At a glance
- Blue Cross offers a variety of Medicare Advantage plans.
- Many plans include prescription drug coverage, or you can purchase a separate Part D plan.
- Many of the Blue Cross Medicare Advantage plans offer $0 monthly premiums along with prescription drug coverage.
- Blue Cross serves over 107 million members across the country, including Washington, DC and Puerto Rico.
Medicare Advantage is an alternative to original Medicare where a private health insurance company offers your Medicare benefits, plus other benefits original Medicare doesn’t traditionally offer. Examples include vision, dental, and preventive health services. Blue Cross Blue Shield is one of these companies.
This article gives you a look at the available Blue Cross Medicare Advantage plans in the United States.
Blue Cross offers a variety of Medicare Advantage plans. Their availability may vary by region and state.
Let’s review the different types of Medicare Advantage plans Blue Cross offers.
Blue Cross HMO plans
Blue Cross offers Health Maintenance Organization (HMO) plans in several states, including Arizona, California, Florida, Massachusetts, and many more. In this plan type, you would have an in-network primary care provider (PCP).
If you were to need specialty care, you would first see your PCP, then they would give you a referral to see a specialist. Your insurance plan would first have to approve the specialty physician referral.
An exception with Blue Cross is that most women wouldn’t need a referral to see an in-network OB/GYN for routine well-woman care, such as a Pap smear.
Blue Cross PPO plans
Blue Cross offers Preferred Provider Organization (PPO) plans in states that include Alabama, Florida, Hawaii, and Montana (just to name a few). As a general rule, a PPO will have a slightly higher premium than an HMO. This is because you don’t usually have to get a referral to see a specialist when you have a PPO.
However, you can save money by choosing in-network providers from the insurance company’s provider list. You may pay more if you choose an out-of-network provider.
Blue Cross PFFS plans
A Private Fee For Service (PFFS) plan is a Medicare Advantage plan that Blue Cross offers in Arkansas only. This plan type doesn’t require you to use a particular PCP, in-network providers, or receive referrals. Instead, the plan sets how much it will reimburse a doctor and you are responsible for paying the remainder of the provider’s reimbursement.
Sometimes, providers will contract with a PFFS plan to provide services. Unlike other Medicare plans, a PFFS plan provider doesn’t have to offer you services just because they accept Medicare. They can choose if they will provide a service at the Medicare reimbursement rate or not.
Blue Cross SNPs
A Special Needs Plan (SNP) is a Medicare Advantage plan dedicated to those who have a particular condition or characteristic. Ideally, the plan provides greater coverage aspects that a person may need. Medicare requires that all SNPs provide prescription drug coverage.
Examples of Blue Cross SNPs include:
- California: Anthem MediBlue Diabetes or Anthem MediBlue ESRD
- Nevada: Anthem MediBlue Breathe, Anthem MediBlue Care on Site, or Anthem MediBlue Diabetes
- Pennsylvania: BlueJourney Alliance Assisted Care, BlueJourney Alliance Heart and Diabetes Care, or BlueJourney Alliance Lung Care
- Virginia: Anthem MediBlue Care on Site, Anthem MediBlue COPD, Anthem MediBlue Diabetes, or Anthem MediBlue Dual Advantage
Medicare Part D plans cover your prescription drugs. Some Medicare Advantage plans through Blue Cross offer prescription drug coverage. However, if the plan does not offer coverage, you can choose a standalone prescription drug plan.
Blue Cross offers “basic” and “enhanced” plans in the prescription drug category as well as Standard, Plus, Enhanced, Preferred, Premium, Select, and more prescription drug policy options. Each will feature a formulary, or list of medications the plan covers and a range of costs. You can check these lists or formularies to be sure any plan you consider includes the medications you take.
Blue Cross Medicare Advantage plans are sold throughout most of the United States, including Washington, DC and Puerto Rico. However, no Medicare Advantage plans are currently sold in Alaska.
Although there is wide availability throughout the country, specific types of plans and coverage options may only be offered in certain areas. This means that if your relative in another state has a Blue Cross plan, the same plan might not be available to you.
As discussed above, each type of Blue Cross Medicare Advantage plan comes with various extra services above what original Medicare offers. Here are a few of the coverage benefits many Blue Cross plans offer:
- prescription drugs
- home healthcare
- SilverSneakers membership
- at-home meal delivery after an inpatient stay
- $0 copays for many preventive services, vaccines, and lab services
The coverage you receive will depend on the plans available in your area and which one you choose.
The Medicare Advantage marketplace is an increasingly competitive one. If you live in a metropolitan county, there may be dozens of plans to choose from.
The following are some examples of Blue Cross Medicare Advantage plans in various locations with their monthly premiums and other costs. These plans do not include the cost of your monthly Part B premium.
|City/plan||Star rating||Monthly premium||Health deductible; drug deductible||In-network out-of-pocket max||PCP copay per visit||Specialist copay per visit|
|Los Angeles, CA: Anthem MediBlue StartSmart Plus (HMO)||3.5||$0||$0; $0||$3,000||$5||$0–$20|
|Phoenix, AZ: BluePathway Plan 1 (HMO)||Not available||$0||$0; $0||$2,900||$0||$20|
|Cleveland, OH: Anthem MediBlue Access Core (Regional PPO)||3.5||$0|
(doesn’t include drug coverage)
|$0; not included||$4,900||$0||$30|
|Houston, TX: Blue Cross Medicare Advantage Basic (HMO)||3||$0||$0; $0||$3,400||$0||$30|
|Trenton, NJ: Horizon Medicare Blue Advantage (HMO)||4||$31||$0; $250||$6,700||$10||$25|
These are just a few examples of available Blue Cross Advantage plans from the Medicare.gov plan finder website. There may be many other options in a ZIP code area.
Having Medicare Advantage (Part C) means that the insurance company that offers your plan will provide coverage for Medicare Part A (hospital coverage), Medicare Part B (medical coverage). Some plans also offer prescription drug coverage. Medicare Advantage plans vary in their out-of-pocket costs and coverage, including copayments and coinsurances.
Deadlines for enrolling in or changing your Medicare Advantage plan
The following are key dates to enrolling in or changing your Medicare Advantage plan:
- Initial enrollment period. The first 3 months before your 65th birthday, your birth month, and 3 months after your 65th birthday.
- Open enrollment period. October 15 through December 7 is the open enrollment period for Medicare Advantage. New plans go into effect on January 1.
- Medicare Advantage open enrollment. During this time period, a person can switch to another Medicare Advantage plan if they already have Medicare Advantage.
- Medicare Advantage special enrollment period. Time period during which you can change your Advantage plan due to special circumstance like a move or a plan that is dropped in your area.
Blue Cross is one of several insurance companies that offer Medicare Advantage plans. You can find available plans by searching the Medicare.gov marketplace or via the Blue Cross website. Keep key dates in mind when deciding when to enroll in a Medicare Advantage plan.