines covered by each plan.

You can download your formulary on our Forms & Documents page.

If you need assistance with additional plan documents, please contact us.

Prior Authorization/Utilization Management

Drug Plan Transition

Pharmacy Information

Medication Therapy Management

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