Frequently Asked Questions from Medicare Members

Posted on Jul 5th 2019 by Florida Blue

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Do you have questions about what your Florida Blue Medicare health plan covers? You can always call Member Services at the number shown on the back of your plan ID card, but you might already have the answer at your fingertips. Your Evidence of Coverage (EOC) is an important legal document that explains what’s covered and how much you pay with your BlueMedicare plan. We update the EOC every year with changes to your plan. We send you a printed copy when you first become a BlueMedicare member.

You can also find your Evidence of Coverage by logging in to your member account at floridablue.com/medicare. In your Welcome Guide mailing, we included a flyer called, “How to Use your EOC”. It’s a handy way to quickly find the information you need in your EOC.

So, what are some of the most common questions our members ask?

What are my dental benefits?

Traditional Medicare covers some dental services, but not all. Medicare does not cover routine dental services but does cover non-routine dental services.

What’s covered (non-routine dental care)

What’s not covered (routine dental care)

Surgery to your jaw or other related structures

Cleanings

Setting fractures of your jaw or facial bones

Routine Exams

Teeth extraction to prepare your jaw for radiation treatments of neoplastic cancer disease

X-rays

Other dental services that would be provided by a medical doctor

Dentures

Check your plan’s EOC to find out how we cover your dental benefits. Depending on you plan, we might cover additional services. Look in Chapter 4 for the heading marked “Dental Services”.

Does Florida Blue cover my medication?

You can find what prescription medications your plan covers by checking your plan’s formulary (list of covered drugs). This list gets mailed to you every year. You can also download your plan’s drug list from floridablue.com/medicare.

What are my wellness benefits?

There are many services Florida Blue offers Medicare members to make sure they are staying healthy.

  • Annual Wellness Visit: As a Florida Blue Medicare member, you can get an Annual Wellness Visit at no cost to you when you see a network doctor. This visit is a chance for you and your doctor to sit down one-on-one and discuss your health goals for the next year. To schedule your Annual Wellness Visit, call your primary care doctor.
  • In-Home Health Visit: If you can’t make it to the doctor, don’t worry. You can also have an in-home health visit with a Nurse Practitioner. This service is no cost to you. To schedule your in-home health visit, call 1-800-809-5504. TTY users, please call 1-844-626-2101. We are open Monday through Friday from 8 a.m. -5 p.m., Eastern Time.
  • HealthyBlue Rewards & Loyalty: If you’re a BlueMedicare HMO, PPO or Group PPO member, you can earn rewards for taking care of your health. Visit floridablue.com/healthyblue to learn more. Sign up here. Or call us at 1-855-209-2427 (TTY users, call 1-800-955-8770). We’re available Monday through Friday, 8 a.m. to 6 p.m. Then log in to your member account at floridablue.com/medicare to access your rewards dashboard. See what activities are rewardable. You can get gift cards to popular stores, like Walmart, Publix or Amazon. It’s our way of thanking you for being loyal to your health.
  • SilverSneakers®: You also have access to the SilverSneakers fitness program. All Florida Blue Medicare Advantage members have SilverSneakers included with their plan. Florida Blue Medicare Supplement members can add SilverSneakers to their plan for an additional monthly premium. If you’re eligible for SilverSneakers, you can visit 16,000 gyms and wellness centers across the country at no cost to you. Depending on where you live, these include the YMCA, Planet Fitness, LA Fitness and Curves locations.

To get unlimited access to participating gyms and classes you will need your 16-digit SilverSneakers ID number. If you don’t have one yet, click here to request you SilverSneakers member ID number.

Will I be covered if I must go to the ER?

Chapter 3 of your EOC has all the details on how we cover ER visits. Know ahead of time what’s covered and when you should go to the ER instead of the doctor or urgent care. You can read our article to understand the difference. As always, if you’re experiencing a medical emergency, call 911.

How do you cover urgent care? How can I find an urgent care center near me?

A health scare can start without warning. You notice stomach pains. You fall and hurt your hip. Or the wrist you thought you simply sprained can no longer move. Nearly one-third of emergency department visits among adults over 65 result from an injury, according to the Centers for Disease Control and Prevention. Depending on the severity, some of these injuries may be treatable at an urgent care clinic. But how do you know when to go to the urgent care clinic or make a trip to the ER?

Urgent care is there to fill the gap between your doctor and the ER. Urgent care clinics stay open after normal business hours. This includes nights and weekends. The ER is open 24 hours a day, 7 days a week. You should visit the ER if you have severe or life-threatening injuries or illnesses. The ER has access to specialists and specific equipment that may be needed.

Depending on how serious your injury or illness is, you could end up waiting a long time to see a doctor in the ER. You’ll also end up paying more for the visit. Check your Medicare health plan’s Evidence of Coverage to find out what you’ll pay at the ER. If you don’t have it handy, you can call our Member Services team to find out what costs you’ll have if you end up in the ER.

You should consider visiting an urgent care clinic if you have:

  • A fever
  • Ear pain
  • Painful urination
  • Sore throat
  • Vomiting
  • Minor trauma such as a common sprain, minor burns or shallow cut
  • Minor rashes

You may receive urgent care services at a doctor’s office or an urgent care center. For a list of the doctors in your plan’s network, see the Provider Directory. To find the Provider Directory click here and log in to your Member portal. Also, you can always call us if you’d prefer. If you don’t have a network doctor or urgent care center available, we’ll cover your out-of-network doctor at the in-network cost share.

Need Help?

If you have more questions or want to know if your plan covers a specific medication or procedure, please call our Member Services team at 1-800-926-6565. TTY users all 1-800-955-8770. We’re open 8 a.m.- 8 p.m. local time, 7 days a week, from October 1 through March 31, except Thanksgiving and Christmas. From April 1 through September 30, we’re open Monday through Friday, 8 a.m.- 8 p.m. local time.

 


Filed under: Medicare News  


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