Blue Cross Blue Shield operates in all 50 U.S. states, Puerto Rico, and the District of Columbia. It provides multiple types of insurance, but this Blue Cross Blue Shield review explores Blue Cross Medicare Advantage plans for 2023 and beyond.
Learn about Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Health Maintenance Organization Point-of-Service plans (HMO-POS), Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs). We discuss the pros and cons of Blue Cross Blue Shield and what to consider when choosing their plans.
Is Blue Cross Blue Shield good insurance?
When exploring Medicare insurance options, you've likely come across Blue Cross Blue Shield, which has provided insurance policies since 1929. Blue Cross Blue Shield Advantage Plans for 2023 offer multiple types of Medicare Advantage coverage and other types of insurance and have garnered positive reviews for their policies. Each individual determines the company most suited to their needs; however, Blue Cross Blue Shield offers plans tailored for almost everyone.
Pros and cons of Blue Cross Blue Shield Medicare plans
Blue Cross Blue Shield's Medicare Advantage plans come in many varieties, with options that vary by region. Their policies generally share many benefits offered under Medicare Advantage, and many come with $0 premiums (aside from the Part B premium costs). The following are advantages and disadvantages a new policyholder may encounter when choosing a Blue Cross Blue Shield Medicare Advantage plan.
Blue Cross Blue Shield MA plan types: how does it work?
Blue Cross Blue Shield offers a variety of Medicare Advantage plans. The options presented here vary by factors such as whether the plan will provide out-of-network coverage, primary care physician selection, and physician referrals to specialists. Some plans will include Part D prescription coverage and some plans will not.
Preferred Provider Organization (PPO) plans allow you to obtain services from in-network providers at lower costs, and you can see out-of-network providers for higher costs. Plans typically don't require choosing primary care doctors or getting referrals to see specialists. Most PPO plans cover Part D medications, but you cannot join a standalone Part D plan in the instance that your PPO does not cover medications.
Health Maintenance Organization (HMO) plans generally don't provide coverage for seeing healthcare providers outside the plan's network (except for emergencies). Most HMOs require selecting a primary care physician and having referrals to see specialists. Most HMO plans include Part D prescription drug coverage, but if it does not, recipients are not able to enroll into a separate Part D plan, because if they do, CMS disenroll them from the Medicare Advantage plan.
Health Maintenance Point-of-Service (HMO-POS) plans operate similarly to standard HMO plans but offer the ability to get coverage for seeing out-of-network providers. This option allows individuals flexibility to see out-of-network providers, but will increase cost sharing.
Private Fee-For-Service (PFFS) plans allow you to see any Medicare-accepting provider that accepts the plan's payment terms which they can decide on a case-by-case basis. Some PFFS plans cover prescriptions, but you can join a separate Part D plan if your plan doesn't. If your plan includes a provider network, you can see the providers who have agreed to treat members per the plan's terms.
Special Needs Plans (SNPs) are designed for groups of individuals with special needs due to serious health problems requiring institutional care or because they also qualify for Medicaid. Some SNPs allow for out-of-network coverage. Not all SNPs require selecting a primary care doctor or needing referrals to see specialists. All SNPs offer prescription drug coverage. The types of SNPs include:
- Chronic condition SNPs (C-SNPs). This is for individuals with severe and chronic medical conditions, such as end-stage renal disease (ESRD), HIV/AIDS, multiple sclerosis, or amyotrophic lateral sclerosis (also known as Lou Gehrig's disease).
- Dual eligible SNPs (D-SNPs). Individuals who qualify for Medicare and Medicaid can enroll in D-SNPs. If you are considering this, you are encouraged to contact your state Medicaid office to determine eligibility.
- Institutional SNPs (I-SNPs). Those living in institutional facilities, such as nursing homes, can join I-SNPs. This eligibility also extends to those who receive private nursing care in their homes.
Blue Cross Blue Shield Medicare Advantage benefits
This list features the expected benefits of Blue Cross Blue Shield's Medicare Advantage plans. However, some plans will vary when it comes to certain features:
- Annual out-of-pocket limit. Policyholders who spend a certain amount on medical care won't have any out-of-pocket costs for the remainder of the year.
- Dental, vision, and hearing. These aren't covered under Original Medicare, but they are covered in certain Medicare Advantage plans.
- Part B Premium Reduction. Some Medicare Advantage plans may rebate a portion or entirety of your Part B premium.
- Bundled coverage. Medicare Advantage provides inpatient and outpatient coverage within the same plan.
- Built-in prescription coverage. Many of Blue Cross Blue Shield's Medicare Advantage plans include prescription coverage as part of its bundled coverage.
- Wellness programs. These assist with incorporating healthy lifestyle changes to help reduce the chances of developing certain health complications.
How much are the Blue Cross Blue Shield Medicare Advantage plans?
Blue Cross Blue Shield Medicare Advantage plans are offered through private insurers, and costs will vary depending on your county and zip code. The following are sample Blue Cross Blue Shield Medicare Advantage plans, examples of the premium and out-of-pocket maximum costs of PPOs, PFFS plans, HMO-POS plans, HMOs, and SNPs.
