Blue Cross Blue Shield Medicare Advantage 2022 Review

Blue Cross Blue Shield is a network of 34 independent providers with widely available low-cost Medicare Advantage plans, but satisfaction varies by company.

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Blue Cross Blue Shield is a collective of 34 independent companies, and together they were the third-largest provider of Medicare Advantage plans in 2021

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Although BCBS companies are all licensed by the Blue Cross Blue Shield Association, they're locally owned and operated and may vary in terms of coverage, benefits and quality of plans. More than 8 in 10 BCBS customers are in a Medicare Advantage contract rated 4 or higher (out of 5) on the Medicare Star Rating scale as of June 2022.

Here’s what you should know about Blue Cross Blue Shield Medicare Advantage.

Blue Cross Blue Shield Medicare Advantage pros and cons

Blue Cross Blue Shield’s offerings have advantages and disadvantages:

Pros

  • Wide network: With BCBS companies providing Medicare Advantage plans in 47 states, there’s a good chance you have access to a plan from a BCBS insurer.

  • Low-cost plans available: BCBS companies offer plans with $0 premiums in 45 states.

  • Concierge services: For members who are unsure of the system, some BCBS plans offer a dedicated concierge who can help them understand the best way to use their benefits, as well as access to chronic condition management.

  • Money for extras: Some plans offer $25 to $100 per quarter on a preloaded debit card that members can use for healthy food or certain over-the-counter items, such as vitamins.

Cons

  • Company strength varies: While BCBS company Highmark scores higher than most other providers in terms of member satisfaction, Blue Cross Blue Shield of Michigan didn't score as many points in J.D. Power’s latest Medicare Advantage study. Depending on your location, you may not have access to a higher-rated Blue.

  • Limited special needs plans: BCBS companies offer SNPs in only about half of U.S. states.

Available Medicare Advantage plans

Blue Cross Blue Shield offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Availability of specific plan types varies by location.

Blue Cross Blue Shield offers Medicare Advantage Prescription Drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage.

Plan offerings include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

HMO point of service, or POS, plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Blue Cross Blue Shield’s private fee-for-service, or PFFS, plans allow you to see any Medicare-approved provider who accepts your Blue Cross Blue Shield plan. You won’t have to pick a primary doctor, and you won’t need a referral to see a specialist.

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Blue Cross Blue Shield offers three types of SNPs:

  • Chronic Condition SNP: Designed to meet the needs of members living with certain chronic conditions, such as diabetes, congestive heart failure and cardiovascular disease.

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

  • Institutional SNP: For people living in a BCBS network nursing home or assisted living community, or another plan-approved spot.

Available Part D prescription drug plans

While many of Blue Cross Blue Shield’s Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans, also known as PDPs. These plans, which are meant to accompany Medicare Part A and Medicare Part B, don't provide medical coverage.

All states offering a stand-alone prescription drug plan have both a basic and an enhanced option. For instance, if you live in Grand Rapids, Michigan, you have the option of the following two PDPs from Blue Cross Blue Shield of Michigan:

  • Prescription Blue PDP Select.

  • Prescription Blue PDP Premium.

Here’s an example of how they compare:

Plan feature

Prescription Blue PDP Select

Prescription Blue PDP Premium

Monthly premium

$96.20.

$113.70.

Annual deductible

$480 for Tiers 2-5 drugs. No deductible for Tier 1 drugs.

None.

Drug copay, Tier 1*

$1.

$1.

Drug copay, Tier 2*

$5.

$5.

Drug copay, Tier 3*

$35.

$40.

*For a one-month supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

These plans differ by premium, by the drugs they cover, by the costs associated with each tier of drugs and by the pharmacies that are in their network of preferred retailers. To find the best drug plan for you, consider plans that offer the lowest costs for your regular prescriptions and preferred pharmacies.

Additional benefits

Because Blue Cross Blue Shield comprises 34 different companies, benefits will vary, depending on the BCBS company in your area. These plans generally include benefits that aren’t covered by Original Medicare, such as wellness programs, hearing aids and vision coverage. Here are some notable perks:

  • Advantage Dollars: Members get a debit card preloaded with $25 to $100 per quarter that can be used for healthy food or over-the-counter items like vitamins or allergy products.

  • Blue Cross Virtual Well-Being: Members can access live weekly webinars designed to teach people how to improve their well-being.

