Medicare Eligibility for Blue Essentials and Blue Option Exchange Members

Medicare Eligibility for Blue Essentials and Blue Option Exchange Members

2/15/2017

Services will not be covered for Blue EssentialsSM and Blue OptionSM members once they are eligible for Medicare. Blue Essentials and Blue Option will not pay claims for services or supplies for which the member is entitled to benefits under Medicare.
 
Members with end stage renal disease (ESRD) will remain covered by us during the first three months of dialysis treatment. Once a patient has received treatment for three months, he or she then becomes eligible for Medicare. 
 
Blue Essentials and Blue Option cover members up to age 65. Once a member is 65 years of age, they are eligible for Medicare and are no longer qualified to retain their Blue Essentials or Blue Option coverage. 
 
If the member is the subscriber, they should:
  1. Enroll in Medicare, if they have not yet done so.
  2. Contact us to cancel their current policy.
  3. If applicable, enroll dependents in a new Blue Essentials or Blue Option plan.
  4. If they receive a subsidy, visit www.HealthCare.gov to update their account. This is not applicable for Blue Option members.
 
If the member is the dependent, the subscriber should:
  1. Enroll the dependent in Medicare, if they have not yet done so.
  2. Contact us to remove the Medicare-eligible dependent from their current policy.
 
If a member is eligible for Medicare due to age or disability but has documentation from Medicare or the Social Security Administration stating that they are not entitled to Medicare benefits, the member will need to submit that information using one of the following methods: 
 
Fax – 803-870-9439
Mail –  BlueCross BlueShield of South Carolina
            P.O. Box 100228
            Columbia, SC 29202-3228
 
Once a member is eligible for Medicare, we will begin denying claims. Claims will remain denied unless the member submits the necessary documentation to show that they are not entitled to Medicare benefits.
 
Members have been notified of this requirement. Letters were initially sent to existing patients at the end of November. New patients will receive notification once they are identified. 
 
If you have questions about this bulletin, please contact Provider Education at 803-264-4730 or submit your question using the Provider Education Contact Form