California Medicare Options - Guide and Review of California Blue Shield Medicare Advantage Plans
Guide and Review to Blue Shield of California's Advantage Plans
Blue Shield has become a dominant force in the Medicare supplement market.
Almost every time we run a quote, they're generally #1 in terms of cost for the G plan (most popular Medigap plan).
Turns out, they're no slouch on the Advantage side as well:
In fact, SCAN, Anthem, and Blue Shield (separate carriers from Anthem Blue Cross
at this level) are pretty much neck and neck in California.
Besides their strong showing in other markets (about 1/3rd of the Covered Ca market), what's driving this enrollment success?
Let's find out!
We'll cover these areas below:
- A quick intro to Blue Shield's Advantage Plans in California
- Are people happy with Blue Shield Advantage plans
- Comparing the different Blue Shield Advantage plans
- How to quote Blue Shield Advantage plans
- How to enroll in Blue Shield Advantage plans
Let's get started.
A quick intro to Blue Shield's Advantage Plans in California
As we mentioned, Blue Shield is a huge player in the California health insurance market and a leader in the Medicare supplement market (see Advantage plans versus Supplements).
Of course, they've also moved aggressively into the HMO side of things (Advantage plans).
The new (as of April 2022) enrollment with Shield Advantage plans is at 92K members per CMS data.
The market is super competitive and we're in a period now where smaller Advantage plan carriers are trying to make a name for themselves and probably undercutting the market.
We've seen this many times in the past across other insurance markets (employer, individual/family, and even Medicare supplements).
It generally runs a few years and then crashes as the claims catch up!
Blue Shield's strategy has always been to price according to their well-earned claims data over decades in the Medicare supplement and individual/family HMO markets.
No shortcuts! We expect strategy to win longer term and it speaks to why Shield has been around for so long...especially on the Senior side of things.
Let's turn to whether their approach is well-received.
Are people happy with Blue Shield of California Advantage plans
As always, we lean heavily on the Medicare Star Rating.
Shield's a top California performer by this metric with plans up to 4 stars!
The rating can differ by plan type so it's important to run your actual quote here:
We'll see sample quotes for three areas below to get a sense of the plan ratings.
Remember...the star rating is part of our Triple Threat selection criteria:
- Star Rating of 4 or higher
- Max out-of-pocket under $1000
- Low or no premium
We explain in our How to Compare Advantage Plans why these are so important...especially when comparing Advantage plans to Medicare Supplements.
One of the big drivers of Shield's enrollment in Advantage plans comes down to networks.
#1 complaint with Advantage plans revolves around not being able to your doctors in a given plan.
We take the guesswork out since our quote tool (free to use) allows you to enter your doctor and medication information.
Shield will have stronger networks like United Health and that's a huge deal with HMO plans since you have to stay within your network.
In fact, this may be the deciding factor for many people which puts Shield in contention.
Let's look at their actual plans in different markets with a focus on the Star Rating.
Comparing the different Blue Shield of California Advantage plans
So...we'll run sample quotes for 3 markets:
- Los Angeles (the biggest Advantage market by far)
- Bay Area (San Jose)
- San Diego
Let's get started.
First...the primary Advantage plan battleground...LA!
Los Angeles Blue Shield of California Advantage Plans
Shield has 3 strong showings in this competitive market:
The Inspire plan hits are 3 criteria right away:
Also, the top 3 Shield plans in the market have 4 star ratings so that's one more checkbox marked!
What's interesting is that all three of these plans have the same doctor networks (we checked...1983 providers: general practitioners, within 15 mile radius from 90023 zip)
So what gives besides the lower max-out-of-pocket?
Here's a little secret from an Insider!
Inspire is a newer plan! It's basically Shield's attempt to be more competitive in the key market and it's easier for a carrier to just create a new plan than to try to resuscitate an older one (Plus).
LA is very competitive so the Inspire option is our go-to outside of Special Needs Plans (more on that below).
The Inspire option actually has more additional benefits so that's our go-to option.
See why it's good to have a trusted friend in the biz! See our Google Reviews here:
You'll see how to run your exact quote below.
Let's turn to the Bay Area.
Bay Area and Blue Shield of California Advantage Plans
There's that Inspire plan again!
Plan#8 among some heavy hitters.
4 star so that's good. The max out-of-pocket has jumped from LA to $3,500 but this matches what's available in the Bay Area.
Very different market and maybe not as well suited cost-wise to the HMO model.
We go through why a max over $1000 is tricky when compared to Medicare supplements in our How to Pick the Best Medicare Plan.
So here...it comes down to network...doctors you have access to.
From the quote you can run below, you'll be able to not only look at provider directories but also enter your doctor and medication info up front!
Okay...San Diego.
San Diego and Blue Shield of California Advantage plans
San Diego is a trickier market for Shield. They're pretty far down the list
after pretty stiff competition from Sharp, SCAN, and United.
Here, we see the recognizable Plus and Select plans. Inspire has not yet been
introduced into this market.
Plus has the 4 star while Select has a 3.5 star. That's a separating factor.
There are two new addition..the AdvantageOptimum plan and the Select PPO plan.
The AdvantageOptimum shares the network with Shield's SNP plans. The Select plan is a PPO advantage.
Technically, more flexible than an Advantage HMO but not as flexible as a Medicare supplement.
For both, we don't like the max-out-of-pockets over $3K. Look, a G plan will run around $150/month for a 65 year old in San Diego.
Very little out of pocket...just the Part B deductible of over $200/annually.
65+ is the wrong time to gamble on lower healthcare costs and take on the risk for $3K+.
The carriers sure love this bet! It speaks to the fact that the Advantage model may not be as well suited to the San Diego area.
Basically, HMOs work when they have lots of people and can bend the cost curve. Outside of Los Angeles, the providers and costs may be less "bendable".
Learn how to
compare Advantage and Medicare supplements.
Okay...3 markets...3 very different results.
What about your situation?
How to quote Blue Shield Advantage plans
So...run your quote here:
We contract with the biggest carriers outside of Kaiser to address great
options in each market.
You can also click on "show special need plans" at the top as well.
This shows plans that work for the following:
- Eligible for both Medicare and Medi-cal
- People with Chronic illnesses
- People who get "extra" help but aren't dual eligible (the medi-cal piece above)
In some cases, these may be the best plans for certain people.
Of course, there's lots of options and it's complicated so reach out to us with any questions!
There's zero cost for our assistance and we're happy to help. help@calhealth.net for question or to schedule a time to talk.
What if you find a plan you like?
How to enroll in Blue Shield Advantage plans
Right through the same quoting tool, you can enroll online and your information is already there from the quote!
This will be available shortly with Blue Shield of California plans as well.
Check with us if you have any questions or difficulties around this as we can send you direct links for enrollment with Shield Advantage plans or Medigap options.
Again, we're happy to help you through the process and hopefully the information above has given you a good vantage point to find the best Shield plan.