Blue Cross Blue Shield Medicare Review 2022Read our review of Blue Cross Blue Shield’s Medicare plans and find out how they compare with other Medicare providers in the United States.
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Founded in 1929, Blue Cross Blue Shield is made up of 34 independent companies.
Together they form the third-largest provider of Medicare Advantage Plans in the U.S.
It’s also the insurer of choice for 88 of the country’s Fortune 100 companies and its plans cover one in every three Americans across 50 U.S. states.
To help you make the right decision, this review will outline everything that you need to know about Blue Cross Blue Shield.
Medicare - What Do All the Parts Mean?
Before we jump into our review, here’s a quick roundup of the Medicare parts.
Part A (Hospital Insurance): This helps cover your care in hospitals, nursing care facilities, and hospices. It also covers home health care.
Part B (Medical Insurance): This helps you cover services from your doctors. It includes cover for medical equipment like wheelchairs, walkers, crutches, and so on. Part B also covers preventative services like screenings and vaccines.
Part C (Medicare Advantage Plans): These plans include all the benefits of Part A and Part B, plus dental care, vision care, hearing care, and wellness programs or fitness center memberships. Medicare Advantage Plans are offered by private insurance companies and are subsidized by the federal government.
Part D (Drug Coverage): This is the part of Medicare that pays for prescription drug coverage.
Note: Original Medicare includes Part A and Part B. Medicare Advantage covers Parts A, B and C. Part D is an optional coverage that you can include with Original Medicare or Medicare Advantage.
Terms You Need To Know:
Deductibles are costs you will pay for your medical tests, items, and services before your Medicare plan covers your expenses.
Coinsurance payments are expenses that you must pay yourself for medical treatments, services, and items. These are different for Medicare Parts A and B, and can either be a percentage of the cost or a fixed amount.
Co-payments or co-pays are amounts that you will pay for medical services, tests, or items. These amounts are set by your health insurance company and can range between $1.00 and a few hundred dollars.
Out-of-pocket expenses are the costs that your health insurance doesn’t cover, which you will have to pay for. Deductibles, co-payments, and coinsurance are all examples of out-of-pocket expenses.
Zero-premium Medicare plans are Medicare Advantage Plans which have no monthly premium. You may need to pay deductibles, coinsurance, or co-pays if you need medical care.
Out-of-network benefits: Out-of-network means that a doctor or physician does not have a contract with your health insurance plan provider. This can sometimes result in higher prices. Some health plans, such as an HMO plan, will not cover care from out-of-network providers at all, except in an emergency.
Blue Cross Blue Shield Medicare Plans Review
Approximately 15% of all Medicare members across the U.S. belong to the Blue Cross Blue Shield Medicare Advantage Plan.
Let’s take a look at some of the benefits of joining Blue Cross Blue Shield:
✅ Wide network: Blue Cross Blue Shield companies provide Medicare Advantage Plans in 50 states, so you should have access to a plan from a Blue Cross Blue Shield insurer.
✅ Extra benefits: There are specific benefits available for vision and dental care. Most plans also include fitness benefits.
✅ Clear pricing: Pricing is completely clear and easy to understand. There are also low-cost and discounted pricing plans available.
✅ Many health care providers: Collectively, Blue Cross Blue Shield companies use over 90% of the doctors and hospitals across the country.
✅ Numerous insurance options: There are multiple plan types including zero-premium Medicare plans. This means that Blue Cross Blue Shield is suitable for virtually any budget.
✅ Concierge services: For those members who are unsure of how the system works, some Blue Cross Blue Shield plans offer a dedicated concierge who will help them understand how to use their benefits and access medications for chronic conditions.
✅ Healthy living support: Some plans offer $25 to $100 per quarter, loaded to a dedicated debit card, which can be used to purchase healthy food and vitamin supplements.
❌ Each plan is different: Blue Cross Blue Shield is an association of 34 independent companies. Each company offers slightly different health care plans. This means that there is no national standard for health care plans with Blue Cross Blue Shield.
❌ Can be confusing: Blue Cross Blue Shield operates across 34 different companies. This means that finding all the information you need on their website can be confusing.
