- Nationwide coverage: The BCBS program is implemented in every state and covers almost one-third of Americans.
- An extensive network of healthcare providers: BCBS companies contract with 90% of the nation’s doctors and hospitals;
- There are many health insurance options: the specifics vary by company, but in general, BCBS plans offer a full range of health insurance options.
- Additional Benefits and Blue365 Discount Program: Some BCBS plans offer Blue365 programs to Medicare members; this program includes discounts on health and wellness-related products and services. Many BCB plans also offer dental, vision, hearing, over-the-counter, telehealth, and fitness benefits.
- Each BCBS plan is independent: Since BCBS is an association of 36 independent companies, there is no single BCBS health plan. You must find BCBS health plans in your area and judge the specific cost, quality, and options of each plan;
- Average Quality Rating: According to the Centers for Medicare and Medicaid Services (CMS), the BCBS average is a little over 3.5 out of 5.0.
Each BCBS program offers its classification of program types. Even within a company, the plans offered may vary by geographic location. Generally, the main types of health insurance are available through BCB.
Medicare Advantage Plan
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 Medicare and prescription drug coverage in one plan, with additional coverage for services such as hearing and vision. In 2021, BCBS plans to offer nearly 300 HMO plans and more than 200 PPO plans nationwide.
Dual Eligible Special Needs Program (D-SNP)
Some BCBS plans offer special needs programs for members who qualify for both Medicaid and Medicare. These programs are designed for low-income individuals 65 and older and/or people with disabilities. Medicaid eligibility varies by state. D-SNPs typically cover all the benefits of Original Medicare, with additional services and support for members with more complex needs;
Medicare Supplemental (Medigap) Insurance Plan
Maddie Gap These plans cover some out-of-pocket expenses not covered by original Medicare. All insurers have fixed premiums and coverage, although prices and additional premiums vary for each insurer;
Independent Prescription Drug Plan
A prescription drug plan is supplemental insurance that pays for prescription drugs not covered by original health insurance. Many Medicare Advantage plans include prescription drug coverage, but prescription drug plans can be paired with Medigap plans or Original Medicare;
Details on the types of coverage available, benefits, cost, and quality vary by BCBS plan, so you’ll have to research specific options in your area.
Each BCB offers its own set of perks, but many BCB plans offer members access to Blue365, which offers discounts on health-related products and services. The program offers discounts on things like gym memberships, nutritional products, personal care, and fitness products. Many BCBS plans also offer dental, vision, hearing, and fitness benefits that weren’t available on original Medicare. For example, Illinois Blue Cross Blue Shield offers its Medicare Advantage members additional coverage including dental, vision, and hearing services and an over-the-counter benefit SilverSneakers fitness program 24/7 nurse hotline and virtual visits.
Prospective BCBS members can call the central customer service number (888-630-2583) to learn about their health insurance options. This line connects people to their local BCBS plan to learn how to sign up for BCBS insurance.
Current members should contact their specific BCBS company or visit the local company’s website for information on specific benefits and coverage. Members can also file a claim, apply for a new membership ID, and estimate their costs;
Customer service hours of operation and website features vary by plan.
The National Association of Insurance Commissioners (NAIC) tracks complaints against all types of insurance companies, including health insurance companies. The NAIC compares the number of complaints with the market share of insurers to develop a complaint index. If the ratio is greater than 1.0, the company has received more complaints than expected based on its size; a complaint index less than 1.0 indicates that the company has received relatively few complaints;
Each BCBS affiliate is assessed separately. For example, Blue Cross Blue Shield of Georgia, whose NAIC Complaint Index was 0.65 in 2020, may include Medicare members in its health insurance business. For its Medicare supplement, the complaint index was 2.33, although this only reflected a total of 4 complaints. The same data from Blue Cross Blue Shield in Michigan shows that in 2020, there were 21 complaints in the personal health category and 0 in the Medicare supplement category, with a complaint index of 0.35.
third party rating
I’m the best
I’m one of the best credit rating agencies that evaluate insurance companies based on their financial strength. Not all BCBS branches are rated by AM Best, although many are. For example, Alabama’s “Blue Cross” and “Blue Shield” are not rated, but Mississippi’s “Blue Cross” and “Blue Shield” are rated “A” for financial strength, indicating that it is fully capable of meeting its financial obligations. Vermont’s Blue Cross and Blue Shield ratings are B+, effective July 1, 2020, reflecting underwriting losses and their inability to obtain approval to increase insurance rates in the market; the program is introducing the Medicare Advantage plan to the market.
National Quality Assurance Agency
The National Council for Quality Assurance (NCQA) accredits and rates health plans based on measures of customer satisfaction, access to health care, and medical quality. Many BCB programs are accredited by the NCQA, some of which were rated in 2019-2020. On a 5.0 scale, most people scored a 3.5 or 3.0. Some BCBS plans are certified and rated for other categories, such as Medicaid or private insurance, but not for their health insurance plans;
In its 2020 U.S. Medicare Advantage Study, JDPower 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 experience. Several BCB programs made the top ten. Highmark tops the list with a score of 830 out of 1000. Anthem, BlueCross BlueShield of Michigan, and WellCare also made the list, ranking seventh, eighth, and tenth respectively;
WHAT YOU NEED TO KNOW
Four of the top 10 Medicare Advantage plans in JDPower’s 2020 survey are BCBS companies.
medical insurance star
Not every health insurance plan is rated by the Centers for Medicare and Medicaid Services (CMS). On CMS’ five-star rating system, 24 of BCBS’s programs scored at least 4.0 out of 5.0 in 2021. Anthem has a plan to earn five stars.
Because BCBS is not one program, but many separate companies, prices for BCBS affiliates can vary widely. In 2021, the BCBS Medicare Advantage price range includes HMO and PPO plans.
- Of the 244 Medicare Advantage HMO plans with prescription coverage and data available on the CMS website, monthly premiums ranged from $0 to $264, with an average of $47; 30% of the plans had no monthly premium. Deductibles ranged from $0 to $445, with an average of $127.34. Annual out-of-pocket maximums for in-network services ranged from $3,400 to $7,550, with an average of $5,807;
- Among the 54 health management organization plans without prescription drug coverage, monthly premiums ranged from $0 to $194, with an average of $27.61. There are no deductibles for these plans. Out-of-pocket maximums ranged from $3,400 to $7,550, with an average of $5,657.41.
- Among the 195 local and regional PPO plans, with prescription drug plans and cost information available, monthly premiums ranged from $0 to $299, with an average of $70. The annual deductible ranges from $0 to $445, with an average of $92.44. Out-of-pocket maximums ranged from $2,500 to $7,550, with an average of $5,840.38.
- Among the 23 PPO plans without drug coverage, monthly premiums ranged from $0 to $66, with an average of $15.87. Most have no insurance premiums and no annual deductibles. Annual out-of-pocket maximums for web services range from $4,700 to $6,700, with an average of $5,760.87.
Match: Blue Cross Blue Shield vs. Humana
BCBS dominates the U.S. health insurance space, but it’s not a huge company. Instead, many affiliates carry the BCBS name or identity and operate independently. BCBS plans have a long history in U.S. health insurance, covering one in three Americans. In terms of Medicare Advantage, the BCBS program ranked third in terms of overall market share in 2020.
Centaurus has the second largest market share and is available in most counties in 2020. On a head-to-head comparison, Humana and BCB are generally comparable. They are represented in every state and offer several types of health insurance. Their overall quality ratings are nearly identical. Choosing between the two comes down to the details. Check quality scores, costs, and types of insurance available locally.