Part D presciption drug plans (also called PDPs) are the most recent addition to Medicare. Part D was created to help people with Medicare be able to afford prescription drugs they may need now or in the future. This coverage can help reduce your costs for medications and is available only from private insurance companies or organizations, such as Florida Blue.
"Stand-alone" prescription drug plans
This is a separate drug plan that you purchase in addition to Original Medicare. Here are the combinations of coverage you can have with a PDP:
- A PDP + Original Medicare
- A PDP + Original Medicare + a Medicare Supplement insurance plan
- Rights and Responsibilities Upon Disenrollment
There are only certain times during the year, or certain situations, when you may voluntarily end your membership from our plans. The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. There are also limited situations where you do not choose to leave, but we are required to end your membership.
If you are leaving our plan, you must continue to get your prescription drugs through our plan until your membership ends.
All members have the opportunity to leave the plan during the Annual Enrollment Period (AEP).
Usually, to end your membership in our plan, you simply enroll in another Medicare prescription drug plan during one of the enrollment periods. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you must ask to be dis-enrolled from our plan. You can make a request in writing to us or you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
If you leave our plan, it may take time before your membership ends and your new Medicare prescription drug coverage goes into effect.
You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy, including through our mail-order pharmacy services.
If you dis-enroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later.
If you receive “Extra Help” from Medicare to pay for your prescription drugs: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.
We must end your membership in our plan if any of the following happen:
- If you do not stay continuously enrolled in Medicare Part A and/or Part B.
- If you move out of our service area.
- If you are away from our service area for more than twelve months. If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area.
- If you become incarcerated (go to prison).
- If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you continuously behave in a way that is disruptive and makes it difficult for us to provide care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will dis-enroll you from our plan and you will lose prescription drug coverage.
We are not allowed to ask you to leave our plan for any reason related to your health.
If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership.
If you have any questions or would like more information on when you can end your membership you can refer to Chapter 8 of you Evidence of Coverage booklet for more details or call Member Services, or you can find additional information in the Medicare & You Handbook.
- Out Of Network Coverage
PDP: We generally cover drugs filled at an out-of-network pharmacy only if you are not able to use one of our network pharmacies (for example, because you are traveling, need emergency or urgent care, or need a drug that it not available at an accessible network pharmacy). Chapter 5 of the Evidence of Coverage provides a full list of situations in which we may cover drugs from an out-of-network pharmacy.
- Interpreter Foreign Language Services
Interpreter services are available to help you to help with questions about our prescription drug plans. To contact an interpreter, please call Member Services. Member Services will connect your call with someone who speaks your language to help you. This service is provided at no additional charge to you.
- Stars Rating Information
- Coverage Determinations
Grievance and Appeals
Florida Blue/Florida Blue HMO wants to ensure our members’ satisfaction. If you are unsatisfied with your prescription drug coverage, please allow us the opportunity to take care of your issue(s). Please contact our Member Services number at 1-800-926-6565. (TTY users should call 1-800-955-8770.) Hours are 8:00 a.m.-8:00 p.m. local time, seven days a week from October 1-February 14, except for Thanksgiving Day and Christmas Day. However, from February 15-September 30, you will have to leave a message on Saturdays, Sundays and Federal holidays. We will return your call within one business day.
Below is information about your member rights to file a grievance about your prescription drug services.
We appreciate the opportunity to resolve any issues you may have with your BlueMedicare Prescription Drug plan.
If you would like to find out the total number of grievances, appeals and exception requests Florida Blue/Florida Blue HMO and Florida Blue Preferred HMO members have filed with us, please call our Member Services Department. Florida Blue/Florida Blue HMO members: Call 1-800-926-6565 (TTY 1-800-955-8770). We are open from 8:00 a.m. – 8:00 p.m. local time seven days a week from October 1 – February 14, except for Thanksgiving and Christmas. From February 15 – September 30, we are open from 8:00 a.m. – 8:00 p.m. local time Monday – Friday, except for Federal holidays. Florida Blue Preferred HMO members: Call 1-844-783-5189 (TTY 1-800-955-8770). We are open from 8:00 a.m. – 8:00 p.m. local time seven days a week.
If you would like a friend, relative, your doctor or other provider, or other person to be your representative to ask for a coverage decision or make an appeal, please call Member Services.
Florida Blue/Florida Blue HMO members call 1-800-926-6565, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week from October 1 - February 14, and closed Federal Holidays except for Thanksgiving and Christmas. From February 15 - September 30, we are open Monday - Friday 8 a.m. - 8 p.m. local time, except for Federal holidays.
Florida Blue Preferred HMO members, please call 1-844-783-5189, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week.
Ask for the “Appointment of Representative” form. (The form is also available on Medicare’s website via the link below). The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must send us a copy of the signed form. Instructions on where to send the form are included in the form.
- CMS Appointment of Representative Form
- Grievance, Organization Determination and Appeals Process Health (PDF)
English | Spanish
- Grievance, Coverage Determination and Appeals Process Rx (PDP) (PDF)
English | Spanish
- BlueMedicare Grievance and Appeal Form (PDF)
What Is This?
- BlueMedicare HMO and BlueMedicare PPO Medicare Reconsideration Request (PDF)
What Is This?
- BlueMedicare Preferred HMO-Grievance, Organization Determination and Appeals Process (PDF)
- BlueMedicare Preferred HMO Grievance and Appeal Form (PDF)
What Is This?
- CMS Appointment of Representative Form
- Service Areas
- Appointment of Representatives
You can ask someone to act on your behalf. If you want to, you can name another person to act for you as your “representative” to ask for an organization decision, coverage decision or make an appeal.
- There may be someone who is already legally authorized to act as your representative under State law.
- If you want a friend, relative, your doctor or other provider, or other person to be your representative, call Member Services and ask for the “Appointment of Representative” form. (The form is also available on Medicare’s website at http://www.cms.hhs.gov/cmsforms/downloads/cms1696.pdf.) The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must give us a copy of the signed form.
- You also have the right to hire a lawyer to act for you. You may contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services if you qualify. However, you are not required to hire a lawyer to ask for any kind of coverage decision or appeal a decision.
- Medication Therapy Management Program (MTMP)
- Extra Help/LIS information
Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. This “Extra Help” also counts toward your out-of-pocket costs.
People with limited income and resources may qualify for “Extra Help.” Some people automatically qualify for “Extra Help” and don’t need to apply. Medicare mails a letter to people who automatically qualify for “Extra Help.”
You may be able to get “Extra Help” to pay for your prescription drug premiums and costs. To see if you qualify for getting “Extra Help,” call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
- The Social Security Office at 1-800-772-1213, between 7 am to 7 pm, Monday through Friday. TTY users should call 1-800-325-0778 (applications); or
- Your State Medicaid Office at 1-800-772-1213, between 7:00 am to 7:00 pm, Monday through Friday. You can use Social Security’s automated telephone services to get recorded information and conduct some business 24 hours a day. TTY users should call 1-800-325-0778.