Members’ Most Frequently Asked Questions…And Answers

Spring Issue

It’s not uncommon to have questions about your Medicare benefits. In fact, here are 10 questions that we get the most.


1. I’ve received a bill from my provider. Do I pay or do I wait for Blue KC notification? 

First, be sure your provider has your 2021 insurance information. Then wait until you receive an Explanation of Benefits (EOB) from Blue KC. It shows you the patient responsibility portion you owe, if any.

2. What do I do if I think a provider is billing for services I did not get? 

Call your provider for an explanation of the bill. You may also call Blue Medicare Advantage Customer Service. If you are not satisfied with your provider’s explanation, you can call the Medicare Advantage Compliance and Fraud, Waste and Abuse Hotline 1-844-227-1790 or report it on-line at

3. How can I find out if a service or procedure is covered by my plan?

Review your Summary of Benefits and Evidence of Coverage documents. These documents can be found in the Plan Benefits section on If you cannot find the service or procedure listed in these documents, Blue Medicare Advantage Customer Service is here to help. Your provider may also be able to help you determine whether a service or procedure is covered by your plan.

4. How do I know if my doctor is in-network?

To find a provider go online at and search by provider name or specialty, download a provider directory, or call Blue Medicare Advantage Customer Service for a copy.

5. How do I use my Over-the-Counter (OTC) benefit? *This benefit varies by plan. 

Members receive over-the-counter (OTC) benefits through our partner program, Healthy Benefits Plus. Your OTC benefit allowance will be automatically loaded onto your card and expires at the end of the allowance period, typically monthly. Use it like a debit or gift card to buy non-prescription drugs and everyday health-related items.

Having trouble with your card? Don’t worry. Just pay for your supplies and send us your receipt with your member information and we will reimburse you.

There are several ways to use your benefit. Call 1-833-832-7308; shop online at; in person at Walmart, Hy-Vee or CVS stores; or you can mail us your receipt for reimbursement.

6. Are my prescriptions covered?

To see if your medications are covered by your plan you can access the formulary search tool or you may download the 2021 Formulary, both available at and on your member portal at You may request a copy of the 2021 Formulary by calling Customer Service.

7. How do I give permission to Blue KC to speak to someone else on my behalf?

Call Blue Medicare Advantage Customer Service. They can assist you with the required documents so someone else can speak on your behalf.

8. How can I tell if a procedure requires a prior authorization?

Ask your care provider. Your provider will obtain prior authorization for any procedure that requires it.

9. What Durable Medical Equipment (DME) is covered by my plan?

You and your care provider should discuss your medical needs and the provider can submit for approval through your plan.

10. Who should I call if I have any more questions?

Contact Blue Medicare Advantage Customer Service at 1-866-508-7140 (TTY 711). Your hometown team is available seven days a week, 8 AM to 8 PM. You may receive a messaging service on weekends and holidays from April 1 to September 30. Please leave a message and your call will be returned the next business day.

And remember, no question is ever too big, or too small, to ask.