BCBSNC Medicare Advantage Plans 2025

Considering Medicare Advantage plans for 2025? Get straight to the facts. This article details the latest BCBSNC Medicare advantage plans 2025, expected costs, and new benefits so you can anticipate what’s ahead and make informed choices about your healthcare. No fluff, just critical updates and insights for Blue Cross Blue Shield Medicare Advantage enrollees.


Key Takeaways

  • BCBSNC has transitioned to the Facets system to manage Medicare Advantage and Supplement claims more efficiently, affecting member IDs and offering plans with supplemental benefits beyond Original Medicare.


  • Eligibility for BCBSNC Medicare Advantage Plans requires enrollment in Medicare Part A and Part B, with varied enrollment periods allowing members to update or change their plans based on their healthcare needs.


  • Comparing BCBSNC Medicare Advantage Plans to other providers involves considering premiums, out-of-pocket costs, member services, and additional benefits, with an emphasis on wellness and personalized healthcare experiences.

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Navigating BCBSNC Medicare Advantage Plans for 2025


BCBSNC Medicare Advantage Plans 2025 Navigating BCBSNC Medicare Advantage Plans for 2025


Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to providing comprehensive healthcare solutions. The organization has transitioned its Medicare Advantage and Medicare Supplement claims operations to the Facets system for enhanced efficiency, effective from January 2024.

The move signifies a new era of streamlined operations, allowing one system to manage all members.

This transition has introduced new member IDs and ID cards, which current BCBSNC members will receive in December 2023. These changes will not affect the continuity of care, as members can still verify their coverage using the Blue e Health Eligibility transaction if they do not have their ID card at the time of service.


Understanding Medicare Advantage with BCBSNC

Medicare Advantage plans are an enticing alternative to Original Medicare, with the bonus of extra benefits such as prescription drug, dental, and vision coverage.

BCBSNC gives beneficiaries the latitude to select either Original Medicare with supplemental plans and standalone prescription drug plans or a comprehensive Medicare Advantage plan.

With each option offering varying coverage levels and costs, individuals need to clarify their healthcare requirements and financial limitations prior to choosing a plan.

BCBSNC stands out as a provider that understands the diverse needs of its members, offering a range of Medicare Advantage plans that go beyond basic coverage. Whether you need a full-fledged plan with additional benefits or a supplemental plan to cover the gaps in Original Medicare, BCBSNC has a solution tailored for you.


Plan Benefits and Features


BCBSNC Medicare Advantage Plans 2025 Plan Benefits and Features


BCBSNC’s Medicare Advantage plans in 2025 offer:

  • Coverage beyond traditional Part A and Part B services


  • Wellness programs


  • Hearing aids


  • Vision services


  • Additional personal care benefits like fitness programs, gym memberships, and dental services


The focus is not just on treating illness but also on promoting overall well-being, demonstrating BCBSNC’s commitment to holistic health care.

To enhance pharmacy benefits, these plans typically cover prescription drugs, encouraging the use of ‘preferred’ pharmacies and lower-tier drugs to manage costs. The introduction of a Medicare Part D plan with a $2,000 cap on out-of-pocket spending in 2025 could provide significant savings on medications.

Additionally, cost management features are designed into these plans, such as lower overall cost-sharing compared to Original Medicare and an annual limit on out-of-pocket expenses, helping to make healthcare expenses more predictable for members.


Network and Provider Access

A key aspect of BCBSNC Medicare Advantage plans is their distinct geographic service areas. Members need to confirm that their physicians are included in the plan’s network to retain coverage.

However, BCBSNC makes this process seamless by providing updated information on in-network providers through Blue Connect. Members can also request a copy of the provider directory for easy reference. It’s worth noting that Novant Health Ballantyne is currently out of network for BCBSNC Medicare Advantage plans.

For seamless healthcare access, members can verify coverage through two methods if an ID card isn’t available at the time of service. Furthermore, providers are advised to ask patients for their new BCBSNC ID cards starting January 1, 2024, and to use the correct member ID for claims, which will depend on the date of service in relation to the transition to the new system.

