Blue Cross Blue Shield Medicare Advantage Review
BCBS is a federation of 36 different health insurance companies, including Anthem, CareFirst, Horizon, Premera, Wellmark and others. Collectively, the BCBS companies are the 3rd largest provider of Medicare Advantage plans.
Large provider network
Strong credit ratings
Extensive cost comparison tools
Special needs plans available
Many affordable options
Most plans include drug coverage
Below-average customer satisfaction rating
Higher out-of-network costs
Doesn't offer plans in nine states
Blue Cross Blue Shield (BCBS) is one of the largest, most reliable, and highest-rated insurance carriers in the United States. According to 2020 data from the Kaiser Family Foundation, BCBS provides coverage to about 15 percent of Medicare Advantage's 24.1 million enrollees. This makes BCBS the third largest Medicare Advantage insurer.
Overall, BCBS is known as being a stable, secure company with a wide variety of Medicare Advantage plans. It's also known to have one of the nation's largest provider networks.
BCBS includes 36 independent and locally operated companies and has provided healthcare coverage in the United States for over 80 years. As BCBS is one of the largest networks of providers, an impressive number (approximately 95 percent) of doctors and hospitals nationwide accept BCBS plans. BCBS offers many Medicare Advantage plans rated 4-stars and above according to the Medicare Star Ratings System.
Who recommends Blue Cross Blue Shield?
The individual companies that make up the BCBS family are recognized almost annually for various awards and recognitions. Here are a few recent honors the BCBS family has received:
The J. D. Power and Associates Medicare Advantage study ranked two BCBS plans among the top 10 plans for 2019.
BCBS was ranked as one of the best insurance companies for Medicare Advantage in 2019 by U.S. News and World Reports.
BCBS is accredited by the National Committee for Quality Assurance (NCQA), a nonprofit organization dedicated to improving healthcare quality.
Blue Cross NC was named one of the World's Most Ethical Companies (2012, 2013, 2014, 2016) by The Ethisphere Institute.
BCBS received the Disease Management Accreditation from the NCQA in 2015, 2016, 2017, and 2018.
How does Blue Cross Blue Shield's Medicare Advantage insurance work?
BCBS offers Medicare Advantage plans in 42 states, plus Puerto Rico. BCBS does not offer Medicare Advantage plans in the District of Columbia and the following nine states:
A Medicare Advantage plan replaces your Original Medicare (Parts A and B) coverage. These plans, which are offered by private insurers like BCBS, cover everything Original Medicare does, and often much more. Many Medicare Advantage plans offer prescription drug coverage, along with additional coverage like hearing, vision, and dental services.
With most BCBS Medicare Advantage plans, you'll receive care from a predetermined network of providers. You will also have cost-sharing responsibilities, like premiums, health and drug deductibles, and copays for doctor visits. Some BCBS plans offer $0 premiums, but the overall costs and availability of specific plans vary depending on where you live.
What Medicare Advantage plans does Blue Cross Blue Shield offer?
With 36 affiliates operating in 42 states and Puerto Rico, the options for BCBS Medicare Advantage plans seem nearly endless. While the details, costs, and coverage of each plan will depend on where you live, the majority of BCBS plans fall into two categories: HMOs (health management organizations) and PPOs (preferred provider organizations). Listed below are a few examples:
BlueMedicare Choice PPO (Florida)
If you are a member of this 3.5 star plan you can see preferred, in-network providers at reduced rates, but you can also see out-of-network providers. If you do opt to go to an out-of-network provider, you will owe the difference between the PPO's discounted rate and the out-of-network rate. You would not need to select a primary care physician or obtain a referral to see a specialist.
Monthly premium for 2020: $47.90
Maximum out-of-pocket limit for 2020: $6,500
Includes drug coverage with $250 deductible
This plan receives high ratings for customer service, health screenings, and timely decisions regarding customer appeals. This plan receives low ratings for member experience with the drug plan, statin therapy, and diabetes drug pricing.
Anthem MediBlue Extra HMO (Ohio)
If you are a member of this 4-star plan, you'll be required to receive most of your care from in-network providers. This means you are required to select a primary care physician and obtain a referral to see a specialist. As care from out-of-network providers is not covered at all, you'll pay 100 percent of that provider's cost, with no limit.
Monthly premium in 2020: $20.60
Maximum out-of-pocket limit in 2020: $6,700
Includes drug coverage with $435 deductible
This plan receives high ratings for customer service, mental health coverage, and diabetes care. It receives low ratings for osteoporosis management, its drug plan, and statin therapy.
