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Medicaid

BlueCross BlueShield of Western New York can help you get the most out of your Medicaid benefits. Get vision care, dental benefits, prescriptions, mental health services and more! See doctors and pick up prescriptions close to home. Use our 24/7 NurseLine to get reliable medical advice any time, day or night.

Your health is important to us. That’s why you get important care and services like:
  • A primary care provider (PCP) to help you get the care you need.
  • Prescriptions*.
  • Wellness visits and immunizations.
  • Specialty physician services.
  • Substance use treatment.
  • Psychiatric services.
  • Disease management for asthma, diabetes and more.
  • Smoking cessation.
  • Coping, crisis prevention, stress management, and life skills training.
  • Family support training.

*Copays may apply for medications. There are no copays for services that are part of your benefits.

Frequently asked questions

How do I get help after my primary care provider’s (PCP) office closes?

Unless it’s a life-threatening emergency, do not go to the emergency room (ER). Instead, call the 24/7 NurseLine at 1-866-231-0847 (TTY 711) to talk to a nurse any time, day or night. Our nurses can answer questions about your health or help you find an urgent care facility near you.

Can I call my specialist’s office directly to set up an appointment?

Your PCP will refer you to a specialist. If you need specialist services you can’t get from a BlueCross BlueShield plan doctor, we’ll work with your PCP to refer you to an out-of-plan specialist. Your PCP must call BlueCross BlueShield at 1-866-231-0847 (TTY 711) to request approval for an out-of-plan referral.

My plan has dental benefits. How do I choose a dentist?

If you need to find a dentist, please call Liberty Dental toll free at 1-833-276-0846 (TTY 1-877-855-8039) Monday through Friday from 8 a.m. to 8 p.m. Eastern time. You can also call Member Services at 1-866-231-0847 (TTY 711). When you visit your dentist, you should show your plan ID card.

How do I get a copy of the BlueCross BlueShield provider directory?

Please call Member Services at 1-866-231-0847 (TTY 711) and request one. You can also view our provider directory online.

How do I see a doctor who is not a BlueCross BlueShield plan doctor?

Please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time with questions.

Enroll in BlueCross BlueShield

Can I call my specialist’s office directly to set up an appointment?

You need a referral from your PCP to see a specialist.  Learn more about how to get specialty care and referrals.

With BlueCross BlueShield of Western New York, you get extra benefits like:
  • New Baby, New LifeSM — a special program for pregnant women to:
    • Help you have a healthy pregnancy and a healthy baby
    • Provide education and emotional support
    • Give information on services and resources in your community
  • Comprehensive programs for chronic conditions like diabetes, asthma, hypertension, stress management, weight control and more
  • Health home care management

Enroll in BlueCross BlueShield

Your member handbook is your go-to guide for health services. It tells you how you can get the most from BlueCross BlueShield of Western New York. You’ll find answers to these items:

  • Your benefits
  • Your rights and responsibilities.
  • How to get help after your doctor's office closes
  • How to choose a primary care provider
  • Renewing your coverage
  • How to reach Member Services if you have a question

Member Handbook

Notice of Privacy Practices

Quality Improvement Overview

Your pharmacy benefits

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with IngenioRx to provide these benefits.

Your copay for prescriptions is $3 for brand-name drugs and $1 for generic drugs. Members under age 21 and pregnant women do not have copays.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is on the Preferred Drug List (PDL).

Go to Pharmacy page

We offer New York State-sponsored Medicaid programs. BlueCross BlueShield of Western New York will help you get the most out of your Medicaid benefits.

You may be eligible for Medicaid if:
  • You live in one of these counties: Allegany, Cattaraugus, Chautauqua,  Erie, Genesee, Niagara, Orleans or Wyoming.
  • You have high medical bills.
  • You receive SSI — see below.*
  • You meet certain income, resource, age or disability requirements.g.

*If you receive Supplemental Security Income (SSI), you automatically receive Medicaid without the need to apply.

You may be eligible for SSI if you:
  • Are elderly.
  • Are blind.
  • Have a disability.
  • Have a behavioral health condition.

Families who don’t qualify for Medicaid may still get health care for their children.

To find out more about eligibility, visit the New York Medicaid website or call NY State of Health, The Official Health Plan Marketplace at 1-855-355-5777.

Already a member and have questions?

Please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. We are happy to help you with your health care!

Enroll in BlueCross BlueShield

Earn Rewards for Healthy Activities

Members are automatically enrolled in the Healthy Rewards program and earn reward points for making healthy choices. Register or login now to redeem your rewards and learn more about which healthy activities qualify!

New Baby, New Life℠ BlueCross BlueShield Healthy Rewards Incentives
  • Earn 250 points ($25) in rewards for attending a prenatal visit in the first trimester or within 42 days of enrollment into BlueCross BlueShield.
  • Earn 250 points ($25) in rewards for attending postpartum visit 21 to 56 days after delivery.
  • Earn 50 points ($5) in rewards for attending at least six well-child checkups by 15 months of age.

For more information, check online at  www.bcbswny.com/healthyrewards. or call 1-800-749-9036.

Our Quality Standards

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Working with your doctor