Blue Cross offers a variety of Medicare Advantage plans, many of which offer $0 monthly premiums and prescription drug coverage.
Medicare Advantage is an alternative to Original Medicare in which a private health insurance company, such as Blue Cross Blue Shield, offers your Medicare benefits plus other benefits original Medicare doesn’t traditionally provide. Examples include:
- vision
- dental
- preventive health services
This article gives you a look at the available Blue Cross Medicare Advantage plans in the United States.
Blue Cross offers a variety of Medicare Advantage plans. Their availability may vary by region and state.
Let’s review the different types of Medicare Advantage plans Blue Cross offers.
Blue Cross HMO plans
Blue Cross offers Health Maintenance Organization (HMO) plans in several states, including Arizona, California, Florida, Massachusetts, and many others. In this plan type, you would have an in-network primary care provider (PCP).
If you needed specialty care, you would first see your PCP, who would then give you a referral to a specialist. Your insurance plan would first have to approve the specialty physician referral.
One exception with Blue Cross is that most people with vaginas wouldn’t need a referral to see an in-network OB/GYN for routine wellness care, such as a Pap smear.
Blue Cross PPO plans
Blue Cross offers Preferred Provider Organization (PPO) plans in states such as Alabama, Florida, Hawaii, and Montana (to name a few). Generally, a PPO will have a slightly higher premium than an HMO. You don’t usually have to get a referral to see a specialist when you have a PPO.
However, you can save money by choosing in-network providers from the insurance company’s provider list. You may pay more if you choose an out-of-network provider.
Blue Cross PFFS plans
A Private Fee-for-Service (PFFS) plan is a Medicare Advantage plan that Blue Cross offers in Arkansas only. This plan type doesn’t require you to use a particular PCP, in-network providers, or receive referrals. Instead, the plan sets how much it will reimburse a doctor, and you are responsible for paying the remainder of the provider’s reimbursement.
Sometimes, providers will contract with a PFFS plan to provide services. Unlike other Medicare plans, a PFFS plan provider doesn’t have to offer you services just because they accept Medicare. They can choose whether to provide a service at the Medicare reimbursement rate.
Blue Cross SNPs
A Special Needs Plan (SNP) is a Medicare Advantage plan dedicated to people with a particular condition or characteristic. Ideally, the plan provides greater coverage than a person may need. Medicare requires that all SNPs provide prescription drug coverage.
Examples of Blue Cross SNPs include:
- California: Anthem MediBlue Diabetes Care or Anthem MediBlue ESRD Care
- Nevada: Anthem MediBlue Lung Care or Anthem MediBlue Diabetes Care
- Virginia: Anthem Diabetes and Heart Care or Anthem MediBlue ESRD Care
Medicare Part D plans cover prescription drugs. Some Medicare Advantage plans through Blue Cross offer prescription drug coverage. However, you can choose a stand-alone prescription drug plan if the plan does not provide coverage.
Blue Cross offers “standard” and “premier” plans in the prescription drug category, as well as Plus, Enhanced, Preferred, Select, and more prescription drug policy options. Each will feature a formulary or list of medications the plan covers and a range of costs. You can check these lists or formularies to be sure any plan you consider includes the medications you take.
Blue Cross Medicare Advantage plans are available throughout most of the United States, including Washington, DC, and Puerto Rico. However, no Medicare Advantage plans are currently sold in Alaska.
Although coverage is widely available throughout the country, specific types of plans and coverage options may only be offered in certain areas. This means that if your relative in another state has a Blue Cross plan, the same plan might not be available to you.
Each Blue Cross Medicare Advantage plan type comes with various extra services above what original Medicare offers. A few of the coverage benefits many Blue Cross plans offer may include:
- vision
- dental
- hearing
- prescription drugs
- home healthcare
- SilverSneakers membership
- at-home meal delivery after an inpatient stay
- $0 copays for many preventive services, vaccines, and lab services
The coverage you receive depends on the plans available in your area and which you choose.
The Medicare Advantage marketplace is an increasingly competitive one. If you live in a metropolitan county, there may be dozens of plans to choose from.
The following are some examples of Blue Cross Medicare Advantage plans with monthly premiums and other costs in various locations. These plans do not include the cost of your monthly Part B premium.
| City/plan | Star rating | Monthly premium | Health deductible; drug deductible | In-network out-of-pocket max | PCP copay per visit | Specialist copay per visit |
|---|---|---|---|---|---|---|
| Los Angeles, CA: Anthem Select (HMO) | 3 | $0 | $0; $0 | $800 | $0 | $0 |
| Phoenix, AZ: Blue Best Life Classic (HMO) | 4 | $0 | $0; $0 | $2,900 | $0 | $20 |
| Cleveland, OH: Anthem Medicare Advantage (HMO) | 3.5 | $0 | $0; $0 | $4,200 | $0 | $35 |
| Houston, TX: Blue Cross Medicare Advantage Basic (HMO) | 3.5 | $0 | $0; $0 | $3,850 | $0 | $20 |
| Chicago, IL: Blue Cross Medicare Advantage Basic (HMO) | 3 | $0 | $0; $0 | $2,500 | $0 | $22 |
These are just a few examples of available Blue Cross Advantage plans from the Medicare.gov plan finder website. There may be many other options in a ZIP code area.
Having Medicare Advantage (Part C) means that the insurance company that offers your plan will provide coverage for Medicare Part A (hospital coverage), Medicare Part B (medical coverage). Some plans also provide prescription drug coverage. Medicare Advantage plans vary in out-of-pocket costs and coverage, including copayments and coinsurances.
Deadlines for enrolling in or changing your Medicare Advantage plan
The following are critical dates for enrolling in or changing your Medicare Advantage plan:
- Initial enrollment period: The first 3 months before your 65th birthday, your birth month, and 3 months after your 65th birthday.
- Open enrollment period: October 15 through December 7 is the open enrollment period for Medicare Advantage. New plans go into effect on January 1.
- Medicare Advantage open enrollment: During this time period, people who already have Medicare Advantage can switch to another plan.
- Medicare Advantage special enrollment period: This is the time period during which you can change your Advantage plan due to a special circumstance, such as a move or a plan that is dropped in your area.
Blue Cross is one of several insurance companies that offer Medicare Advantage plans. You can find available plans by searching the Medicare.gov marketplace or the Blue Cross website. Remember critical dates when deciding when to enroll in a Medicare Advantage plan.