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 eligibles (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.
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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. We’ve sampled just a few plans to highlight what BCBS can offer.
Blue Cross Blue Shield sample plans*
|Anthem MediBlue Essential (HMO)||Anthem MediBlue Access Core (Local PPO)||Empire MediBlue Choice (HMO-POS)||BlueCare Plus (HMO SNP)||Anthem Care on Site (HMO SNP)|
|Location||Springdale, OH 45246||Grand Rapids, MI 49507||Brooklyn, NY 11225||Knoxville, TN 37916||Henderson, NV 89074|
|Out-of-pocket maximum||$4,900||$5,400 in network; $5,400 combined||$6,700 in network; $10,000 combined||$6,700||$1,500|
|PCP||$5||$10||$15 in network;|
30% out of network
|Specialist||$40||$30||$45 in network;|
30% out of network
|Network||Must stay in-network||Lower costs for in-network services||Lower costs for in-network services||Must stay in-network||Must stay in-network|
Anthem MediBlue Essential (HMO)
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.
The MediBlue Essential plan that we sampled is slightly above average, with a 4/5 Medicare Star Rating. It includes one of the following annually: a dental exam and cleaning, a routine eye exam, glasses or contacts, a hearing exam, and hearing aids. Also included in the plan is physical therapy, chiropractic care, foot care, and even outpatient substance abuse therapy for a copayment. The ever-popular SilverSneakers membership is also complimentary in this HMO.
The MediBlue Essential plan can be a great value to anyone in the service area wanting these types of extra benefits as part of their coverage. And with the option to increase dental and vision coverage, this plan can be more comprehensive than many other HMO offerings.
Anthem MediBlue Access Core (Regional PPO)
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.
The plan we sampled is above average quality, with a 3.5/5 Medicare Star Rating. It covers a routine eye exam yearly, preventative dental, and up to 80% of the cost of a hearing aid fitting.
The Anthem MediBlue Access Core can be a solid choice for people who want good, flexible coverage. This plan’s regional PPO network allows for great choice of in-network providers, which could result in savings.
Empire MediBlue Choice (HMO-POS)
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.
The plan we sampled is a little above average in quality, with a 3/5 Medicare Star Rating. The MediBlue Choice plan doesn’t cover any hearing, vision, or dental services (such as preventive or routine coverage) other than what Original Medicare provides. However, there is an option to add all three for an additional fee. There is some coverage for mental health also. And, as an added benefit, the MediBlue Choice plan comes with a free subscription to SilverSneakers.
The MediBlue Choice plan could be a good option for people who like some flexibility, such as the freedom to add extra dental coverage or to see a doctor outside their network.
BlueCare Plus (HMO SNP)
In this HMO SNP plan, enrollees must see doctors or seek services within the plan’s network. Most of these services will have heavily discounted copays (and in some cases $0 copays). It is only available to a smaller group, however, because it is a D-SNP. With this type of plan, only those who are dual eligible for both Medicare and Medicaid may enroll.
The plan we sampled is above average in quality, with a 3.5/5 Medicare Star Rating. It included vision, dental, hearing, and drug coverage with no additional charges or copays. In fact, most services—from doctor visits to mental health visits—have $0 copays.
The BlueCare Plus plan could be a good choice for any dual eligible in the service area, but many will need to see if they qualify for assistance before enrolling.
Anthem Care On Site (HMO SNP)
In this HMO SNP plan, the enrolled individual must see doctors and receive services within the network. However, in this Institutional Special Needs Plan (I-SNP), the services are specially tailored for people in nursing homes, assisted living facilities, or at home but needing care that a nursing home would provide.
The plan we sampled is above average in quality, with a 3.5/5 Medicare Star Rating. As a plan geared toward people in institutions, the Blue Care Plus plan provides home health care (with a $0 copayment). Home health care is especially convenient for those with mobility limitations, as the doctor comes to you. It also includes personal coordination of care with a nurse practitioner, hearing and vision services, mental health care, renal dialysis, and even a Silver Sneakers membership.
The Anthem Care On Site plan can be an excellent option for people in assisted-living facilities or nursing homes as well as those who need many of their health care services to come to them. To qualify for this plan, applicants must 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. So whether it’s Anthem Blue Cross in California with its nine SNP plans (plus fourteen other options), BCBS Minnesota with its Cost plans, or BCBS New York with a wealth of variety in its twenty-eight plans, BCBS offers options to suit a wide range of customers.
Want to see if a Blue Cross Blue Shield MA plan could work for you? Call a licensed agent for help.
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