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Blue Cross Blue Shield Medicare Advantage 2024 Review
Blue Cross Blue Shield is a network of 33 independent providers with widely available low-cost Medicare Advantage plans, but satisfaction varies by company.
Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 18 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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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. Slightly more than half (57%) of BCBS customers are in a Medicare Advantage contract rated 4 or higher (out of 5) on the Medicare star rating scale.
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:
Wide network: With BCBS companies providing Medicare Advantage plans in 48 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 and Puerto Rico
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
Company strength varies: While some BCBS companies land above the industry average in some major Medicare markets in terms of member satisfaction, others don'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.
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 2024 Medicare Advantage plans get an average rating of 3.86
Of Blue Cross Blue Shield’s rated contracts, 43% are rated 4 stars and up. Of Blue Cross Blue Shield’s Medicare Advantage members who are in rated contracts, 57% were in contracts with 4 stars or more as of October 2023
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.
You can find a plan’s rating with the Medicare plan finding tool.
Blue Cross Blue Shield Medicare Advantage plan types
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.
A health maintenance organization (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 (POS) plans are HMO plans that allow members to get some out-of-network services, but they’ll pay more for those services.
Preferred provider organization (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 (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 (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 BCBS 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.
Almost 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 Select.
Prescription Blue Premium.
Here’s an example of how they compare:
Prescription Blue Select
Prescription Blue Premium
$545 for Tier 2-5 drugs. No deductible for Tier 1 drugs.
Drug copay, preferred generic*
Drug copay, generic*
Drug copay, preferred brand*
*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.
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:
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 July 7, 2023, AM Best affirmed the following ratings for Blue Cross Blue Shield companies
Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company
Blue Cross Blue Shield of Michigan Mutual Insurance Co.
Blue Cross and Blue Shield of Florida Inc.
Blue Cross and Blue Shield of Kansas Inc.
Blue Cross and Blue Shield of Nebraska Inc.
Blue Cross and Blue Shield of Vermont
Blue Cross of California
Blue Cross & Blue Shield of South Carolina
Highmark West Virginia Inc.
Wellmark of South Dakota Inc.
Regence BlueCross BlueShield of Oregon
Regence BlueCross BlueShield of Utah
Regence BlueShield of Idaho Inc.
Health Care Service Corp. (and subsidiaries)
California Physicians' Service (Blue Shield of CA)
Triple-S Salud Inc.
USAble Mutual Insurance Company
*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.
In its 2023 U.S. Medicare Advantage Study — the ninth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the five biggest Medicare markets, and here’s how Blue Cross Blue Shield companies ranked out of all major providers
California: Blue Shield of California is 5th out of 7, Elevance Health (formerly Anthem) is 6th out of 7.
Florida: Elevance Health is 4th out of 6, Florida Blue is 5th out of 6.
New York: Excellus BlueCross BlueShield is 1st out of 8, Elevance Health is 5th out of 8.
Pennsylvania: Highmark is 2nd out of 7, Independence Blue Cross is 7th out of 7.
Texas: Blue Cross Blue Shield of Texas is 1st out of 6.
Score range: 2.5 to 4.0 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 2023 ratings of Blue-branded plans, the NCQA awarded scores between 2.5 and 4.0
Blue Cross Blue Shield Medicare Advantage service area
Blue Cross Blue Shield offers Medicare Advantage plans in 48 states and Puerto Rico, and Medicare prescription drug plans in 41 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 5.6% of national market share for Medicare Advantage in 2023, according to a report from health care analytics firm The Chartis Group. Nonprofit Blue companies gained 0.1% of market share, accounting for 10.1% of the national market in 2023
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 33 independent and locally operated companies across the country. Nationwide, it provides health care coverage to 115 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.
See Blue Cross Blue Shield companies available around the country.
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?
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).