❌ Customer service ratings: In some states, Blue Cross Blue Shield gets an average rating of just above 3.5 out of 5. Medicare Advantage Star Ratings across all medical insurance companies averaged at 4.37 stars.
❌ Limited special needs plans: Blue Cross Blue Shield providers offer special needs plans (SNPs) in only about half of the U.S. states that they serve.
What Is Blue Cross Blue Shield’s Medicare Star Rating?
The Centers for Medicare and Medicaid Services (CMS) uses a star rating system to measure the performance of Medicare Advantage and Part D health plans.
Blue Cross Blue Shield’s average star rating (2022): ⭐⭐⭐⭐
Here’s what the different star ratings mean:
(No stars): New Plan
⭐⭐: Below average
Blue Cross Blue Shield’s Medicare Advantage Plans and their prescription drug plans have an average rating of 4.1, in comparison to the average 4.37 star review for all Medicare plans from all providers in 2022.
What Are Medicare Star Ratings?
The aim of the Medicare star rating that the CMS provides, is to make it easy for buyers to compare the quality of all the health care plans on offer.
They also provide an overall star rating score for each health insurance company that offers Medicare Advantage and Part D prescription drug plans.
The rating for Medicare Part C considers 28 different factors.
The rating for Medicare Part D considers 12 factors.
The rating for Medicare Advantage Plans with Part D coverage considers 38 factors.
The CMS rates health insurance companies and their plans on:
How Medicare providers keep their beneficiaries healthy (for example, preventive services and other health benefits).
How they manage long-term or chronic conditions.
Their members’ experience (overall customer satisfaction).
Member complaints (complaints submitted and whether members are leaving the health plan).
The plan’s overall customer service (call center services, processed claims, appeals, and enrollments).
Other Third-Party Ratings of Blue Cross Blue Shield.
Some companies and organizations provide ratings of Medicare health insurance providers each year.
This is to measure the quality of an insurance company.
Here is what they said about Blue Cross Blue Shield.
In its 2022 U.S. Medicare Advantage Study, J.D. Power rated Medicare Advantage Plans based on member satisfaction.
Blue Cross Blue Shield came 6th in a top ten list with a score of 802 out of 1,000.
The National Committee for Quality Assurance (NCQA) accredits and rates health plans based on:
The quality of care patients receive.
How happy patients are with their care.
Health plans’ efforts to keep improving.
Ratings are updated annually in September.
Across all states, Blue Cross Blue Shield plans received a maximum rating of 4.5 and one minimum rating of 2.5. It's important to note that most plans received a rating of 3.5.
AM Best is a credit rating agency that reviews insurance companies based on their financial strength.
Blue Cross Blue Shield is provided through 34 different companies across the U.S.
Not all Blue Cross Blue Shield companies are rated by AM Best.
Blue Cross Blue Shield Mississippi, for example, received an upgrade of their Long-Term Issuer Credit Rating to an A+ from a previous rating of A.
This credit rating reflects the strength of the Blue Cross Blue Shield of Mississippi’s balance sheet.
How Does Blue Cross Blue Shield Compare to Other Health Insurance Providers?
Blue Cross Blue Shield operates through many subsidiaries, so it is difficult to compare it to other health insurers generally.
However, let’s take a look at how Blue Cross Blue Shield stacks up against their competition:
Blue Cross Blue Shield vs. UnitedHealthcare
Both Blue Cross Blue Shield and UnitedHealthcare serve 50 states.
Blue Cross Blue Shield also serves the District of Columbia and Puerto Rico, while UnitedHealthcare serves:
Northern Mariana Islands.
U.S. Virgin Islands.
UnitedHealthcare has 26 million members, while Blue Cross Blue Shield has 62 million Medicare members. Blue Cross Blue Shield operates through 34 companies, which extends its reach considerably.
Both UnitedHealthcare and Blue Cross Blue Shield offer a wide variety of health insurance plans. This includes health maintenance organization (HMO) and preferred provider organization (PPO) plans.
While Blue Cross Blue Shield offers plans at every price point, UnitedHealthcare is somewhat more expensive across the plans that are available.
Blue Cross Blue Shield vs. Aetna
Aetna and Blue Cross Blue Shield are two of the largest health insurance providers in the country.
Aetna is available nationwide and has an estimated 39 million members as opposed to Blue Cross Blue Shield which has 62 million beneficiaries.
