Blue California Medicare Advantage Reviews

Blue Shield of California Medicare Advantage plans offer comprehensive coverage, including medical, prescription drug, and additional benefits, providing seniors with a reliable and coordinated healthcare option.
By . Last update: June 18, 2024

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Blue Shield of California Medicare Advantage Reviews
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Blue Shield of California (Blue California) offers Medicare Advantage plans that combine the benefits of Original Medicare with additional coverage options, including prescription drugs, vision, dental, and hearing care. Blue California is known for its robust network of healthcare providers and strong customer service, making it a popular choice.

In this editorial review, we will evaluate some of Blue Shield of California’s top plans, focusing on their coverage options, costs, network of healthcare providers, and feedback from members about their experiences.

Table of Contents

Member Reviews for Blue Shield of California

The following Blue Shield of California reviews have been left by our members.

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PROS

  • Comprehensive coverage: Includes medical, prescription drugs, dental, vision, and hearing benefits.
  • Zero-dollar premiums: Offers plans with $0 premiums, making them affordable for many seniors.
  • Additional perks: Provides extra benefits such as gym memberships, wellness programs, and telehealth services.
  • Strong provider network: Extensive network of healthcare providers, ensuring wide access to doctors and specialists.
  • Care coordination: Offers care management programs to enhance care coordination and improve health outcomes.
  • Preventive care programs: Emphasizes preventive care with programs aimed at chronic disease management and wellness.

CONS

  • Network restrictions: Some plans may require the use of in-network providers, limiting choice and flexibility.
  • Prior authorization: Certain services and treatments may need prior authorization, potentially delaying care.
  • Plan limitations: Benefits like dental and vision may have annual limits or restrictions, leading to out-of-pocket expenses.
  • Geographic limitations: Availability of plans may be restricted to certain areas, limiting options for some beneficiaries.
  • Annual changes: Plan details, including premiums, benefits, and provider networks, can change annually.
FEATURED PARTNER OFFER [i]
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Blue Shield of California Medicare Advantage Reviews
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How Do Blue Shield of California Medicare Advantage Plans Work?

Blue Shield of California Medicare Advantage plan members get all their hospital coverage (Medicare Part A) and medical coverage (Medicare Part B) benefits through their plan. This covers screenings, preventive care, vaccinations, visits to doctors and specialists, hospital stays, skilled nursing, and hospice.

All Blue Shield of California Medicare Advantage plans include coverage for:

  • Inpatient hospital admissions.
  • Doctor and specialist care.
  • Preventive care, screenings, and vaccinations.
  • Diagnostic services, lab work, X-rays and other imaging.
  • Outpatient services.
  • Ambulance transportation for emergencies.
  • Durable medical supplies and equipment.

Medicare rules mandate that all Medicare Part C plans offer coverage and benefits that match or exceed those of Original Medicare. However, Blue Shield of California sets its own out-of-pocket costs.

Some Blue Shield of California plans offer additional benefits like routine dental, vision, hearing, and wellness programs, which are not usually covered by Original Medicare.

When you join a Blue Shield of California Medicare Advantage plan, you can manage all your healthcare needs under one plan. This often comes with lower out-of-pocket costs and extra benefits suited to your health and lifestyle.

However, it's important to note that lower costs aren't guaranteed. Costs depend on the specific plan and how much you use healthcare services. Also, the Blue Shield of California plan you choose may have access restrictions, such as needing referrals and prior authorization. Original Medicare does not have these restrictions.

Extra Benefits from Blue Shield of California

Blue California Medicare Advantage plans typically include a range of additional benefits designed to enhance members' overall health coverage. Here are some of the common additional benefits:

  1. Dental Coverage: Many plans offer preventive dental services, including oral exams, cleanings, and fluoride treatments with low or no copays. Comprehensive dental services like restorative services and endodontics may also be covered with varying copays​​​​.

  2. Vision Benefits: Routine eye exams and contact lenses are commonly included, often with minimal copays. Some plans may also offer coverage for eyeglass frames and lenses​​​​.

  3. Hearing Services: Blue Shield plans often include hearing exams, although coverage for hearing aids can vary and may not always be included​​.

  4. Over-the-Counter (OTC) Allowance: Certain plans provide an allowance for over-the-counter medications and health products, helping members manage minor health concerns without additional out-of-pocket expenses​​.

  5. Fitness Programs: Many Blue Shield Medicare Advantage plans include memberships to fitness programs like SilverSneakers, promoting physical activity among seniors​​.

  6. Transportation Services: Some plans offer transportation benefits for medical appointments, making it easier for members to access healthcare services​​.

  7. Meal Delivery Services: Post-hospitalization meal delivery services are often included, helping members recover with nutritious meals delivered to their homes​​​​.

These benefits provide additional coverage beyond traditional Medicare coverage, addressing a broader range of healthcare needs for seniors.

What Types of Plans Does Blue Shield of California Offer?

Not all Blue Shield of California plans are the same. And, Blue Shield of California may not offer all plan types where you live, so it pays to explore using our Medicare Advantage Plan Finder tool. Here are the plan types Blue Shield of California offers:[6]

Health maintenance organization (HMO) plans require that you use a specific network of doctors and hospitals. Also, with a Blue Shield of California HMO plan you may need a referral from your primary care doctor in order to see a specialist. Out-of-network benefits are usually very limited. However, in an emergency you are not limited to care from your local hospital of emergency room.

Medicare preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. With a PPO plan, you generally do not need to choose a primary care doctor, and you don’t need referrals to see specialists. And you can seek out-of-network care, although it may cost more than seeing an in-network doctor.

NOTE: Blue Shield of California may also offer Medicare Advantage Special Needs Plans (SNPs). Due to the highly specialized nature of D-SNP (dual eligible), C-SNP (chronic condition), and I-SNP (institutional) insurance plans, we review them separately.

How Much Do Blue Shield of California Plans Cost?

The cost of a Blue Shield of California plan will vary depending on the specific plan chosen, your location, usage of healthcare services, and the plan's out-of-pocket costs. We detail out-of-pocket costs on all Blue Shield of California Medicare Advantage Plans in our plan finder.

Generally, Blue Shield of California will charge you a monthly premium, which can vary based on the level of coverage and additional benefits included. You must also continue to pay your Part B premium. If you're a high-income earner, Medicare may add a Income Related Monthly Adjustment Amount (IRMAA) to your premium.[5]

Blue Shield of California’s monthly premiums are highly dependent on where you live. For instance, the average cost of a Medicare Advantage plan from Blue Shield of California in California is $16.39 per month, but in California the average cost is $16.39 per month. These averages do not include Special Needs Plans.

Blue Shield of California's Premiums vs. Competitors

The following list shows Blue Shield of California's nationwide average monthly premium (excluding Special Needs Plans) vs. several competitors.

Blue Shield of California
$16.39
AARP/UHC
$13.97
Aetna
$42.17
Kaiser
$7.75
Wellcare
$22.97

You might also encounter copayments or coinsurance for healthcare services, including doctor visits and hospital stays. In each Blue Shield of California plan we assessed, the costs differed based on the coverage level and the specific services received.

Some plans offer $0 premiums or minimal copayments for certain services, while others might have higher premiums with lower out-of-pocket expenses. Carefully reviewing the cost and coverage details of each plan is the only way to find the one that aligns best with your needs.[7]

We analyzed the following popular Blue Shield of California plans to give you an idea of what members pay to use healthcare services. This is just a sample, use our Medicare Advantage Plan Finder to see plans and costs where you live.

Important costs for plan ID H0504-028-0 reviewed in San Diego County, CA.
  • Monthly premium: $0
  • Out-of-pocket max: $3,800
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $5.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H4937-002-0 reviewed in San Diego County, CA.
  • Monthly premium: $57
  • Out-of-pocket max: $4,200
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $5.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H5928-010-0 reviewed in San Diego County, CA.
  • Monthly premium: $0
  • Out-of-pocket max: $4,200
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $3.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None

Is Blue Shield of California a Good Medicare Advantage Plan?

Blue Shield of California Medicare Advantage plans provide a diverse range of options designed to cater to various healthcare needs and preferences. The quality and suitability of these plans can significantly differ depending on an individual's specific health conditions, financial considerations, and personal healthcare priorities. This variety ensures that beneficiaries can find a plan that aligns well with their unique situations, offering comprehensive coverage and a robust network of healthcare providers.

Several consumer intelligence organizations and review sites provide insights into the quality of Blue Shield of California's Medicare Advantage plans. Here’s a summary based on recent evaluations.

J.D. Power Ranking In the 2023 U.S. Medicare Advantage Study by J.D. Power, which measures member satisfaction based on eight factors, Blue Shield of California ranked 5th in California, indicating some room for improvement compared to competitors in the region. SCAN Health Plan ranked highest in California, followed by Humana, Kaiser, and UnitedHealthcare​​.

NCQA Health Plan Score The National Committee for Quality Assurance (NCQA) rates health plans on a 5-point scale, assessing factors such as quality of care, patient satisfaction, and ongoing improvement efforts. In the latest ratings, Blue Shield of California's Medicare Advantage plans generally received scores between 3.0 and 4.0 stars. This places them in the mid to upper range compared to other plans, indicating a solid performance in quality and member satisfaction.

Better Business Bureau (BBB) The Better Business Bureau (BBB) assigns ratings based on customer complaints and business responses. Blue Shield of California has a D- rating from the BBB, indicating some concerns related to customer service and complaint resolution.

ConsumerAffairs ConsumerAffairs collects user reviews and ratings for various services, including health insurance. Unfortunately, the website does not distinguish between Anthem Blue Cross and Blue Shield of California. They are different organizations.  Blue Shield of California's Medicare Advantage plans have mixed reviews, with members often praising the comprehensive coverage and provider network, but some expressing concerns about customer service and prior authorization processes.

Blue Shield of California's Medicare Star Ratings

Blue Shield of California's average 5-star rating: 3.50*
*Our calculation is weighted by enrollments in public plans, excluding Special Needs Plans, with CMS star ratings across 3 contracts covering 108,697 members.

To understand the government's perspective on the quality of Blue Shield of California's Medicare Advantage plans, you can refer to the Centers for Medicare and Medicaid Services' star ratings. These ratings grade each plan on a scale from 1 (worst) to 5 (best) stars, based on quality of care and customer satisfaction. The ratings are updated annually.[9]

Every Medicare Advantage plan is reviewed based on CMS health plan standards. Those that provide prescription drug coverage are also rated on drug plan criteria. Using the most recent data and accounting for enrollment figures, Blue Shield of California’s 2024 Medicare Advantage plans achieve an average of 3.50 stars.[9] [11]

Of all Blue Shield of California members who are in contracts with a Medicare star rating, 0% are in contracts rated 4 stars or above as of January 1, 2024.

You can find all plan ratings in your area using our Medicare Advantage Plan finder tool.

Blue Shield of California's Top Plans

Here's a list of Blue Shield of California's most popular plans (by enrollments):[9][10]

Medicare Advantage Search and compare Medicare Advantage plans available in your area.

Find Plans in your area with your ZIP Code

Frequently Asked Questions

The following are the most frequently asked questions we found about Blue Shield of California's Medicare Advantage plans:

With a Medicare Advantage plan you pay most of your costs when you use healthcare services through deductibles, copayments and/or coinsurance. As a result, private health plans can be difficult to budget. Learn More...

There is no debate when it comes to which plan offers better coverage. Original Medicare and a supplement plan offer the best coverage, but it costs more up-front. For a complete breakdown of the differences between Medicare Advantage plans and Medigap plans, read: Medicare Advantage vs Medigap: Which is Best for You?

Medicare Advantage is a great deal if you are not the one paying the copays. Many people with Medicare Advantage plans, including federal, railroad, and large company retirees, have retirement benefits that pay all of some of their Medicare Advantage plan copays. Other people, like Veterans and low-income individuals, have other government programs available to help pay their healthcare costs. If you're not in one of these groups, Medicare Advantage can be very expensive. Read more about the pros and con in 9 Reasons Why Medicare Advantage Plans are Bad

Researching your health plan options is important. Here are some key questions to consider before choosing a Medicare Advantage plan as well as additional companies to read about:

Key Questions

All plans potentially have monthly premiums, deductibles, copayments, and/or coinsurance, including plans from Blue Shield of California. Are these costs within your budget?

  • Does the plan cover your prescriptions? Knowing how a plan covers them is important if you have regular prescriptions because costs and coverage vary widely from plan to plan.
  • Are your doctors in the plan’s network? If you have preferred providers, ensure they participate in the plan’s network.
  • Is routine dental, vision, and hearing covered? Traditional Medicare doesn’t cover these services. If you need it, be sure to explore plans that cover it.
  • What extras does the plan include? Plans may include many beneficial extras, like gym memberships (SilverSneakers), medical transportation, meal delivery, telehealth, and more.

If you have additional questions, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

About Blue Shield of California

Blue Shield of California, based in Oakland, California, is a not-for-profit health plan that offers a range of Medicare Advantage plans (Medicare Part C), as well as Medicare Part D (prescription drug plans) and Medicare Supplement Plans (Medigap). The company aims to provide high-quality, affordable healthcare to its members.

Blue Shield of California recently announced a significant change in its pharmacy care model. The insurer has decided to replace CVS Caremark as its primary pharmacy benefit manager (PBM), instead partnering with multiple companies, including Amazon Pharmacy and Mark Cuban Cost Plus Drug Company, to enhance transparency and reduce costs. This initiative, known as Pharmacy Care Reimagined, aims to cut prescription drug costs by 10-15%, saving approximately $500 million annually​​.

Additionally, Blue Shield of California was affected by a data breach involving a vendor using the MOVEit secure file-transfer tool. Members impacted by this breach have been offered free credit monitoring and identity restoration services to mitigate any potential fallout from the incident​​.

You can enroll in a Blue Shield of California plan during your Initial Enrollment Period (IEP) at age 65, during the annual Open Enrollment Period (Oct 15 - Dec 7), or during a Special Enrollment Period (SEP), which Medicare grants based on special circumstances, such as moving or losing employer coverage.

Company
California Physician’s Service
Phone Number
833-713-1025
Website
https://www.blueshieldca.com/en/medicare
Facebook Page
https://www.facebook.com/BlueShieldCA/
X (Twitter) Page
https://twitter.com/BlueShieldCA

Citations

MedicareWire uses trustworthy sources to inform its work, including government websites, government data, actuarial service data, consumer intelligence websites, and peer-reviewed studies. All content is fact-checked for accuracy, timeliness, and relevance. We used the following information sources in this review: