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Empire BlueCross BlueShield is a Medicare Advantage Plan with a Medicare contract. For Dual-Eligible Special Needs Plans: Empire BlueCross BlueShield is an HMO DSNP with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Empire BlueCross BlueShield depends on contract renewal.

Benefits, premiums, copays and plans may vary by county. Medicare Advantage plans may not be available in all counties. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

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CF290 8/2021
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