Blue Cross Blue Shield is a private insurer that offers Medicare Advantage (Part C) plans. The plans they offer have various pros and cons, including cost and coverage.
Private insurance companies offer Medicare Advantage (Part C) plans, which offer the same coverage as Original Medicare (parts A and B) and extra benefits like vision, dental, or hearing insurance.
Original Medicare has consistent premiums, coinsurance, deductibles, and benefits across all areas. However, Medicare Advantage plans vary between regions, providers, and types of plans.
Blue Cross Blue Shield (BCBS) is an association of insurance companies in the United States that offers Medicare Advantage and Part D plans in every state, Washington, D.C., and Puerto Rico.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
BCBS has operated since 1929 and has a beneficiary base of around 118 million people. It is an association of 33 companies and licensees that allows it to administer healthcare coverage in every state. These companies will often have “Blue Cross Blue Shield” in their name or a slight variation.
Examples include:
- Anthem Blue Cross and Blue Shield of Georgia
- Blue Cross Blue Shield of North Dakota
- Blue Cross and Blue Shield of Texas
- Highmark Blue Shield of Northeastern New York
- Premera Blue Cross
BCBS Medicare Advantage plans may offer the following extra benefits:
- dental services, including routine care
- routine vision services
- hearing aids
- a yearly limit on out-of-pocket costs
- a $0 premium on some plans
In addition, some BCBS plans may also offer prescription drug coverage. BCBS offers a finder tool to help people locate their nearest BCBS company and speak to them about what is available in their region.
The pros and cons of any insurance plan depend on an individual’s needs. However, here is a breakdown of what to consider when looking at BCBS Medicare plans:
BCBS Pros
- BCBS offers a BlueCard program that allows beneficiaries to access coverage anywhere in the country, with treatment charged at local rates.
- BCBS provides a flexible range of Medicare Advantage plan structures, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Fee-for-Service (FFS) plans.
- Medicare Advantage plans provide coverage for a broader range of services than Original Medicare, including hearing, vision, and dental. Many also include prescription drugs.
- Some plans may have a $0 premium, depending on the insurance provider.
BCBS Cons
- Beneficiaries will often need to pay a Part B premium as well as a Medicare Advantage premium.
- BCBS does not offer as many Special Needs Plans (SNPs) as other types of Medicare Advantage plans.
- Premiums and benefits might change every year on January 1.
- As with other Medicare Advantage plans, most people with a BCBS Medicare Plan can only use healthcare providers within an approved network.
The different types of Medicare Advantage plans that BCBS offers impact whether a beneficiary can visit out-of-network doctors or claim for drug costs. These are:
- Health Maintenance Organization (HMO): These generally require in-network healthcare professionals, referals for specialists, and a primary doctor
- Preferred Provider Organization (PPO): These generally allow seeing out-of-network healthcare professionals and do not require a referral for specialists or a primary doctor.
- Private Fee For Services (PFFS): PFFS plans typically offer included drug coverage and allow people to see any Medicare-approved provider who agrees to the payment terms.
The exact types of BCBS Medicare Advantage plans available depend on a person’s location. It is also important to note that if someone joins an HMO or PPO without drug coverage, they cannot get a separate Part D drug plan, but those in a PFFS without drug coverage can apply. That said, depending on a person’s state, BCBS also offers stand-alone Part D plans such as Blue MedicareRx or MedicareBlue Rx.
The cost of BCBS Medicare Advantage plans varies greatly depending on the company, the coverage level, and the plan type.
Every person with Medicare Advantage will need to pay the $185 Part B premium along with the Medicare Advantage premium from BCBS.
Some providers offer plans with a $0 Medicare Advantage premium. The copayments or coinsurance amounts may be different than those in Original Medicare.
The table below compares several examples of BCBS HMOs and PPOs from different states. A person can find the exact options in the area on Medicare.gov.
| Location | Provider | Plan | Out of Pocket Limits | Deductibles | Other costs |
|---|---|---|---|---|---|
| Louisville, KY | Anthem Blue Cross and Blue Shield | Anthem Medicare Advantage (PPO) | $10,100 in and out-of-network $6,750 in-network | $350 for drugs | $40 copay for specialist |
| Boston, MA | Blue Cross Blue Shield of Massachusetts | Tufts Medicare Preferred HMO Smart Saver Rx (HMO) | $5,200 in-network | $0 | $40 copay for specialist |
| San Francisco, CA | Anthem Blue Cross Life and Health Insurance Company | Anthem Medicare Advantage (PPO) | $13,300 in and out-of-network $8,850 in-network | $590 annual $575 for drugs | $10 copay for primary doctor $30 copay for specialist |
| Chicago, IL | Blue Cross Blue Shield of Illinois | Blue Cross Medicare Advantage Basic (HMO) | $4,500 in-network | $0 | $20 copay for specialist |
Is Blue Cross Blue Shield Advantage a good plan?
Assessing an insurer’s reputation is complex, especially when they have as many subsidiary companies as BCBS. Medicare has a system called the Health Insurance Exchange Quality Ratings System that simplifies this and uses survey data to show how people rate insurance companies. The online tool on the Medicare website allows people to compare plans and find more information on official star ratings.
Is Blue Cross Blue Shield better than United Healthcare?
United Healthcare (UHC) and BCBS are both major insurers offering Medicare Advantage plans. BCBS partners with 2 million healthcare professionals, while UHC works with around 1.7 million. BCBS has 118 million members, whilte UHC covers about 170 million people in the U.S. That said, individual plans vary, and people may benefit from comparing plans to determine which is best for their health and lifestyle needs.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Blue Cross Blue Shield (BCBS) offers a variety of Medicare Advantage HMO and PPO plans in every state, as well as prescription drug plans through Medicare Part D.
Their network of doctors is expansive, and many of their policies cover hearing aids and routine dental and vision care.
However, the number of Special Needs Plans is limited, and prices may change yearly, depending on the plan. Speak to a local Medicare office to determine whether a particular Medicare Advantage provider is more suitable than others.