  • MyBlue Concierge program: Some members have access to a dedicated concierge who can tell them about benefits and help them with things like making appointments, getting in touch with customer service and reaching a care management team if they have a chronic condition.

  • SilverSneakers: Members get access to local fitness centers, specialized fitness classes and seminars to help with weight management.

  • Chronic condition management: If members have conditions like coronary artery disease, or CAD; chronic obstructive pulmonary disease, or COPD; diabetes; congestive heart failure; or depression, their plan may have a program that can help them monitor and manage their condition.

  • Discounts: Some members have access to discounts from national companies, such as Fitbit and EyeMed.

  • Blue Cross Rewards: Some plans offer incentives to encourage members to practice health-minded behaviors, such as tracking steps, tracking mood or joining friends in a healthy competition.

  • Virtual Visits: Some plans offer coverage for visits with a medical provider by phone, mobile app or online video.

Customer service

Blue Cross Blue Shield members can contact their plan’s customer service in the following ways:

  • Call the toll-free number on the back of their member ID card.

  • Find their BCBS company for specific contact information.

  • Call 888-630-2583 to get connected with their local BCBS company.

Service area

Blue Cross Blue Shield offers Medicare Advantage plans in 47 states and Puerto Rico, and Medicare prescription drug plans in 42 states. Nationally, BCBS offers plans in 2,190 counties, or about 68% of U.S. counties

Kaiser Family Foundation. Medicare Advantage 2022 Spotlight: First Look. Accessed Jun 27, 2022.
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The Blue Cross Blue Shield family of companies includes Anthem, the second-largest health insurer in the country by market share. Anthem captured 5.64% of national market share for Medicare Advantage in 2022, according to a report from health care analytics firm The Chartis Group. But nonprofit Blue companies lost 0.2% of market share, dropping to 10% of the national market in 2022

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Cost

Medicare Advantage plan costs will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and Blue Cross Blue Shield offers $0-premium Medicare Advantage plans in 45 states and Puerto Rico. For Blue-branded Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $2.10 to $301

Centers for Medicare & Medicaid Services. 2022 MA Landscape Source Files (v 10 26 21) (ZIP). Accessed Jun 27, 2022.
. Blue-branded special needs plans have premiums that range from $0 to $59.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $170.10 per month in 2022. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s plan finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Blue Cross Blue Shield plans, or compare across carriers. You can also shop directly from Blue Cross Blue Shield’s website by entering your ZIP code, and you’ll be able to compare the plans available.

Medicare star ratings

Average star rating: 4.1

The Centers for Medicare & Medicaid Services, or CMS, maintains its own database of star ratings on every Medicare Advantage and separate Medicare Part D plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Blue Cross Blue Shield’s 2022 Medicare Advantage plans get an average rating of 4.1, and the company’s prescription drug plans (Part D) also get an average score of 4.1. For comparison, the average star rating for plans from all providers in 2022 is 4.37

Centers for Medicare & Medicaid Services. Part C and D Performance Data, 2022 Star Ratings Fact Sheet_10_8_2021 (PDF). Accessed Jun 27, 2022.
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Of Blue Cross Blue Shield’s contracts, the majority are rated 4.5, 4 or 3.5. Of Blue Cross Blue Shield’s Medicare Advantage members who are in rated contracts, 85% were in contracts with 4 stars or more in 2022

Centers for Medicare & Medicaid Services. Monthly Enrollment by Contract, 2022-06. Accessed Jun 27, 2022.
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To get an overall star rating, the CMS ranks contracts on 40 plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here are the areas where Blue Cross Blue Shield plans earned an average score of 4.5 stars (out of 5) and above:

  • Care for older adults — medication review.

  • Care for older adults — pain assessment.

  • Complaints about the health plan.

  • Plan makes timely decisions about appeals.

  • Reviewing appeals decisions.

  • Call center — foreign language interpreter and TTY availability.

  • Complaints about the drug plan.

Blue Cross Blue Shield contracts averaged a sub-3.0 score in just a couple of categories. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.)

  • Osteoporosis management in women who had a fracture.

  • Reducing the risk of falling.