In line with recent legislative changes, BCBSNC now covers acupuncture services for Medicare Advantage members, expanding the range of available healthcare services. BCBSNC emphasizes non-discrimination on the basis of race, color, national origin, sex, age, or disability in its health programs and activities, ensuring equal access to member services for all eligible beneficiaries.


Enrollment Periods and Eligibility Criteria

Enrollment periods are pivotal times when individuals can sign up for BCBSNC Medicare Advantage plans for the upcoming year. BCBSNC allows members to switch to other available plans within their offerings during these specified periods to better meet their changing health care needs.

Eligibility to enroll in a BCBSNC Medicare Advantage Plan typically requires being a resident of North Carolina, aged 65 or older, or meeting specific disability criteria.

Given the constantly changing health care landscape, it’s vital that enrollees stay updated about potential eligibility modifications like Medicaid expansion or policy changes that might impact their future enrollment options.


Key Dates for Your Calendar

The world of health care is governed by a calendar of critical dates. The annual open enrollment period for joining, changing, or discontinuing Medicare Advantage plans runs from October 15 to December 7, with changes becoming effective on January 1. This is your window of opportunity to review your plan, compare it with other options, and make changes if necessary.

For current Medicare Advantage plan members, another important period is the Medicare Advantage Open Enrollment Period, which occurs from January 1 to March 31. During this time, you can make changes such as switching plans or reverting to Original Medicare.

Additionally, Special Enrollment Periods are provided under circumstances like moving to a new area, losing current coverage, or qualifying for Medicaid, and the timing of these periods may vary.

Understanding these key dates can ensure you take full advantage of the opportunities to optimize your healthcare coverage.


Who is Eligible?

To be eligible for a BCBSNC Medicare Advantage plan, individuals must be enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). This is a standard requirement across all Medicare Advantage Plans, tying eligibility to existing enrollment in Medicare.

Also, Medicare beneficiaries under 65 in North Carolina, who are enrolled due to disability, also have access to BCBSNC Medicare Advantage plans. This inclusion ensures that individuals with disabilities, who often face greater healthcare challenges, have access to comprehensive coverage.

Notably, those new to Medicare Part B can join any BCBSNC Medicare Advantage Plan with or without drug coverage during the 3 months before their Part B coverage starts. Furthermore, the Medicaid expansion in North Carolina may influence the eligibility and choices of individuals previously not eligible for comprehensive health coverage but now newly eligible for Medicaid.

This development highlights the dynamic nature of healthcare eligibility, reinforcing the importance of staying informed about legislative changes and policy shifts.

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Comparing BCBSNC Medicare Advantage to Other Providers

In health care, a one-size-fits-all approach doesn’t work. Therefore, comparing BCBSNC Medicare Advantage plans with those of other providers is vital, taking into account not just cost but also service quality and member support.


Premiums and Out-of-Pocket Costs

BCBSNC Medicare Advantage Plans 2025 Comparing BCBSNC Medicare Advantage to Other Providers


A key consideration in choosing a Medicare Advantage plan is the cost. By choosing providers within the BCBSNC Medicare Advantage network, members can benefit from lower costs.

BCBSNC Medicare Supplement plans, on the other hand, can help cover coinsurance, deductibles, or charges greater than the amount allowed by Medicare, providing financial protection from unexpected costs. This dual approach allows members to balance their routine healthcare expenses with a safety net for unexpected costs.

BCBSNC Medicare Advantage plans offer the following benefits:

  • Provider networks, which means members can receive greater savings by visiting doctors or hospitals that are in-network


  • Additional benefits such as fitness and discount programs


  • Comparing out-of-pocket costs like copays and prescription costs


Therefore, when comparing plans, it’s important to look beyond the stated premium and consider the total cost of care.


Member Services and Support

In addition to cost, the quality of member services and support is a significant distinguishing factor between healthcare providers. BCBSNC ensures equal access to member services without discrimination based on:

  • race


  • color


  • national origin


  • sex


  • age


  • disability


This commitment to equality extends across all facets of its services, ensuring that every member receives the support they need.

In a move to enhance member services, BCBSNC is transitioning its Medicare Advantage and Medicare Supplement claims operations to the Facets system as of January 2024. This transition aims to improve the efficiency of claims processing for all members, reducing the time and stress associated with health care administration.

