2021 Medicare Advantage Plans

Would you like a Medicare Preferred Provider Organization (PPO) plan with built-in prescription drug benefits? With BlueCross Total Value (PPO), you can enjoy all of the benefits original Medicare offers — and more.

Coverage in 22 South Carolina Counties

Our service areas are:

  • BlueCross Total Value Upstate — Anderson, Cherokee, Greenville, Oconee, Pickens, Spartanburg and York counties
  • BlueCross Total Value Midlands/Coastal — Aiken, Calhoun, Chesterfield, Dillon, Fairfield, Florence, Horry, Kershaw, Lexington, Marion, Marlboro, Orangeburg, Richland, Saluda and Sumter counties

How Much Does BlueCross Total Value Cost?

The monthly premium for BlueCross Total is:

  • BlueCross Total Value Upstate — $0
  • BlueCross Total Value Midlands/Coastal — $0
  • You must continue to pay your Medicare Part B premium.

Can I Choose My Doctors?

BlueCross has formed a network of doctors, specialists and hospitals. BlueCross Total Value members may elect to receive care from in-network providers, or out-of-network providers who are eligible to participate in Medicare, as long as the services are covered benefits and are medically necessary. However, if you use an out-of-network provider, your share of the costs for your covered services may be higher. See our plan's Out-of-Network Coverage Rules for more information.

As a member of BlueCross Total Value, you do not have to choose a network Primary Care Provider (PCP); however, we strongly encourage you to choose a PCP and let us know whom you have chosen. Your PCP can help you stay healthy, treat illnesses, and coordinate your care with other health care providers. You do not need a referral to visit a specialist.

You can find an up-to-date list of Primary Care Providers, Specialists, Durable Medical Equipment Suppliers and Hospitals in our network in our online Doctor and Hospital FinderProvider Directory, or our Out-of-State Lookup.

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Prescription Drug Coverage

BlueCross Total Value includes coverage for Medicare Part D prescription drugs. For an explanation of the rules you must follow when you get your Part D drugs, visit the plan's Prescription Drug Page. The page includes information about how to use the plan's List of Covered Drugs (Formulary). You also can review several kinds of restrictions that apply to coverage for certain rules. The page explains where to get your prescription drugs filled.

Medication Therapy Management (MTM) Program

The MTM Program is a free service for eligible members of our plan and is not considered a benefit. This program is designed to help members keep their medications on the right track. The purpose is to:

  • Make sure all your medications are the right choice for your medical conditions
  • Teach you how to get the most from your medications
  • Lower your risk for potential harmful drug reactions and side effects
  • Teach you why it’s important to take your medications on time
  • Help you potentially find ways to save money

It’s easy to get started in the MTM program. If you are eligible, you are automatically enrolled, and you will receive a letter in the mail inviting you to participate. There is no added cost for participating, and you may decline individual services or opt-out of the program at any time. Learn more about the MTM Program.

Frequently Asked Questions

Where can I get my prescriptions?

BlueCross has formed a network of pharmacies that you must use to receive BlueCross Total Value prescription drug benefits. In general, you must use network pharmacies to access your prescription drug benefit, except in special circumstances. 

The pharmacy network may change at any time. You will receive notice when necessary. For an up-to-date list of the pharmacies in our network, see our Pharmacy Directory, or search by pharmacy name or location using the Pharmacy Locator. If you would like a Pharmacy Directory mailed to you, please call Customer Service at 1-855-204-2744.

Which prescriptions are covered?

BlueCross Total has a List of Covered Prescription Drugs (Formulary). The formulary may change at any time. You will receive notice when necessary. For the most current information, see our Comprehensive Formulary (list of covered prescription drugs effective 05/01/2021) or our Drug Search Tool (this link leads to a third-party website). Restrictions may apply. For a list of upcoming changes, see the Formulary Change Notice. For information about our preferred vendor for blood glucose test strips, see our Preferred Test Strips Vendor Notice.

Do certain drugs have additional requirements?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include Prior Authorization, Quantity Limits, or Step Therapy. Links to our plan's Prior Authorization and Step Therapy criteria are below.

Prior Authorization: Requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval before you fill your prescriptions. If you don’t get approval, the plan may not cover the drug. Quantity Limits: For certain drugs, the plan limits the amount of the drug that will be covered. Step Therapy: In some cases, the plan requires you to first try certain drugs to treat your medical condition before another drug will be covered for that condition.

How Can I Compare My Options?

You can compare BlueCross Total Value to other plans using our Summary of Benefits. Please note the Summary of Benefits does not list every service that we cover, or list every limitation or exclusion. To get a complete list of our benefits, please review the Evidence of Coverage for your plan: BlueCross Total Value Upstate EOC or BlueCross Total Value Midlands/Coastal EOC.

Can I Change Plans After I Enroll?

Enrollment in this plan is generally for the entire year. You may leave this plan or make changes during the Annual Election Period from Oct. 15 to Dec. 7. The Medicare Advantage Open Enrollment Period (OEP) occurs each year between Jan. 1 – Mar. 31. If you are enrolled in a Medicare Advantage Plan you can leave your plan and switch to Original Medicare or join another Medicare Advantage plan. Medicare may also allow you to change plans under special circumstances, such as:

  • If you permanently move out of your plan’s service area
  • If you get help from your state Medicaid program paying Medicare premiums and/or cost sharing
  • If you qualify for extra help paying for prescription drugs
  • If you enter, live in or leave a nursing home

The Medicare program rates how well health plans perform in different categories (for example, ratings in customer service and detecting and preventing illnesses). By visiting the website www.medicare.gov, you can compare the ratings for plans in your area by selecting “Find Health and Drug Plans.” You can also get a copy of our plans' ratings by calling us at 1-855-204-2744 (TTY 711) — 8 a.m. to 8 p.m., seven days a week.

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BlueCross BlueShield of South Carolina is a Medicare Advantage PPO and HMO plan with a Medicare contract. BlueCross Essential, Rx Value and BlueCross Rx Plus are stand-alone prescription drug plans with a Medicare contract. Enrollment in BlueCross Total, BlueCross Total Value, BlueCross Blue Basic, BlueCross Secure, BlueCross Essential, BlueCross Rx Value or BlueCross Rx Plus depends on contract renewal.

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 copayments/coinsurance may change on January 1 of each year.

Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of South Carolina Medicare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call Customer Service or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English. Read our Non-Discrimination Statement and Foreign Language Access policy.