Medicare Member Resources
Customer service and guidance
We are here step by step to help you manage your plan, understand your benefits, and more.
Medicare Advantage Plans
Speak with an expert today.
If you’re not sure which number to call, check your Blue Shield member ID card.
Medicare Advantage members
(800) 776-4466 (TTY: 771)
8 a.m. to 8 p.m., seven days a week
Medicare Advantage members in the California Public Employees Retirement System (CalPERS)
(888) 802-4599 (TTY: 771)
7 a.m. to 8 p.m., seven days a week
Medicare Advantage members in the San Francisco Health Service System (SFHSS)
(800) 370-8852 (TTY: 771)
8 a.m. to 8 p.m., seven days a week
Need help getting care?
Care Navigators work with doctor’s offices to find earlier appointments and help resolve prior authorizations.
Call 8 a.m. to 4:30 p.m., Monday through Friday
Medicare + Medi-Cal (D-SNP)
For members who qualify for both Medicare and Medi-Cal.
Dual Eligible Special Needs Plans (D-SNP)
(800) 452-4413 (TTY: 771)
8 a.m. to 8 p.m., seven days a week
Need help getting care?
Care Coordinators can help with appointments, in-home care, prior authorizations and more.
Call 8 a.m. to 6 p.m., Monday through Friday
Medicare Supplement or Prescription Drug Plan (PDP)
For members who purchased a Medicare Supplement and/or Prescription Drug Plan (PDP) plan for extra coverage for Original Medicare.
Medicare Supplement Plan
(800) 248-2341 (TTY: 771)
8 a.m. to 8 p.m., seven days a week
Prescription Drug Plan
(888) 239-6469 (TTY: 771)
8 a.m. to 8 p.m., seven days a week
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Frequently asked questions from Medicare members
How do I register for an online account or get the app?
An online account makes it easier to manage your plan:
You can:
• Download your digital Blue Shield member ID card
• Check your benefits and costs
• Find doctors and specialists
• See all your health records and perscriptions in one place.
The app makes accessing your account easier when you are on the go. It’s the same information, but on your smartphone. It's available for both iOS and Android.
What is a referral and when do I need it?
A referral is a request for an appointment from your primary care provider (PCP) to a specialist. A specialist is a provider who focuses on a specific disease or part of the body such as a heart doctor, surgeon or physical therapist:
When do I need a referral?
• If you have an HMO plan, you'll need a referral from your PCP to see a specialist.
When do I NOT need a referral?
• If you have a PPO plan
• To receive emergency or urgent care
How does a referral work?
Referrals are often initiated during a visit with your PCP. You can also contact your provider to request a referral. Your provider will then send a referral to the specialist's office with relevant medical information.
Referrals may take a few days to be processed. The best way to know the status of your referral is to call your provider's office. Ask for the phone number of the specialist so you can call to make an appointment after the referral has been processed.
What if the specialist I'm referred to is booked?
Your provider may refer you to a specialist that has a very busy schedule. In this case, call Customer Service. We can help you find appointments with other specialists to get you care sooner.
What is a prior authorization and how do I track it?
Prior authorization is a request for pre-approval of certain tests, procedures, medical equipment, and medications ordered for you. Your provider must get that approval from Blue Shield before they proceed.
The Blue Shield team will review the prior authorization request to ensure that Medicare covers everything and that the care meets the best available clinical research. Without this pre-approval, Blue Shield may not pay for your medication or medical procedure. You will then have to pay out of pocket.
Who starts the prior authorization process?
Typically, your provider starts the process by submitting a request on your behalf. It will include details about your diagnosis and why the service or medication is needed. Prior authorizations usually take 1 to 3 days.
To know if your prior authorization has been processed, you have two options:
• Log in to your account. Under the "myblueshield" dropdown menu, select "Prior authorization." Here you can see a list of all prior authorization requests, as well as those that Blue Shield has approved.
• Call Customer Service or your doctor's office. They can help determine the status of your prior authorization. If you need help moving a prior authorization along call Customer Service to help.
What if my prior authorization is denied?
You have the right to appeal if Blue Shield denies your prior authorization request.
Learn more about Appeals and Grievances
Y0118_24_702B1_C 12262024
H2819_24_702B1_C Accepted 12312024
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For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.
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Medicare has neither reviewed nor endorsed this information. Blue Shield of California is an HMO, HMO D-SNP, PPO, and PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.