Blue Cross Blue Shield is both — it runs plans under Medicare and separate plans under Medicaid, depending on which program you enroll in
Blue Cross Blue Shield (BCBS) is not one program; it is a network of independent insurance companies operating in different states. Some BCBS companies offer Medicare Advantage plans (Part C) and Medigap policies (supplemental coverage for Original Medicare). Other BCBS companies offer Medicaid plans for people who meet their state's income and asset limits. A few operate both. The plan you get depends on which program you may have access to for and which BCBS company serves your state.
If you are already on Medicare, you may see BCBS advertised as a Medicare option. If you are under 65 and have low income, you may see BCBS advertised as a Medicaid option. They are different products with different costs, coverage rules, and networks — even though they carry the same name.
Key Takeaways
- Blue Cross Blue Shield operates as separate companies in each state, and each one decides whether to offer Medicare plans, Medicaid plans, or both.
- BCBS Medicare plans include Medicare Advantage (Part C) and Medigap policies, both designed for people 65 and older who have already enrolled in Medicare.
- BCBS Medicaid plans are for people under 65 (or over 65 in some cases) whose income falls below their state's limit.
- The doctors, hospitals, and pharmacies covered differ between BCBS Medicare and BCBS Medicaid plans, so you cannot assume your current doctor is in both networks.
- You enroll in Medicare plans during the annual enrollment period (October 15 to December 7), and Medicaid plans through your state's Medicaid office year-round.
How BCBS Medicare Plans Work
If you are 65 or older and have enrolled in Medicare, BCBS offers two types of plans. Medicare Advantage plans (also called Part C) replace Original Medicare and typically include prescription drug coverage. You pay a monthly premium to BCBS, and BCBS coordinates your care through its network of doctors and hospitals. Medigap policies are supplemental insurance that work alongside Original Medicare — they help pay the costs that Medicare does not cover, such as copays and coinsurance.
BCBS Medicare plans vary by state. Some states have many BCBS Medicare Advantage options; others have few or none. You can see which plans BCBS offers in your state by visiting Medicare.gov and entering your zip code, or by calling 1-800-MEDICARE. The plans available, their premiums, and their networks change every year.
How BCBS Medicaid Plans Work
Medicaid is a joint federal and state program for people with low income. Each state runs its own Medicaid program and decides which insurance companies, including BCBS, can offer plans. If your state's BCBS company offers Medicaid, you may be able to enroll if your income and assets fall below your state's limits.
Medicaid may be able to access and enrollment rules differ by state. In most states, you explore through your state's Medicaid office or through a website managed by your state. Some states use managed care, meaning Medicaid pays BCBS (or another insurer) a fixed amount per month to cover your care. Others use fee-for-service, where Medicaid pays providers directly. You do not pay a premium for Medicaid coverage, though you may have small copays for some services.
The Key Differences Between BCBS Medicare and BCBS Medicaid
| Feature | BCBS Medicare Plans | BCBS Medicaid Plans |
|---|---|---|
| Who it is for | People 65 and older (or younger with disability or ESRD) | People with low income (age varies by state) |
| Monthly premium | Yes, varies by plan | No (state-funded) |
| Enrollment period | October 15 to December 7 each year | Year-round in most states |
| Where you enroll | Medicare.gov or 1-800-MEDICARE | Your state's Medicaid office or website |
| Doctor network | BCBS Medicare network (varies by plan) | BCBS Medicaid network (often broader) |
| Prescription drugs | Included in Medicare Advantage; separate for Medigap | Covered by Medicaid (formulary varies by state) |
How to Find Out Which BCBS Plans Are Available in Your State
For Medicare, go to Medicare.gov, click "Find Care Providers," and enter your zip code. You will see all Medicare Advantage and Medigap plans available from all insurers, including BCBS. You can compare premiums, deductibles, and networks side by side. You can also call 1-800-MEDICARE and speak with a representative who can tell you which BCBS plans serve your area.
For Medicaid, contact your state's Medicaid office directly. You can find your state office at Medicaid.gov. Some states have a single website where you can see all Medicaid managed care plans available; others require you to call. Your state office can tell you whether BCBS offers a Medicaid plan in your area and what the income limits are.
What Happens If BCBS Does Not Serve Your Area
Not every BCBS company operates in every state, and not every BCBS company offers both Medicare and Medicaid plans. If BCBS does not offer a Medicare plan in your zip code, you can enroll in a Medicare Advantage or Medigap plan from another insurer during the annual enrollment period. If BCBS does not offer Medicaid in your state, you can enroll in a Medicaid plan from another managed care company, or you may be able to use fee-for-service Medicaid (where you see any Medicaid-accepting provider).
The availability of plans changes year to year. An insurer that did not offer coverage in your area last year may offer it this year, or vice versa. Check each enrollment period to see what is new.
Frequently Asked Questions
Can I have both a BCBS Medicare plan and a BCBS Medicaid plan at the same time?
No. You enroll in one or the other based on which program you may have access to for. If you are 65 or older, you are in Medicare. If you have low income and are under 65 (or meet your state's rules for Medicaid at 65 and older), you may be in Medicaid. Some people may have access to for both Medicare and Medicaid (called "dual may be able to access"), but you still enroll in each program separately — you would have a BCBS Medicare plan and a BCBS Medicaid plan that coordinate with each other.
If I switch from BCBS Medicare to a different insurance company, can I keep my current doctor?
It depends on whether your doctor is in the new plan's network. Networks differ between insurance companies and between plans from the same company. Before you switch, check whether your doctor accepts the new plan. You can call your doctor's office or use the new plan's provider search tool on its website.
Does BCBS Medicaid cover the same services as BCBS Medicare?
No. Medicaid and Medicare cover different services and have different rules. For example, Medicaid in many states covers dental and vision care, which Medicare does not. Medicare covers certain preventive services that Medicaid may not. The specific services covered also vary by state for Medicaid and by plan for Medicare. Read your plan's summary of coverage before you enroll.
How do I know if I may have access to for BCBS Medicaid in my state?
Income and asset limits for Medicaid vary by state and change each year. Contact your state's Medicaid office to learn the current limits and to find out whether you meet them. You can find your state office at Medicaid.gov. Some states have online tools where you can enter your income and see whether you may be may be able to access.
Can I enroll in a BCBS Medicare plan outside the annual enrollment period?
Only if you have a may have access to life event, such as turning 65, losing employer coverage, moving to a new state, or having a major change in income. Otherwise, you can enroll during the annual enrollment period from October 15 to December 7. If you miss this window and do not have a may have access to event, you may have to wait until the next year to change plans.