BCBSNC also provides local customer care specialists across North Carolina to support Medicare plan members, demonstrating a commitment to personalized, locally accessible support.

Beyond these foundational services, Blue Medicare plans from BCBSNC offer various additional benefits and support, aiming to provide a comprehensive package to members beyond the standard coverage. Members can access:

  • a provider directory


  • the flexibility to visit any doctor who accepts Medicare without being restricted to a network


  • new coverage for acupuncture services due to recent legislative changes


This extensive suite of services ensures that members receive not just medical coverage but a holistic support system for their healthcare journey.


How to Maximize Your Plan Benefits

After selecting a BCBSNC Medicare Advantage plan, it’s important to learn how to get the most out of it. From utilizing wellness incentives to accessing preventive services, there are numerous methods to optimize your plan benefits.


Wellness and Preventive Care


BCBSNC Medicare Advantage Plans 2025 How to Maximize Your Plan Benefits


One of the key benefits of BCBSNC Medicare Advantage plans is the focus on wellness and preventive care. Medicare beneficiaries are entitled to a range of free preventive services, which include:

  • Screenings for cardiovascular disease


  • Screenings for depression


  • Vaccines for flu


  • Vaccines for pneumonia


These services can help detect potential health issues early, allowing for timely treatment and better health outcomes.

The annual wellness visit is another important component of preventive care. It offers a thorough health risk assessment and personalized health advice to help maintain good health.

Beyond standard Medicare benefits, some BCBSNC Medicare Advantage plans may include extra wellness services such as gym memberships and senior-focused exercise classes through programs like SilverSneakers.

By taking advantage of these incentives, members can not only improve their health but also potentially lower their overall healthcare costs.


Managing Chronic Conditions

For individuals with chronic conditions, managing their health can be challenging. BCBSNC Medicare Advantage plans recognize this, offering special benefit packages tailored to meet the specific needs of members with chronic illnesses.

These packages can enhance their ability to manage their health conditions effectively and improve their quality of life.

Members with chronic conditions who face service denials because a treatment is deemed not medically necessary also have the right to appeal these decisions. This ensures that they maintain access to crucial healthcare services, reinforcing BCBSNC’s commitment to member advocacy.

Included in the Medicare Advantage plans are chronic care management services, which encompass:

  • A comprehensive care plan that outlines an enrollee’s health problems, goals, medication details, and the coordination among healthcare providers


  • Personalized approach to assist with medication management


  • Around-the-clock access to urgent care


  • Support for transitions between healthcare settings


  • Ongoing medication reviews tailored to individuals’ chronic care needs


These services are designed to provide comprehensive and personalized care for individuals with chronic conditions.


The Impact of Recent Health Care Legislation on Medicare Advantage

The healthcare landscape is persistently transforming due to continuous legislative changes. Comprehending the effects of these changes on Medicare Advantage plans enables beneficiaries to make knowledgeable decisions regarding their healthcare coverage.


Legislative Changes and Your Coverage


BCBSNC Medicare Advantage Plans 2025 The Impact of Recent Health Care Legislation on Medicare Advantage


Legislative changes can have a significant impact on health care coverage, including state health plan modifications. For instance, recent changes have led to BCBSNC covering acupuncture services for Medicare Advantage members.

Other potential changes include a CMS proposed rule for 2025 that could introduce a once-per-month Special Enrollment Period for certain individuals in standalone prescription drug plans.

Beginning in 2025, a new Special Enrollment Period will also allow dually eligible individuals to choose an integrated dual eligible special needs plan (D-SNP) every month.

This proposed CMS rule aims to increase the percentage of dually eligible Medicare Advantage enrollees receiving integrated Medicare and Medicaid services, potentially expanding eligibility for integrated care options.

In addition to these changes, Blue Cross NC will transition Medicare Advantage and Medicare Supplement claims operations to the Facets system effective January 1, 2024. Members affected by this transition will receive new member IDs and ID cards in December 2023.

It’s also important to monitor North Carolina’s healthcare legislation, such as the 1115 waiver extension request that impacts Medicaid coverage and services, and stay informed about the initiatives of the North Carolina Foundation.


