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Getting help with My Advocate
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) collaborates with Change Healthcare’s My Advocate® program to help find out if you’re eligible for government programs and Extra Help to reduce your health care costs. By working with an advocate, you’ll receive personalized assistance, eligibility information, and help through the application process if you qualify.
To make the assessment, My Advocate will gather personal financial information necessary to make a determination, so be prepared for questions regarding your finances. Rest assured that Change Healthcare does not share this information with any company or agency other than government agencies that require it should you qualify. The Blue Cross NC contract with Change Healthcare requires that your information be protected. Blue Cross NC does not receive the information that Change Healthcare gathers.
With Dual Enrollment Advocate™, My Advocate will perform an individual screening to determine your eligibility for Medicaid services and Medicare Savings Programs that can help with some of your Medicare costs based on your income and financial asset level. If eligible, an advocate will help you through the enrollment process.
My Advocate can also help identify if you are eligible to receive Extra Help to pay for prescription medication and assist you with completing the program application.
How Extra Help works
"Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. Some people qualify for Extra Help automatically, and other people have to apply. Visit medicare.gov to view income limits and to apply.
As a member of a Blue Medicare HMO℠ or PPO℠ or Blue Medicare Rx℠ PDP plan, you may pay a plan premium and a Medicare Part B premium. If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.
Extra Help discounts are not applied to any Medicare Part B premium you may have to pay.
Apply for Extra Help
If you aren't getting Extra Help, you can see if you qualify by calling your State Medicaid Office or the Social Security Administration at 800-772-1213. TTY users should call 800-325-0778 between 7 AM and 7 PM, Monday through Friday or by applying online at medicare.gov.
If you have any questions, please call Customer Service at 888-310-4110 for HMO, 877-494-7647 for PPO, or 888-247-4142 for PDP (TTY: 711). We are available for phone calls 8 AM to 8 PM daily. Calls to these numbers are free.
Best Available Evidence policy
Extra Help is also known as Part D Low-Income Subsidy (LIS). In certain cases, CMS systems do not reflect a beneficiary's correct LIS status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.
To address these situations, CMS created the Best Available Evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.
Please visit medicare.gov for materials related to the CMS BAE policy.
2024 Low-Income Subsidy (LIS)
This table shows you what your monthly plan premium will be if you get Extra Help.
2024 Blue Medicare℠ Plan | Monthly premium |
|---|---|
PPO Enhanced (H3404-003-001) | $0.00 |
PPO Enhanced (H3404-003-002) | $2.10 |
Essential Plus (HMO-POS) (H3449-023-001) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-002) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-004) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-005) | $0.00 |
Enhanced (HMO-POS) (H3449-024-001) | $0.00 |
Enhanced (HMO-POS) (H3449-024-002) | $0.00 |
Enhanced (HMO-POS) (H3449-024-003) | $11.00 |
Choice (HMO) (H3449-026-000) | $0.00 |
Essential (HMO) (H3449-027-001) | $0.00 |
Essential (HMO) (H3449-027-002) | $0.00 |
Healthy Blue + Medicare℠ (HMO-POS D-SNP) | $0.00 |
Rx Standard (PDP) (S5540-002-000) | $55.40 |
Rx Standard (PDP) (S5540-004-000) | $84.40 |
2025 Low-Income Subsidy (LIS)
This table shows you what your monthly plan premium will be if you get Extra Help.
2025 Blue Medicare℠ Plan | Monthly premium |
|---|---|
PPO Enhanced (H3404-003-001) | $0.10 |
PPO Enhanced (H3404-003-002) | $20.10 |
Essential Plus (HMO-POS) (H3449-023-001) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-002) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-004) | $0.00 |
Essential Plus (HMO-POS) (H3449-023-005) | $0.00 |
Enhanced (HMO-POS) (H3449-024-001) | $14.50 |
Enhanced (HMO-POS) (H3449-024-002) | $29.50 |
Enhanced (HMO-POS) (H3449-024-003) | $35.50 |
Choice (HMO) (H3449-026-000) | $0.00 |
Essential (HMO) (H3449-027-001) | $0.00 |
Essential (HMO) (H3449-027-002) | $0.00 |
Healthy Blue + Medicare℠ (HMO-POS D-SNP) | $0.00 |
Rx Standard (PDP) (S5540-002-000) | $52.20 |
Rx Standard (PDP) (S5540-004-000) | $62.00 |
Disclosures:
Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.
Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
Blue Medicare Supplement plans offered: Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.
Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.
The federal government requires all Medicare Advantage members to continue paying their Part B premium each month.
Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
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Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.
Out-of-network / non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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Blue Cross NC contracts with independent companies to provide supplemental benefits. Those companies are responsible for the services they provide. They do not provide Blue Cross or Blue Shield products or services. Marks and trade names are property of their respective owners.
Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.
FitOn Health is an independent company providing health and fitness services on behalf of Blue Cross and Blue Shield of North Carolina.
CareLinx is an independent company providing in-home care solutions on behalf of Blue Cross and Blue Shield of North Carolina.
TruHearing is an independent company providing hearing health and hearing aids on behalf of Blue Cross and Blue Shield of North Carolina.
Current as of 07/12/2024 | Y0079_12997_M CMS Accepted 11132024 | U36079, 6/24
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