What is the Blue Medicare PPO Provider Directory?

The Provider Directory is a list of Blue Medicare PPO, a preferred provider health insurance plan, which also includes provider and basic information about how to get your covered services. To get more detailed information about your health care coverage, please see the Evidence of Coverage.

• EOC - Value Plan 
• EOC - Advantage Plan 
• EOC - Premier Plan 

For a Blue Medicare PPO plan provider in your area, please check our comprehensive Texas Provider Directory 

What are plan providers?

Providers is the term we use for doctors, other health care professionals, hospitals, and other health care facilities that are licensed or certified by Medicare and by the state of Texas to provide health care services.

We call them "plan providers" when they participate with our Plan. When we say that plan providers "participate in our Plan," this means that we have arranged with them to coordinate or provide covered services to Blue Medicare PPO members.

Can the Provider Directory change?

Yes. Blue Medicare PPO may add or remove plan providers from our Provider Directory throughout the year. To get the most up-to-date information about Blue Medicare PPO plan providers in your area, please check the Texas Provider Directory.

For questions about the Provider Directory, please call our Customer Service Department at (800) 718-2031, 8 a.m. - 5 p.m., local time, Monday - Friday. For the hearing or speech impaired, please call (888) 844-5530.

How do I find Blue Medicare PPO providers in my area?

The Texas Provider Directory  is separated into sections based on the type of service the plan provider offers. There is also an alphabetical listing of plan providers located in the back of the directory.

Can I use non-plan providers to get covered services?

While you are a member of Blue Medicare PPO you may use either plan providers or non-plan providers. Medicare requires that we have enough in-network plan providers to give you covered services that are medically necessary.

Plan Providers: These are providers who are contracted with Blue Medicare PPO to provide you with health care services. Your out-of-pocket costs will generally be lower if you use plan providers. When you get services from plan providers, we call these "in-network services."

Non-Plan Providers: These are providers that are not part of the Blue Medicare PPO network, i.e., they are not contracted with us. You may use non-plan providers to get your covered services. Although, your out-of-pocket costs may be higher if you use non-plan providers. A health care service you get from a non-plan provider is known as "out-of-network" service. You do not need to get a referral or prior authorization when you get out-of-network care from non-plan providers. However, before getting an out-of-network service, you may want to check with us to see if the services you are getting are covered by Blue Medicare PPO and are considered medically necessary.

To get more detailed information about your health care coverage, please consult the Evidence of Coverage.

When do I use my Membership Card?

As a member of Blue Medicare PPO you will receive a membership card. You must use our membership card for services covered by this Plan and prescription drug coverage at network pharmacies. While you are a member of a Blue Medicare PPO plan, do not use your red, white, and blue Medicare card to get covered services, items, and drugs. Blue Medicare PPO will pay for all of your covered Medicare services.