About Blue Cross Blue Shield

Last Updated : 09/09/20184 min read

You may find Blue Cross Blue Shield to be a familiar name in the Medicare health plan market. If you’re thinking about enrolling in a Medicare Advantage plan, Medicare Part D Prescription Drug Plan, or Medicare Supplement plan, here are some facts about Blue Cross Blue Shield and its Medicare plan options.

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What is Blue Cross Blue Shield?

Blue Cross Blue Shield (BCBS) is a company with a long history in the health insurance industry. It’s actually a federation of 36 different locally operated, independent, private insurance companies. These companies are licensed to operate in all 50 states plus the District of Columbia; over 105 million people in the U.S. are enrolled in Blue Cross Blue Shield plans, or approximately one in three Americans, according to Blue Cross Blue Shield. In terms of coverage, over 96% of hospitals and 92% of health-care providers contract with the BCBS companies.

When it comes to Medicare, Blue Cross Blue Shield has partnered with the federal government to process Medicare payments and claims since 1966, when the program started. BCBS affiliates processed over 83% of all Medicare Part A claims in 2011, and nearly 70% of all Medicare Part B claims. It is a leading provider of Medicare health plans and Medicare Part D Prescription Drug Plans. Each of the private Blue Cross Blue Shield independent insurance companies offering Medicare plans is contracted with Medicare to provide benefits and is licensed in the state(s) in which it operates to offer the Medicare plans described below.

What kinds of Medicare plans does Blue Cross Blue Shield offer?

In most states, you may be eligible to enroll in one of the following popular types of Medicare Advantage plans and Medicare Part D Prescription Drug Plans from Blue Cross Blue Shield (BCBS). Please note that BCBS may not offer every plan type in every state or county.

  • Medicare Advantage Health Maintenance Organization (HMO) plans. Most HMO plans include prescription drug coverage and require you to select a primary care provider to oversee your care. You must get your care within your plan’s local network in order to access benefits, except for medically necessary emergency care.
  • Medicare Advantage HMO-POS (Point of Service) plans. These are similar to standard HMO plans, but if you frequently travel out-of-network, you may be able to arrange for covered routine health care at your destination with a provider in the national Blue Cross Blue Shield network. Many HMO-POS plans include prescription drug coverage.
  • Medicare Advantage Special Needs Plans (SNPs). These are HMO-type plans with enrollment restricted to people with certain chronic diseases or conditions, living in a nursing home or other facility, or eligible for both Medicare and Medicaid in their state. They include prescription drug coverage.
  • Medicare Advantage Preferred Provider Organization (PPO) plans. If you like the flexibility of choosing any provider you like, you may prefer a PPO plan. You can go to an out-of-network doctor, but you typically pay less out-of-pocket if you get your care within the plan’s network. As with other Medicare Advantage plans, many PPO plans cover prescription drugs.*
  • Stand-alone Medicare Part D Prescription Drug Plans. These plans use a formulary to determine which prescription drugs are covered; plans may change their formularies from time to time, but will notify you when necessary. These plans are designed to work alongside your Original Medicare (Part A and Part B) coverage.

In some states, BCBS may offer Medicare Supplement (Medigap) plans. If you are enrolled in Original Medicare (Part A and Part B), a Medigap plan can help pay your out-of-pocket expenses for Medicare-covered services. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

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Keep in mind that you may have copayments, coinsurance amounts, and deductibles with your Medicare plan from Blue Cross Blue Shield. In addition, please note that not all plans may be available in all locations, and plan benefits and premiums may vary from place to place. You must also continue to pay your Part B premium if you enroll in a Medicare Advantage plan, a Medigap plan, or a stand-alone Medicare Prescription Drug Plan.

You can start comparing plans, including those from Blue Cross Blue Shield, by clicking the Find Plans button on this page.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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