- Blue Cross offers a variety of Medicare Advantage plans and types in most states in the United States.
- 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.
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 (BCBS) is one of these companies.
This article will cover 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. You can find out more about Blue Cross’ Medicare Advantage plans by visiting the Medicare.gov plan finder.
Blue Cross Medicare Advantage 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.
If you were to need specialty care (such as referral to a orthopedic doctor for knee pain or a gastroenterologist for stomach problems), you would first see your primary care provider (PCP), then your PCP would potentially refer you to 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 Medicare Advantage 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 Medicare prescription plans (Part D plans)
Medicare Part D plans are prescription drug plans. 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 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 primary care physician, 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 Medicare Special Needs plans (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
You can search for available Medicare Advantage plans by state and region at the Medicare plan finder and at your provider’s website.
The Medicare Advantage marketplace is an increasingly competitive one. In 2020, the average of available Medicare Advantage plans in most areas is 28. If you live in a metropolitan county, there may be as many as 31 plans available on average or 16 plans in the average rural area.
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, which is $144.60 for every person enrolled in Medicare Part B.
Select BCBS plan comparison in a few U.S. cities*
|City and Policy||Star rating||Monthly premium with drug coverage||Health plan deductible per year||Drug deductible per year||In-network out-of-pocket max||Primary doctor copays/coinsurance per visit||Specialist copays/coinsurance per visit|
|Seattle, WA, Premera Blue Cross Medicare Advantage (HMO)||4 stars||$0||$0||$300||$6,300||$15 copay or 0 to 15 percent coinsurance||$45 copay or 0 to 15 percent coinsurance|
|Phoenix, AZ, Blue Cross Blue Shield of Arizona Advantage Blue Medicare Advantage Classic (HMO)||3 stars||$0||$0||$0||$4,250||$0 copay||$35 copay|
|Cleveland, OH, Anthem MediBlue Access Core (Regional PPO)||3.5 stars||$18|
(without drug coverage)
|Little Rock, AK, AR Blue Cross – Medi-Pak Advantage MA (PFFS)||3 stars||$59|
(without drug coverage)
|$1,000 out-of-network||N/A||$6,700 (in- and out-of-network)||$30|
|Trenton, New Jersey, Horizon Blue Cross Blue Shield of New Jersey Horizon Medicare Blue Advantage||3.5 stars||$0||$0||$250||$6,700||$10 copay||$25 copay|
*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.
An estimated 34 percent of people with Medicare utilize Medicare Advantage, according to the Kaiser Family Foundation. Of those with Medicare Advantage, an estimated 97 percent have a plan that offers additional benefits, such as dental, fitness, hearing, and vision.
Having Medicare Advantage means that the insurance company that offers your plan will provide coverage for Medicare Part A (hospital coverage), Medicare Part B (medical coverage) and some plans offer prescription drug coverage. Medicare Advantage plans vary in their out-of-pocket costs and coverage, including copayments and coinsurances.
Anyone who qualifies for original Medicare can qualify for Medicare Advantage. This includes those older than age 65 and those with a qualifying disability, end stage renal disease, or amyotrophic lateral sclerosis (ALS).
Another consideration for qualifying for Medicare Advantage is by the area where you live. Most plans are region- or state-specific. If you have a Medicare Advantage plan and you move to another area, you will have to switch plans.
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.