How Blue Cross Blue Shield Works With Medicare

What Blue Cross Blue Shield offers alongside Medicare

Blue Cross Blue Shield (BCBS) is a network of independent insurance companies that work with Medicare to offer coverage plans. They do not replace Medicare — they work alongside it. BCBS offers two main types of plans: Medicare Advantage (Part C) and Medigap (supplemental insurance). Which one you choose changes what you pay and which doctors you can see.

Medicare Advantage plans bundle your hospital, medical, and prescription drug coverage into one plan run by BCBS instead of Original Medicare. You pay a monthly premium to BCBS, and the plan covers your costs after you meet a deductible. Medigap plans, by contrast, work with Original Medicare — you keep your Medicare coverage and add BCBS on top to cover costs Medicare does not pay, like copayments and coinsurance.

BCBS operates in most states but not all. The plans available to you depend on where you live. You can only change plans during specific windows: when you first turn 65, during the annual Medicare open enrollment period (October 15 to December 7), or if you experience a may have access to life event like moving to a new state.

Key Takeaways

Blue Cross Blue Shield offers Medicare Advantage plans that replace Original Medicare and Medigap plans that supplement it, and you choose one or the other, not both.
Medicare Advantage plans include prescription drug coverage and often dental or vision benefits, but limit you to in-network doctors and require referrals for specialists.
Medigap plans let you see any doctor who accepts Medicare, but do not cover prescription drugs, and you must enroll within six months of turning 65 to avoid higher premiums.
BCBS plans vary by state and county, so the options available to you depend on where you live and may change year to year.
You can switch plans only during open enrollment (October 15 to December 7) or if you have a may have access to life event, so choosing carefully the first time matters.

Medicare Advantage plans through BCBS

A BCBS Medicare Advantage plan (Part C) bundles hospital insurance, medical insurance, and prescription drug coverage into one monthly premium. You do not pay the standard Medicare Part B premium to Medicare — BCBS collects one combined premium instead. Many BCBS Advantage plans charge zero monthly premium, though you still pay Medicare's Part B premium separately to Medicare.

In exchange, you accept limits. You must use doctors and hospitals in the BCBS network, except in emergencies. If you want to see a specialist, most BCBS Advantage plans require your primary care doctor to refer you first. The plan sets its own copayments and deductibles — these vary by plan and by state. Prescription drugs are included, but BCBS controls which drugs are covered and at what cost through a formulary (a list of approved medications).

BCBS Advantage plans often add benefits Original Medicare does not cover: dental cleanings, vision exams, hearing aids, or fitness programs. These extras vary widely by plan. Some plans cover routine dental work; others cover only cleanings. Read the plan's summary of benefits to see exactly what is included in the plan you are considering.

Medigap supplemental plans from BCBS

A BCBS Medigap plan (supplemental insurance) works alongside Original Medicare, not instead of it. You keep your Medicare Part A and Part B coverage and your Medicare card. BCBS covers the costs that Medicare does not — copayments, coinsurance, and deductibles. You pay BCBS a monthly premium on top of your Medicare Part B premium.

The main advantage of Medigap is freedom. You can see any doctor or specialist in the United States who accepts Medicare, without referrals or network restrictions. You are not locked into a plan's formulary for prescriptions — your doctor and pharmacist decide what you take, and Medicare Part D (prescription drug coverage you buy separately) covers it.

The trade-off is cost and timing. Medigap premiums are often higher than Medicare Advantage premiums, and they rise with age. More importantly, you have a six-month window to buy Medigap at the best rates: the month you turn 65 and enroll in Medicare Part B. If you wait longer, BCBS can charge you more based on your health history, and some plans may deny you coverage entirely. After that window closes, you can still buy Medigap, but the price is higher.

How to find BCBS plans in your area

BCBS operates through regional subsidiaries — Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Massachusetts, and so on — so the plans available depend on your state and county. Not every BCBS subsidiary offers both Advantage and Medigap plans in every location.

To see which BCBS plans are available where you live, visit Medicare.gov and use the plan finder tool. Enter your ZIP code, and the tool shows all Medicare Advantage and Medigap plans available to you, including BCBS options. The tool displays the monthly premium, deductible, copayments, and which doctors and hospitals are in-network. You can compare plans side by side.

You can also contact BCBS directly. Find your state's Blue Cross Blue Shield website and look for the Medicare section. Most state BCBS websites have a phone number for Medicare questions. A BCBS representative can walk you through plans available in your county and answer questions about coverage.

