Blue Cross Blue Shield is a private insurer that offers Medicare Advantage (Part C) plans. The plans they offer have various pros and cons, including cost and coverage.
Private insurance companies offer Medicare Advantage plans that combine Medicare Parts A and B coverage with extra elements, such as vision, dental, and prescription drugs.
Blue Cross Blue Shield (BCBS) is an association of insurance companies in the United States that offer Medicare Advantage in every state, Washington D.C., and Puerto Rico.
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 has operated since 1929 and has a beneficiary base of around 115 million people. It is an association of 33 companies and licensees that allow it to administer healthcare coverage in every state. These companies will often have “Blue Cross Blue Shield” in their name or a slight variation.
Examples include:
- Anthem Blue Cross and Blue Shield of Georgia
- Blue Cross Blue Shield of North Dakota
- Blue Cross and Blue Shield of Texas
- Highmark Blue Shield of Northeastern New York
- Premera Blue Cross
Original Medicare has consistent premiums, coinsurance, deductibles, and benefits across all areas. However, Medicare Advantage varies between regions, providers, and types of plans.
Despite the variation, Medicare Advantage plans must follow Medicare regulations and cover all medically necessary services included in Parts A and B.
Many Medicare Advantage plans under BCBS also offer prescription drug coverage, as well as the following services:
- dental services, including routine care
- routine vision services
- hearing aids
- prescription medications
- a yearly limit on out-of-pocket costs
- a $0 premium on some plans
BCBS offers a finder tool to help people locate their nearest BCBS company and speak to them about what is available in their region.
Learn more about the monthly cost of Medicare Advantage.
The pros and cons of any insurance plan depend on an individual’s needs. However, here is a breakdown of what to consider when looking at BCBS Medicare plans:
BCBS Pros
- BCBS offers a BlueCard program that allows beneficiaries to access coverage anywhere in the country, with treatment charged at local rates.
- BCBS provides a flexible range of plan structures, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee for Services (PFFS) plans.
- Medicare Advantage plans provide coverage for a broader range of services than Original Medicare, including hearing, vision, and dental. Many also include prescription drugs.
- Some plans may have a $0 premium, depending on the insurance provider.
BCBS Cons
- Beneficiaries will often need to pay a Part B premium as well as a Medicare Advantage premium.
- BCBS does not offer as many Special Needs Plans (SNPs) as other types of Medicare Advantage plans.
- Premiums and benefits might change every year on January 1.
- As with other Medicare Advantage plans, most people with a BCBS Medicare Plan can only use healthcare providers within an approved network.
Learn about Original Medicare vs. Medicare Advantage.
The different types of Medicare Advantage plans that BCBS offers impact whether a beneficiary can visit out-of-network doctors or claim for drug costs.
Health Maintenance Organization (HMO)
An HMO plan specifies a network of non-emergency doctors, hospitals, and specialists that a person can visit, and BCBS will pay. However, this does not apply to emergency treatment.
HMOs usually offer drug cover and usually charge a premium alongside the monthly Part B premium.
Some HMOs require that a person receive a referral from their primary care physician (PCP) before seeing a specialist, and individuals must also choose a specific PCP.
Learn more about HMO plans.
Preferred Provider Organization (PPO)
PPOs offer broader treatment and provider options for BCBS beneficiaries because these plans provide some funding for out-of-network healthcare providers. An individual does not need to select a particular PCP.
However, BCBS still pays more to in-network providers than out-of-network providers. People who are part of a PPO do not need a physician’s referral to consult with a specialist.
PPOs also usually offer drug coverage.
Learn about Medicare referrals.
Private Fee For Services (PFFS)
People with PFFS plans can visit any Medicare-approved provider who accepts the payment terms. The plan decides how much a person pays and sets out how much BCBS will pay before treatment starts.
PFFS plans usually offer drug coverage. If a person joins an HMO or PPO that does not cover drugs, they cannot get a separate Part D drug plan. However, people who join a PFFS with no drug coverage may apply for Part D.
