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Changes to our plans and benefits for 2020
November 1, 2019

Beginning January 1, 2020, we will make several changes to our health plans and benefits. Because of these changes, it is important to always check your patient’s Blue Cross member ID card and to verify their eligibility and benefits using Online Services, or another similar technology.

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Coverage changes in 2020


We are pleased to announce that Blue Cross members – except Medicare Advantage – will have coverage for acupuncture services beginning on their account anniversary. Federal Employee Program members already have this benefit.

Blue Cross members will now have coverage for 12 acupuncture visits by a contracted licensed acupuncturist each calendar year. Eligible members pay the same cost as a specialist office visit for these services. No referral or authorization is required.

We will allow large employers (100 employees or more) to exclude this coverage or customize the number of covered visits and member cost.


Members seeking lactation counseling services from providers in our local network will be able to use telehealth to increase their access to this service. This service will also be available to out-of-state (BlueCard®) members receiving care in Massachusetts from a provider in our local network.

Large employers (51 employees or more) will be able to offer a lower copay for their members.

To learn more, log in, go to News>Claims, Coding, Payment and look for the November 1, 2019 News Alert: Lactation counseling added to Telehealth payment policy.

New plan designs

Higher deductible plans

To meet employers’ needs for high-deductible plan options, we’re introducing the following new plans:

For employers with fewer than 51 employees For large employers with 51 employees or more
  • Preferred Blue PPO $4,500 Deductible
  • HMO Blue New England $4,500 Deductible*
  • Preferred Blue PPO Saver $4,500
  • HMO Blue New England Saver $4,500
These plans are available with health savings and health reimbursement options
  • Preferred Blue PPO Deductible II
  • HMO Blue New England Deductible II*
  • Preferred Blue PPO Saver II
  • Access Blue New England
    Saver II*

* Authorization for chiropractic services is required for these plans after the initial 12 visits.

New simpler plan

For large employers (51 employees or more), we’re also introducing HMO Blue New England $3,000 Deductible with First $500 Coverage:

  • Blue Cross covers the first $500 of medical services before the deductible applies.
  • The deductible equals the maximum out-of-pocket. Once the deductible is met, all medical services and medication costs are covered at 100 percent.
  • Prescription drugs do not count toward the first $500 coverage. The deductible applies at the first medication fill.
  • Blue Cross will continue to pay full coverage for preventive services, but the cost will not count towards the first $500 coverage amount.
Changes to Medicare Advantage

Prior authorization requirements

Effective January 1, 2020, prior authorization will be required for repetitive transcranial magnetic stimulation (rTMS) services when performed in an outpatient setting using these CPT codes:

  • 90867
  • 90868
  • 90869

Read more.

New opioid treatment benefit

Pending Centers for Medicare & Medicaid (CMS) approval, we’ll cover the following opioid use disorder treatment services when administered through a certified opioid treatment provider enrolled in Medicare:

  • FDA-approved medications for treatment of opioid use disorder and the dispensing and administration of the medications
  • Individual and group therapy with a physician or psychologist
  • Substance use counseling by a professional to the extent allowed under state law
  • Toxicology testing

Opioid treatment programs are certified through the Substance Abuse and Mental Health Services Administration.

Please note that this benefit may become effective on or after January 1, 2020 as directed by CMS.

Hearing aid coverage

Members of HMO Saver, HMO Value, and PPO Value plans now have a $400 hearing aid allowance every three years. This coverage includes the cost of hearing aids, fittings, evaluations, dispensing fees, and repairs. Please bill us for these services first, before charging the member.

Lower cost share

Members of HMO PlusRx, HMO SaverRx, and HMO ValueRx will have lower costs for:

  • Office visits
  • Commonly used services, including urgent care, cardiac rehabilitation, hearing services, outpatient surgery, podiatry, pulmonary, supervised exercise therapy, and vision services
  • Diagnostic labs, procedures, and tests
Changes to Medex

Introducing Medex Sapphire®

Starting January 1, 2020, we will offer a new Medicare supplement plan called Medex Sapphire that will cover member’s co-insurance and Part A deductible. Members will now be responsible for their annual Medicare Part B deductible.

Sample ID Card

A new federal law

Due to changes in the federal law (Medicare Access and CHIP Reauthorization Act), we will no longer offer Medex Bronze® or Medex Choice® to newly eligible beneficiaries as of January 1, 2020. Current members who have these plans can continue with their coverage.

Medication benefit and coverage changes

We are making changes to our members’ medication benefits and formulary coverage. This includes changes to our Medicare Advantage and Blue MedicareRx® formularies, including moving medications to non-covered, tier changes, and more.

To learn more, log in, go to News>Clinical & Pharmacy and look for the August 30, 2019 News Alert: Medication coverage changes.


If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.

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