Blue Cross Medicare Review: What to Know in 2023

Blue Cross Blue Shield is a massive health insurance company. Through local companies, BCBS provides health insurance to more than 100 million across the United States, including Washington D.C., and Puerto Rico.

These local companies are easy to identify. They typically include some variation of “Blue Cross Blue Shield” in their name, such as Anthem Blue Cross Blue Shield Colorado or Florida Blue.

Depending on your location, details of coverage, and monthly premiums for BCBS Medicare Advantage, plans will vary.

However, all plans include original Medicare benefits (parts A and B, which cover hospitalizations, outpatient care, and doctor visits), as well as some added benefits not typically covered by Medicare. That’s why Medicare Advantage is also referred to as Medicare Part C.

Here’s a quick look at what BCBS Medicare Advantage plans typically cover (remember, this will vary by your location and the type of plan you choose):

• dental
• hearing
• vision
• prescription drugs
• $0 copays (for some preventive services, but not all)
• an annual limit on out-of-pocket expenses

Blue Cross Blue Shield offers a variety of Medicare Advantage plans.

These are the main types of Medicare Advantage plans you can enroll in with Blue Cross Blue Shield (again, availability varies by location):

Health Maintenance Organization (HMO) plans

Blue Cross Blue Shield’s Medicare Advantage HMOs are based on in-network primary care, so you’ll choose a primary care professional (PCP) when you enroll. For most specialty care, you’ll see your PCP firstto get a referral for specialty care. There are some exceptions, including emergency care and well-woman exams.

Medicare Advantage HMOs generally include prescription drug costs and often are available with low cost premiums, copays, and deductibles.

Preferred Provider Organization (PPO) plans

Blue Cross Blue Shield’s Medicare Advantage PPOs offer more choices when it comes to primary care. However, you’ll pay less if you choose an in-network professional than if you opt for someone out of network.

Medicare Advantage PPOs can be costlier than HMOs, especially if you choose to visit out-of-network professionals. As with HMOs, most Medicare Advantage PPOs include prescription drug costs. However, PPOs can charge a deductible for both the plan and prescription drugs.

Copays also vary, and they typically range from $0–$50 depending on whether you visit an in-network or out-of-network professional.

Blue Cross Part D (Medicare Part D) plans

Medicare Part D covers prescription drug plans. While some HMOs and PPOs include prescription drug coverage, you can choose a standalone plan if that’s not the case.

Depending on your area, BCBS may offer a few Part D plans for prescription coverage. They have lists of covered medications you can check before enrolling to make sure you’ll benefit.

Some of the BCBS Part D plans require you to pay coinsurance every time you fill a prescription, and many require a copay. Medicare Part D also has a low income subsidy program if you need financial assistance with the cost of your medications.

Private Fee For Services (PFFS) plans

Blue Cross Blue Shield only offers a Medicare Advantage PFFS plan in Arkansas. PFFS plans allow you to choose the healthcare professional you want, regardless of whether they’re in network. You’ll know up front how much your PFFS plan will pay the professional and then you (the insured) are responsible for the remainder.

However, PFFS healthcare professionals can choose whether or not to provide services at the Medicare reimbursement rate. Prescription drug costs aren’t always covered with PFFS plans.

Shopping for insurance can be dizzying, and many states offer dozens of Medicare Advantage options from various insurance companies.

The cost of Blue Cross Blue Shield Medicare Advantage coverage will vary by your location and the plan type you choose. All Medicare Advantage plans require you to pay the standard premium for Medicare Part B, which is $164.90 in 2023.

The right choice for you will depend on your specific coverage needs. To explore your options, type in your zip code using the Medicare Plan Finding Tool. Filter the results by selecting your local BCBS company from the “Insurance Carrier” dropdown menu.

Here are a few example plans for BCBS Medicare Advantage coverage across the United States. For the sake of comparison, we stuck to HMO plans.

