at a glance
- Excellus offers Medicare Advantage plans in central and upstate New York.
- Excellus offers HMO and PPO Medicare Advantage plans that include Part D prescription drug coverage.
- Coverage options and costs for Excellus Medicare Advantage plans will vary based on the ZIP code where you live.
- Excellus provides health insurance to nearly 1.5 million members collectively.
Excellus is a division of Blue Cross Blue Shield based in Rochester, New York. The company offers insurance plans throughout the region, including many Medicare Advantage options.
Excellus offers both HMO and PPO plans at a variety of price points, including plans with no premiums in some counties. Excellus plans include Part D prescription drug coverage, as well as coverage for extras like SilverSneakers memberships, vision care, and optional dental coverage.
Let’s take a closer look at the different types of plans offered by Excellus and how much they may cost in different areas.
Excellus offers Medicare Advantage plans in a few different formats and at multiple price points. The exact plans available to you will depend on your region, but all Excellus plans in are either Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans.
Excellus HMO plans
An HMO is a common type of health insurance plan. HMOs use a set network of providers. Care you receive from any of these in-network providers will be covered, while care you receive from providers outside the network won’t be.
Some Excellus HMO plans are standard HMOs, but others are HMO Point-of-Service (HMO-POS) plans. An HMO-POS is like a blend of an HMO and PPO. You have more freedom to see providers outside of your network, but you’ll pay a higher copay.
Generally, there are rules about when you’re able to see out-of-network providers. For example, a POS plan may allow you to use providers out of your network if you’re traveling within the United States and need to see a doctor or fill a prescription.
You’ll also be able to see providers outside of your network in an emergency situation no matter what type of HMO you have.
Excellus PPO plans
A PPO is another common type of insurance plan. PPOs work a lot like HMOs, but you’ll have even more flexibility. PPOs have a network, but you can get coverage for care outside the network.
Coverage outside the network will come at a higher price to you than coverage within your plan’s network. For example, your plan might have $25 copayment for seeing a doctor in-network, but a $45 copayment for seeing an out-of-network provider.
With a PPO you also won’t need a referral to see a specialist, as you would with an HMO.
Excellus Medicare Advantage plans include Medicare Part D prescription drug coverage. However, Excellus doesn’t offer standalone Part D plans. If you want Part D coverage through Excellus, you’ll need to purchase a Part C plan.
Excellus Medicare Advantage plans are offered throughout the state of New York. Areas served include central New York, eastern New York, and the Greater Rochester area.
Excellus divides its coverage area into five regions:
- Central New York region: Broome, Cayuga, Chemung, Chenango, Cortland, Jefferson, Lewis, Onondaga, Oswego, Schuyler, St. Lawrence, Steuben, Tioga, and Tompkins counties
- East region: Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Montgomery, and Otsego counties
- Rochester region: Livingston, Monroe, Ontario, Seneca, Wayne, and Yates counties
- Utica Rome region: Herkimer, Madison and Oneida counties
The exact plans available to you will depend on your specific region, county, and ZIP code.
Excellus plans cover all the services required by Medicare, including those covered under Medicare parts A and B. Excellus Medicare Advantage plans also include additional coverage options.
Your exact services covered are based on the plan you choose, but all Excellus plans offer:
- Part D coverage
- routine vision care
- an eyewear allowance
- SilverSneakers membership
- hearing exams
- a hearing aid allowance
- optional dental coverage
- acupuncture coverage
Coverage, premiums, deductibles, and other out-of-pocket costs may vary from plan to plan. Here are some example costs you’ll see with Excellus Medicare Advantage plans in different coverage areas in 2022:
|City, plan||Monthly premium||Health deductible, drug deductible||PCP visit|
|Syracuse, NY: Medicare BlueEssential (PPO)||$0||$0, $150||$5 in network, $25 out of network||$35 in network, $60 out of network||$7,550 in network, $11,300 in and out of network|
|Amsterdam, NY: Medicare BluePlus (PPO)||$116||$0, $480||$5 in network, 30% coinsurance out of network||$50 in network, 30% coinsurance out of network||$6,000 in network, $9,300 in and out of network|
|Rochester, NY: Medicare Blue Choice Value (HMO)||$71||$0, $225||$5||$40||$6,700 in network|
|Utica, NY: Medicare Bassett (HMO-POS)||$111||$0, $0||$5 in network, 30% coinsurance out of network||$40 in network, 30% coinsurance out of network||$6,700 in network|
Medicare Advantage (Part C) plans take the place of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), often referred to as original Medicare.
Medicare Advantage plans are offered by private insurance companies, like Excellus, who contract with Medicare to provide coverage. Medicare regulates these plans and makes sure they cover all the same services as original Medicare including:
- emergency ambulance transportation
- hospital stays
- emergency room visits
- urgent care visits
- limited home healthcare
- doctors’ visits
- specialist visits
- at-home medical equipment
- physical, occupational, and speech therapy visits
Many plans also offer extra coverage for things original Medicare doesn’t cover, like dental, vision, and hearing services.
Plans have their own costs associated with them. Any premium for a Medicare Advantage plan will be in addition to the premium you pay for Part B.
The Medicare Advantage plans available to you will depend on where you live. Some plans only cover certain states or even ZIP codes. Other plans might be available in more places, but the price will vary based on your location.
You can shop for plans in your area using the Medicare plan finder tool.
- Excellus Medicare Advantage plans are offered to New York residents at multiple price points.
- Depending on your county, you can choose from PPOs, HMOs, or HMO-POS plans.
- Plans include Part D coverage as well as coverage for extra services like vision care, hearing exams, and optional dental care. Additional benefits of Excellus plans may include an allowance for eyewear and hearing aids, as well as a SilverSneakers membership.