The Blue Cross Blue Shield Association are a federation of 36 different health insurance companies within the United States. They offer different Medicare Advantage plan options.
The Blue Cross Blue Shield Association (BCBSA) provide health coverage within the U.S.
A group of 36 independent and locally operated BCBS companies make up the association.
Medicare Advantage plans are available through the BCBSA, and this article will look at the options available, the expected costs, and how to compare plans.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
BCBS Medicare Advantage plans have defined geographic service areas, which means that the types of policy from which a person can choose are different from state to state.
BCBS Medicare Advantage plans are available in 42 states, but they are not currently available in:
- Alaska
- Delaware
- Iowa
- Maryland
- Mississippi
- North Dakota
- South Dakota
- Vermont
- Wyoming
It may be beneficial for a person to research which plan options best suit their needs.
An individual can compare details of the policy options in each state, and, if they have any additional questions, a local State Health Insurance Assistance Program (SHIP) may be able to provide further advice.
BCBS Medicare Advantage Plans include:
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- HMO with Point-Of-Service Option (HMO-POS)
- Private Fee-For-Service (PFFS)
PPO plans
PPO plans consist of a network of doctors, hospitals, and other healthcare providers that have agreements with the company administering the policy. Therefore, these healthcare providers will be in a plan’s network.
A person usually pays less if they use in-network doctors, services, and hospitals. Choosing care outside of the network may result in higher costs.
HMO plans
In an HMO plan, a person must receive their healthcare services from a list of providers within the plan’s network, but exceptions might be possible for:
- emergency care
- out-of-area urgent care
- out-of-area dialysis
HMO-POS plans
Some HMO plans allow a person to choose a healthcare provider who is out-of-network for some types of services.
This type of plan is a Medicare Advantage HMO Plan with a Point-Of-Service option.
PFFS plans
If a person joins a PFFS plan, the plan will decide how much they will pay for healthcare. It will also determine the amount a person pays toward their healthcare costs.
An individual does not have to use in-network services but can use an out-of-network doctor, hospital, or provider who accepts the plan’s rules and requirements.
SNPs
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan for people with specific conditions or diseases.
The plans customize the choice of providers, benefits, and drug formularies to meet the needs of their members as best as possible.
SNPs usually provide individuals with access to medical specialists who are experienced in the diseases or conditions that affect them.
Private insurance companies that administer Medicare Advantage plans usually include the option to add prescription drug coverage (Medicare Part D). All SNPs are required to include Medicare prescription drug coverage automatically.
Medicare Cost Plans are a type of HMO, and they are only available in Minnesota.
They work in much the same way as other HMO plans. A person may choose to use the Cost Plan provider network, or they can opt to receive their healthcare from a non-network provider. If an individual decides to visit a non-network provider, original Medicare will cover eligible costs.
Costs may vary by state and depend on which plan a person chooses, but the general costs may include:
- monthly premiums
- deductibles
- copayments
- coinsurance
- excess charges
All Medicare Advantage plans require that members continue to pay the monthly premium for Part B. Depending on the plan that a person selects, they will also typically pay a separate monthly premium for their Medicare Advantage plan.
The Blue Cross Blue Shield Association offer Medicare Advantage plans in many U.S. states.
If an individual joins a BCBS Medicare Advantage plan, they will receive cover for original Medicare parts A and B. The plan may also include prescription drug coverage and additional benefits, such as dental or vision care.
Many doctors and specialists contract with BCBS companies, making them in-network. Using in-network healthcare providers usually costs less than using non-network providers.
Different Medicare Advantage plans may charge different deductibles, copayments, and coinsurance.