North Carolina 2023 Medicare plan changes Healthy Blue + Medicare SM (HMO D-SNP)

Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Annual benefit changes for Medicare plan members under Blue Cross NC will be effective January 1, 2023.

The following is a summary of these changes. Complete details are in the member’s Evidence of Coverage (EOC). Visit the Medicare page for EOC, formularies, and benefit summaries, or contact Provider Services at the number on the back of the member’s ID card. Changes may include medical and Part D benefits, copays, coinsurance, deductibles, formulary coverage, pharmacy network, premiums, and out-of-pocket maximums. 

Some group-sponsored Medicare Advantage plan benefits vary from the Medicare Advantage plans offered to individuals. Please refer to the member’s EOC or call Provider Services at the number on the back of the member’s ID card for more benefit details. 

2023 highlights

Not all benefits listed below are available to all Medicare members. Complete details are in the member’s EOC:

The Inflation Reduction Act

• The Inflation Reduction Act will provide Part D insulins to all members at $35 or less for 2023. In addition, the following Part D vaccines will be moving to $0:    
  • Tetanus, diphtheria, and pertussis (Tdap)
  • Measles, mumps, rubella (MMR)
  • Chickenpox (Varicella)
  • Japanese encephalitis
  • Hepatitis A and B
  • Shingles (Zostavax and Shingrix)
  • Rabies

Personal home helper

Effective January 1, 2023, personal home helper will no longer be an active benefit available to Medicare individual members

New: over-the-counter (OTC) items and healthy groceries

• A combined $185 monthly allowance on a benefits prepaid card to help members with purchases towards healthy groceries and OTC items.
• For 2023, the allowance for OTC items and the allowance for healthy groceries has been combined into one monthly allowance to be used by members.
• Unused amounts do not roll over to the next month or calendar year.

Transportation — unlimited health and non-health related trips

For 2023, unlimited trips will be provided to assist members to health-related locations, such as the doctor’s office and pharmacies, as well as grocery stores under the Value Based Insurance Design (VBID) model.

Post-discharge meals

In 2023, post-discharge meals have been increased to two meals per day for up to 14 days following discharge from a hospital or skilled nursing facility.

Vision eyewear allowances

In 2023, the eyewear allowance has been increased to $400 for eyeglasses or contact lenses.

VBID model

• The VBID model allows plans the flexibility to offer not primarily health related benefits. Our plan(s) base eligibility criteria of these benefits on socioeconomic status of members enrolled in the plans participating in the VBID model:
• MyDirectives®
  • For 2023, we will offer MyDirectives on plans that participate in the Value-Based Insurance Design (VBID) model.
  • Members have access to an online advance care planning resource called, MyDirectives. 
  • This resource helps them create an advance directive where they can combine the elements of a: Living will, medical power of attorney, organ donation form and more, including religious preference statements. 
  •  MyDirectives is available to the member and their designated medical providers 24 hours a day, seven days a week. 
  • You can help members to get started, all the member needs to do is log into the member website and go to the Programs Dashboard and select Advance Directive Programs. It will take members to MyDirectives to create a new account or link their existing account.
  • Please read plan details for more information.

2023 Service Area changes

The existing Healthy Blue + Medicare (HMO D-SNP) plan will expand into many new counties in 2022.

Plan name: Healthy Blue + Medicare (HMO D-SNP) 

Counties: Camden, Carteret, Cherokee, Clay, Craven, Currituck, Dare, Onslow, Pasquotank, Perquimans

Formulary and pharmacy

Encourage your patients to review the 2023 formulary information within their Annual Notice of Change mailing, their new member kit, or online. Ask your patients if the coverage for any of their prescriptions has been changed. If your patient has been impacted by changes to prescription coverage, consider alternative medications in a lower cost-sharing tier.

Prior authorization for Medicare plans

Prior authorization requirements are available at availity.com. Contracted and noncontracted providers who are unable to access Availity may call Provider Services at the phone number on the back of the member’s ID card for prior authorization requirements.

Please check the member’s ID card for any identification and/or group number changes that may affect claim submissions. Sample 2023 member ID cards will be available at our Healthy Blue Medicare page.