New York, New York

• Plan: Empire MediBlue Select (HMO)
• Covers: health and drug coverage, vision, dental, fitness benefits, worldwide emergency, telehealth
• Monthly premium: $0 (not including standard Part B premium of $164.90)
• Health deductible: $0
• Drug deductible: $350
• Out-of-pocket maximum: $8,300 (in network)

St. Louis, Missouri

• Plan: Anthem MediBlue Plus (HMO)
• Covers: health and drug coverage, vision, hearing, dental, fitness benefits, transportation, worldwide emergency, telehealth, in-home support, home safety devices
• Monthly premium: $0 (not including standard Part B premium of $164.90)
• Health deductible: $0
• Drug deductible: $0
• Out-of-pocket maximum: $2,800 (in network)

Portland, Oregon

• Plan: Regence Blue Advantage (HMO)
• Covers: health and drug coverage, vision, hearing, dental, fitness benefits, worldwide emergency, telehealth, in-home support
• Monthly premium: $0 (not including standard Part B premium of $164.90)
• Health deductible: $0
• Drug deductible: $200
• Out-of-pocket maximum: $5,500 (in network)

San Antonio, Texas

• Plan: Blue Cross Medicare Advantage Value (HMO)
• Covers: health and drug coverage, vision, hearing, dental, fitness benefits, worldwide emergency, telehealth
• Monthly premium: $0 (not including standard Part B premium of $164.90)
• Health deductible: $0
• Drug deductible: $0
• Out-of-pocket maximum: $3,000 (in network)

Blue Cross Blue Shield is a widely known health insurance company. It has provided health coverage since 1929 and offered Medicare coverage since the program began in the 1960s.

As far as reputation goes, BCBS doesn’t shine on third-party platforms like Better Business Bureau and Trustpilot. That said, we’re talking about health insurance, a notoriously complex system. When’s the last time someone told you they love their health insurance company?

However, one helpful way to tell whether your local BCBS options are worth exploring is by noting the stars on the Healthcare.gov or Medicare.gov websites.

The Centers for Medicare & Medicaid Services (CMS) uses a 5-star rating system based on survey data to help folks better compare their options. You can learn more about how the CMS determines those ratings.

How does Medicare work?

Medicare is government-funded healthcare for people ages 65 years or older, as well as people under 65 who qualify based on certain conditions or disabilities.

It can be used as primary insurance, or as supplemental insurance on top of private insurance coverage. You’ll automatically be enrolled in Medicare if you’re receiving social security benefits, or you can enroll up to 3 months before your 65th birthday.

There are a few parts to Medicare:

• Part A, which covers hospitalizations and hospice plans for the terminally ill.
• Part B, which covers outpatient care and general preventive services.
• Part C (Medicare Advantage), which is offered by private insurance companies. It includes parts A and B, but it also offers added benefits like dental, vision, and prescription drug coverage. These plans often have additional fees and copays.
• Part D, which covers prescription drugs. The cost of Part D will depend on your income, and your copays will depend on your specific medications.

Is Blue Shield better than United Healthcare for Medicare?

Blue Cross Blue Shield and United Healthcare both offer Medicare Advantage services. Both companies partner with over 1.2 million healthcare professionals and have extensive customer bases.

However, BCBS is more widely accessible than United Healthcare. Ultimately, you’ll want to compare the individual plans available to you to determine the right fit.

What Blue Cross Blue Shield Medicare plan is best for me?

The right BCBS Medicare Advantage plan for you will depend on a few factors. Consider the following:

• Do you have a PCP you love? If so, consider opting for a Blue Cross Blue Shield PPO so you can have more choice in the doctors you see. Just be sure to check that your doctor is in network.
• Do you need prescription drugs? If so, you’ll want to make sure the plan you choose includes or reduces the cost of your medications. You can see this information in advance when exploring your options on the Medicare.gov website.
• Do you want a low cost premium, deductible, and copays? If so, you may want to opt for a Blue Cross Blue Shield HMO. They’re often more cost effective than PPOs, although you’ll be limited to in-network professionals.

Is Blue Cross Blue Shield private insurance or Medicare?

Blue Cross Blue Shield is a private insurance company, but it does provide plans for Medicare Advantage (Part C) in all 50 U.S. states, as well as Washington D.C. and Puerto Rico. Medicare Advantage offers the benefits of traditional Medicare and added benefits like vision, dental, and prescription drug coverage.

If you’re considering a Medicare Advantage plan, Blue Cross Blue Shield is a widely accessible option that offers a variety of HMO and PPO plans across the United States. There are also options for Medicare Part D (for prescription drugs) as well as some Medicare Special Needs Plans (although these aren’t as widely available).

To explore other companies that offer Medicare Advantage plans, be sure to read our full review of the best health insurance companies — and yes, BCBS made the list. You can also learn more about the ins and outs of Medicare Advantage in our article.