Blue Advantage is a Medicare Advantage plan, not Original Medicare

Blue Advantage is a type of Medicare Advantage plan (also called Part C) offered by Blue Cross Blue Shield in certain states. It is not Original Medicare — it is an alternative way to receive your Medicare benefits through a private insurance company that contracts with Medicare.

When you enroll in Blue Advantage, you are still covered by Medicare, but Blue Cross Blue Shield becomes the organization that manages your benefits. You pay a monthly premium (which may be zero dollars), and the plan covers hospital care, doctor visits, and prescription drugs all in one policy. You must continue to pay your Part B premium to Medicare, and you cannot be enrolled in both Original Medicare and a Medicare Advantage plan at the same time.

Blue Advantage plans vary by state and by year. Not every state offers them, and the specific benefits, costs, and doctor networks change annually. You can only enroll during Medicare's open enrollment period (October 15 through December 7 each year) unless you have a may have access to life event.

Key Takeaways

  • Blue Advantage is a Medicare Advantage plan run by Blue Cross Blue Shield, meaning a private company manages your Medicare benefits instead of the federal government.
  • You must live in a state where Blue Advantage is offered and choose it during the annual enrollment window (October 15 to December 7) to join.
  • Blue Advantage includes hospital, doctor, and prescription drug coverage in one plan, but you pay a monthly premium and use only doctors and hospitals in the plan's network.
  • If you switch from Original Medicare to Blue Advantage, you lose coverage under Original Medicare and cannot use Medicare-approved providers outside the plan's network except in emergencies.

How Blue Advantage differs from Original Medicare

Original Medicare is run directly by the federal government. You can see any doctor or hospital that accepts Medicare, and Medicare pays the provider. You pay a deductible and coinsurance for each service. Prescription drugs are covered under a separate Part D plan you choose yourself.

Blue Advantage is run by Blue Cross Blue Shield. You must see doctors and hospitals in the plan's network, or pay more out of pocket (or nothing, depending on the plan). The plan includes prescription drug coverage built in. Monthly premiums are often lower than Original Medicare plus a separate drug plan, but your out-of-pocket costs for each visit may be higher if you use an out-of-network provider.

Blue Advantage plans often include benefits that Original Medicare does not cover, such as dental, vision, or hearing aids. However, you give up the freedom to see any Medicare provider you choose. If you need a specialist, you may need a referral from your primary care doctor.

What Blue Advantage covers

All Blue Advantage plans must cover the same core benefits as Original Medicare: hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D equivalent). Beyond that, coverage varies by plan and by state.

Many Blue Advantage plans include dental care, vision exams and glasses, hearing aids, and fitness programs — benefits Original Medicare does not pay for. Some plans cover transportation to medical appointments or over-the-counter health items. You need to check the specific plan's summary of benefits for your state to see what is included.

All plans have a maximum out-of-pocket limit, which means once you spend a certain amount on covered services in a year, the plan pays 100 percent of covered costs for the rest of that year. This limit varies by plan but is set by Medicare law.

Network restrictions and how they affect your care

Blue Advantage plans have a network of doctors, hospitals, and pharmacies. If you use a provider in the network, you pay the plan's copay or coinsurance. If you use a provider outside the network, you typically pay much more, or the plan may not cover the visit at all (except in emergencies).

Before you enroll, you should check whether your current doctors are in the Blue Advantage network in your state. If your doctor is not in the network and you want to keep seeing them, you may need to stay on Original Medicare instead. Blue Advantage plans do cover emergency care outside the network, but you will pay more.

Some Blue Advantage plans are HMOs, which require you to choose a primary care doctor and get referrals for specialists. Others are PPOs, which let you see specialists without a referral but charge more for out-of-network care. The type of plan available depends on your state and ZIP code.

When you can enroll in Blue Advantage

You can enroll in Blue Advantage during Medicare's Annual Enrollment Period, which runs from October 15 through December 7 each year. Coverage begins January 1 of the following year. This is the main window for joining, switching plans, or dropping a plan.

If you have a may have access to life event — such as losing employer coverage, moving to a new state, or getting married — you may be able to enroll outside the annual window. You must report the event to Medicare within 60 days to be may be able to access for a Special Enrollment Period.

If you are newly may be able to access for Medicare (turning 65 or becoming may be able to access due to disability), you have a seven-month Initial Enrollment Period centered on your birthday or the month you become may be able to access. During this time, you can enroll in Blue Advantage without waiting for the annual enrollment period.

Costs: premiums, deductibles, and out-of-pocket limits

Blue Advantage plans have a monthly premium, which may be zero dollars but is often $20 to $100 or more, depending on the plan and your location. You must also continue to pay your Part B premium to Medicare (currently $164.90 per month for most people in 2024, though this amount changes yearly).

Each plan has its own deductible, copays, and coinsurance. A copay might be $10 for a doctor visit or $5 for a generic prescription. Coinsurance means you pay a percentage of the cost (for example, 20 percent of a hospital stay). These amounts vary widely by plan.

All Blue Advantage plans have a maximum out-of-pocket limit set by Medicare law. Once you reach this limit in a calendar year, the plan covers 100 percent of covered services for the rest of that year. The limit is typically between $6,700 and $7,500 for in-network care, but varies by plan.

How to find and compare Blue Advantage plans in your area

Blue Advantage is not available everywhere. Blue Cross Blue Shield operates in all 50 states, but Blue Advantage Medicare plans are offered only in certain states and counties. You can check whether Blue Advantage is available in your ZIP code by visiting Medicare.gov and using the plan finder tool.

On Medicare.gov, you can enter your ZIP code and see all Medicare Advantage plans available to you, including Blue Advantage options. The tool shows the monthly premium, deductible, copays, which doctors are in the network, and what extra benefits each plan includes. You can compare plans side by side and see which one fits your needs and budget.

You can also contact Blue Cross Blue Shield directly for your state to ask about Blue Advantage plans, or call Medicare at 1-800-MEDICARE to speak with someone who can walk you through your options. Many people find it helpful to compare three to five plans before deciding.

Frequently Asked Questions

Can I switch from Original Medicare to Blue Advantage at any time?

No. You can only enroll in or switch to Blue Advantage during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event. If you miss the window, you will have to wait until the next October to make a change.

If I join Blue Advantage, can I go back to Original Medicare later?

Yes. During the Annual Enrollment Period, you can drop Blue Advantage and switch back to Original Medicare. If you do, you should also enroll in a separate Part D prescription drug plan and a Medigap policy if you want coverage for costs Original Medicare does not pay. You have until December 7 to make the switch for January 1 coverage.

Do I need a Medigap policy if I have Blue Advantage?

No. Medigap policies are designed to work with Original Medicare. Blue Advantage already includes prescription drug coverage and has its own out-of-pocket limits, so a Medigap policy would be redundant and is not sold to Blue Advantage members.

What happens to my Blue Advantage coverage if I move to a different state?

Your coverage ends on the last day of the month you move. You will have a Special Enrollment Period to enroll in a new plan in your new state within 60 days of moving. Contact Medicare or Blue Cross Blue Shield in your new state to find out what plans are available.

Does Blue Advantage cover care outside the United States?

Most Blue Advantage plans do not cover routine care outside the U.S., though they may cover emergency care. If you travel internationally, check your plan's coverage rules before you go. Some plans offer limited coverage in Canada and Mexico.