Blue Cross Blue Shield Medicare Review

National association of health insurers offers coverage options in every state

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Blue Cross/Blue Shield

 Blue Cross/Blue Shield

Our Take

Blue Cross Blue Shield is not a single health plan but an association of 36 independent Blue Cross Blue Shield (BCBS) health insurance companies. BCBS has a long history and many of its affiliated plans are well established. Though not all BCBS plans are of equal quality or cost, you’re likely to find a solid BCBS option where you live because of its wide availability and range of plans. 

  • Pros & Cons
  • Key Takeaways
  • Company Overview
Pros & Cons
Pros
  • Nationwide coverage

  • Wide network of healthcare providers

  • Lots of Medicare insurance options

  • Extra benefits and the Blue365 discount program

Cons
  • Each BCBS plan is separate

  • Average quality ratings

Key Takeaways
  • BCBS is an association with 36 individual companies.
  • Each BCBS plan operates independently and offers its own assortment of options, benefits, and services. 
  • In most states, a BCBS-affiliated plan is among the largest Medicare Advantage plans.
Company Overview

The Blue Cross Blue Shield Association (BCBSA) is a nonprofit organization that licenses BCBS trademarks to companies around the country. Each affiliated company operates independently. Some BCBS companies are for-profit while others are nonprofit. Many include Blue Cross and/or Blue Shield in their names, but some are better known by names that may not make their Blue Cross Blue Shield affiliation obvious, such as Anthem or Highmark. 

Founded in 1929 to help Dallas school teachers pay hospital costs, Blue Cross later merged with Blue Shield, which had started to help loggers and miners in the Pacific Northwest get the medical care they needed. BCBS companies processed the claims of nearly five million Medicare members in the first year after Medicare was created. 

Today, BCBS plans cover 109 million members in the U.S. Collectively, BCBS companies cover 3.7 million Medicare Advantage members and 8.9 million people through Medicaid.

Geographical Restrictions

BCBS plans operate in all 50 states, Washington, D.C., and Puerto Rico. The association also owns trademarks and issues licenses internationally, including in Canada, Central and South America, and the U.S. Virgin Islands.

  • Year Founded 1929
  • Kinds of Plans Medicare Advantage, Dual-eligible Special Needs Plans, Medicare Supplement (Medigap) Insurance, Stand-alone Prescription Drug Plans (specific options vary by plan)
  • Number of Plans 4+ (Depends on the local BCBS plan)
  • Payment Options Depends on the local BCBS plan
  • Customer Service Depends on the local BCBS plan
  • Phone Number 888-630-2583 or the local BCBS plan
  • Official Website www.bcbs.com

Pros Explained

  • Nationwide coverage: BCBS plans operate in every state and cover nearly one in three Americans.
  • Wide network of healthcare providers: Collectively, BCBS companies contract with more than 90% of doctors and hospitals across the country. 
  • Lots of Medicare insurance options: Specifics vary by company, but overall, BCBS plans offer a full range of Medicare insurance options.
  • Extra benefits and the Blue365 discount program: Some BCBS plans offer the Blue365 program to Medicare members; this program includes discounts on health and wellness-related products and services. Many BCBS plans also offer dental, vision, hearing, over-the-counter, telehealth, and fitness benefits.

Cons Explained

  • Each BCBS plan is separate: Because BCBS is an association of 36 independent companies, there is no single BCBS health plan. You must find the BCBS health plan in your area and judge each one’s specific costs, quality, and options. 
  • Average quality ratings: According to the Centers for Medicare and Medicaid Services (CMS), BCBS averages just above 3.5 out of 5.0.

Available Plans

Each BCBS plan offers its own assortment of plan types. Even within one company, plans offered can vary across geographies. Generally, the main types of Medicare insurance are available through BCBS.

Medicare Advantage Plans

Local BCBS plans offer a variety of Medicare Advantage plans, including Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. These plans typically combine medical and prescription drug coverage in one plan, along with extra coverage for services such as hearing and vision. In 2021, BCBS plans nationwide offer nearly 300 HMO plans and more than 200 PPO plans.

Dual-eligible Special Needs Plans (D-SNP) 

Some BCBS plans offer Special Needs Plans for members who qualify for both Medicaid and Medicare. These plans are designed for low-income people who are 65 and over and/or disabled. Medicaid eligibility varies by state. D-SNPs typically cover all the benefits of Original Medicare with extra services and support for members with more complex needs.

Medicare Supplement (Medigap) Insurance Plans

Medigap plans cover some of the out-of-pocket costs that Original Medicare doesn’t cover. There are set benefits and coverage levels across all insurers, though prices and extra benefits differ by each insurance carrier. 

Stand-alone Prescription Drug Plans 

Prescription Drug Plans are a type of supplemental coverage to cover the cost of prescription medications that are not covered in Original Medicare. Many Medicare Advantage plans include prescription drug coverage, but Prescription Drug Plans can pair with Medigap plans or Original Medicare. 

Details on available insurance types, benefits, costs, and quality vary by BCBS plan, so you have to research the specific options in your area.

Extra Benefits 

Each BCBS offers its own set of extra benefits, but many BCBS plans offer members access to Blue365, which offers discounts on health- and wellness-related products and services. The program provides discounts on gym memberships, nutritional products, and personal care and fitness products.

Many BCBS plans also offer dental, vision, hearing, and fitness benefits that are not available on Original Medicare. For example, Blue Cross Blue Shield of Illinois offers its Medicare Advantage members extra coverage, including dental, vision, and hearing services as well as over-the-counter allowances, the SilverSneakers fitness program, a 24/7 nurse line, and virtual visits.

Customer Service

Prospective BCBS members can call a centralized customer service number (888-630-2583) to learn about their Medicare options. This line connects people to their local BCBS plan to learn about enrolling in BCBS insurance.

Current members should contact their specific BCBS company or visit the local company’s website for information about specific benefits and coverage. Members can also file claims, request a new member ID card, and estimate their costs. 

Customer service hours of operation and website functionality vary by plan.

Customer Satisfaction 

Each individual BCBS-affiliated company is evaluated separately by the National Association of Insurance Commissioners. For example, the NAIC complaint index for Blue Cross Blue Shield of Georgia was 0.81 in 2021 for its individual health insurance business, which could include Medicare members.

For its Medicare Supplement products, the complaint index was 0.62, though that reflects only one complaint. The same data for Blue Cross Blue Shield of Michigan reveals a complaint index of 0.39 in 2021 for 20 complaints in the individual health category and zero complaints in the Medicare Supplement category.

The NAIC tracks complaints against all types of insurers, including health insurers. NAIC compares the number of complaints to the insurer’s market share to develop a complaint index. If that ratio is greater than 1.0, the company has received more complaints than expected based on its size; a complaint index of less than 1.0 suggests the company has received relatively fewer complaints.

Third-Party Ratings

AM Best

AM Best, a credit rating agency, reviews insurance companies based on their financial strength. Not all BCBS affiliates are rated by AM Best, though many are. For example, Blue Cross and Blue Shield of Alabama is not rated, but Blue Cross and Blue Shield of Mississippi has an A rating for financial strength, indicating it is well-positioned to meet its financial obligations.

Blue Cross and Blue Shield of Vermont has a B++ rating, reflective of underwriting losses and its inability to get approval to raise its Marketplace insurance rates; the plan is in the process of introducing Medicare Advantage plans to the market. 

NCQA

The National Committee for Quality Assurance (NCQA) accredits and rates health plans according to measures of customer satisfaction, access to healthcare, and quality of care. Many BCBS plans are accredited by NCQA and several were rated in 2021. Most scored 3.5 or 3.0 out of 5.0. Some BCBS plans are accredited and rated for other categories, such as Medicaid or private insurance, but not for their Medicare plans. 

J.D. Power

In its 2021 U.S. Medicare Advantage Study, J.D. Power rated Medicare Advantage plans based on member satisfaction with various aspects of the plan, including customer service, benefits and coverage, available healthcare providers, and billing experiences. Several BCBS plans made the top-10 list. Highmark too second place, with a score of 834 out of 1,000. Anthem, and BlueCross BlueShield of Michigan also made the list, coming in at fifth, eighth, and tenth place, respectively.

