2021 BlueCross Secure (HMO)

Would you like a Medicare Health Maintenance Organization (HMO) plan with built-in prescription drug benefits? With BlueCross Secure (HMO), you can enjoy all of the benefits original Medicare offers — and more.

BlueCross Secure is open to residents in two South Carolina counties who have both Medicare Part A and Part B. Our service areas are:

  • BlueCross Secure Greenville — Greenville County
  • BlueCross Secure Richland — Richland County

How Much Does BlueCross Secure Cost?

The monthly premium for BlueCross Secure is:

  • BlueCross Secure Greenville — $0.00
  • BlueCross Secure Richland — $10.00

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. In most situations, BlueCross Secure members must receive care from a network provider. There are exceptions, including for medical emergencies and when you get approval from our plan. Our plan also covers urgently needed care that you get from an out-of-network provider when network providers are temporarily unavailable or inaccessible (e.g., when you are temporarily outside of the plan’s service area).

As a member of BlueCross Secure, you must have a network Primary Care Provider (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.

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 BlueCross Secure Doctor and Hospital Finder. You also may view a printed Provider Directory. If you would like a printed Provider Directory mailed to you, please call Customer Service at 1-855-204-2744.

Prescription Drug Coverage

BlueCross Secure 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.

How Can I Compare My Options?

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 October 15 to December 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.

Coverage Decisions & Appeals

Coverage decisions are decisions we make about whether a service is covered by the plan and the amount, if any, we are required to pay for the service. Coverage decisions are also call organization determinations. If you are not satisfied with the outcome of a coverage decision, you can appeal the decision by requesting a plan reconsideration. Learn more about coverage decisions and reconsiderations, and filing grievances. Call a customer service representative to get an aggregate number of grievances and appeals filed with BlueCross Secure.

To request a coverage decision or reconsideration:

Call 1-855-204-2744 (TTY 711)
Fax your request to 1-803-264-9581
Email your request to medhelp@bcbssc.com
Download a reconsideration request form
You can name another person to act as your “representative” and ask for a coverage decision or reconsideration on your behalf, such as a friend, relative, doctor or other prescriber. To have a representative act on your behalf, both you and the representative must sign the Appointment of Representative Form.

More Important Information

Multi-Language and Non-Discrimination Policy
LIS Premium Summary Chart
Beneficiary Rights and Responsibilities Upon Disenrollment
Our Privacy Practices

How to Contact Us

To Enroll: 1-800-930-2836 (TTY 711). Calls to this number are answered by a licensed insurance agent.
Already a Member: Call our Customer Service representatives at 1-855-204-2744 between 8 a.m. - 8 p.m. (Eastern Time), seven days a week.
Address: Medicare Advantage, BlueCross BlueShield of South Carolina, P.O. Box 100191, Columbia, SC 29202-3191
Provider Services: 1-855-209-7267
Prior Authorization Fax: 1-803-264-6552
Mental Health: 1-800-868-1032

Submit feedback to Medicare about your BlueCross Secure plan
Find out how the Medicare Beneficiary Ombudsman works for you
How to Report Fraud

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. To read our Non-Discrimination Statement and Foreign Language Access policy, click here.

BlueCross Secure is a Medicare Advantage HMO plan with a Medicare contract. Enrollment in BlueCross Secure 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.

Last updated: 08/02/2021