Tools & Information | Patrius Health - Patrius
Helpful Tools
Help Tool
Choose Documents to Show:
Member Materials (Blue Advantage):
Plan Policies (Blue Advantage):
Notices (Blue Advantage):
Frequently Asked Questions:
-
A Medicare Advantage Plan is a Medicare approved program that allows you to have all the rights and protections of Original Medicare. Your Medicare benefits, however, will be provided by a private insurance company such as Patrius Health. Medicare Advantage is a comprehensive plan that includes the same coverage as Medicare Part A, Part B and often Part D. Out-of-pocket costs may be lower, and plans usually offer supplemental benefits not covered under Original Medicare like dental and vision.
-
To be eligible for Blue Advantage Capital you must be a resident of Hinds, Madison and Rankin counties in Mississippi. You must continue to pay your Medicare Part B premium (unless paid for you by Medicaid or another third party). You must be entitled to Medicare Part A and enrolled in Medicare Part B. To be eligible for Medicare you must be 65 years of age or on disability. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed.To be eligible for Blue Advantage Magnolia you must be a resident of Calhoun, Chickasaw, Clay, Itawamba, Lee, Monroe, Pontotoc, Tishomingo and Union counties in Mississippi. You must continue to pay your Medicare Part B premium (unless paid for you by Medicaid or another third party). You must be entitled to Medicare Part A and enrolled in Medicare Part B. To be eligible for Medicare you must be 65 years of age or on disability. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed.To be eligible for Blue Advantage Plus you must be a resident of Hancock, Harrison, Jackson and Stone counties in Mississippi. You must continue to pay your Medicare Part B premium (unless paid for you by Medicaid or another third party). You must be entitled to Medicare Part A and enrolled in Medicare Part B. To be eligible for Medicare you must be 65 years of age or on disability. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed.
-
If you have more than one address, you will need to provide your permanent physical address on your application. This address must match your primary address as listed with Social Security and Medicare. Your address will be used to determine your product eligibility and plan premiums. Failure to report your correct address can delay the processing of your application or result in the loss of coverage. If needed, you may also provide an alterate address (such as a Post Office Box) for billing and/or correspondence.
-
Premium rates for Blue Advantage plans are based on the benefit design and overall utilization of medical services.
With all options, you are required to continue paying your Medicare Part B premium unless otherwise paid for by Medicaid or another third party. If you qualify for Low Income Subsidy, your premium may be reduced based on the level of subsidy for which you qualify.
-
Premiums are always due on the 1st of the month and are considered late if not received by the 10th.
There are several ways you can pay your plan premium:
- Automatic monthly payment by E-Check, Credit Card, or Debit Card
- Over the telephone with Visa, MasterCard, Discover or E-Check
- Automatic deduction from your monthly Social Security or Railroad Retirement Board benefits check
- Mail a check
- Set up online bill payment through your financial institution. Please be sure to include your contract number when setting up online bill payment.
-
The Annual Election Period allows you to make changes to your plan anytime between October 15 and December 7. Elections made during this time will be effective on January 1 of the following year. When Medicare has been notified of your election change, your membership with your previous MAPD and/or Part D plan will be cancelled effective December 31. To cancel coverage other than Medicare Advantage or Part D Plans (like Medicare Supplement/Medicare Select plans), please contact your insurance carrier.
-
A current Medicare Advantage plan enrollee is allowed to make a one-time change during the Medicare Advantage Open Enrollment Period, which takes place from January 1 to March 31 or the last day of the 3rd month after their Part A and B entitlement date. This period allows you to disenroll from a Medicare Advantage plan and return to your Original Medicare, change from one Medicare Advantage plan to another Medicare Advantage plan or from one Part D plan to another Part D Plan.
Other times that you are allowed to make changes to your coverage outside of AEP are:
- Initial Coverage Election Period (ICEP) - three months before your Medicare eligibility effective date the month of your Medicare eligibility date, and three months after.
- Special Election Period (SEP) - You can change plans anytime during the year if you gain, lose or have a change in your dual eligible or Low Income Subsidy status. You are also allowed to make elections within 60 days of the day you lose coverage with your employer and within 60 days of the day you move into a new coverage area.
-
There are several ways to submit your enrollment application:
- Online
- Call us at 888-832-0046 (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From December 8 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
- Mail us an application or request an enrollment kit packet to be mailed to your house.
-
Your membership will end the last day of the month prior to when your new plan's coverage begins.
