Blue cross blue shield prescription cost estimator nc

Published July 5, 2022

Blue Cross and Blue Shield companies are committed to providing cost transparency tools designed to make it easier for patients to compare prices, estimate potential costs of procedures and/ or medication while ultimately saving money. These digital solutions support affordability and make health care less complicated for individuals and families. Here are some examples:

Blue Cross and Blue Shield companies in Illinois, Montana, New Mexico, Oklahoma and Texas offer access to Benefits Value Advisor. This live advocate helps individuals as they consider treatment options by easily enabling them to identify in-network providers and locate the best value through cost and quality comparisons for a variety of medical procedures. Through the Member Rewards program, individuals can estimate out-of-pocket costs, and when a quality, lower-cost service, provider or procedure is selected, members may receive a cash reward.

Federal employees enrolled in the Blue Cross and Blue Shield Federal Employee Program® (FEP®) can utilize the Healthcare Cost Advisor planning tool to get access to personalized cost data, including understanding current and past costs and out-of-pocket spending. Members can estimate potential out-of-pocket expenses based on expected or anticipated life changes or events as well as get help calculating annual health care budget. All while allowing members the ability to make the most informed health care decisions quickly and easily.

Blue Cross and Blue Shield of Nebraska’s cost tool gives estimates for common procedures based on each individual’s specific benefits, with that individual’s co-pays and deductibles spelled out. In addition to comparing costs, patient reviews and details on care also are available.

Blue Cross and Blue and Shield of North Carolina (Blue Cross NC) provides specific, transparent pricing information to all members. The company was the first insurer in the country to make in-network prices available to the public by publishing an online tool that allows people to compare pricing for specific procedures by provider and location. For members, the tool provides estimates specific to their plan and deductible for the entire episode of care so they can comparison shop and make informed decisions. Members on eligible plans can even take advantage of a program that promotes awareness of health care costs by paying participants cash for shopping and comparing costs of common medical procedures. When program participants choose the most affordable doctors and hospitals delivering high-quality care, a check is mailed to their home.

In Kansas City, Blue KC members can utilize Find Care, a tool that comes complete with a provider finder plus cost-sharing estimates and price comparison details. Find Care allows members to see and compare costs for health care and find providers that fit their needs. The cost transparency tool provides insight for members to understand health care expenses prior to a doctor visit or procedure. The estimated cost for services is based on claims data and provider type for medical concerns. Find Care allows members to find local facilities with the lowest estimated out-of-pocket costs. Members can also see costs associated with common medical services including surgeries and diagnostic imaging. The service is available through the Plan’s MyBlueKC.com website or the MyBlueKC mobile app.

Blue Cross and Blue Shield of Nebraska, Blue Cross and Blue Shield of North Carolina, Blue Cross and Blue Shield of Kansas City, Health Care Service Corporation, Anthem Blue Cross and Blue Shield, are independent licensees of the Blue Cross Blue Shield Association.

Flexible Content

Prescription Drug Coverage (Part D)

Medicare Prescription Drug plans are offered by private health insurance companies and cover your prescription drug costs for covered medications. 

You can choose to receive this coverage in addition to:

• Original Medicare (Part A and Part B)
• Original Medicare (Part A and Part B) with a Medigap Plan

Part D coverage is generally included in most Medicare Advantage (Part C) plans.

Costs

Limits and Considerations

Limits

Most Part D plans have “formularies,” which are lists of covered prescription drugs. Part D plans also have networks of approved pharmacies in your area.

Things to Consider 

• Costs for Part D plans can vary, so choose a plan that meets your needs and budget.
• Part D insurance premiums may change each year. You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
• Medicare Part D has a low-income subsidy program, and Medicare beneficiaries may qualify for financial assistance with the cost of their medications based upon their income and assets.

Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Parts A or B, you can select other coverage options like a Prescription Drug Coverage (Part D) plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.

How to Enroll

You must be entitled to Part A or enrolled in Part B, and you must live in the designated geography of the plan you want to enroll in before joining a Medicare Part D plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Part D plan and getting enrolled.
 

Open Enrollment Period

October 15 through December 7

Open Enrollment runs from October 15 through December 7 and it provides an annual opportunity for Medicare-eligible consumers to review and make changes to their Medicare coverage. This includes the opportunity to select or make changes to Prescription Drug Coverage (Part D). However, if you elect to receive Part D coverage after your Initial Enrollment Period window closes, a late enrollment penalty may be added to your premium.

Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.