Blue Cross Blue Shield Hmo or Insurance Company
Blue Cross Blue Shield (BCBS) companies are part of the Blue Cross Blue Shield Association (BCBSA), an alliance of separate health insurance businesses covering members in each state. Policyholders can use a Blue Cross Blue Shield insurance card almost anywhere in the U.S., subject to provider participation and plan benefits.
Each Blue Cross Blue Shield private insurance company is locally owned and independently operated. Individual BCBS companies sell and service health insurance relative to their "home" states or regions. As such, customers rate and report on interactions with their home BCBS plan, rather than the association as a whole. While some customers reported concerns related to payment and service, the companies we reviewed received overall positive marks from the Better Business Bureau and other reporting entities.
- Blue Cross Blue Shield medical insurance: Our thoughts
- Plan costs and options
- Member resources and unique benefits
- Reviews and customer complaints
Blue Cross Blue Shield medical insurance: Our thoughts
Blue Cross Blue Shield insurance offers a variety of coverage types including dental, vision, short-term medical and individual major medical. Specifically, BCBS provides Affordable Care Act (ACA) major medical plans for new enrollees in all but three states: Mississippi, Nebraska and South Dakota. Existing members may be able to continue their current coverage in these three states.
Some BCBS companies do business in multiple states. For example, a BCBS entity called CareFirst covers Maryland, Virginia and the District of Columbia. Other BCBS businesses, such as Horizon Blue Cross and Blue Shield of New Jersey, operate in a single state.
Availability of BCBS policies
Listed below are the BCBS entities in each state. In some cases, multiple BCBS companies operate in a single state. For example, depending on where you live in California, you would be covered by either Blue Shield of California or Anthem Blue Cross.
As a reminder, BCBS does not offer ACA plans in Mississippi, Nebraska and South Dakota.
Plan costs and options
Below are Bronze, Silver and Gold levels of a Blue Cross and Blue Shield of Illinois insurance plan and one offered by Blue Cross Blue Shield of Michigan. In both cases, our cost estimates are based on a 40-year-old individual. It is important to note that some of these plans may not be available in all areas of these states, so it is vital to visit your own health insurance exchange to see what plans are available.
Blue Cross and Blue Shield of Illinois
| Plan name | Individual deductible | Premium | Coinsurance | PCP copay |
|---|---|---|---|---|
| Plan 205 – Blue Precision Bronze HMO | $7,400 | $389 | 50% | $60 |
| Plan 206 – Blue Precision Silver HMO | $3,000 | $492 | 50% | $30 |
| Plan 207 – Blue Precision Gold HMO | $750 | $565 | 30% | $20 |
Blue Cross Blue Shield of Michigan
| Plan name | Individual deductible | Premium | Coinsurance | PCP copay |
|---|---|---|---|---|
| Blue Cross Preferred HMO Bronze | $8,500 | $273 | 0% | $35 |
| Blue Cross Preferred HMO Silver | $3,000 | $420 | 30% | $30 |
| Blue Cross Preferred HMO Gold | $850 | $455 | 20% | $30 |
In a ValuePenguin report on ACA plans in Michigan, we found that BCBS of Michigan was among the few companies offering the cheapest Silver health insurance plan in 84% of Michigan counties.
Blue Cross Blue Shield of Michigan Silver HMO quotes vs. competitor Silver HMOs
To maintain focus, we narrowed our review of competitor insurance products to a single state. The graph below compares individual rates for a Blue Cross Blue Shield of Michigan Silver health insurance plan to similar Silver HMOs offered by Priority Health and McLaren Health Plan Community.
Find Cheap Health Insurance in Your Area
Deductible amounts for the sample plans range from a low of $2,400 for Priority Health to a high of $3,700 for McLaren Health Plan Community. Out-of-pocket maximums are similar between the three options, ranging from $8,150 for McLaren to $8,550 for Priority Health.
Deductibles, coinsurance and copays are assessed differently among the plans. For example, only BCBS of Michigan applies prescription costs to the annual deductible, meaning prescriptions are not covered until the deductible is met.
The plans also vary in how they handle emergency room (ER) services. BCBS of Michigan and Priority Health both assess a $250 copay per ER visit after the annual deductible is met, plus 30% coinsurance. McLaren charges 20% coinsurance after the $3,700 deductible is met but no ER copay.
In a scenario where you received ER services totaling $5,000 before meeting any portion of your deductible, your combined out-of-pocket expense would be your full deductible, copay (if one is charged) and coinsurance for the remaining amount. The cost calculation for each plan is shown below.
- BCBS: $3,000 + $250 + 30% of the remaining amount, or $525 = $3,775
- McLaren: $3,700 + 20% of the remaining amount, or $260 = $3,960
- Priority Health: $2,400 + $250 + 30% of the remaining amount, or $705 = $3,355
In this situation, Priority Health has the lowest out-of-pocket expense. Priority Health also has the cheapest premium compared to the other two options. As mentioned before, BCBS rates may be higher than those charged by competitors in some areas. If price is a main factor, a BCBS health plan may not be the best option depending on where you live. The BCBS provider network and company standing might be features to consider but could come at a slightly higher cost.
Member resources and unique benefits
As part of the BCBS Association, many BCBS plans provide access to additional health-related resources like those listed here. It is important to remember that these are not health insurance benefits.
- A 24/7 nurse line
- Blue365 for discounts on health and fitness clubs, weight loss programs and other health-related products
- Telemedicine
- A mobile app and a separate member website
Reviews and customer complaints
BCBS is an established health insurance company with widespread availability and a large provider network. BCBS insurance plans include multiple coverage options with rates comparable to — or sometimes higher than — rates from other companies. Overall, BCBS has received positive ratings from reporting agencies such as the Better Business Bureau and the National Association of Insurance Commissioners (NAIC).
BCBS companies are separate entities but often have similar names. As a result, customers have reported challenges in finding the correct department to address their servicing needs.
Customers reported concerns with both BCBS of Illinois and BCBS of Michigan relative to claim payments and servicing, including issues with hold times, lack of follow-through and inaccurate information. However, in calculating ratings, the Better Business Bureau considers the number of complaints and how promptly they are addressed, along with a company's size relative to complaint totals and its time in business. With all factors combined, the Better Business Bureau gave BCBS of Illinois and BCBS of Michigan ratings of A- and A+, respectively.
In the individual health category, NAIC complaint totals for both BCBS of Illinois and BCBS of Michigan were below average relative to company size. BCBS of Illinois received a median NAIC index of 0.00, meaning no complaints were reported by the Illinois insurance department for the 2020 review period. For BCBS of Michigan, the NAIC reported a median complaint index of 0.38 for 2020.
Source: https://www.valuepenguin.com/blue-cross-blue-shield-health-insurance-review
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