-
Blue Advantage offers a large network of providers who are willing to serve you.
To see if a provider participates in the Blue Advantage network, you may:
Visit our online doctor finder.
Call the Member Services number on the back of your ID card (non-members may call 1-888-950-0705 8 a.m. to 8 p.m., seven (7) days a week). From March 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
Request that a Provider Directory for your county be mailed to you.
Outside of your Blue Advantage service area, medical emergencies and visits to an Urgent Care Facility will process at an in-network benefit level, regardless of whether the provider is in the Blue Advantage network. For all other services outside of the coverage area, facility and provider participation may vary. To find out if an out-of-state facility or provider participates in the Blue Advantage network, contact Member Services.
-
Patrius Health has several programs in place, such as our health management and disease management programs, to help reduce the cost of health care. Our nurses actively work with members to provide support for chronic conditions, such as Case Management, Chronic Condition Management and Serious Illness Care Management programs.
-
Once the amount of drugs you have purchased for the year reaches $5,030 you will enter the coverage gap. However, you will receive a 75% discount on brand drugs if the manufacturer is contracted with CMS. For generic drugs, you will be discounted up to 75% of the plan allowable cost. After your total out-of-pocket cost reaches $8,000 you will enter the Catastrophic Coverage Phase. During this final phase, you will pay nothing for your drugs. If you need additional assistance during the coverage gap, please contact your pharmacy for manufacturer discount programs, or call Social Security at 1-800-772-1213 to see if you qualify for extra help with your prescription drugs.
-
- Call us at 1-888-832-0046 (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From December 8 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
-
This plan is only available to certain counties in Mississippi. Please note that failure to report an address change can result in the loss of your coverage.
If you move within Hinds, Madison or Rankin counties, you are still elgible to keep your Blue Advantage plan; however, premium and plan options may vary based on the county that you live in. Please contact our Customer Service to advise of an address change and to determine if your move will constitute any changes to your plan.
If you move outside of Hinds, Madison or Rankin counties, Medicare will allow you 60 days from the day you move to enroll into another MAPD or Part D plan that is located in your new state. If you are temporarily moving out of the coverage area, you are allowed to have a temporary address for up to 12 months. You are responsible for notifying us if your living status changes from a temporary to permanent residence or of any permanent changes to your physical address.
This plan is only available to certain counties in Mississippi. Please note that failure to report an address change can result in the loss of your coverage.
If you move within Calhoun, Chickasaw, Clay, Itawamba, Lee, Monroe, Pontotoc, Tishomingo or Union counties, you are still elgible to keep your Blue Advantage plan; however, premium and plan options may vary based on the county that you live in. Please contact our Customer Service to advise of an address change and to determine if your move will constitute any changes to your plan.
If you move outside of Calhoun, Chickasaw, Clay, Itawamba, Lee, Monroe, Pontotoc, Tishomingo or Union counties, Medicare will allow you 60 days from the day you move to enroll into another MAPD or Part D plan that is located in your new state. If you are temporarily moving out of the coverage area, you are allowed to have a temporary address for up to 12 months. You are responsible for notifying us if your living status changes from a temporary to permanent residence or of any permanent changes to your physical address.
This plan is only available to certain counties in Mississippi. Please note that failure to report an address change can result in the loss of your coverage.
If you move within Hancock, Harrison, Jackson or Stone counties, you are still elgible to keep your Blue Advantage plan; however, premium and plan options may vary based on the county that you live in. Please contact our Customer Service to advise of an address change and to determine if your move will constitute any changes to your plan.
If you move outside of Hancock, Harrison, Jackson or Stone counties, Medicare will allow you 60 days from the day you move to enroll into another MAPD or Part D plan that is located in your new state. If you are temporarily moving out of the coverage area, you are allowed to have a temporary address for up to 12 months. You are responsible for notifying us if your living status changes from a temporary to permanent residence or of any permanent changes to your physical address.
-
Medicare requires all Medicare Advantage and Prescription Drug plans to notify members of the upcoming year's changes by September 30 of each calendar year.
-
ID cards do not expire and will not be issued annually. If you need a new ID card, please contact Member Services at 1-888-950-0705 (TTY 711), Monday - Friday 8 a.m. - 8 p.m. Central Time. From October 1 to March 31, the hours of operation are Monday - Sunday, 8 a.m. - 8 p.m. Central Time. You may be required to leave a message for calls made after hours, weekends and holidays. Calls will be returned the next business day.
