Excellus blue cross blue shield medicare advantage plans

Copyright © 2022 Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved.

Terms of Use | Web Privacy Policy | Accessibility Statement

Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal.
Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. 

Y0028_5455a_M 
Date Last Updated 4/1/2019

Pros Explained

• High-quality health plans: Excellus Medicare Advantage plans earned an average of 4.5 out of 5.0 Stars from CMS.
• One of the largest Medicare Advantage plans in New York: Excellus has deep roots in upstate New York, resulting from the merger of several local Blue Cross and Blue Shield plans founded in the 1930s.
• Offers many Medicare Advantage options: Compared to some competitors, Excellus offers more Medicare Advantage plans in its service area.
• Members can access Blue365 discounts: As a BlueCross BlueShield plan, Excellus offers its members access to Blue365 discounts on a range of health- and wellness-related services and products.

Cons Explained

• Limited geography: Excellus is only available in parts of New York.
• Though plans are highly rated, health plan ratings are lower: Excellus plans perform well on quality measures but worse on NCQA scores specific to members’ experience with the health plan. 
• No standalone Prescription Drug Plans: Excellus offers Medicare Advantage HMO and PPO plans with and without prescription drug coverage but does not offer standalone prescription drug plans for people who may just need drug coverage. 

Available Plans

Medicare Advantage Plans

Excellus offers HMO, HMO-POS, and PPO Medicare Advantage plans. Some of these plans include preventive dental care such as cleanings and X-rays, but members can also buy extra coverage for restorative and major dental care with a maximum $1,000 benefit.

For 2022, some Excellus Medicare Advantage HMO, HMO-POS, and PPO plans offer discounts on insulin—$25 copayment for a 30-day supply at preferred pharmacies or $30 for a 30-day supply at standard pharmacies. Members can also get a 90-day supply of insulin for $50 at preferred pharmacies or $60 at standard pharmacies. 

HMO and HMO-POS Plans 

In 2022, Excellus offers 72 HMO plans with prescription drug coverage and 13 without. Like most HMO plans, Excellus’s HMOs usually require members to use in-network hospitals, other health care providers, and pharmacies. In some HMO-POS plans, members may be able to see providers who are not in the network.

PPO Plans 

For 2022, Excellus has 75 PPO plans with prescription drug coverage and 24 without. These plans tend to be more flexible. Seeing in-network providers for covered services may cost less than going out-of-network, but PPO members can see providers who participate in Medicare but are not in the Excellus network. PPO members must generally use pharmacies in the Excellus network to fill prescriptions for covered Part D medications.

Medicare Supplement Insurance (Medigap) Plans

Medicare Supplement Insurance plans, also called Medigap, help Medicare members pay some of the out-of-pocket costs that Original Medicare doesn’t cover. There are 10 standard Medigap plan types, each with set benefits across all insurers. Only the premium or other costs and benefits vary depending on the insurer. Not every insurer offers all 10 plan types. Excellus offers six Medigap plans, including: 

• Plan A: This plan covers hospital coinsurance not covered by Medicare Part A, helps pay some Medicare Part B expenses, and pays the 20% coinsurance for Medicare-eligible expenses after you meet the Medicare Part B deductible.
• Plan B: This plan covers everything that Plan A covers plus the Medicare Part A deductible.
• Plan C: This plan covers the basic benefits of Plan A plus coverage for skilled nursing coinsurance, the Medicare Parts A and B deductibles, and overseas travel emergency care.
• Plan F: This plan covers everything included in Plan B as well as help paying for skilled nursing coinsurance, the Medicare Part B deductible, and 100% of additional covered physician services, and overseas travel emergency care.
• Plan F+: This plan offers the same coverage as Plan F with lower premiums and a $2,490 deductible in 2022.
• Plan G: This plan covers the part A deductible, Offers no copays for doctor visits, offers some nursing support, and provides for foreign travel benefits.
• Plan N: This plan covers everything included in Plan B plus coverage for skilled nursing coinsurance and overseas travel emergency care. After you meet the Medicare Part B deductible, this plan covers services with up to $20 for office visits and up to $50 for emergency room visits. 

Extra Benefits 

Most Medicare health plans include extra benefits beyond core medical coverage. These extras typically include dental, vision, hearing, fitness, and other benefits.

Many Excellus plans include fitness, hearing, vision, and dental benefits. Additionally, Excellus members can get the Blue365 discounts, which include additional discounts on fitness programs and products, eye exams and eyeglass frames, nutrition programs and products, hearing screening and hearing aids, and other wellness-related benefits.