You can find a plan’s rating with the Medicare plan finding tool.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:

AM Best

Financial Strength Rating: A+ (Superior) to B++ (Good)

AM Best is a credit rating agency that specializes in the insurance industry. Because Blue Cross Blue Shield is a collection of companies, AM Best has rated some — but not all — Blue Cross firms.

As of June 30, 2022, AM Best affirmed the following ratings for Blue Cross Blue Shield companies

AM Best. AM Best Rating Services. Accessed Jul 27, 2022.
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Company

Financial Strength Rating

Anthem Health Group (and subsidiaries)

A (Excellent)**.

BCBSM Inc.

A- (Excellent).

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company

A (Excellent).

Blue Cross Blue Shield Healthcare Plan of Georgia Inc.

A (Excellent).

Blue Cross Blue Shield of Michigan Mutual Insurance Co.

A (Excellent).

Blue Cross and Blue Shield of Florida Inc.

A+ (Superior)*.

Blue Cross and Blue Shield of Kansas Inc.

A (Excellent).

Blue Cross and Blue Shield of Nebraska Inc.

A- (Excellent).

Blue Cross and Blue Shield of Vermont

B++ (Good)***.

Blue Cross of California

A (Excellent).

Blue Cross & Blue Shield of South Carolina

A+ (Superior).

Highmark West Virginia Inc.

A (Excellent).

Highmark Inc.

A (Excellent).

Wellmark Inc.

A (Excellent).

Wellmark of South Dakota Inc.

A (Excellent).

Regence BlueCross BlueShield of Oregon

A (Excellent).

Regence BlueCross BlueShield of Utah

A (Excellent).

Regence BlueShield

A (Excellent).

Regence BlueShield of Idaho Inc.

A- (Excellent).

Health Care Service Corp. (and subsidiaries)

A (Excellent).

California Physicians' Service (Blue Shield of CA)

A (Excellent).

Triple-S Salud Inc.

A- (Excellent).

USAble Mutual Insurance Company

A (Excellent).

*An A+ rating in this category indicates that AM Best believes the company has a superior ability to meet its ongoing insurance obligations.

**An A or A- rating in this category indicates that AM Best believes the company has an excellent ability to meet its ongoing insurance obligations.

***A B++ rating in this category indicates that AM Best believes the company has a good ability to meet its ongoing insurance obligations.

J.D. Power

Ranking: 2nd, 5th and 8th out of 9

In its 2021 U.S. Medicare Advantage Study — the seventh it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. Because Blue Cross Blue Shield has so many companies, J.D. Power included three in its list of Medicare Providers: Highmark, Anthem and Blue Cross Blue Shield of Michigan. On customer satisfaction measures, Highmark ranked second (834 points out of 1000), Anthem ranked fifth (797 points) and Blue Cross Blue Shield of Michigan ranked eighth (788 points) out of the top nine Medicare Advantage providers

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NCQA

Score range: 2.5 to 4.5 out of 5

The National Committee for Quality Assurance, or NCQA, rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA accreditation survey. The ratings highlight the results of care and what patients say about their care.

In its 2021 ratings of Blue Cross Blue Shield plans, released in September 2021, the NCQA awarded scores between 2.5 and 4.5. Among the association’s plans with ratings, the Excellus Health Plan and Highmark Western and Northeastern New York plan received 4.5 ratings. All other plans were rated 4 or lower

NCQA. Health Plans. Accessed Jun 27, 2022.
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Compare alternatives

See how Medicare Advantage competitors stack up to Blue Cross Blue Shield.

Compare Medicare Advantage providers

Percent in a 4-star plan or higher: 85%.

Service area: 46 states and Washington, D.C.

Average Medicare star rating: 3.8 stars.

Percent in a 4-star plan or higher: 72%.

Service area: 24 states and Puerto Rico.

Average Medicare star rating: 3.9 stars.

Percent in a 4-star plan or higher: 85%.

Service area: 44 states.

Average Medicare star rating: 4.1 stars.

Percent in a 4-star plan or higher: 84%.

Service area: 26 states and Washington, D.C.

Average Medicare star rating: 4.2 stars.

Percent in a 4-star plan or higher: 98%.

Service area: 47 states and Puerto Rico.

Average Medicare star rating: 4.1 stars.

Percent in a 4-star plan or higher: 100%.

Service area: 8 states and Washington, D.C.

Average Medicare star rating: 5 stars.

Percent in a 4-star plan or higher: 95%.