-
Please contact the Social Security Administration to see if you are required to reapply for Low Income Subsidy each year. There is no guarantee that you will automatically qualify each year, as the income criteria is subject to change. The Social Security Administration can be reached at 1-800-772-1213. If eligible for LIS, Social Security will send you a letter advising of your level of eligibility. Patrius Health will also be notified of any changes to your LIS eligibility.
-
If your modified adjusted gross income, as reported on your IRS tax return, is above a certain amount ($97,000 if you file individually or $194,000 if you’re married and file jointly), you will pay an extra amount in addition to your monthly plan premium. You may also hear this referred to as a surcharge, and can get more information on it here. If you have to pay an extra amount, the Social Security Administration (SSA) will send you a letter to advise what the extra amount is and how to pay it.
-
If you would like update the account you are using for automatic monthly draft or change your payment method, please call the customer service number located on the back of your ID card or log into your myBlueCross account. In the meantime, you are responsible for making sure your plan premium is paid on time.
-
To see if a specific drug is covered under Blue Advantage you may:
- View formularies online: Plus
- Look up your drug in our Find Drugs tool
- Call the Member Services number on the back of your ID card (non-members may call 1-888-950-0705) (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
- Request that a formulary be mailed to you.
To see if a specific drug is covered under Blue Advantage you may:
- View formularies online: Capital
- Look up your drug in our Find Drugs tool
- Call the Member Services number on the back of your ID card (non-members may call 1-888-950-0705) (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
- Request that a formulary be mailed to you.
To see if a specific drug is covered under Blue Advantage you may:
- View formularies online: Magnolia
- Look up your drug in our Find Drugs tool
- Call the Member Services number on the back of your ID card (non-members may call 1-888-950-0705) (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
- Request that a formulary be mailed to you.
-
To request coverage for a medication not on the formulary, contact your physician and ask that a formulary exception request form be submitted on your behalf. This process can take up to 72 hours for a standard request. If your life, health or ability to regain maximum function may be at risk by waiting for a standard request decision, we will let you know our decision within 24 hours. This is considered an expedited request. If a non-formulary medication is approved to be added to your formulary, the copay will process as a Tier 4 for non-preferred drugs or Tier 2 for generic drugs.
You may also contact Member Services at 1-888-950-0705 (TTY 711), 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
-
Send your request for payment, along with receipts documenting the amount paid, to:
Part D Claims
PO Box 20970
Lehigh Valley, PA 18002-0970 -
Yes, we offer the convenience of having your medications purchased through our mail order program. Click here to view more information
-
Patrius Health offers a number of standard Drug Utilization Management (DUM) services such as formulary management, prior authorization, quantity limits and step-therapy. These programs encourage safe, appropriate and cost-effective use of drugs. The goal of DUM is to monitor and prevent over- and under-utilization of prescription drugs while respecting the physician's prescribing authority. Using DUM, we also track and trend utilization, identify opportunities for improvement and document and implement corrective actions when necessary. All policies are reviewed quarterly by an independent committee of pharmacists and physicians.
-
The MTM Program is a free service offered by your plan that can help you keep your medications on the right track. To learn more about the MTM Program go here.
-
Prime Therapeutics is an independent company providing pharmacy benefit management services for Patrius Health Blue Advantage (PPO) members.
-
CMS collects information about Medicare beneficiaries’ experiences with, and ratings of, Medicare Advantage (MA-only) plans, Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Medicare Prescription Drug Plans (PDP) by participating in the Consumer Assessments of Health Plans Study (CAHPS) Survey. To review the CAHPS survey results please visit www.MA-PDPCAHPS.org
-
The Part D Low Income Subsidy (LIS) provides financial support for people with Medicare who have limited income and resources.
- It helps pay their Medicare Prescription Drug Benefit costs (plan monthly premiums, co-payments and the annual deductible)
- Depending on your income and assets, you may qualify for a full or partial subsidy.
- Also called "Extra Help"
Third Party Website Disclaimer
You are about to leave the Blue Cross and Blue Shield of Alabama Medicare products website to visit one of our social media sites. Although content of our social media sites is maintained by Blue Cross, Blue Cross does not control the security and/or privacy practices of these external social media sites. Therefore, Blue Cross advises users of these sites against sharing any personal health information or any other information the user would otherwise not feel comfortable being made public. Blue Cross shall not be liable for privacy breaches, security incidents or similar events due to the use of social media sites.
To continue, click "Accept." If you want to stay on the Blue Cross and Blue Shield of Alabama Medicare website, click "Cancel."