Customer Service

Prospective members: Call 800-671-6081 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday (available seven days a week between October 1 and December 30). 

Current members: Call 877-883-9577 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday (available seven days a week between October 1 and March 31).

Online, members can use a drug cost lookup tool and a cost estimator that gives members information on average costs for more than 1,600 treatments and more than 400 procedures. With online accounts or the mobile app, members can find doctors, track deductibles and spending, and view or request a new member ID card. 

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) evaluates health insurers based on the number of complaints against them compared to their share of premiums. A complaint index of 1.0 or less indicates the company had fewer than expected complaints relative to its market share. A complaint index of greater than 1.0 means the company had a disproportionate number of complaints relative to its market share.

Excellus’s complaint index in the individual accident and health category was well below 1.0 for 2021 (0.21), 2020 (0.11), and 2019 (0.11). In the Medicare supplement category, Excellus’s complaint index in 2021 was 3.4, though that score was based on one complaint that year.

Third-Party Ratings

Financial Strength

Excellus is not rated by AM Best, the credit rating agency that assesses insurance companies’ financial strength. The company reports that Standard and Poor’s gave it a financial strength rating of “BBB+” (Stable). 

NCQA

The National Committee for Quality Assurance (NCQA) is one of the accrediting bodies for health insurance plans. Each year, NCQA reviews and rates accredited health plans. In the 2021 ratings, Excellus had six plans rated by NCQA. Four Excellus HMO plans scored 4.5 out of 5.0 overall, a good indication of how satisfied members are with the health plan services. Two Excellus PPO plans scored 4.0 overall.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) rates Medicare plans based on a five-star rating system. Star Ratings evaluate a range of customer experience and health care quality measures. Excellus had two plans that were included in CMS’ 2021 Star Ratings. Both plans earned 4.5 out of 5.0 stars. Both plans earned 4.5 out of 5.0 on Medicare Advantage Part D and 4.0 out of 5.0 on Part C. 

Cost

In 2022, Excellus’ Medicare Advantage plans price ranges include the following options.

HMO plans with prescription drug coverage:

• Monthly premiums range from $0 to $302, averaging $47; 37 plans have premiums less than $100 per month, including 22 plans with no premiums.
• Deductibles range from $0 to $480, averaging $198; about one-half have no deductible.  
• Annual out-of-pocket maximums for in-network services range from $4,500 to $7,550, averaging $7,017. 

HMO plans without prescription drug coverage:

• These plans do not have annual deductibles.
• Annual out-of-pocket maximums for in-network services are $4,500.

PPO plans with prescription drug coverage:

• Monthly premiums range from $0 to $298, averaging $38; 34 plans have no premiums. 
• Deductibles range from $0 to $480, averaging $205.
• Annual out-of-pocket maximums for in-network services range from $3,400 to $7,550, averaging $6,521. 

PPO plans with prescription drug coverage:

• There are no annual deductibles.
• Annual out-of-pocket maximums for in-network services are $4,500.

Though some Excellus premiums are higher than competitors, those higher premiums may be offset by lower out-of-pocket costs such as deductibles and annual out-of-pocket maximums.

Competition: Excellus BlueCross BlueShield vs. Aetna

Excellus and Aetna are among the largest Medicare plans in New York. In the 17 counties where both operate, Excellus generally has more Medicare Advantage plans to choose from, though Aetna has more types of coverage (e.g., Special Needs Plans, Stand-Alone Prescription Drug Plans). Aetna’s Medicare Advantage tends to have lower premiums and higher out-of-pocket maximums, on average. Excellus plans have a wider range of deductibles, but the average deductibles are lower than Aetna’s.

Choosing one of these plans based on cost requires knowing what type of costs you care more about. If lowering your monthly cost is most important, Aetna works better, but you might spend more overall if you use a lot of health care services.

Excellus is only available in parts of New York, so it may not be ideal for people who travel domestically or live part of the year in another state. For quality and selection of Medicare Advantage plans, though, Excellus wins.

Verdict

Excellus BlueCross BlueShield is one of New York’s largest Medicare Advantage plans, offering a wide variety of Medicare Advantage options and an average of 4.5 out of 5.0 Stars from CMS. Though some plans may cost more in monthly premiums than competitor plans, out-of-pocket costs may be lower. For Medicare enrollees in upstate New York, Excellus is a popular choice for a good reason.

How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

What is the most popular Medicare Advantage plan?

What are the negatives of a Medicare Advantage plan?

What are 3 types of Medicare Advantage plans?

What is the best Medicare Advantage plan in New York 2022?