Staying Informed and Prepared

Staying informed and prepared for changes in health care legislation is crucial for making the most of your Medicare Advantage plan.

Blue Cross NC provides educational resources to help members stay informed about their health plan details and changes. This includes a dedicated webpage to educate members on updates to their ID cards and the transition to the Facets system.

Beneficiaries also have the right to fight for their Medicare benefits if they are inappropriately denied, which can involve filing an appeal or getting assistance from a state health insurance assistance program. By staying informed and taking action when necessary, members can ensure they receive the coverage they are entitled to.


Personalizing Your Medicare Advantage Experience

Health care is an intensely personal journey, and BCBSNC acknowledges this by providing opportunities to customize your Medicare Advantage plan. BCBSNC ensures that all eligible beneficiaries have equal access to modify their Medicare Advantage plans, irrespective of personal characteristics, so you can create a plan that caters to your specific healthcare needs.


Customizing Your Coverage

One of the benefits of a BCBSNC Medicare Advantage plan is the flexibility to customize your coverage. Members have the option to add supplemental benefits such as dental, vision, and hearing coverage to their plan.

BCBSNC also offers add-on options like fitness programs, over-the-counter drug allowances, and transportation benefits.

You can also enroll in specialized programs addressing needs such as weight management or quitting smoking, further broadening the coverage’s practical application. These additional wellness services can be selected during initial enrollment or added during the annual enrollment period as plan options.

For additional information, please refer to the provided resources.

However, it’s important to remember that customizing a plan may affect monthly premiums, potential copays, and overall out-of-pocket costs. BCBSNC provides personalized consultations to guide beneficiaries through the process of customizing their Medicare Advantage plans according to their unique health needs.

Health Navigators are also available to help members understand their options, maximize benefits, and select additional coverage aligned with personal health goals.


Collaborating with Your Healthcare Team

Collaborating with your healthcare team is essential for optimizing your Medicare Advantage plan benefits. BCBSNC offers a variety of resources, including dedicated webpages, to educate members on effective communication with their healthcare team.

By discussing your chronic care management services with your healthcare providers, you can understand how these can be included in your Medicare coverage.

BCBSNC promotes the availability of all items and services to eligible beneficiaries and underscores the importance of a collaborative approach in tailoring individual care within the plan’s offerings.

This collaborative approach ensures that your healthcare team understands your unique needs and can provide personalized care that aligns with your health goals.



Navigating the complexities of Medicare Advantage Plans can seem daunting, but with the right resources and understanding, it’s possible to make informed decisions that best serve your healthcare needs.

BCBSNC offers a comprehensive suite of Medicare Advantage plans, with a strong emphasis on preventive care, chronic condition management, and member support. By staying informed about legislative changes, maximizing plan benefits, and personalizing your coverage, you can truly make the most of your BCBSNC Medicare Advantage Plan.

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Frequently Asked Questions


Is there a lifetime max on Medicare Advantage plans?

No, Medicare Advantage plans do not have a lifetime max limit, as they are required to offer better coverage than traditional Medicare.


How many Medicare Advantage plans are there in North Carolina?

There are 163 Medicare Advantage plans available in North Carolina in 2024, and the number is likely to vary by ZIP code. It’s important to explore your options before making a decision.


What is the most popular Medicare Supplement plan in North Carolina?

Medigap Plan G is the most popular Medicare Supplement plan in North Carolina, followed by Plans F and N, which have high levels of coverage. However, Plan F is only available to those who became eligible for Medicare before January 1, 2020.


Why do they keep pushing Medicare Advantage plans?

They keep pushing Medicare Advantage plans because they are often cheaper than Medicare supplements and the private insurers make significant profits from them. This is evident from the fact that over half of Medicare beneficiaries are enrolled in Medicare Advantage plans.


What are some of the additional benefits included in BCBSNC Medicare Advantage plans?

BCBSNC Medicare Advantage plans offer additional benefits such as wellness programs, gym memberships, dental services, and prescription drug coverage. These benefits can contribute to a comprehensive healthcare package and improve overall well-being.

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