Blue Cross Blue Shield May Decide The Success (Or Failure) Of Health Exchanges

Blue Cross Blue Shield (BCBSA) offers plans to more than 100 million persons through 36 separate companies, and on nearly all State Health Insurance Exchanges. Open Enrollment of individuals, families and businesses begins in November each year, although plans are offered year-round with an SEP exception. Medical coverage is offered through a network of brokers and reputable websites like ours. Coverage can also be purchased directly through the local carrier.

Group policies are offered through large and small employers, and Senior Medicare plans are available in all states. Their Federal Employee program covers an additional 5 million persons. More than 95% of the nation’s hospitals accept network coverage, and provide substantial discounts to existing customers. The same percentage of doctors and specialists participate in a network, and are able to offer significant cost reductions.

But noticeably absent from most of the Marketplaces are Aetna, Cigna, Humana, and UnitedHealthcare, four of the largest health insurers in the US. Currently, they are active in every state, offering consumers choices of many types of private and Senior policies. All four carriers will “wait and see” what happens in 2019 and 2020, when any applicant, regardless of medical conditions (pastor existing) will continue to be approved, although additional changes may occur.

Another giant carrier, Kaiser, is only active in several states, while many smaller carriers, such as Ambetter, will operate in a handful of states.  Oscar, a newer company, is slowly expanding into additional states, and increasing their service area in Ohio. Medicare Supplement (Medigap) plans have not been significantly impacted by legislative changes. Most of the recent changes affect applicants under age 65.

Blue Cross Blue Shield Health Insurance Plans

BCBS Offers Senior Medicare And Under-65 Coverage

History of BCBS

The Blues companies are the most recognizable name of all carriers. They insure more persons than any other company and offer plans to children, adults, Seniors, self-employed persons, small companies, and large corporations. They will continue to succeed if they offer affordable health insurance prices and of course, put some profit in their pocket. Can this continue? Yes. Especially if  healthy young persons enroll in the Marketplace…and of course, stay out of the hospital! By negotiating lower pricing from physicians, specialists, medical facilities, and hospitals, consumers that purchase their products often enjoy lower out-of-pocket costs.

Their track record is impressive. For about 80 years, policies have been offered in all states, and just about every county in the US. Although some Blues companies are “for profit,” and others aren’t, it’s still the most recognizable name in the industry. Between call centers and retail sales locations, you can purchase a policy from multiple locations, including our website which gives you direct pricing. Although temporary coverage is generally no longer offered by BCBS, ancillary plans, such as dental, vision, and hearing, are available privately or through an employer.  Large group and small group healthcare coverage can be easily customized to match employee needs.


US Blue Cross Blue Shield Companies

Alabama – BCBS of Alabama

Alaska – Premera BCBS of Alaska

Arizona – BCBS of Arizona

Arkansas – Arkansas BCBS

California – Blue Shield of California and Anthem Blue Cross

Colorado – Anthem BC of Colorado

Connecticut – Anthem BCBS Connecticut

Delaware – Highmark BCBS Delaware

District of Columbia – CareFirst BCBS

Florida – Florida Blue

Georgia – BCBS of Georgia

Hawaii – BCBS of Hawaii

Idaho – Regence Blue Shield of Idaho and Blue Cross of Idaho

Illinois – BCBS of Illinois

Indiana – Anthem BCBS of Indiana

Iowa – Wellmark BCBS

Kansas – BCBS of Kansas

Kentucky – Anthem BCBS Kentucky

Louisiana – BCBS of Louisiana

Maine – Anthem BCBS Maine

Maryland – CareFirst BCBS

Massachusetts – BCBS of Massachusetts

Michigan – BCBS of Michigan

Minnesota – BCBS of Minnesota

Mississippi – BCBS of Mississippi

Missouri – BCBS of Kansas City and Anthem BCBS of Missouri

Montana – BCBS of Montana

Nebraska – BCBS of Nebraska

Nevada – Anthem BCBS  Nevada

New Hampshire – Anthem BCBS New Hampshire

New Jersey – Horizon BCBS of New Jersey

New Mexico – BCBS of New Mexico

New York – Excellus BCBS, BlueShield of Northeastern New York, BCBS of Western New York, and Empire BCBS

North Carolina – BCBS of North Carolina

North Dakota – BCBS of North Dakota

Ohio – Anthem BCBS  Ohio

Oklahoma – BCBS of Oklahoma

Oregon – Regence BCBS

Pennsylvania – Independence Blue Cross, Highmark BCBS, Highmark Blue Shield, and Capital BlueCross

Rhode Island – BCBS of Rhode Island

South Carolina – BCBS of South Carolina

South Dakota – Wellmark BCBS

Tennessee – BCBS of Tennessee

Texas – BCBS of Texas

Utah – Regence BCBS

Vermont – BCBS of Vermont

Virginia – Anthem BCBS  Virginia and CareFirst BCBS

Washington – Premera Blue Cross and Regence BlueShield

West Virginia – Highmark BCBS West Virginia

Wisconsin – Anthem BCBS Wisconsin

Wyoming – BCBS of Wyoming


US Market Share

In many areas, they are still the biggest player, including large states  California, Florida, New Jersey, Michigan, New York, Pennsylvania, and Ohio. Several of the states that they are not the largest provider include Hawaii, Maryland, Nevada, Oregon and Utah. In  secondary medical coverage, they are still not the major force that they would like to be. But that could change by the end of the decade, as additional ancillary products are introduced.

