Breakdown of Blue Cross Blue Shield Medicare Advantage Plans

• Medicare Advantage (MA) plans are known as supplemental plans to Original Medicare for they work to cover the gaps in standard Medicare coverage.

• Blue Cross Blue Shield (BCBS) is a popular health insurance company nationwide. BCBS holds a Medicare contract with the Federal Medicare Program and is a common provider of MA plans to seniors.

• MA plans require enrollees to choose a specific plan type, such as a health maintenance organization (HMO) plan, preferred provider organization (PPO) plan, private-fee-for-service (PFFS) plan, etc.

• Blue Cross Blue Shield MA plans include a wide range of additional services depending on where beneficiaries live. Certain benefits may include hearing or vision coverage, various discounts, a SilverSneakers program membership, and more.

Medicare Advantage plans, otherwise known as ​“Medicare Part C” or ​“MA Plans,” are supplement plans to Original Medicare. MA plans work to fill the gaps in Original Medicare’s coverage by providing Part A, Part B, Part D, and occasionally additional coverage for dental, hearing, and vision all wrapped into one plan for enrollees. Private health insurance companies that have contracts with the Federal Medicare Program offer MA plans to all beneficiaries that are eligible for standard Medicare. While Original Medicare does not require renewal once a beneficiary enrolls, MA plans may change annually inciting a contract renewal for various enrollees.

To learn more about Medicare Advantage plans, visit this source.

Blue Cross Blue Shield (BCBS) is a health insurance company and mutual legal reserve company that provides healthcare coverage to over 110 million individuals throughout the United States. This widespread insurance system operates through 35 local BCBS companies that hold contracts with over 1.7 million doctors and hospitals. One of these contracts is with the Federal Medicare Program, allowing them to provide Medicare Advantage coverage to a large portion of Americans. Due to each of the 35 companies being individually owned and operated, coverage and terms may vary depending on one’s zip code and personal insurance plan.

Blue Cross Blue Shield also provides Medicaid services in various locations nationwide. To learn more about BCBS’s Medicaid plans and coverage options, visit this source.

Anthem Insurance is included as a member of the Blue Cross Blue Shield Association of companies. In total, the BCBS companies available nationwide include 60+ locations, including:

• 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 (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.

Note: Blue Cross Blue Shield members can contact a licensed insurance agent from their plan by calling the toll-free number on the back of their member ID card or by calling (888) 630‑2583 to get in touch with their local BCBS company. To find a BCBS health care service corporation near you, visit this source.

When an individual chooses to enroll in a Medicare Advantage plan, they have the option to pick between a variety of plan types that each have unique coverage options, cost variations, and healthcare networks. The most common types of Medicare plans include health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, private-fee-for-service (PFFS) plans, and special needs plans (SNPs).

Health Maintenance Organization (HMO) Plans

HMO plans are known for being cost-friendly and convenient as they require a provider to have a primary care physician (PCP). This primary care physician works to coordinate a holistic healthcare experience for the patient; they guide the patient’s health and wellness by coordinating the patient’s care and various providers. The downside to this plan is that all care must be done in-network, otherwise, enrollees may face high costs. Not to mention, referrals are required if patients wish to see a different provider or specialist.

To learn more about HMO plans, visit this source.

Preferred Provider Organization (PPO) Plans

PPO plans are also known to be cost-friendly and popular as they provide a patient with more flexibility over their care. A PCP is not required with this plan, nor are referrals or in-network coverage. However, it should be noted that out-of-network providers may be more expensive.

To learn more about PPO plans, visit this source.

Private-Fee-For-Service (PFFS) Plans

PFFS plans leave room for much flexibility as well for they don’t require a primary care provider or referrals. PFFS insurance plans decide on a case-by-case basis how much insurance will cover and how much the enrollee is responsible to cover.

To learn more about PFFS plans, visit this source.

Special Needs Plans (SNPs)

SNPs are Medicare Advantage plans that cover individuals with specific diseases or illnesses. The benefits, providers, and drug coverage provided with this plan are uniquely tailored to the individuals being treated and covered under a special needs plan. In most cases, a PCP is necessary along with referrals for other providers or specialists.

To learn more about SNPs, visit this source.

While most BCBS Medicare Advantage plan options include Part D prescription drug coverage, BCBS also offers stand-alone prescription drug plans. These stand-alone Part D plans are otherwise known as ​“PDPs” and are made to accompany Part A (hospital insurance) and Part B (medical insurance) coverage. 

PDPs include two options for enrollees, the standard option otherwise called Prescription Blue PDP Select, and the enhanced option otherwise known as Prescription Blue PDP Premium. These two PDP plan options differ in their monthly premium price, the type of prescription drugs they cover, the pharmacies within their network, and more.

Since Blue Cross Blue Shield includes 35 individually owned and operated companies throughout the nation, their benefit and coverage options may vary. However, the vast majority of companies include additional benefits that Original Medicare does not cover such as dental, vision, and hearing assistance. Certain benefits may include but are not limited to:

• Advantage Dollars: Members may receive a pre-loaded debit card per quarter that can be used on over-the-counter health and wellness products such as vitamins, allergy products, and more.

• Blue Cross Rewards: Some plans include various incentives for members that practice healthy behaviors such as step tracking, mood tracking, and more. This rewards program is meant to motivate seniors in their daily health and wellness.

• Blue Cross Virtual Webinars: Certain plans offer weekly webinars where members can learn insights on how to improve their health and overall wellbeing.

• Chronic Condition Management: For members that have specific ongoing health problems, BCBS MA plans may offer programs that can assist them in monitoring and managing their condition.

• Discounts: Many BCBS MA plans offer discounts on a variety of things from LensCrafters to Hotels.com and more.

• SilverSneakers: Certain members may have access to a SilverSneakers health plan through their MA plan. This gives them nationwide gym access along with the ability to join various workout and health classes online. To learn more about SilverSneakers, visit this source.

A variety of factors are included when considering the cost of any MA plan such as monthly premiums, deductibles, out-of-pocket costs, copayments, and coinsurance. One’s Blue Cross Blue Shield Medicare Advantage plan cost is dependent on where one lives, which plan one chooses, and what one’s specific health needs are. 

Regardless of specific BCBS costs, all MA plan beneficiaries are required to pay their Part B premium which is projected to be approximately $158.50 per month in 2022.

To learn more about costs associated with BCBS Medicare Part C plans, visit this source.

Before finalizing one’s Medicare Advantage plan, one should visit Medicare online to use the government’s Medicare Advantage plan comparison tool. Some things patients should consider and ask before deciding:

• Cost:

  • How much are they willing to spend monthly on a premium?

  • What do they want their deductible to look like?

• Coverage:

  • Will their prescriptions be covered under this plan?

  • Is additional coverage offered for services such as dental, vision, or hearing?

  • Will their current doctors or specialists be covered?

• Convenience:

  • Where is their insurance office in case they need assistance?

  • Does their insurance provide transportation to and from healthcare appointments if needed?

Note: Oak Street Health provides transportation to and from healthcare appointments for patients that need assistance. They also have providers that are trained and willing to guide patients through their insurance benefits whenever needed.