These rates are based on costs for the upcoming year for those who do not receive other forms of assistance from federal or state programs, except for Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) from Blue Cross and Blue Shield of Texas, which is reserved for those who are eligible for both Medicare and Medicaid.
|Plan type - BCBS plan sponsor||County (Zip code)||Premiums||Annual out-of-pocket maximum|
|Blue Advantage Freedom (PPO) - Blue Cross Blue Shield of Tennessee||Bradley (37312)||$0||$3,200 (in-network); $5,750 (in-network and out-of-network combined)|
|Blue Medicare Value (PFFS) - Arkansas Blue Cross Blue Shield||Jefferson (72079)||$39||$7,500 (in-network and out-of-network combined)|
|Blue Cross Medicare Advantage Premier Plus (HMO-POS) - Blue Cross Blue Shield of Illinois||Cook (60601)||$76||$3,500 (in-network)|
|Anthem Veteran Select (HMO) - Empire Blue Cross Blue Shield||New York (10001)||$0||$6,700 (in-network)|
|Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) - Blue Cross Blue Shield of Texas||Dallas (75202)||$0||$8,850 (in-network)|
Blue Cross Blue Shield reviews and ratings
Since Blue Cross Blue Shield is a private insurer offering coverage in multiple states, the ratings will vary depending on the plan. For instance, Minnesota, North Carolina, and Tennessee have Blue Cross Blue Shield plans, but each has a different Medicare Star rating. North Carolina has a Medicare Star rating of 3/5 (an average score), while Minnesota and Tennessee have 4.5/5 and 5/5-star ratings, indicating excellence.
JD Power ratings may best convey Blue Cross Blue Shield's quality of Medicare Advantage policies. A 2022 study found that Blue Cross Blue Shield's health plans were the highest rated in 12 of the 22 regions in the study. In 2023, Blue Cross Blue Shield's Medicare Advantage plans in Texas and New York ranked highest among other Medicare Advantage plans.
What to consider when choosing a Blue Cross Blue Shield Medicare Advantage plan
The following are areas in which Blue Cross Blue Shield's Medicare Advantage plans may differ. Not all plans will have these features, and if a particular feature is essential to you, it is best to discuss this with the insurer before enrollment.
- Dental, vision, and hearing. Many Medicare Advantage plans provide coverage for dental, vision, and hearing aids, which are services that are not covered in Original Medicare (Parts A and B).
- Out-of-network coverage. Coverage for seeing an out-of-network provider may be one of the most significant determining factors for enrolling in a plan. If there is a provider you prefer to see who isn't in the plan's network, you may want to consider a policy that allows for out-of-network coverage.
- Whether your healthcare provider is in your plan's network. Out-of-network coverage may not be a priority if your provider is in a plan's network. In this case, a policy offering coverage for in-network providers may be a solid choice.
- Prescription coverage. Many Medicare Advantage plans cover prescriptions, but not all plans cover the same medications. Consider whether your medications are included when choosing a plan with prescription coverage.
Many of Blue Cross Blue Shield's Medicare Advantage plans are highly rated and popular among those enrolled. From out-of-network coverage to built-in medication coverage and additional benefits not seen in Original Medicare, it's easy to see why Blue Cross Blue Shield has attained such popularity and acclaim.
How do I know if I have Medicare Advantage?
Medicare Advantage is only available through private insurance. If you have a Medicare Advantage plan, it will have network-based coverage and may be referred to as a type of health insurance policy (e.g., HMO, PPO, or PFFS) instead of simply "Medicare."
What is the biggest disadvantage of Medicare Advantage?
The biggest disadvantage of Medicare Advantage may be in how plans can vary in costs, benefits, and selection based on zip codes and counties. Individuals are limited to plans offered within a certain area, which may not have the same quality of selection as what is offered in other zip codes and counties.
What is the most expensive Medicare plan?
This will depend on the area you live. In general, monthly rates have an inverse relationship with deductibles, out-of-pocket maximum costs, and coinsurance costs. The higher the premium, the lower your other costs will usually be. If your premium is lower than other plans, you'll likely have higher deductibles, annual out-of-pocket maximum expenses, and coinsurance costs.
- Medicare. Medicare & You 2024.
- Blue Cross Blue Shield. 2023 Medicare Advantage and Prescription Drug Plans Offered by Blue Cross and Blue Shield Companies.
- Blue Cross Blue Shield. Comparing & Combining Medicare Options.
- JD Power. Normalizing Utilization and Pivot to Value-Based Care Delivery Models Present Opportunities for Employer-Sponsored Health Plans, J.D. Power Finds.
- Blue Cross and Blue Shield of North Carolina. 2024 Medicare Star Ratings.
Show all references
- JD Power. For Medicare Advantage Plans, Trust and Problem Resolution Closely Associated with Likelihood to Renew, J.D. Power Finds.
- Medicare. BlueAdvantage Freedom (PPO).
- Medicare. BlueMedicare Value (PFFS).
- Medicare. Blue Cross Medicare Advantage Premier Plus (HMO-POS).
- Medicare. Anthem Veteran Select (HMO).
- Medicare. Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP).