The Blue Cross Blue Shield (BCBS) Association offers different Medicare Advantage plan options.
BCBS Medicare Advantage plans may differ from state to state. A person may find it beneficial to research which plan options best suit their needs.
Read on to learn more about the types of plans, associated costs, and more.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
BCBS Medicare Advantage plans include:
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- HMO with Point-of-Service Option (HMO-POS)
- Private Fee-For-Service (PFFS)
- Special Needs Plan (SNP)
- Medicare Cost Plan
PPO plans
PPO plans consist of a network of doctors, hospitals, and other healthcare providers that have agreements with the company administering the policy. Therefore, these healthcare providers will be in a plan’s network.
A person usually pays less if they use in-network doctors, services, and hospitals. Choosing care outside of the network may result in higher costs.
HMO plans
In an HMO plan, a person must receive their healthcare services from a list of providers within the plan’s network, but exceptions might be possible for:
- emergency care
- out-of-area urgent care
- out-of-area dialysis
Learn more about HMO and PPO plans.
HMO-POS plans
This type of plan is a Medicare Advantage HMO plan with a Point-of-Service option.
Some HMO plans allow a person to choose an out-of-network healthcare professional for some types of services.
PFFS plans
If a person joins a PFFS plan, the plan will decide how much they will pay for healthcare. It will also determine the amount a person pays toward their healthcare costs.
An individual does not have to use in-network services but can use an out-of-network doctor, hospital, or provider who accepts the plan’s rules and requirements.
SNPs
BCBS offers SNPs. A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan for people with specific conditions.
The plans customize the choice of providers, benefits, and drug formularies to meet the needs of their members as best as possible.
Private insurance companies that administer Medicare Advantage plans usually include the option to add prescription drug coverage (Medicare Part D). All SNPs are required to include Medicare prescription drug coverage automatically.
Medicare Cost Plans
Medicare Cost Plans are a type of HMO that are only available from BCBS in Minnesota.
A person may choose to use the Cost Plan provider network or opt to receive their healthcare from a non-network provider. If an individual decides to visit a non-network provider, they will pay the Original Medicare costs.
Every Medicare Advantage plan must offer the same coverage as Original Medicare. This includes Part A (hospital insurance) and Part B (medical insurance).
Most BCBS Medicare Advantage plans also include prescription drug coverage.
Some plays may offer additional benefits, such as:
- wellness services
- dental care
- hearing care
Learn about the pros and cons of Medicare Advantage plans.
Costs may vary by state and depend on which plan a person chooses, but the general costs may include:
- monthly premiums
- deductibles
- copayments
- coinsurance
A person must pay the Medicare Part B premium with every Medicare Advantage plan. Depending on the plan a person selects, they may also pay a separate monthly premium for their Medicare Advantage plan.
Unlike Original Medicare, Medicare Advantage plans have an out-of-pocket maximum each year. The amount will depend on the specific plan.
The BCBS online tool allows users to search for Medicare Advantage plans in their area using their ZIP code.
The following information includes examples of costs associated with BCBS Medicare Advantage plans.
Medicare HMO Blue SaverRx (HMO-POS)
The 2025 costs of the Medicare HMO Blue SaverRx (HMO-POS) plan from the Blue Cross Blue Shield of Massachusetts can include:
- a monthly premium of $0
- a specialist copay of $0 to $40 per visit
- a primary doctor copay of $0
- an in-network maximum of $6,200
- an in- and out-of-network maximum of $6,200
CareFirst BlueCross BlueShield Advantage Complete (PPO)
The 2025 costs of the CareFirst BlueCross BlueShield Advantage Complete (PPO) plan from the CareFirst BlueCross BlueShield Medicare Advantage can include:
- a monthly premium of $42
- a specialist copay of $35 per visit
- a primary doctor copay of $0
- an in-network maximum of $7,300
- an in- and out-of-network maximum of $12,300
- an out-of-network maximum of $12,300
The Blue Cross Blue Shield (BCBS) Association offers numerous Medicare Advantage plans, including HMOs, PPOs, PFFS, and SNPs.
If an individual joins a BCBS Medicare Advantage plan, they will receive cover for Original Medicare parts A and B. The plan may also include prescription drug coverage and additional benefits, such as dental and vision care.
Different Medicare Advantage plans may charge different deductibles, copayments, and coinsurance. The BCBS website allows people to find out more about costs and compare plans by searching with their ZIP code.
