Blue Cross Blue Shield Medicare

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Blue Cross Blue Shield (BCBS) Medicare

The Blue Cross Blue Shield Association (BCBSA) is comprised of a group of 37 independent companies which license the Blue Cross Blue Shield trademark for branding and marketing purposes. The 37 companies cover more than 103 million Americans nationwide and offer a number of insurance products such as large employer group insurance, insurance for small businesses, Medicare insurance products, and coverage for individuals. Blue Cross and Blue Shield developed separately in the early to mid 1900s and merged in 1982. The largest managed healthcare company in the Blue Cross Blue Shield Association is WellPoint, formed when WellPoint Health Networks, Inc. merged with Anthem in 2004. WellPoint is currently seeking to change its name to Anthem, pending the approval of their shareholders in a November 2014 meeting. The change is based on consumer surveys as well as adapting to the post-reform environment. BCBS companies operating in different states as well as in different regions of the same state may have different names. For example, in Washington the company is called Premera Blue Shield but in Virginia there are two BCBS companies called Anthem Blue Cross Blue Shield and CareFirst BlueCross BlueShield which operate in the state.

Medicare Insurance Products from Blue Cross Blue Shield

Blue Cross Blue Shield companies have processed Medicare fee-for-service claims and payments since the beginning of the Medicare program in 1965. Over 158 million Part A (hospital services) claims and over 687 million Part B (physician services) claims were processed by BCBS Medicare contractors in 2011. Considering there were more than 190 million total Part A claims and more than 990 million total Part B claims filed during the entire year, BCBS processed more claims than any other single carrier in 2011.

BCBS offers various Medicare Advantage, Medicare Supplement, and Prescription Drug plans depending on your state of residence. The following include some examples of these products. The name and availability may differ depending on where you live:

Medicare Advantage with a Prescription Drug Component (MAPD):

  • Medicare HMO BlueSM ValueRx
  • Medicare HMO BlueSM PlusRx
  • Medicare PPO BlueSM SaverRx
  • Medicare PPO BlueSM ValueRx
  • Medicare PPO BlueSM PlusRx

The HMO plans provide coverage for Original Medicare (Part A & B) benefits as well as routine dental, vision, and hearing benefits. HMO plans also includes coverage for prescription drugs. Beneficiaries receive routine care from an in-network primary care physician who helps coordinate care with other providers in the network. The PPO plans also provide coverage for Original Medicare (Part A & B) benefits as well as routine dental, vision, and hearing benefits. PPO plans also include coverage for prescription drugs. Beneficiaries have access to in-network and out-of-network providers without referral requirements. Cost-sharing for in- and out-of-network covered services are the same for most services. However, for certain benefits you may have to pay higher out-of-pocket expenses if you receive out-of-network care. PlusRx plans have the highest premium costs whereas SaverRx or ValueRx have the lowest premium costs.

Medicare Supplement (Medigap):

  • Medex® Core: A supplemental plan which helps cover a portion of healthcare costs after a beneficiary’s current Medicare plan has paid its portion of costs. This plan also includes travel coverage but does not cover prescription drug coverage. However, you can combine this plan with a standalone prescription drug plan.
  • Medex® Bronze: Similar to the Core plan. This plan provides full coverage for care received outside of the U.S. but does not include prescription drug coverage.

Prescription Drug Plans (Part D):

  • Blue MedicareRx Value Plus (PDP): A standalone prescription drug plan with $1 copays for a one-month supply of a tier 1 preferred generic drug obtained through a preferred network pharmacy or a 90-day supply via a mail order service. The plan includes a $0 annual deductible for tier 1 preferred generic drugs and tier 2 non-preferred generic drugs.
  • Blue MedicareRx Premier (PDP): Higher monthly premiums than the Value Plus plan but includes a $0 annual deductible for all covered drugs. If you fall into the coverage gap, the plan will still cover tier 1 preferred generic drugs and tier 2 non-preferred generic drugs.

Our Medicare and Medigap plan comparison tools allow you to easily compare Blue Cross Blue Shield Medicare products with other similar offerings in your area.



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Sources:

About Blue Cross Blue Shield Association http://www.bcbs.com/about-the-association/

About the Blue Cross and Blue Shield Companies http://www.bcbs.com/about-the-companies/

WellPoint Changes Its Name to Anthem (August 12, 2014) http://online.wsj.com/articles/wellpoint-changes-its-name-to-anthem-1407877202

2014 Medicare Plans http://www.bluecrossma.com/medicare-options/2014/medicare-plans/

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