Blue Cross Blue Shield Medicare Advantage Review
Blue Cross Blue Shield (BCBS) offers a large variety of Medicare Advantage (MA) plans in 41 states.1 Overall, the Blue Cross Blue Shield network is the third-largest provider of Medicare Advantage plans nationally, capturing a 15% share of the market.2
Blue Cross Blue Shield isn’t a traditional health care company—it exists as an association of 36 independent companies that operate under the BCBS license. It’s not unlike a franchise, such as McDonald’s or 7-Eleven, only its companies offer health care services instead of Big Macs and Slurpees.
Blue Cross Blue Shield may go by different names depending on which company owns the license in that area—Premera, Anthem, CareFirst, Regence, Wellmark, Horizon, Empire, Excellus, Capital, Highmark, or Independence are all names you may see associated with the brand. No matter what they go by, you’ll likely still see a “Blue Cross” and/or “Blue Shield” or even just “Blue” thrown in.
Is a Blue Cross Blue Shield Medicare Advantage plan right for you?
As a collection of so many companies with regional differences, it’s hard to pinpoint any generalities across the board with BCBS plans. But overall, it can be a good option for a lot of people in quite a few different circumstances:
- Fans of HMOs and PPOs: The vast majority of BCBS plans fall into these two categories.
- SNP plan recipients: Quite a few states offer SNP plans from BCBS, either for dual eligible (people who qualify for Medicare and Medicaid) or for those who have diabetes, COPD, or other chronic conditions.
- People who need drug coverage: Many BCBS plans include creditable drug coverage.
- SilverSneakers enthusiasts: BCBS plans frequently come with a SilverSneakers program membership.
- Puerto Ricans: BCBS has nine plans in Puerto Rico, including four SNPs.
States Blue Cross Blue Shield serves
BCBS offers Medicare Advantage plans in 41 states. BCBS does not currently offer MA plans in the following places:
- North Dakota
- South Dakota
- Washington, DC
Blue Cross Blue Shield Medicare Advantage policies
Blue Cross Blue Shield offers a large variety of plans, with the vast majority consisting of HMOs and local PPOs. In specific locations, there are quite a few plans to choose from, including SNP plans.
Blue Cross Blue Shield HMO Medicare Advantage plans
In an HMO plan, you can see doctors, hospitals, or specialists within the specified network only, except in case of emergencies. These plans typically require a doctor’s referral before seeing a specialist.
Blue Cross Blue Shield's HMO plans could include extra benefits that you can't find with Original Medicare, such as vision and dental benefits or hearing aids. Sometimes, BCBS plans give you the option to purchase extra coverage for a higher premium.
Blue Cross Blue Shield regional PPO plans
In a PPO plan, you generally pay less for doctors or services in the network, but you have the freedom to go out of the network if you’re willing to pay more. Regional PPOs typically possess a much larger network than local PPOs, so you might have an easier time travelling and still getting health care coverage.
BCBS regional PPOs may include extra perks such as eye exams, preventative dental, and hearing aids. You may also be able to find a SilverSneakers or other fitness membership.
Blue Cross Blue Shield HMO-POS plans
In an HMO-POS (Health Maintenance Organization Point of Service) plan, enrollees gain the option to go outside of their traditional HMO network, but it will generally cost more.
Depending on your plan, you may be able to add extra benefits, such as vision and dental, for a higher premium. You may be able to access a free subscription to SilverSneakers with a BCBS HMO-POS plan too.
BCBS offers HMO SNPs. In these plans, enrollees must see doctors or seek services within the plan’s network.
With a D-SNP (Dual Eligible Special Needs Plan), many services will likely have much lower copays than with other HMO plans. This is because D-SNPs are available only to those who have both Medicare and Medicaid.
BCBS may also provide I-SNPs. Institutional Special Needs Plans (I-SNPs) are specially-tailored for people in nursing homes, assisted living facilities, or at home but needing care that a nursing home would provide.
As such, I-SNPs from BCBS may include home health care. Home health care is especially convenient for those with mobility limitations, as the doctor comes to you. Plans may also include personal coordination of care with a nurse practitioner, hearing and vision services, mental health care, renal dialysis, and even a Silver Sneakers membership.
To qualify for an I-SNP, applicants must usually live in a nursing home or assisted living facility within the service area. Applicants may also live at home, but only if they are in the service area and need the same amount of care as those in a nursing home.
Bottom line: Blue Cross Blue Shield offers diverse plans to serve a wide audience
As a collection of 36 companies under the BCBS license, the regional providers exhibit affordability with variety in both plan types and offerings.
Blue Cross Blue Shield Medicare Advantage plans provide comprehensive benefits like that of a big company—but with the feel of a regional health care provider. The individual companies possess the autonomy to deliver benefits that work for clients in their service area.
Want to see if a Blue Cross Blue Shield MA plan could work for you? Call a licensed agent for help.
To learn more about Blue Cross Blue Shield or Medicare, see what else we’ve written:
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