Find Your Doctor, Hospital & Pharmacy
With our plans, you have access to thousands of doctors, hospitals and pharmacies:
- Find a Participating Doctor or Specialist
- Find a Participating Hospital or Facility
- Find a Participating Dentist
- Find a Participating Pharmacy
- View or Print Our Provider and/or Pharmacy Directories
The pharmacy network and/or provider network may change at any time. You will receive notice when necessary.
Medicare Advantage plans have network providers. These are the doctors and other healthcare professionals, medical groups, hospitals and other healthcare facilities that have an agreement with us to accept payment and any plan cost-sharing as payment in full. We have arranged with these providers to deliver covered services to members in our plan.
Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis.
- If You Select an HMO Plan...
With an HMO, you must select one of our participating providers as your Primary Care Physician. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from Out-of-Network providers neither Medicare nor Excellus BlueCross BlueShield will be responsible for the costs. See your Evidence of Coverage for more information. Generally, with an HMO, you pay copayments, coinsurance and deductibles for most services.
- With an HMO Point-of-Service (POS) Plan... you have the extra flexibility to get some covered services from doctors, hospitals, labs or other health care providers that are not in our provider network without paying the entire cost yourself. An annual dollar limit applies to this benefit. Once your costs go above this limit you’re responsible for 100% of the remaining costs for the out-of-network services.
- If You Select a PPO Plan...
With a PPO, you don’t need to select a Primary Care Physician. You have access to both In- and Out-of-Network providers and you may see any Medicare participating provider. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in emergencies or urgently needed care. You do not need a referral or prior authorization (prior approval) when you get care from Out-of-Network providers; however, before getting services from Out-of-Network providers you may want to confirm with us that the services you are getting are covered and are medically necessary. Your cost sharing responsibility will be greater Out-of-Network when your Out-of-Network coinsurance is based on the Medicare allowed amount and our In-Network provider contract rate for the service is lower than the Medicare allowed amount.
- For HMO-POS and PPO Plans...
Out-of-network/non-contracted providers are under no obligation to treat Excellus BlueCross BlueShield members, except in emergency situations. Please call our Customer Care number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
A network pharmacy is a pharmacy that is contracted to participate in our network to provide you with covered prescription drugs. Our network has contracts with pharmacies that equal or exceed the CMS requirement for pharmacy access in your area. Our pharmacy network includes retail, home delivery, long-term care, home infusion, and Indian/Tribal/Urban pharmacies.
There are 65,000 pharmacies participating in our nationwide pharmacy network. The network also includes 35,000 pharmacies that are considered preferred pharmacies. You will save money using a preferred pharmacy because your copays will be lower for prescriptions on tiers 1 through 4. There will be a higher copay for prescriptions on tiers 1 through 4 (on average $5 more for each tier) if a standard pharmacy is utilized. 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 preferred pharmacies in your area, please call 1-877-883-9577 (TTY: 1-800-662-1220), consult the online pharmacy directory at ExcellusMedicare.com/Providers (which is shown above), or search for your pharmacy with our online toolLink to an External Website.
Generally, you must use network pharmacies to get your prescription drugs covered, except under non-routine circumstances, and quantity limitations and restrictions may apply.
We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:
- If the prescriptions are related to care for a medical emergency or urgently needed care.
- If you are unable to get a covered prescription drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
- If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).
In these situations, please check first with our Pharmacy Help Desk to see if there is a network pharmacy nearby.
For information on network coverage, how to request reimbursement for Out-of-Network claims, Out-of-Network Coverage or Coverage Determinations and Appeals call Customer Care at 1-877-883-9577, Monday – Friday, 8 a.m. to 8 p.m.; From October 1 through March 31, 8 a.m. to 8 p.m., 7 days a week. (TTY/TDD 1-800-662-1220). Or see the Evidence of Coverage for more information.
Monday - Friday:
8 a.m. to 8 p.m.
From Oct. 1 - Dec. 30:
advisors are also available weekends 8 a.m. to 8 p.m.
Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day
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Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_7465_C.
This page last updated 10-01-2020.