Medicare Advantage Plans

Medicare Advantage plans offer all the coverage of Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage and extra health and wellness options. Blue Cross and Blue Shield of Illinois (BCBSIL) offers both individual and group Medicare Advantage plans.

• The Blue Cross Medicare Advantage (HMO)^SM plan offers health coverage to members who reside in Cook, DuPage, Will and Kane counties.
• The Blue Cross Medicare Advantage (PPO)^SM plan offers health coverage to members who reside in  Cook, DuPage, Will and Kane counties.
• For more details about our Medicare Advantage plans including names, network summary and geographic areas, see the Government Programs Networks and Benefit Products.

Our strong brand recognition and our historical relationship with Medicare makes BCBSIL an excellent choice for Medicare-eligible individuals. We maintain and monitor a network of participating providers including physicians, hospitals, skilled nursing facilities, ancillary providers and other health care providers through which members obtain covered services.

Medicare Group Plans

• Our retiree group Medicare plans are Blue Cross Group Medicare Advantage (PPO)℠, Blue Cross Group Medicare Advantage Open Access (PPO)℠ and Blue Cross Group MedicareRx (PDP)℠.
• Out-of-network providers: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSIL, you may treat Blue Cross Group Medicare Advantage Open Access (PPO)^SM as an out-of-network provider. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. In-network providers will be paid at their contracted rate.

Join the Illinois Medicare Advantage Network

To join our Blue Cross Medicare Advantage network, follow the process for Contracting. 

Pre-service Requirements

It’s important to refer to the applicable BCBSIL Provider Manual to ensure you are aware of your responsibilities as a network provider.

• Always check eligibility and benefits first. This step will help you determine coverage, prior authorization requirements and other information.
• Visit the Utilization Management section for an overview of the Prior Authorization process. This section also includes a Support Materials (Government Programs) page for quick access to a Medicare Advantage PPO prior authorization requirements summary and procedure code list.
• Go to the Medical Policy page for active and pending policies.

Claims

The fastest way to conduct business with BCBSIL throughout the entire claims process is via Electronic Data Interchange (EDI). Refer to the Claim Submission section for an introduction to filing claims with BCBSIL. Medicare Advantage claims must be submitted within 180 days of the date of service and/or discharge date.

Medicare Marketing Guidelines

All providers who contract with BCBSIL to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSIL or Blue Cross Medicare Advantage products or benefits. View the guidelines that are applicable to providers in the Medicare Marketing Guidelines.

Blue Cross Medicare Advantage plans are HMO, HMO-POS and PPO plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.