Service area: 50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

Average Medicare star rating: 4.2 stars.

Percent in a 4-star plan or higher: 53%.

Service area: 36 states.

Average Medicare star rating: 3.6 stars.

About Blue Cross Blue Shield

Blue Cross Blue Shield began as two companies — Blue Cross and Blue Shield — that offered affordable health care solutions in the early 1900s and started to come together in the 1940s. It was made official in 1982 when they formed the Blue Cross Blue Shield Association, which now includes 34 independent and locally operated companies across the country. Nationwide, it provides health care coverage to 110 million members in the U.S. and Puerto Rico.

The Blue Cross Blue Shield Association has two main offices, in Chicago and Washington, D.C.

  • Blue Cross and Blue Shield of Alabama.

  • Premera Blue Cross and Blue Shield of Alaska.

  • Blue Cross Blue Shield of Arizona.

  • Arkansas Blue Cross and Blue Shield.

  • Anthem Blue Cross (California).

  • Blue Shield of California.

  • Anthem Blue Cross and Blue Shield Colorado.

  • Anthem Blue Cross and Blue Shield Connecticut.

  • Highmark Blue Cross Blue Shield Delaware.

  • CareFirst BlueCross BlueShield (Washington, D.C.).

  • Florida Blue.

  • Blue Cross Blue Shield of Georgia.

  • Blue Cross and Blue Shield of Hawaii.

  • Blue Cross of Idaho.

  • Regence BlueShield of Idaho.

  • Blue Cross and Blue Shield of Illinois.

  • Anthem Blue Cross and Blue Shield Indiana.

  • Wellmark Blue Cross and Blue Shield (Iowa).

  • Blue Cross and Blue Shield of Kansas.

  • Anthem Blue Cross and Blue Shield Kentucky.

  • Blue Cross and Blue Shield of Louisiana.

  • Anthem Blue Cross and Blue Shield Maine.

  • CareFirst BlueCross BlueShield (Maryland).

  • Blue Cross and Blue Shield of Massachusetts.

  • Blue Cross Blue Shield of Michigan.

  • Blue Cross and Blue Shield of Minnesota.

  • Blue Cross & Blue Shield of Mississippi.

  • Anthem Blue Cross and Blue Shield Missouri.

  • Blue Cross and Blue Shield of Kansas City (Missouri).

  • Blue Cross and Blue Shield of Montana.

  • Blue Cross and Blue Shield of Nebraska.

  • Anthem Blue Cross and Blue Shield Nevada.

  • Anthem Blue Cross and Blue Shield New Hampshire.

  • Horizon Blue Cross and Blue Shield of New Jersey.

  • Blue Cross and Blue Shield of New Mexico.

  • Empire Blue Cross Blue Shield (New York).

  • Highmark Blue Cross Blue Shield of Western New York.

  • Highmark Blue Shield of Northeastern New York.

  • Excellus BlueCross BlueShield (New York).

  • Blue Cross and Blue Shield of North Carolina.

  • Blue Cross Blue Shield of North Dakota.

  • Anthem Blue Cross and Blue Shield Ohio.

  • Blue Cross and Blue Shield of Oklahoma.

  • Regence BlueCross BlueShield (Oregon).

  • Capital BlueCross (Pennsylvania).

  • Highmark Blue Shield (Pennsylvania).

  • Highmark Blue Cross Blue Shield (Pennsylvania).

  • Independence Blue Cross (Pennsylvania).

  • BlueCross BlueShield of Puerto Rico.

  • Blue Cross & Blue Shield of Rhode Island.

  • Blue Cross and Blue Shield of South Carolina.

  • Wellmark Blue Cross and Blue Shield (South Dakota).

  • BlueCross BlueShield of Tennessee.

  • Blue Cross and Blue Shield of Texas.

  • Regence BlueCross BlueShield (Utah).

  • Blue Cross and Blue Shield of Vermont.

  • Anthem Blue Cross and Blue Shield Virginia.

  • CareFirst BlueCross BlueShield (Virginia).

  • Premera Blue Cross (Washington).

  • Regence BlueShield (Washington).

  • Highmark Blue Cross Blue Shield West Virginia.

  • Anthem Blue Cross and Blue Shield Wisconsin.

  • Blue Cross Blue Shield of Wyoming.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a health plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs in, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

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