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The Balanced Budget Act of 1997 established a Medicare program called the Medicare+Choice (M+C) now known as Medicare Advantage. This action significantly expanded the healthcare options available to Medicare beneficiaries.
Blue Cross and Blue Shield of Alabama contracted with the Centers of Medicare & Medicaid Services (CMS) to provide Medicare covered services to beneficiaries through a Medicare Advantage Plan. This plan, Blue Advantage, is a Medicare approved Preferred Provider Organization (PPO) Plan option for beneficiaries. Blue Advantage is offered to beneficiaries residing in the state of Alabama. Blue Advantage will provide the same level of benefits that a beneficiary would be entitled to if covered by Medicare.
Blue Advantage works much like the traditional Medicare program. Beneficiaries are free to go to any physician or hospital they choose as long as the provider is an eligible participating Medicare provider and has agreed to participate with the Blue Advantage plan. Agreements for participation are extended to all appropriate providers in order to maintain a sufficient network for beneficiaries. Included is specialty care and direct access to participating providers that specialize in women’s healthcare for routine and preventive services. Arrangements will be made for specialty care outside of the coverage area when necessary as well as emergency and urgent needs, such as dialysis. Blue Cross offers a continuation of enrollment option to Blue Advantage beneficiaries when they no longer reside in the service area of a plan and permanently move into the geographic area designated by Blue Cross as a continuation area. A beneficiary who moves out of the service area and into the continuation area has the choice of continuing enrollment or disenrolling from Blue Advantage. Blue Cross continues to provide healthcare benefits to its Blue Advantage beneficiaries until the contract period expires. This continuation of services exists through hospitalizations and insolvency that may occur on the contract expiration date.
For individuals with serious medical conditions, Blue Advantage follows the same procedures that CMS utilizes to diagnose those individuals, assess their conditions, monitor their health and implement treatment plans. A health assessment is conducted on all new enrollees within 90 days. Blue Advantage ensures that enrollees are informed of specific healthcare needs that require follow-up and receive appropriate training in self care and other measures, such as care management, to promote their health.
Blue Cross provides CMS with all required information necessary to administer and evaluate the program and provide current and potential beneficiaries with information in order to make informed decisions about their available choices for Medicare coverage. Participating Blue Advantage providers agree to cooperate with any quality and improvement initiatives, medical policies and medical management procedures. Blue Cross will share with CMS the quality and performance indicators regarding enrollee satisfaction with the program health outcomes, and disenrollment rates for beneficiaries enrolled in Blue Advantage for the previous two years.
If Blue Cross terminates Blue Advantage or reduces the service area, a written notice will be given to all beneficiaries in the affected area(s) along with a notice of the effective date of termination or area reduction. Included with that notice will be a description of alternatives for obtaining benefits under the Medicare Plus Program.
Blue Advantage is a Medicare-approved PPO Plan.
Last Updated December 2013