Although BCBS is seeking to to expand their market share, growth, and potential, other big carriers, such as Humana, Aetna, and UnitedHealthcare, are taking a more cautious approach. They’ll carefully study Marketplace results in their target states, and determine which areas to offer plans for 2020. It’s also possible these carriers will continue to underwrite only non-Exchange plans. Short-term coverage continues to expand, and if profitability remains high, the Blues companies may re-enter the marketplace.

Get Cheap Blue Cross Blue Shield Prices

BCBS Family Healthcare Coverage Is Very Affordable

Since BCBS can not increase Exchange plan premiums because of pre-existing conditions (other than smoking), there have been many unhealthy applicants that have been required to be approved, that were perhaps declined five years earlier. So to offset the large anticipated increase in claims, it’s critical, as mentioned earlier, that a large amount of persons under age 30 purchase coverage, since they are unlikely to have many claims.

So how can the Blues reach out to the younger segment of the population and convince them to purchase a policy, especially when many of them have never bought coverage before. One way is educating consumers about the specifics of benefits they will receive, and the federal tax subsidy that could drastically reduce their premium. Maternity and treatment and counseling for mental illness are covered, which is appealing to many younger applicants.

In several states, there already are community outreach programs in place, which include churches, local business organizations, soup kitchens and volunteer groups. These groups of people not only potentially increase the number of customers Blue Cross Blue Shield will write, but they provide easier access of information to many persons that aren’t aware of their healthcare options or are not actively utilizing the internet. It’s essentially free education for consumers.


Formation Of  State Exchanges

Each State Exchange was previously set up one of three ways. The federal government can control the operation. The state government can control the operation. Or, it can be a partnership of both governments (seven states have chosen this option). 25 states have defaulted to the federal option while 19 states are administering their own Exchange. For states that have defaulted to the federal government handling the process, that decision can be changed the following year.

Currently, 28 states are federally-facilitated, 11 states are state-based, 6 states partner with the Marketplace, and 5 states utilize a state-based Marketplace federal platform. HHS performs all duties and functions when federally-facilitated.  State-based platforms can provide their own customer-assistance, partner platforms allow federal-run functions, and state-based Marketplaces perform most functions.

One of the big advantages of a state-run Marketplace is that the local legislature can enact laws that are pertinent to that particular state, as opposed to parts of the country hundreds of miles away. It’s also possible that a state-operated program will simply be less costly and employ more local residents than a federally-operated program. And of course, most consumers have a bigger  influence on a non-federal entity.


20 States With Largest Blue Cross (Or Affiliated Company) Marketplace Enrollments

California – Anthem  741,000

North Carolina – BCBS Of NC  418,000

Arkansas – Arkansas BCBS  271,000

Maryland – CareFirst  251,000

Michigan – BCBS Of Michigan  239,000

South Carolina – BCBS Of SC  239,000

Virginia – Anthem  230,000

Tennessee – BCBS Of Tennessee  220,000

New Jersey – BCBS Of NJ  205,000

Alabama – BCBS Of AL  179,000

Pennsylvania – Independence Blue Cross  174,000

Arizona – BCBS Of Arizona  139,000

Washington – Premera BC  135,000

Minnesota – BCBS Of Minnesota  116,000

Kentucky – Anthem  115,000

Iowa – Wellmark BCBS  115,000

Kansas – BCBS Of Kansas  96,000

Indiana – Anthem  98,000

Nebraska – BCBS Of NE 72,000

Idaho – Blue Cross Of ID  70,000


Blue Cross Medicare Coverage For Seniors

Advantage Plans (Part C), prescription drug coverage (Part D), Medigap (Supplement), and Cost Plans (cover Parts A and B) are available. Low-income families and single persons, along with applicants with disabilities, may be eligible for both Medicare and Medicaid.  BCBS, UnitedHealthcare, and Humana together issue more than half of new Medicare Advantage enrollments. Other carriers that issue a significant number of plans include Kaiser Permanente, Cigna, Aetna, and WellCare.

Blue Cross is well-represented when comparing carrier market share for in-force Medicare Supplement plans. Last year, the top-10 companies accounted for about 70% of the market with approximately 9 million enrollments. These companies are (in order) UnitedHealthcare, Mutual Of Omaha, Aetna, HCSC, Anthem, Cigna, CNO Financial, Humana, BCBS of Massachusets, and Wellmark BCBS. The nine companies with the largest MA (Medicare Advantage) market share are (in order) Humana, UnitedHealthcare, Aetna, BCBS, Anthem, Centene, Wellcare, Kaiser, and Cigna

BCBS Medicare Supplement plans are offered in the following states: Colorado, California, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia, and Wisconsin.

Blue Cross Blue Shield offers plans in all states. They will continue to insure more individuals and families in the Exchanges than any other company. They believe that affordable prices can be offered to consumers and still leave room for a profit. It’s in everyone’s best interest that they are right.