Pros
- Offers Medicare Advantage, Part D and Medigap options.
- Many plans include drug coverage and extra benefits.
- Strong local BCBS company support.
- HMO, PPO and other plan types may be available.
- Blue365 may offer health and wellness discounts.
Cons
- Plan availability varies by location.
- Benefits and costs differ by local BCBS company.
- Some plans may limit provider choice.
- Blue365 discounts are not insurance benefits.
The Blue Cross and Blue Shield Association, a collective of 33 independently operated regional corporations, functions as a non-governmental health insurer. These affiliates extend Medicare Advantage plans to qualified beneficiaries across the United States. Recognized as a leading national health coverage provider, the BCBS network insures over 100 million individuals throughout the nation.
It’s important to note that the specific details of their Medicare Advantage offerings, such as the scope of benefits and the associated monthly premiums, are subject to variation depending on the enrollee’s geographical location and other relevant factors.
What is Blue Cross Blue Shield?
Blue Cross began in 1929 with a focus on providing hospital coverage, while Blue Shield was established in 1939 to help cover physician services. The two organizations joined forces in 1982, forming what is now known as Blue Cross Blue Shield. Today, the company offers some of the top-rated Medicare Advantage plans available, with options that include HMO, PPO, and HMO-POS formats.
Plans
BCBS provides a range of Medicare Advantage plans to meet different healthcare needs. Depending on where you live, here are the primary types of Medicare Advantage plans available through BCBS:
HMO Plan
BCBS Medicare Advantage HMO plans focus on coordinated care within a provider network, requiring members to select a primary care physician (PCP) during enrollment. Typically, you’ll will first consult with a primary care giver who will provide the referral needed to meet a specialist. However, certain services—such as emergency treatment and routine women’s health exams—do not require referrals. These HMO plans usually include prescription drug coverage and are frequently offered with budget-friendly premiums, copayments, and deductibles.
PPO Plan
BCBS Medicare Advantage PPO plans provide greater flexibility in selecting primary care providers. While you’re free to see doctors outside the plan’s network, you’ll usually pay lower costs when using in-network providers.
These PPO plans often come with higher expenses than HMO options, particularly when you seek care from out-of-network professionals. Like HMO plans, most Medicare Advantage PPOs include coverage for prescription medications, though deductibles may apply to both the medical plan and drug benefits.
Copayment amounts can differ, typically ranging from $0 to $50 based on whether you receive care from an in-network or out-of-network provider.
PFFS Plan
BCBS offers a PFFS plan exclusively in Arkansas. This type of plan gives you the flexibility to visit any healthcare provider, whether they’re part of a network or not. However, it’s up to the provider to decide if they will accept the payment terms outlined in the plan and provide care at the Medicare-approved payment rate. With a PFFS plan, you’ll be informed in advance of the amount the plan will cover for a service, and if the provider’s charge exceeds that amount, you’ll be responsible for paying the difference.
If you’re a fan of Blue Cross Blue Shield’s plans, you might find their additional benefits appealing. These can include discounts on health-related products and services, such as savings on fitness essentials like gym memberships, depending on the specific plan you choose. Additionally, if you plan to travel during retirement, some Blue Cross Blue Shield plans provide coverage even when you’re abroad.
Part D Plan
Medicare Part D helps pay for prescription drugs. While some HMO and PPO plans already include this coverage, you also have the option to enroll in a separate Part D plan if needed. Depending on your location, BCBS may provide several standalone prescription drug plans under Part D. Each plan comes with a formulary—a list of covered medications—which you should review ahead of time to make sure your prescriptions are included.
Certain BCBS Part D plans may require a copay when you pick up your medication, and others may include coinsurance costs. If you qualify for financial help, Medicare offers a subsidy program to assist low-income individuals with prescription expenses.
Cost
The costs of BCBS Medicare Advantage plans depends on your geographic area and the specific plan you select. Regardless of the plan, you’ll still need to pay the standard Medicare Part B premium, which is set at $185 for 2025.
Choosing the best plan will depend on your individual healthcare requirements. To compare available options, use the Medicare Plan Finder tool by entering your ZIP code. You can narrow your search by choosing your regional BCBS provider from the “Insurance Carrier” filter.
Below are several examples of BCBS Medicare Advantage HMO and PPO plans available in different parts of the United States. Each of these plans has earned a minimum rating of 3 out of 5 stars from the Centers for Medicare & Medicaid Services (CMS).
| City | Plan Name | Type | Coverage Includes | Not Covered | Monthly Premium | Health Deductible | Drug Deductible | Out-of-Pocket Max |
| New York | Anthem Medicare Advantage, Empire BCBS | HMO | Health & drug coverage, vision, fitness, worldwide emergency, telehealth, OTC drugs | Hearing, dental, transportation | $24 (excl. $185 Part B) | $0 | $350 | $8,900 (in-network) |
| St. Louis | Anthem Medicare Advantage, Anthem BCBS | HMO | Health & drug coverage, vision, hearing, dental, fitness, transportation, worldwide emergency, telehealth, OTC, more | In-home support | $0 (excl. $185 Part B) | $0 | $0 | $2,800 (in-network) |
| Boise, Idaho | True Blue Rx Extend, Blue Cross of Idaho | HMO | Health & drug coverage, vision, hearing, dental, fitness, worldwide emergency, telehealth, OTC drugs | Transportation, in-home support, home safety devices/modifications, emergency response device | $0 (excl. $185 Part B) | $0 | $100 | $4,200 (in-network) |
| San Antonio | BC Medicare Advantage Choice Plus, BCBS of TX | PPO | Health & drug coverage, vision, hearing, dental, fitness, worldwide emergency, telehealth | OTC drugs, in-home support, home safety devices/modifications, emergency response devices, transportation |
All plans are rated between 3 and 3.5 stars, indicating average to above-average quality as rated by CMS. All plans cover health and drug benefits, vision, fitness benefits, and worldwide emergency care. Telehealth is included in all plans except the San Antonio PPO plan, which does not cover over-the-counter (OTC) drugs.
Common exclusions across the plans include in-home support and emergency response devices. The New York plan is missing coverage for hearing, dental, and transportation, while the San Antonio PPO plan lacks coverage for OTC drugs, transportation, and other home safety services.
Customer Support
For assistance with your BCBS health insurance coverage, benefits, or treatment inquiries, you can reach customer service by calling the toll-free number located on the back of your member ID card. Additionally, you can use the tool on the BCBS website to locate the page for your local BCBS provider.
Conclusion
Blue Cross Blue Shield (BCBS) provides a range of Medicare Advantage HMO and PPO plans across all states, along with Medicare Part D prescription drug coverage. Their extensive network includes a wide variety of healthcare providers, and many plans offer coverage for hearing aids as well as routine dental and vision care.
However, there is a limited selection of Special Needs Plans, and premiums may fluctuate annually based on the chosen plan. To find the most suitable provider, it’s recommended to consult with a local Medicare office for personalized guidance.