Both companies are well established. While Blue Cross Blue Shield was founded in the 1920s, Aetna was established as an insurance company in the 1800s.
When comparing the health insurance options offered by the two companies, Aetna is the best option if you qualify for Medicare or are employed by a company.
Blue Cross Blue Shield is the better choice if you’re shopping as a private individual or for a family plan.
Blue Cross Blue Shield also has one of the biggest networks of health providers which may be an advantage for some individuals.
Aetna offers fewer benefits as compared to Blue Cross Blue Shield. Whereas Blue Cross Blue Shield offers individual and family plans, as well as dental and vision cover, Aetna does not offer any of these.
Blue Cross Blue Shield’s prices are slightly higher than the average Medicare insurance plans offered by competitors.
You are getting some distinct advantages with them, like their support of individuals and small business owners.
Aetna Insurance is difficult to buy unless it is offered by an employer.
Blue Cross Blue Shield vs. Humana
Founded in 1961, Humana is the third largest health insurance provider in the U.S. and has over 13 million customers.
Available in 47 states including Puerto Rico, Humana has a slightly smaller reach compared to Blue Cross Blue Shield, which is available in 50 states.
Humana has been rated as being more widely available to Americans than any other health insurance provider. Humana offers health insurance plans in over 2,700 counties. All their plans are high-quality and top-rated plans.
Blue Cross Blue Shield does not operate as a direct service provider, but is available through its network of 34 independent companies.
This means that service delivery and plans can differ slightly between companies and the states in which they operate.
Medicare Advantage Plans Offered by Blue Cross Blue Shield
Blue Cross Blue Shield offers various Medicare Advantage Plans and each varies in terms of cost, structure, and benefits. These plans also differ depending on the region.
The Medicare Advantage Plans include the following types:
Medicare Advantage Plans
These plans include all the benefits of Part A and Part B, plus dental, vision, and hearing care, as well as wellness programs or fitness center memberships. Medicare Advantage Plans are offered by private insurance companies and are subsidized by the federal government.
Health maintenance organization plans
An HMO (health maintenance organization) plan requires that you use a specific network of doctors and hospitals. You will likely need a referral from your primary doctor to visit a specialist. Out-of-network benefits are limited.
Health maintenance organization - Point of service (HMO-POS) plans
HMO point of service, otherwise known as HMO-POS plans, allow members to receive out-of-network services; however, these services are generally more expensive.
Preferred provider organization or PPO plans, provide more freedom in choosing health care providers that will accept your insurance.
You will not need a referral to see a specialist and you can seek out-of-network care, although this care will come at a higher cost than in-network doctors.
Private fee-for-service (PFFS) plans
The Blue Cross Blue Shield private fee-for-service, or PFFS plans, allow you to see any approved health care provider who will accept your insurance with Blue Cross Blue Shield.
You do not need a referral letter from a primary doctor to see a specialist.
Special needs plans (SNPs)
Special needs plans provide membership for people with certain diseases or profiles.
The benefits, health care provider network, and the formularies are tailored to meet the specific needs of those members. Blue Cross Blue Shield offers three types of SNPs:
Institutional special needs plan
This suits people living in a network nursing home, assisted living community, or other approved facility.
Chronic condition special needs plan
This has been designed for people with certain chronic conditions such as diabetes, congestive heart failure, and so forth.
Dual-eligible special needs plan
This is the SNP option for people who are entitled to Medicare and who also qualify for assistance from the Medicaid program.
How Much Do Blue Cross Blue Shield Medicare Advantage Plans Cost?
Medicare Advantage Plan costs differ according to your zip code and your health needs.
Blue Cross Blue Shield offers a zero-premium Medicare Advantage Plan in 45 states, including Puerto Rico.
A zero-premium plan is a Medicare Advantage Plan that does not cost anything, in other words it has no monthly premium. For private insurers to afford to offer zero-premium plans, they make up for the costs through other ways such as deductibles, co-pays, and coinsurance.
Medicare Advantage Plans—where there is a consolidated Part C and Part D—range from $2 to $300.
Special needs plan premiums range from $0 to $59.
Your Medicare Part B plan premium, which you will even as a Medicare Advantage user have to cover, is at least $170 per month.