BlueAdvantage Diamond (Tennessee)
If you are a member of this 4-star PPO plan, you do not need to choose a primary care provider or obtain a referral to see a specialist within the plan's network. If you want to see a provider outside of the plan's network, you'll have to pay the difference between the PPO's discounted rate and the out-of-network provider rate.
Monthly premium in 2020: $216
Maximum out-of-pocket limit in 2020: $3,700
Includes prescription drug coverage with $0 deductible
This plan receives high ratings for member experience, mental health coverage, and care coordination. It receives low ratings for upholding appeals and chronic care management of rheumatoid arthritis.
BCBS Medicare Advantage Special Needs Plans (SNPs)
Blue Cross Blue Shield also offers SNPs. These plans have limited eligibility and are specifically tailored to people with certain diseases or circumstances. These plans fall into three categories at BCBS:
Dual Eligible SNPs for beneficiaries who are eligible for both Medicare and Medicaid. Depending on your level of Medicaid eligibility, you may have lower or no cost-sharing responsibilities.
Chronic Condition SNPs for beneficiaries with particular diseases. These plans contract with providers who specialize in a specific chronic condition. They also offer special formularies with a focused list of covered prescriptions that treat the specific chronic condition. Examples of covered chronic conditions include cancer, dementia, HIV/AIDS, alcohol and drug dependence, cardiovascular disorders, chronic liver disease, stroke, and more.
Institutional SNPs for beneficiaries who live in an institution like a nursing home, or who need nursing care provided in their own home.
How do Blue Cross Blue Shield's Medicare Advantage plans compare to other insurance providers?
BCBS offers such a wide variety of plans, any beneficiary is sure to find something that meets their needs. That said, BCBS plans can have higher deductibles on average, compared with other carriers. And while some BCBS plans get high marks for customer service, it's important to remember you're navigating a large company. For this reason, it can be tough to get the personalized services many beneficiaries are seeking.
BCBS has a comprehensive, user-friendly website and mobile app, which makes it easy for beneficiaries to compare plans, find a provider or pharmacy, file a claim, check claim status, change coverage, and much more. Also worthy of note is that BCBS allows enrollees to go completely paperless. You even gain access to a virtual ID card, so you never have to worry about misplacing it.
What sets Blue Cross Blue Shield Medicare plans apart?
Blue Cross Blue Shield might be the right Medicare Advantage plan provider for you if:
You're looking for drug coverage. Most BCBS Medicare Advantage plans include drug coverage with a low drug premium.
You don't mind sticking within a provider network. Many BCBS plans are HMOs or PPOs, which offer discounts for getting care from in-network providers. In contrast, out-of-network providers can be costly.
BCBS also offers Medicare Advantage enrollees the following extra features:
A free cost comparison tool, enabling you to compare the costs of over 1,600 procedures (more than any other health insurer in the United States)
A rewards plan where enrollees can receive gift cards for completing certain health actions each year (like getting a flu shot or breast cancer screening)
How does pricing work with Blue Cross Blue Shield, and can I get any discounts?
The cost of Medicare Advantage plans have been decreasing for the past several years. The average Medicare premium decreased from $19 to $11 per month between 2018 and 2019, according to the 2019 eHealth, Inc. Medicare Index Report. The average deductible also decreased (from $150 to $130), and the average out-of-pocket maximum decreased from $5,589 to $5,415.
There are also currently more plans with $0 premiums available to more beneficiaries than ever before. In fact, in over one-third of states, $0 premium plans are available in every single county, according to the same eHealth report. Some BCBS plans offer premium assistance to low-income enrollees. If you qualify, you could receive premium assistance to pay 25 percent, 50 percent, or 75 percent of your premium.
How do I know if I am eligible and can enroll in a Blue Cross Blue Shield Medicare Advantage plan?
Are you eligible for Medicare and over 65 years of age? Do you live in the United States or Puerto Rico? If you can answer yes to both of those questions, you can enroll in a BCBS Medicare Advantage plan, provided one is available in your area.
The best time to sign up for a BCBS Medicare Advantage plan is during your Initial Enrollment Period. You can also sign up during the Open Enrollment Period, which runs from October 15 through December 7 each year. If you are already enrolled in a Medicare Advantage plan but want to switch to a different plan, you can do that during Medicare Advantage Open Enrollment, which occurs annually between January 1 and March 31.
Best for network coverage
Multiple plan options available in many locations.
Reliable online experience
BCBS has a comprehensive, user-friendly website and mobile app.
Low drug premiums
Most BCMS plans include drug coverge with a low drug premium.
By: Andrea Bonner
Andrea Bonner is a healthcare writer with more than 10 years of experience covering senior health. She is from the Raleigh-Durham area in North Carolina.