Costs: premiums, deductibles, and out-of-pocket limits

BCBS Medicare Advantage plans have a monthly premium (which may be zero), an annual deductible, and copayments or coinsurance for each service. The plan also sets an out-of-pocket maximum — the most you will pay in a year before the plan covers everything at no cost. Once you hit that limit, BCBS covers 100 percent of covered services for the rest of the year.

BCBS Medigap plans have a monthly premium but typically no deductible and no copayments for covered services. You pay the premium and then Medicare and BCBS split the costs of care. The exact coverage depends on which Medigap plan you choose — BCBS offers plans labeled A through N, and each covers a different set of costs. Plan G, for example, covers most of what Medicare does not, while Plan A covers less but costs less per month.

Costs change year to year. BCBS announces new premiums and deductibles each fall for plans starting January 1. If your plan's costs rise too much, you can switch to a different BCBS plan or a plan from another company during open enrollment.

Prescription drug coverage with BCBS

BCBS Medicare Advantage plans include prescription drug coverage (Part D). The plan's formulary lists which drugs are covered and at what cost. Some drugs are covered at a low copayment; others require a higher copayment or are not covered at all. If your doctor prescribes a drug not on the formulary, you can ask BCBS for an exception — the plan may cover it anyway if your doctor explains why you need it.

If you choose a BCBS Medigap plan, prescription drug coverage is not included. You must buy Part D coverage separately, either through BCBS or another insurance company. You have a two-month window to enroll in Part D without penalty: the month you first become may be able to access for Medicare. If you wait longer, Medicare charges a late enrollment penalty on top of your Part D premium for as long as you have Part D coverage.

When and how to switch BCBS plans

You can change BCBS plans or switch to a different company's plan during Medicare's annual open enrollment period: October 15 to December 7 each year. Changes take effect January 1. During this window, you can switch from a BCBS Advantage plan to a BCBS Medigap plan, from one BCBS plan to another, or from BCBS to a competitor.

You can also change plans if you experience a may have access to life event: you move to a new state or county where your current plan is not available, you lose other health coverage, or you become may be able to access for Medicaid. These events give you a 60-day window to switch. Contact BCBS or Medicare to report the event and confirm your window.

If you do nothing during open enrollment, your current BCBS plan renews automatically for the next year. Review your plan each fall to see if the premium, deductible, or covered doctors have changed. If your plan no longer meets your needs, open enrollment is your chance to switch.

Questions to ask BCBS before you enroll

Before you choose a BCBS plan, ask these questions to make sure it fits your situation:

Is my current doctor in the plan's network? (For Advantage plans only.)
What is the monthly premium, annual deductible, and out-of-pocket maximum?
What copayments do I pay for doctor visits, specialist visits, and hospital stays?
Are my current medications on the plan's formulary, and at what copayment?
Does the plan cover services I use regularly, like physical therapy or mental health care?
If I travel or move, will the plan cover me? (For Advantage plans, coverage outside the network is limited.)

Write down the answers or ask BCBS to send them in writing. Keep this information with your Medicare documents so you can refer back to it if questions come up later.

Frequently Asked Questions

Can I have both a BCBS Medicare Advantage plan and a Medigap plan?

No. Medicare does not allow you to have both at the same time. You choose one or the other. If you switch from Advantage to Medigap, you may face higher Medigap premiums if you enroll more than six months after turning 65, because you missed the initial enrollment window.

What happens to my BCBS plan if I move to a different state?

Your plan may no longer be available in your new state. Contact BCBS or use Medicare.gov to see which plans are available in your new location. You have 60 days from your move to switch plans without waiting for open enrollment. If you do not switch within 60 days, you are locked into your current plan until the next open enrollment period.

Does BCBS cover out-of-network doctors?

It depends on the plan. Medicare Advantage plans cover out-of-network care only in emergencies. Medigap plans cover any doctor who accepts Medicare, whether in-network or not. If you see many specialists or travel frequently, Medigap may be a better fit.

What if BCBS denies coverage for a service my doctor recommended?

You have the right to appeal. Contact BCBS and ask for the reason for the denial in writing. If you disagree, you can file a formal appeal with BCBS, and if that fails, you can ask Medicare to review the decision. BCBS must respond to appeals within 30 days for urgent care and 60 days for routine care.

Can I switch from my BCBS plan to a different company's plan mid-year?

Only if you have a may have access to life event like moving, losing other coverage, or becoming may be able to access for Medicaid. Otherwise, you must wait for open enrollment in October. If your plan changes in a way that affects you — your doctor leaves the network, a drug is removed from the formulary — contact BCBS to see if a life event exception applies.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.