Excellus BlueCross BlueShield is a nonprofit plan based in upstate New York. It earns high-quality marks and offers a good selection of Medicare Advantage HMO and PPO plans. Members have the option of buying enhanced dental and vision coverage. Excellus plans include standard extra benefits plus access to the Blue365 discount program. For Medicare beneficiaries in Excellus’ service area, it’s a high-quality option.
- Pros & Cons
- Key Takeaways
- Company Overview
High-quality health plans
One of the largest Medicare Advantage plans in New York
Offers many Medicare Advantage options
Members can access Blue365 discounts
Though plans are highly rated, ratings of the health plan are lower
No stand-alone Prescription Drug Plans
- A nonprofit BlueCross Blue Shield plan with deep roots in upstate New York
- A high-quality health plan
- Offers Medicare Advantage and Medigap Plans
- Some Excellus plans may have higher premiums but lower deductibles or out-of-pocket costs than competitors
Excellus BlueCross BlueShield is a nonprofit health plan based in Rochester, New York. Excellus was formed as a holding company through the merger of BlueCross BlueShield plans of Rochester and Central New York, which were founded in 1935 and 1936, respectively. Excellus’ parent company, The Lifetime Healthcare Companies, offers health insurance in upstate New York and long-term care insurance across the country. Overall, the company serves 1.5 million members.
Excellus offers insurance in 31 counties in New York State, including in the Central New York, Central New York Southern Tier, Rochester, and Utica regions. The company maintains regional offices in each area.
- Year Founded 1996
- Kinds of Plans Medicare Advantage HMO, HMO-POS, PPO Plans, Medicare Supplement Insurance (Medigap) Plans
- Number of Plans 4
- Payment Options Pay by mail, phone, online, or mobile app, or through automatic deduction from your bank account or Social Security income
- Customer Service Telephone, online, live online seminar, one-on-one in-person meeting
- Phone Number Prospective Members: 800-671-6081; Current Members: 877-883-9577
- Official Website www.excellusbcbs.com/medicare-coverage/medicare-plans
- High-quality health plans: Excellus Medicare Advantage plans earned an average of 4.5 out of 5.0 Stars from CMS.
- One of the largest Medicare Advantage plans in New York: Excellus has deep roots in upstate New York, resulting from the merger of several local Blue Cross and Blue Shield plans founded in the 1930s.
- Offers many Medicare Advantage options: Compared to some competitors, Excellus offers more Medicare Advantage plans in its service area.
- Members can access Blue365 discounts: As a BlueCross BlueShield plan, Excellus offers its members access to Blue365 discounts on a range of health- and wellness-related services and products.
- Limited geography: Excellus is only available in parts of New York.
- Though plans are highly rated, ratings of the health plan are lower: Excellus plans perform well on quality measures, but worse on NCQA scores specific to members’ experience with the health plan.
- No standalone Prescription Drug Plans: Excellus offers Medicare Advantage HMO and PPO plans with and without prescription drug coverage but does not offer standalone prescription drug plans for people who may just need drug coverage.
Medicare Advantage Plans
Excellus offers HMO, HMO-POS, and PPO Medicare Advantage plans. Some of these plans include preventive dental care such as cleanings and X-rays, but members can also buy extra coverage for restorative and major dental care with a maximum $1,000 benefit.
For 2021, some Excellus Medicare Advantage HMO, HMO-POS, and PPO plans offer discounts on insulin—$25 copayment for a 30-day supply at preferred pharmacies or $30 for a 30-day supply at standard pharmacies. Members can also get a 90-day supply of insulin for $50 at preferred pharmacies or $60 at standard pharmacies.
HMO and HMO-POS Plans
In 2021, Excellus offers 72 HMO plans with prescription drug coverage and 13 without. Like most HMO plans, Excellus’ HMOs usually require members to use in-network hospitals, other health care providers, and pharmacies. In some HMO-POS plans, members may be able to see providers who are not in the network.
For 2021, Excellus has 75 PPO plans with prescription drug coverage and 24 without. These plans tend to be more flexible. Seeing in-network providers for covered services may cost less than going out-of-network, but PPO members can see providers who participate in Medicare but are not in the Excellus network. PPO members must generally use pharmacies in the Excellus network to fill prescriptions for covered Part D medications.
Medicare Supplement Insurance (Medigap) Plans
Medicare Supplement Insurance plans, also called Medigap, help Medicare members pay some of the out-of-pocket costs that Original Medicare doesn’t cover. There are 10 standard Medigap plan types, each with set benefits across all insurers. Only the premium or other costs and benefits vary depending on the insurer. Not every insurer offers all ten plan types. Excellus offers six Medigap plans, including:
- Plan A: This plan covers hospital coinsurance not covered by Medicare Part A, helps pay some Medicare Part B expenses, and pays the 20% coinsurance for Medicare-eligible expenses after you meet the Medicare Part B deductible.
- Plan B: This plan covers everything that Plan A covers plus the Medicare Part A deductible.
- Plan C: This plan covers the basic benefits of Plan A plus coverage for skilled nursing coinsurance, the Medicare Parts A and B deductibles, and overseas travel emergency care.
- Plan F: This plan covers everything included in Plan B as well as help paying for skilled nursing coinsurance, the Medicare Part B deductible, and 100% of additional covered physician services, and overseas travel emergency care.
- Plan F+: This plan offers the same coverage as Plan F with lower premiums and a $2,340 deductible.
- Plan N: This plan covers everything included in Plan B plus coverage for skilled nursing coinsurance and overseas travel emergency care. After you meet the Medicare Part B deductible, this plan covers services with up to $20 for office visits and up to $50 for emergency room visits.
Most Medicare health plans include extra benefits beyond core medical coverage. These extras typically include dental, vision, hearing, fitness, and other benefits. Many Excellus plans include fitness, hearing, vision, and dental benefits. Additionally, Excellus members can get the Blue365 discounts, which include additional discounts on fitness programs and products, eye exams and eyeglass frames, nutrition programs and products, hearing screening and hearing aids, and other wellness-related benefits.
Prospective members call 800-671-6081 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday (available seven days a week between October 1 and December 30).
Current members call 877-883-9577 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday (available seven days a week between October 1 and March 31).
Online, members can use a drug cost lookup tool and a cost estimator that gives members information on average costs for more than 1,600 treatments and more than 400 procedures. With online accounts or the mobile app, members can find doctors, track deductibles and spending, and view or request a new member ID card.
The National Association of Insurance Commissioners (NAIC) evaluates health insurers based on the number of complaints against them compared to their share of premiums. A complaint index of 1.0 or less indicates the company had fewer than expected complaints relative to its share of the market. A complaint index of greater than 1.0 means the company had a disproportionate number of complaints relative to its market share. Excellus’ complaint index in the individual accident and health category was well below 1.0 for 2019 (0.12), 2018 (0.08), and 2017 (0.10). In the Medicare supplement category, Excellus’ complaint index in 2019 was 2.81 and in 2017 it was 1.93, though those scores were based on one complaint each year. There were no Medicare supplement complaints against Excellus In 2018.
Excellus is not rated by AM Best, the credit rating agency that assesses insurance companies’ financial strength. The company reports that Standard and Poor’s gave it a financial strength rating of “BBB+” (Stable).
The National Committee for Quality Assurance (NCQA) is one of the accrediting bodies for health insurance plans. Each year, NCQA reviews and rates accredited health plans. In the 2019-2020 ratings, Excellus had four plans rated by NCQA. Two Excellus HMO plans scored 4.5 out of 5.0 overall, though each received just 2.0 on measures related to members’ rating of the health plan specifically, a good indication of how satisfied members are with the health plan services. Two Excellus PPO plans scored 4.0 overall and 3.0 on the ratings of the health plan.
Although Excellus Medicare Advantage plans score well overall in NCQA ratings, the two HMO plans rated by NCQA score only 2.0 out of 5.0 on the health plan-specific ratings.
Medicare Star Ratings
The Centers for Medicare and Medicaid Services (CMS) rates Medicare plans based on a five-star rating system. Star Ratings evaluate a range of customer experience and health care quality measures. Excellus had two plans that were included in CMS’ 2021 Star Ratings. Both plans earned 4.5 out of 5.0 stars. Both plans earned 4.5 out of 5.0 on Medicare Advantage Part D and 4.0 out of 5.0 on Part C.
In 2021, Excellus’ Medicare Advantage plans price ranges include:
HMO plans with prescription drug coverage
- Monthly premiums range from $0 to $256, averaging $84.38; 41 plans have premiums less than $100 per month, including 13 plans with no premiums.
- Deductibles range from $0 to $380, averaging $130.27; about one-half have no deductible.
- Annual out-of-pocket maximums for in-network services range from $4,500 to $7,550, averaging $6,531.
HMO plans without prescription drug coverage
- Monthly premiums are either $45 or $117.
- These plans do not have annual deductibles.
- Annual out-of-pocket maximums for in-network services are $4,500.
PPO plans with prescription drug coverage
- Monthly premiums range from $0 to $138, averaging $75.64; 16 out of 75 plans have no premiums.
- Deductibles range from $0 to $445, averaging $80.39; two-thirds of these plans have no deductible.
- Annual out-of-pocket maximums for in-network services range from $5,000 to $7,550, averaging $6,548.
PPO plans with prescription drug coverage
- Monthly premiums are either $45 or $61.
- There are no annual deductibles.
- Annual out-of-pocket maximums for in-network services are $4,500.
Though some Excellus premiums are higher than competitors, those higher premiums may be offset by lower out-of-pocket costs such as deductibles and annual out-of-pocket maximums.
Competition: Excellus BlueCross BlueShield vs. Aetna
Excellus and Aetna are among the largest Medicare plans in New York. In the 17 counties where both operate, Excellus generally has more Medicare Advantage plans to choose from, though Aetna has more types of coverage (e.g., Special Needs Plans, Stand-Alone Prescription Drug Plans). Aetna’s Medicare Advantage tends to have lower premiums and higher out-of-pocket maximums, on average. Excellus plans have a wider range of deductibles, but the average deductibles are lower than Aetna’s. Choosing one of these plans based on cost requires that you know what type of costs you care more about. If lowering your monthly cost is most important, Aetna works better, but you might spend more overall if you use a lot of health care services. Excellus is only available in parts of New York, so it may not be ideal for people who travel domestically or live part of the year in another state. For quality and selection of Medicare Advantage plans, though, Excellus wins.
|Excellus BlueCross BlueShield||Aetna|
|Number of States Available||1||46|
|Customer Service Options||Telephone, online, live online seminar, one-on-one in-person meeting||Telephone, email (through website)|
|AM Best Rating||Not rated||A (Excellent)|
|Average CMS Star Rating||4.5||3.7|
Excellus BlueCross BlueShield is one of New York’s largest Medicare Advantage plans, offering a wide variety of Medicare Advantage options and an average of 4.5 out of 5.0 Stars from CMS. However, according to NCQA, Excellus plans earn just 2.0 out of 5.0 on ratings specific to members’ experience with the health plan, though the plans score better overall. Though some plans may cost more in monthly premiums than competitor plans, out-of-pocket costs may be lower. For Medicare enrollees in upstate New York, Excellus is a popular choice for good reason.
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.
Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed September 4, 2021.
Becker’s Payer Issues. “The largest Medicare Advantage insurers in each state.” Accessed September 4, 2021.
Centers for Medicare and Medicaid Services. “2021 MA Landscape Source Files.” Accessed September 4, 2021.
NCQA. “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicare).” Accessed September 4, 2021.
Medicare.gov. “What’s Medicare Supplement Insurance (Medigap)?” Accessed September 4, 2021.
Kaiser Family Foundation. “Medicare Advantage 2021 Spotlight: First Look.” Accessed September 4, 2021.
National Association of Insurance Commissioners. “Excellus Health Plan IncNational Complaint Index Report.” Accessed September 4, 2021.