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What is Medicare?
Medicare is a federal health insurance program that offers coverage for:

  • People aged 65 and older
  • Certain disabled people under age 65
  • Anyone with kidney failure

The program is managed by the Centers for Medicare & Medicaid Services.
What is a Medicare Advantage Plan (Medicare Part C)?
Part C is known as Medicare Advantage. It’s an alternative to Parts A and B which bundle several coverage types, including Parts A, B, and D. It may also include Vision, Hearing, and Dental Insurance. You must sign up for Part A or Part B before enrolling in a Medicare Advantage plan.

Medicare Part C is a CMS-approved health coverage option that is provided by private insurance under contract with the CMS.
  • CMS must approve your enrollment into a CalPERS Medicare Advantage plan.
  • If CMS disenrolls or rejects your CalPERS Medicare Advantage plan enrollment, your CalPERS health coverage may be cancelled.

If you are ready to enroll in Medicare and Blue Shield of California, Visit here. or myCalPERS, or call 1-888-CALPERS (1-888-225-7377) .
When am I eligible?
You will receive a notification from CalPERS four months prior to the month you or your dependent turns 65.

  • This notification informs you of CalPERS requirements to continue your health coverage along with Medicare enrollment and eligibility information.
  • If you are eligible for premium-free Medicare Part A, you must enroll in Medicare Part A and Part B and transfer to a CalPERS Medicare health benefits plan.
Blue Shield Medicare (PPO)
Offers comprehensive medical and prescription drug coverage (Part D).
Blue Shield Medicare (PPO) highlights:
  • $0 copayment for 24/7 virtual care through NurseHelp 24/7 and Teladoc.
  • $80 quarterly allowance for over-the-counter items such as allergy medicines, pain relievers, and more†.
  • Personal Emergency Response System (PERS) from LifeStation®.
  • Transportation (Non-Medicare covered) to plan-approved health related locations.
  • Basic gym access through SilverSneakers® Fitness, to help you stay healthy.
Medicare prescriptions drug coverage (Part D) highlights:
  • Convenient access to an extensive pharmacy network including Safeway/Vons, Costco and CVS (including CVS Pharmacy® in Target stores).
  • Get 90-day refills for covered drugs for the cost of two 30-day copayments from select pharmacies.
  • $1,000 mail service out-of-pocket maximum. See the plan’s Evidence of Coverage for more details.

Pharmacy resources

Plan features
Blue Shield Medicare (PPO) with Optional Supplemental Vision & Dental benefits
Offers comprehensive medical and prescription drug coverage (Part D). This plan is only offered to public agency and school employees.
Blue Shield Medicare (PPO) highlights:
  • $0 copayment for 24/7 virtual care through NurseHelp 24/7 and Teladoc.
  • $80 quarterly allowance for over-the-counter items such as allergy medicines, pain relievers, and more†.
  • Personal Emergency Response System (PERS) from LifeStation®.
  • Transportation (Non-Medicare covered) to plan-approved health related locations.
  • Basic gym access through SilverSneakers® Fitness, to help you stay healthy.
Medicare prescriptions drug coverage (Part D) highlights:
  • Convenient access to an extensive pharmacy network including Safeway/Vons, Costco and CVS (including CVS Pharmacy® in Target stores).
  • Get 90-day refills for covered drugs for the cost of two 30-day copayments from select pharmacies.
  • $1,000 mail service out-of-pocket maximum. See the plan’s Evidence of Coverage for more details.
Optional Supplemental vision & dental highlights:
  • Monthly $39.14 plan premium.
  • Access to in-network and out-of-network providers.
  • $0 copayment for oral exams & routine cleanings (once every 6 months).
  • $0 copayment for routine eye exam (once every 12 months).
  • $70 eyewear and $105 contact lens allowance (once every 24 months).

Pharmacy resources

Plan features
How to access care
Your Blue Shield Medicare (PPO) plan gives you flexibility and choice. You have the option to see doctors and other healthcare providers in the Blue Shield network as well as any Medicare participating providers for the same cost share.
In-Network Providers
Are doctors, medical groups hospitals, and other healthcare facilities that have an agreement with us to deliver covered services to members in our plan.

  • If you are an existing patient, the doctor or healthcare providers must continue to see you.
  • If you are not an existing patient and the doctor or healthcare provider is not accepting any new Medicare patients, they may choose not to see you.
  • You will only pay your plan’s copayment or coinsurance. Your doctor or healthcare provider will bill us for the rest of the cost of your covered services.


Out-of-Network Providers
Are doctors, medical groups hospitals, and other healthcare facilities that do not have an agreement with us to deliver covered services to members in our plan.

  • You may see any out-of-network doctor or healthcare provider that participates in Medicare and is willing to treat you and bill us.
  • If your doctor is not willing to accept the plan, we are happy to contact them to explain how the plan works.
  • You will pay your plan’s copayment or coinsurance. We will pay the rest of the cost of your covered services including any excess charges to the limit set by Medicare.
  • Please note: Some doctors may refuse to bill us and may ask that you pay the full allowable amount yourself. If you pay the doctor, you can submit a claim to us for reimbursement.
If you have more questions about how your plan works or how to submit a claim, call CalPERS Shield Concierge at (888) 802-4599 (TTY 711), 7 a.m. to 8 p.m., seven days a week.

In-network, Out-of-network, and Global provider resources


* These discount program services are not a covered benefit of your Blue Shield Medicare plan and none of the terms or conditions of the Blue Shield Medicare plan apply. The networks of practitioners and facilities in the discount programs are managed by external program administrators, including any screening and credentialing of providers. Blue Shield does not review the services provided by discount program providers for medical necessity or efficacy, nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products. Some services offered through the discount program may already be included as part of the Blue Shield Medicare covered benefits. Members should access those covered services prior to using the discount program. Members who are not satisfied with products or services received from the discount program may use the grievance process described in their Evidence of Coverage.

Blue Shield of California is a PPO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Blue Shield of California offers individual and employer group retiree plans to Medicare beneficiaries who have Part A and Part B. Individual plans are open to all Medicare beneficiaries who reside within a plan’s specific service area. Employer group retiree plans are open only to Medicare beneficiaries who are eligible group retirees and who reside within a plan’s specific service area. Individual and employer group retiree plans have different service areas, benefits and provider networks.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

+You can place two orders per quarter and cannot roll over your unused allowance into the next quarter. Some limitations may apply. Refer to the OTC catalog for more information.

Blue Shield of California’s pharmacy network includes limited lower-cost, pharmacies with preferred cost sharing in certain counties within California. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost pharmacies with preferred cot sharing in your area, please call Customer Service at the phone number listed on your id card, (TTY: 711), 8 a.m. to 8 p.m., seven days a week, or consult the online pharmacy directory at blueshieldca.com/medpharmacy2024.

Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities.

NurseHelp 24/7 and LifeReferrals 24/7 are service marks of Blue Shield of California.

SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers LIVE, SilverSneakers On-Demand and SilverSneakers GO are trademarks of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved
©2023 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc Health, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA-controlled substances, non-therapeutic drugs, and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Your network providers may offer telehealth and in-office services. Contact your primary care provider, treating specialist, facility, or other health professional to learn whether telehealth is an option. Network telehealth and in-person services are subject to the same timely access to care standards. If your plan has out-of-network benefits they are subject to your plan’s cost sharing obligations and balance billing protections.

The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律，並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。

Page Last Updated 09/13/2023
H4937_23_338A_C 09132023