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*From Oct. 1 to Dec. 30, representatives will be available seven days a week from 8 a.m. to 8 p.m. (TTY/TDD users call 1-800-662-1220).

$0 Premium Plans not available in all areas.

1$0 Tier 1 generics and select vaccines when you use a preferred pharmacy

2Applies to prescription drugs in Tier 1 through Tier 4.

3Copays may apply.

4Preventive dental services are 2 cleanings, 2 oral exams and 2 bitewing x-rays per year.

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Excellus BlueCross BlueShield contracts with the Federal Government and 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

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Date Last Updated 10/1/2021
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