Pros and cons of blue cross blue shield health insurance

Our Verdict

Blue Cross Blue Shield’s Medicare Advantage plans provide Original Medicare benefits with other bundled options, such as wellness programs, dental coverage and vision services. Availability of specific plans varies based on location, but overall, Blue Cross Blue Shield’s offerings are workable solutions for those looking for comprehensive Medicare coverage.

Key Features

• Plan offerings: Choose between health maintenance organization
  (HMO) plans, preferred provider organization (PPO) plans, regional PPO plans and private fee-for-service plan options.
• Drug coverage: Some plans include Medicare Part D, which covers prescription drugs.
• Limits: Blue Cross Blue Shield maintains an annual limit on out-of-pocket expenses (unlike original Medicare).

Blue Cross Blue Shield is a collection of 34 separate local Blue Cross Blue Shield companies that collectively form one of the nation’s most popular health insurers. The company’s history dates back to 1929 when it began providing health care coverage, and it has delivered Medicare coverage to customers since the program’s inception in the 1960s.

How It Works

Blue Cross Blue Shield’s Medicare Advantage plans vary in their specific coverage options and monthly premiums, but they all deliver Original Medicare benefits with added coverage to the consumer.

All of Blue Cross Blue Shield’s Medicare Advantage plans cover Medicare Part A and Part B. Part A accounts for hospitalizations and the use of other care like some nursing facilities, hospice care and even home health care. Part B accounts for visits to the doctor, other outpatient care and preventative services and medical supplies. Blue Cross Blue Shield Medicare Advantage plans also offer additional benefits, such as vision services, hearing health coverage and wellness programs. Additionally, telehealth services, transportation services, over-the-counter health product coverage and gift card rewards are available with certain plans. Some Medicare Advantage plans also offer Part D for coverage of prescriptions drugs and recommended shots and/or vaccines.

Blue Cross Blue Shield’s affiliates currently offer Medicare Advantage plans in 2,190 counties —the most of all major health insurers.

The Cost

Medicare Advantage plans typically feature lower monthly premiums than Original Medicare, though customers are still required to pay the standard Part B premium determined by the Centers for Medicare and Medicaid Services (CMS), which is $164.90 for 2023. Blue Cross Blue Shield’s plans are required by the federal government to place caps on out-of-pocket spending, and individuals with these plans tend to enjoy lower overall cost sharing, meaning Blue Cross Blue Shield shares responsibility of costs with the customer.

Coinsurance and copays may be required with some Blue Cross Blue Shield plans. Defined geographic service area limits apply, so customers should ensure their preferred health care providers are in network. Choosing an out-of-network provider typically comes at a higher cost.

The Fine Print

Blue Cross Blue Shield offers an expansive provider network including over 342,000 providers. However, customers using a Medicare Advantage plan may need referrals for specialist visits. These private Blue Cross Blue Shield plans operate on annual contracts with Medicare and must follow Medicare’s coverage rules. These rules include notifying insured individuals about any changes to their plans before the start of the next enrollment year.

What Experts Say

“The Medicare Advantage audience in particular benefits from high-value care and coverage that prioritize the overall wellbeing of the entire person,” says John Bulger, D.O., chief medical officer for insurance operations and strategic partnerships at Geisinger Health, and a Forbes Health Advisory Board member. “Plans that put the member first and deliver this type of experience are usually great options for people [ages] 65 and over, and often tend to come from non-profit, community-based payers.” For these reasons, BCBS Medicare Advantage plans tend to serve their beneficiaries well. As of 2021, Blue Cross Blue Shield has a rating of 3.8 out of 5 from CMS.