Blue Cross Blue Shield Medicare Review

Pros Explained

• Medicare Advantage available in most states: BCBS’ Medicare Advantage plans are sold in 41 states. 
• Plans offer additional drug coverage in the donut hole: The Medicare donut hole or coverage gap begins once you and your plan spend $4,430 ($4,660 in 2023) on covered drugs. During this time, you’re responsible for up to 25% of the cost of brand name and generic drugs. But some companies, like BCBS, offer plans with additional coverage during this period which can be invaluable if you expect to enter the gap.
• Wide selection of Medigap plans: BCBS sells 12 Medigap plans, which is more than any other insurer we reviewed: A, B, C, D, F, F-high deductible, G, G-high deductible, K, L, M, and N. It’s also our runner-up for the best Medicare supplement plans.
• High Medicare star ratings: Out of the top Medicare providers with a national presence, BCBS Medicare Advantage plans have the highest Medicare star rating. BCBS plans average 4.3 out of 5 stars; the next highest national provider’s plans average 4.2 stars (UnitedHealthcare’s AARP plans). This is one reason BCBS took third place in our review of the best Medicare Advantage providers of 2023.

Cons Explained

• Plans are different in every state: There are 34 independent BCBS organizations, so you have to do your own research to learn about plan types, costs and ratings for your location. 
• Expensive costs: Based on 2023 CMS data, BCBS plan costs, including the average premium and average deductible, are much higher than most competitors.

Third-Party Ratings

BCBS has good third-party ratings.  AM Best gives its multiple subsidiaries ratings that range from A+ (Superior) to A- (Excellent), which means the company as a whole is very capable of meeting its financial obligations.

The company has excellent Medicare star ratings across its Medicare Advantage (4.3 stars, on average) and Part D plans (4.0 stars, on average). However, BCBS’ average rating from the National Committee for Quality Assurance (NCQA),which is based on features like quality of care and availability of care, is not as impressive. The organization gives it 3.5 out of 5 stars, putting it behind Aetna (3.8 stars), UnitedHealthcare (3.9 stars), and Humana (3.6 stars). 

In J.D. Power’s 2022 U.S. Medicare Advantage Study, BCBS affiliates had mixed ratings. Highmark was rated 3rd out of nine companies, with a score of 802 out of 1,000, which is above the industry average of 809. However, BCBS Michigan ranked 5th out of nine companies, with a below average score of 802.

Policies Available 

Medicare Advantage (Part C) Plans

BCBS offers HMO and PPO Medicare Advantage plans, including plans with prescription drug coverage. Most of those offer additional coverage in the Part D donut hole. Many plans also offer $0 physician copays.

The average costs for BCBS’ Medicare Advantage plans in 2023 are relatively high:

• Average premium: $35.96
• Average deductible: $146.62
• Average out-of-pocket maximum: $5,188.70

Medicare Advantage plans, also called Medicare Part C, include Part A (hospital insurance) and Part B (medical insurance). Many plans also include Part D (Prescription Insurance).

Part D Prescription Drug Plans

BCBS sells standalone Medicare Part D plans if you have Original Medicare or a Medicare Advantage plan without drug coverage. Some BCBS Part D plans provide additional drug coverage during the gap period, but less than a third of available plans include this feature in 2023. In addition, Part D coverage from BCBS is not available in all states. 

Medicare Supplement Plans 

Medicare supplement plans, also called Medigap plans, can help pay out-of-pocket expenses that Original Medicare doesn’t cover, like Part A and Part B deductibles, copayments and coinsurance. 

BCBS offers 12 Medigap plans, including Plans A, B, C, D, F, G, K, L, M and N. You can also purchase a high-deductible Plan F or high-deductible Plan G.

In terms of cost, BCBS’ Medigap prices are decent. The average monthly cost of Plan G for a 65-year-old non-smoker in Texas and Florida is about $200. To compare, AARP plans, issued by UnitedHealthcare, had the lowest average Plan G premium at $184 per month.

Special Needs Plans

BCBS sells Special Needs Plans (SNPs) through Anthem, which is one of its subsidiaries. There are three SNPs available through Anthem/BCBS:

• Dual-Eligible SNP: The D-SNP plan is available for people who qualify for both Medicare and Medicaid based on their state’s income requirements. This plan includes coverage for vision, dental, hearing and prescription medications.
• Chronic Condition SNP: The C-SNP plan provides higher levels of coverage for people who have been diagnosed with a serious medical condition, like diabetes or heart disease. Most of Anthem’s C-SNP plans have low or $0 premiums, as well as a $0 deductible and tailored health benefits.
• Institutional SNP: Members are eligible for the I-SNP plan if they need long-term care in a skilled nursing facility for 90 days or longer.

Cost

BCBS’ plans are expensive when looking at national average costs. Out of the largest Medicare providers, BCBS has the second-highest average premium for Part C ($35.96), second to Kaiser Permanente. It has the third-highest average drug deductible ($146.62)—Wellcare’s and Humana’s are higher. However, its average maxmium out-of-pocket amount ($5,188.70) is lower than all major competitors, except for Kaiser Permanente ($5088.01).

Customer Service

To get in touch with BCBS, you can call the company at (888) 630-2583. You can also use the online directory to find the local BCBS organization in your area. When you visit your local BCBS chapter’s website, you can see which specific contact options are available. 

Methodology

Literature Review

We identified top companies by market share within the industry offering Medicare plans from various business and market insight databases including Statistia, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans. 

Data Collection and Verification

Our data was collected through third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicaid and Medicare Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s plan types. Factors considered for companies offering Medicare plans were: 

• Plan quality and customer satisfaction: CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment. 
• Cost to value: This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
• Additional coverage offered in the Medicare gap: The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
• State availability: This measure indicates how widely available plans are across the U.S.
• Additional plan benefits: This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth. 
• Types of plans available: Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
• Special needs plans: This is a measure of whether the company offers plans designed for those with specific diseases.
• Financial strength: This measure accounts for each company’s AM Best financial strength rating to understand how well it’s positioned to pay insurance claims. 

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