We're the only Medicare Advantage provider based in South Carolina, and we've been covering South Carolinians for over 70 years. Our local and experienced agents are here to help you navigate your Medicare options. Browse our affordable plans, and give us a call if you have questions.
A message from our Chief Medical Officer, Dr. Bill Logan
Medication Therapy Management (MTM) Program
Prescription Drug Coverage
Unlike Original Medicare, our plans include coverage for Medicare Part D prescription drugs. You're also eligible for our free therapy management program designed to help you keep your medications on the right track.
- 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
Extra Benefits with Medicare Advantage
Access online programs, no-cost fitness center memberships, and home fitness programs through our Silver&Fit program.
E-Shop for Your Health
Our Medline Over-the-Counter (OTC) program allows members to shop online or by phone to order OTC supplies.
Vision, Hearing & Dental
Get excellent eye care and eyewear with Blue Cross Blue Shield of South Carolina and VSP® Vision care.
A dedicated nurse is available to help you manage chronic conditions and coordinate your care.
Shop for Plans in Your Area
Use our online enrollment and comparison tools to shop for plans. Note: this link will direct you to another site and prompt you to share your zip code for plan information.
Frequently Asked Questions
General Plan Coverage
- Do I have to choose a network Primary Care Provider (PCP)?
If you have a Total or Total Value PPO plan, it's not required.
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.
If you have a Secure HMO plan, you must have a PCP on file with us.
It is very important that you choose a network PCP and tell us whom you have chosen. Your PCP can help you stay healthy, treat illnesses, and coordinate your care with other health care providers. Your PCP will provide most of your care, and when you need more specialized services, he/she will coordinate your care with other providers. Your PCP will help you find a specialist and will arrange for covered services you get as a member of our plan.
- How can I find a list of in-network doctors?
You can find an up-to-date list of Primary Care Providers, Specialists, Durable Medical Equipment Suppliers and Hospitals in our network using our online finder tools.
- How do I compare plans and enroll?
Comparison & Enrollment Tools
It's easy to shop and compare plans using our online enrollment tools.
You can also take a look at our resources based on your plan of interest:
- You can compare BlueCross Total 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 Annual Notice of Changes: BlueCross Total Upstate ANOC, BlueCross Total Midlands/Coastal ANOC or BlueCross Total Lowcountry ANOC.
- Also review the annual Evidence of Coverage for you plan: BlueCross Total Upstate EOC, BlueCross Total Midlands/Coastal EOC or BlueCross Total Lowcountry EOC.
Total Value PPO:
- 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 Annual Notice of Changes: BlueCross Total Value Upstate ANOC, BlueCross Total Value Midlands/Coastal ANOC
- To get a complete list of our benefits, please review the Evidence of Coverage for your plan: BlueCross Total Value Upstate EOC, BlueCross Total Value Midlands/Coastal EOC or BlueCross Total Value Midlands/Coastal EOC.
- You can compare BlueCross Blue Basic 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.
- You can compare BlueCross Secure 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 Annual Notice of Changes: BlueCross Secure Greenville County ANOC or BlueCross Secure Richland County ANOC.
- Also review the annual Evidence of Coverage for your plan: BlueCross Secure Greenville County or BlueCross Secure Richland County.
- 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.
Prescription Drug Coverage
- 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 your plan's Pharmacy Directory on the Forms & Policies page, 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 Total/Secure Formulary or Total Value Formulary (list of covered prescription drugs effective 01/01/2022) or our Drug Search Tool (these links leads to a third-party website) - Total/Secure Drug Search and Total Value Drug Search. 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.
- Do I qualify for subsidized prescription drug coverage?
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/seven days a week.
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- Your State Medicaid Office.
Learn about the Medicare Extra Help program. This program provides additional help for people with limited income. You can also view the Centers for Medicare & Medicaid Services (CMS) Best Available Evidence (BAE) policy.
- How do I enroll in the MTM program?
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.
Already a member?
Last Updated: May 2, 2022
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.