Blue Cross Blue Shield Medicare Advantage 2023 Review
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Blue Cross Blue Shield is a 34-company collective, and performance varies.
BCBS offers $0 plans in 44 states.
BCBS Medicare Advantage plans have below-average ratings, but individual companies may have higher scores.
Blue Cross Blue Shield is a collective of 34 independent companies, and together they are the third-largest provider of Medicare Advantage plans in 2022.
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. Fully 85% of BCBS customers are in a Medicare Advantage contract rated 4 or higher (out of 5) on the Medicare star rating scale, as of September 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 and Puerto Rico, 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 44 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 lands above the industry average in terms of member satisfaction, Anthem (now Elevance Health) 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 Cross Blue Shield company.
Limited special needs plans: BCBS companies offer SNPs in only 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:
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 Detroit, 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 | $94.50. | $112. |
Annual deductible | $505 for Tiers 2-5 drugs. No deductible for Tier 1 drugs. | None. |
Drug copay, preferred generic* | $0. | $1. |
Drug copay, generic* | $3. | $5. |
Drug copay, preferred brand* | $30. | $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 Medicare Advantage 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 Nutrisystem.
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.
The Blue Cross Blue Shield family of companies includes Anthem (now Elevance Health), the fourth-largest Medicare Advantage provider in the country among for-profit health plans. 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.
Costs
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. Blue Cross Blue Shield offers $0-premium Medicare Advantage plans in 46 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 $8 to $285. Blue-branded special needs plans have premiums that range from $9.30 to $59.
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $164.90 per month in 2023. (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, weighted by enrollment: 3.92
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.
Weighted by enrollment, Blue Cross Blue Shield’s 2023 Medicare Advantage plans get an average rating of 3.92.
For comparison, the average star rating for plans from all providers in 2023 is 4.15.
Of Blue Cross Blue Shield’s contracts, more than half are rated 4 stars and up. Of Blue Cross Blue Shield’s Medicare Advantage members who are in rated contracts, 85% were in contracts with 4 stars or more as of September 2022.
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 Oct. 5, 2022, AM Best affirmed the following ratings for Blue Cross Blue Shield companies:
J.D. Power
Ranking: 3rd, 5th and 7th out of 9
In its 2022 U.S. Medicare Advantage Study — the eighth it's done — 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, Blue Cross Blue Shield of Michigan, and Anthem (now Elevance Health). On customer satisfaction measures, Highmark ranked third (811 points out of 1000), Blue Cross Blue Shield of Michigan ranked fifth (802 points), and Anthem ranked seventh (791 points) out of the top nine Medicare Advantage providers.
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 September 2022 ratings of Blue-branded plans, the NCQA awarded scores between 2.5 and 4.5. Among the association’s plans with ratings, the Excellus Health Plan received a 4.5 rating. All other plans were rated 4 or lower.
Compare Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
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 114.5 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.
Find the right Medicare Advantage plan
It’s important to do your research before selecting a Medicare Advantage 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 on, 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?
