Excellus Medicare Advantage plans: What to know

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Medicare Advantage is an option where a person can choose a private insurance company to provide their Medicare benefits.

Legally, Medicare Advantage plans must cover the same benefits as original Medicare, but their deductibles and copayments may vary. In addition, a person must still pay their Medicare Part B premium every month.

Medicare Advantage plans:

• may have additional premiums
• usually include Part D, which involves coverage of prescription drugs
• may have extra benefits beyond that of original Medicare, such as dental, hearing, and vision care
• may limit a person’s choice of healthcare provider
• have an out-of-pocket limit, with Medicare rules stating private insurers may not charge more than $7,550 in 2021

Medicare Advantage encompasses several different plans.

• Health Maintenance Organization (HMO): If a person has an HMO, they will usually choose from a list of in-network healthcare providers and select a primary care physician (PCP) to direct their care. A doctor must give a specialist referral when required.
• Preferred Provider Organization (PPO): In a PPO, a person benefits from the most significant cost-savings by choosing in-network providers, although they may also visit out-of-network providers. Most PPO plans do not require a person to select a PCP, and they do not usually need a specialist referral.
• Private Fee-for-Service (PFFS): Medicare decides how much a person will pay for their care in a PFFS plan. Individuals can get healthcare from any provider that accepts the plan’s terms.
• Special Needs Plans (SNPs): An SNP is a plan for people with particular medical conditions such as congestive heart failure or end stage renal disease. These plans are specific to a person’s needs, and all provide Part D coverage for prescription drugs.

According to the Kaiser Family Foundation (KFF), HMOs are the most popular Medicare Advantage plan type, representing an estimated 62% of Medicare Advantage enrollees, with an estimated 31% of Medicare Advantage enrollees in PPO plans.

Excellus are part of the Blue Cross Blue Shield network and were formerly known as Blue Cross Blue Shield of Central New York, Rochester Area, and Utica-Watertown. Today, Excellus operate four regional headquarters:

• Central New York region: Covering Cayuga, Cortland, Jefferson, Lewis, Onondaga, Oswego, St. Lawrence, and Tompkins counties.
• Central New York Southern Tier region: Covering Broome, Chemung, Chenango, rchuyler, Steuben, and Tioga counties.
• Rochester region: Covering Livingston, Monroe, Ontario, Seneca, Wayne, and Yates counties.
• Utica region: Covering Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Madison, Montgomery, Oneida, and Otsego counties.

Excellus have an estimated 1.5 million members in New York, which includes enrollees of Medicare Advantage plans and long-term care insurance. Plans are available to residents in 31 State of New York counties.

Most Medicare Advantage companies rely on healthcare provider networks to keep their costs low and provide additional services. For this reason, most private insurers, including Excellus, offer region-specific plans.

Each region may offer different plans that include varying out-of-pocket limits for in-network coverage and different copayments for primary care doctors and specialist visits.

Excellus offer residents in Clinton, Essex, Franklin, Fulton, Hamilton, and Montgomery Counties — within the Utica region — two Medicare Advantage plans — the Medicare BlueBasic PPO, at $61 a month, and the Medicare BluePlus PPO, at $130 a month, for 2021.

In the Central New York region, Excellus offer four PPO plans, including the BlueEssential plan that has a $0 monthly premium for 2021. This plan has an in-network, out-of-pocket limit of $7,550, which is the maximum allowed in 2021 under Center for Medicare ad Medicaid Services (CMS) rules.

In the East region, which includes Delaware and Otsego counties, Excellus offer two PPO plans and one HMO plan for 2021. Their HMO plan is known as Medicare Bassett, has a $110 monthly premium, and features a point-of-service benefit. For Excellus, this means subscribers can receive some covered services from out-of-network providers up to a coverage limit, which is $3,000 for 2021.

Some people choose Medicare Advantage plans because they offer more benefits than original Medicare. While types of service vary based on a person’s preferred plan, Excellus plans may include:

• Dental coverage: If a person wants to include dental coverage as part of their plan, they can often add it for a monthly fee. For example, with the Medicare BlueBasic PPO, a person in Essex County can purchase comprehensive dental coverage for $39 a month.
• Hearing aids: Excellus offer a hearing benefit called TruHearing. A person can pay between $699–999 per hearing aid and $50 extra for a rechargeable option.
• Over-the-counter (OTC) benefit: Some plans will provide $30 a quarter for medications and supplies available OTC at most pharmacies.
• Silver & Fit Fitness: This is a program where a person can join a fitness center in their area for a reduced membership fee, or choose home fitness kits, such as the company’s Chair Exercise or Aquatic Exercise equipment.
• Vision exam: Many Excellus plans cover a routine vision exam. There is a $0 copayment when individuals use in-network physicians.

Additional extra services may vary by plan and service region.

Excellus Medicare Advantage plans are currently available in New York State only.

Plan availability varies by region and county, and a person can use their zip code to search either the Excellus website or the Medicare plan finder.

In both cases, search results will show a brief overview of costs, including associated out-of-pocket expenses. A person can select any plan to review more in-depth information about the coverage.

The Medicare plan finder will also show all plans available in a zip code, not just plans from Excellus.

New York State is part of a national network of organizations called the State Health Insurance Assistance Programs (SHIP).

SHIP offer non-biased insurance information and guidance on selecting a Medicare Advantage plan.

For information specific to New York, a person can call 800-701-0501. This service is free to residents and can help people with specific questions.

An estimated 34% of Medicare enrollees chose Medicare Advantage plans in 2020, according to the KFF.

Excellus are one of several companies in New York State that administer Medicare Advantage plans.

Available plans vary by region and include PPO and HMO options with varying premiums based on coverage.