For people on a BCBS plan, PFFS options are only available in Arkansas.
Learn more about PFFS plans.
Blue Cross Part D
Medicare Part D provides coverage for prescription drugs, and many BCBS Medicare Advantage plans cover prescription drug expenses.
However, if they do not, some plans allow a person to take out Part D coverage along with their Advantage plan. Part D also includes a formulary, or a list of the specific medications they cover.
Like Medicare Advantage (Part C), private insurers administer Part D. BCBS is no exception, offering a range of Part D products depending on a person’s region. Many plans require a copayment or coinsurance for drug costs.
Learn more about the Medicare drug list.
The cost of BCBS Medicare Advantage plans varies greatly depending on the company, the coverage level, and the plan type.
Every person with Medicare Advantage will need to pay the $174.70 Part B premium along with the Medicare Advantage premium from BCBS.
Some providers offer plans with a $0 Medicare Advantage premium. The copayments or coinsurance amounts may be different than those in Original Medicare.
The table below compares several examples of HMOs from different states. Scroll to the left to see more information in the table.
| State | Provider | Plan | Covers | Monthly premium (not including Part B) | Deductible (Health) | Deductible (Drugs) | Out-of-pocket limit |
|---|---|---|---|---|---|---|---|
| Massachusetts | Blue Cross and Blue Shield of Massachusetts | Medicare PPO Blue Saver Rx | •vision •dental •hearing •fitness benefits •worldwide emergency •telehealth | $0 | $0 | $0 | $5,600 |
| Kentucky | Anthem Blue Cross and Blue Shield | Anthem Medicare Advantage (HMO) | •vision •dental •hearing •fitness benefits •worldwide emergency •telehealth •transportation | $0 | $0 | $0 | $4,800 |
| Illinois | Blue Cross and Blue Shield of Illinois | Protect PPO | •vision •dental •hearing fitness benefits, •worldwide emergency •telehealth •transportation | $0 | $0 | $545 (not included in main plan) | $6,350 |
| California | Blue Shield of California | Blue Shield Inspire (HMO) | •vision •dental •hearing •fitness benefits •worldwide emergency •telehealth •transportation | $0 | $0 | $0 | $699 |
Medicare offers a plan-finding tool to filter the results after a person chooses the nearest BCBS company or licensee in the insurance carrier dropdown menu.
Learn more about Blue Cross Medicare Advantage plans.
BCBS is a long-established insurer that has provided Medicare since its inception in 1966.
Assessing an insurer’s reputation is complex, especially when they have as many subsidiary companies as BCBS. Medicare has a system called the Health Insurance Exchange Quality Ratings System that simplifies this and uses survey data to show how people rate insurance companies.
The official Medicare overall star rating for BCBS North Carolina in 2024 is 4.5 stars. Individuals can compare plans and find more information on official star ratings using the online tool on the Medicare website.
Learn more about Medicare’s star rating system.
United Healthcare (UHC) is another large insurer that provides Medicare Advantage.
BCBS claims to partner with 1.7 million healthcare providers, while UHC has relationships with slightly fewer — 1.5 million providers.
Both have large customer bases, with BCBS boasting 115 million members and UHC claiming to cover around 170 million people in the United States.
However, over 90% of doctors in every State, Washington D.C., and Puerto Rico accept BCBS, which may not be the case for UHC.
Individual plans vary, and people may benefit from comparing plans to determine which is best for their health and lifestyle needs.
The online comparison tool can help compare plans from multiple providers.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Blue Cross Blue Shield (BCBS) offers a variety of Medicare Advantage HMO and PPO plans in every state, as well as prescription drug plans through Medicare Part D.
Their network of doctors is expansive, and many of their policies cover hearing aids and routine dental and vision care.
However, the number of Special Needs Plans is limited, and prices may change yearly, depending on the plan. Speak to a local Medicare office to determine whether a particular Medicare Advantage provider is more suitable than others.