What Medicare Part D Plans Does Blue Cross Blue Shield Offer?
Prescription drug coverage or Part D plans cover your prescription drug costs for all covered medications.
Part D is included in Blue Cross Blue Shield’s Medicare Advantage (Part C) medical insurance and Medicare Advantage members do not need to purchase a Part D plan.
What Medicare Supplement Plans Does Blue Cross Blue Shield Offer?
Blue Cross Blue Shield provides eight Medicare Supplement Insurance Plans that are available for purchase by any Medicare member.
Blue Cross Blue Shield also offers Medigap Plan C and Plan F.
What Are Medicare Supplement Plans?
A Medicare Supplement Insurance Plan (Medigap) is sold by private companies, separate from Medicare. These pay for the costs, or ‘gaps’ in coverage not paid for by Original Medicare, and can include prescriptions, doctors’ visits, as well as vision, hearing, and dental care.
These are the various Medicare Supplement Insurance Plans. These are also known as Medigap.
Medigap Plan A — the basic benefits included in every Medigap plan without any extras.
Medigap Plan B — basic benefits plus coverage for the Medicare Part A deductible.
Medigap Plan C — out-of-pocket expenses not met by Original Medicare.
Medigap Plan D — a mid-cost option that covers most Medigap benefits.
Medigap Plan F — coverage for gaps in Original Medicare for co-payments, coinsurance, and deductibles.
Medigap Plan G — the highest coverage option available to new Medicare members.
Medigap Plan K — the lowest cost Medigap plan, with 50% coverage for most benefits.
Medigap Plan L — a low-cost option with 75% coverage for most benefits.
Medigap Plan M — coverage for most benefits, but only half of the Part A deductible.
Medigap Plan N — a plan with lower premiums but higher co-pays.
Tips for Finding The Right Medicare Advantage Plan
If you’re looking for a Medicare Advantage Plan, you may be wondering how to choose the best plan for your needs.
What you end up choosing will depend largely on what you can afford and your medical needs.
Here are some pointers to help make your decision easier:
Research CMS Star Ratings
The CMS or Centers for Medicare and Medicaid Services implemented a 5-star rating system to help measure the quality of health and drug services provided by Medicare Advantage and Medicare Part D plans.
Every year the CMS releases the star ratings to the public, download the 2022 data here.
Decide on your budget
One of the most important considerations when it comes to choosing a Medicare plan is what the premium will be per month. Find a plan that lists the following information for you:
Part B premium.
In-network annual deductible.
In and out-of-network out-of-pocket max.
Co-pays and coinsurance
Review the benefits you may already have
If you already receive any other health care benefits, factor these in to decide what you will really need out of a new plan.
Consider what is important in terms of coverage
All Medicare Advantage Plans cover what Original Medicare does, which include hospital coverage (Part A) and medical coverage (Part B).
When choosing a Medicare Advantage Plan, you will want to first consider what type of coverage you need in addition to the coverage you are already getting.
Most Medicare Advantage Plans cover the following:
Prescription drug coverage.
Where Can I Learn More about Medicare Advantage Plans?
For comprehensive insights into Medicare Advantage Plans, head on over to the Medicare.gov website.
Here you will learn all that you need to know about the various plans and plan structures, as well as how to join a good plan.
You will also find the Rules for Medicare Health Plans on the Medicare.gov site, which is an excellent resource.
Frequently Asked Questions (FAQs) about Blue Cross Blue Shield Medicare
How do I enroll in a Blue Cross health insurance policy?
You will need to find a Blue Cross Blue Shield sales representative in your area.
To find a list of where Blue Cross Blue Shield is available, visit their Member Services Page and search for a local Blue Cross Blue Shield company.
Is Medicare Advantage the same as Blue Advantage?
Blue Advantage (PPO) is a Medicare Advantage (Medicare Part C) plan. Choose this plan if you are looking for health and prescription drug coverage with extra benefits for dental, vision, hearing, and fitness—all in one plan.
Is Blue Cross Blue Shield a good insurance company?
Blue Cross Blue Shield is a highly rated, quality health insurance provider that offers you a large network of health care providers and extensive coverage.
What If I Need More Information?
We are here to help you choose the best health insurance for your needs.