What You Need to Know

Three of the top 10 Medicare Advantage plans in J.D. Power’s 2021 survey were BCBS companies.

Medicare Star Ratings

Not every Medicare insurance plan is rated by the Centers for Medicare and Medicaid Services (CMS). Of the BCBS plans that are rated on CMS’ five-point Star Rating system, two dozen earned at least a 4.0 out of 5.0 in the 2021 ratings. Anthem has a plan which earned five stars.

Cost

Because BCBS is not one plan, but many independent companies, prices can vary widely across BCBS affiliated companies. In 2021, BCBS Medicare Advantage price ranges include health maintenance organization (HMO) and preferred provider organization (PPO) Plans.

HMO Plans 

  • In 244 Medicare Advantage HMO plans with prescription drug coverage with available data on the CMS website, monthly premiums range from $0 to $264, averaging $47; 30% of these plans have no monthly premium. Deductibles range from $0 to $445, averaging $127.34. Annual out-of-pocket cost maximums for in-network services range from $3,400 to $7,550, averaging $5,807. 
  • In 54 HMO plans without prescription drug coverage, the monthly premiums range from $0 to $194, averaging $27.61. These plans have no deductibles. Out-of-pocket maximums range from $3,400 to $7,550, averaging $5,657.41.

PPO Plans 

  • In 195 local and regional PPO plans with prescription drug plans with available cost information, monthly premiums range from $0 to $299, averaging $70. Annual deductibles range from $0 to $445, averaging $92.44. Out-of-pocket maximums range from $2,500 to $7,550, averaging $5,840.38.
  • In 23 PPO plans without drug coverage, monthly premiums range from $0 to $66, averaging $15.87. Most have no premium and none has an annual deductible. Annual out-of-pocket maximums for in-network services range from $4,700 to $6,700, averaging $5,760.87.

Competition: Blue Cross Blue Shield vs. Humana

BCBS dominates health insurance in the U.S., but it is not one large company. Instead, many affiliated companies carry the BCBS name or identity and operate independently. BCBS plans have a long history in American health insurance and cover one in three Americans. In Medicare Advantage, BCBS plans ranked third in overall market share in 2021.

On a head-to-head basis, Humana and BCBS overall are comparable. They are each represented in every state and offer several types of Medicare insurance. Their overall quality ratings are virtually the same. To pick between these two, the choice will be in the details. Check the quality scores, costs, and available insurance types in your local area.

  Blue Cross Blue Shield Humana
Number of States Available 50 50
Medicare Plans 4+ (Depends on the plan) 7
Customer Service Options Depends on the plan Telephone, online, in person, chat (for members)
AM Best Rating Depends on the plan A- (Excellent)
Average CMS Star Rating 3.67 3.63
Final Verdict

BCBS is an iconic health insurance brand represented by numerous independent affiliated companies. BCBS companies have been part of the Medicare program since it began in 1966 and now offers multiple Medicare insurance options. Though quality and costs vary by company and by specific plan within those companies, most BCBS plans offer decent value and benefits across a range of health plan options.

How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

Article Sources
Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy.
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  2. BlueCross BlueShield Association. "Blue Facts," Page 1.

  3. Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2022 Star Ratings Data Table.”

  4. Centers for Medicare and Medicaid Services. “2022 MA Landscape Source Files.”

  5. BlueCross BlueShield. "Medicare Overview."

  6. Healthcare.gov. "What's Medicare Supplement Insurance (Medigap)?"

  7. BlueCross BlueShield. "Welcome Blue Cross Blue Shield Members."

  8. BlueCross BlueShield. "Contact Us."

  9. National Association of Insurance Commissioners. “BCBS Healthcare Plan of GA Inc National Complaint Index Report.”

  10. National Association of Insurance Commissioners. “BCBS of MI Mut Ins Co National Complaint Index Report.”

  11. BlueCross BlueShield of Mississippi. "About Us."

  12. AM Best. “AM Best Revises Issuer Credit Rating Outlook to Stable for Blue Cross and Blue Shield of Vermont and Its Subsidiary.”

  13. National Committee for Quality Assurance. “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicare).”

  14. J.D. Power. “2021 U.S. Medicare Advantage Study.”