Blue Cross Blue Shield is both — it offers plans under Medicare and separate plans under Medicaid, depending on which program you enroll in

Blue Cross Blue Shield (BCBS) is a large insurance company that contracts with both Medicare and state Medicaid programs. This means you might see a Blue Cross Blue Shield plan when you shop for Medicare coverage, and you might also see one when you look at Medicaid options in your state. They are not the same plan, even though they carry the same name. Which one you get depends entirely on which program you enroll in and which state you live in.

The confusion happens because the name is the same, but the rules, costs, and coverage are different. A Blue Cross Blue Shield Medicare Advantage plan works one way. A Blue Cross Blue Shield Medicaid plan works another way. Understanding which one you are looking at matters, because your out-of-pocket costs and which doctors you can see will depend on it.

Key Takeaways

  • Blue Cross Blue Shield offers Medicare plans (both Medicare Advantage and Medigap) in many states, as well as separate Medicaid plans in states where it contracts with the state program.
  • A Blue Cross Blue Shield Medicare plan and a Blue Cross Blue Shield Medicaid plan are different products with different costs, coverage rules, and networks — the name alone does not tell you which one you have.
  • Your enrollment method depends on which program you may have access to for: Medicare enrollment happens through Medicare.gov, while Medicaid enrollment happens through your state.
  • Not every state has Blue Cross Blue Shield plans in both programs, and availability changes year to year.

How Blue Cross Blue Shield works with Medicare

Blue Cross Blue Shield contracts with Medicare to offer Medicare Advantage plans (also called Part C) and Medigap plans (also called Supplement plans) in many states. If you are already on Medicare and you see a Blue Cross Blue Shield plan option during the annual enrollment period, you are looking at one of these two types.

Medicare Advantage plans through Blue Cross Blue Shield include hospital, doctor, and prescription drug coverage all in one plan. You pay a monthly premium, and you have a network of doctors and hospitals you must use (or pay more if you go out of network). Medigap plans through Blue Cross Blue Shield work differently — they fill in gaps left by Original Medicare, and they typically let you see any doctor who accepts Medicare.

Blue Cross Blue Shield Medicare plans are available in some states but not all. Availability also changes from year to year, so a plan that existed last year might not be offered this year in your area. You can check which Blue Cross Blue Shield Medicare plans are available to you by visiting Medicare.gov during the annual enrollment period (October 15 to December 7 each year).

How Blue Cross Blue Shield works with Medicaid

Blue Cross Blue Shield also contracts with state Medicaid programs in many states to offer Medicaid coverage. If you are low-income and you enroll in Medicaid, you might be offered a Blue Cross Blue Shield Medicaid plan as one of your options. This is a completely separate product from the Medicare plans the company offers.

Medicaid plans through Blue Cross Blue Shield cover hospital, doctor, and prescription drug services, but the rules about copays, deductibles, and which doctors you can see depend on your state's Medicaid program and the specific plan. Some states require Medicaid members to enroll in a managed care plan like Blue Cross Blue Shield; others let you choose. Not every state contracts with Blue Cross Blue Shield for Medicaid, and the plans available vary widely by state.

You enroll in Medicaid through your state, not through a federal website. Each state has its own Medicaid office or online portal. You can find your state's Medicaid contact information by visiting Medicaid.gov or calling 1-800-MEDICARE to ask for your state's number.

The difference between a Blue Cross Blue Shield Medicare plan and a Medicaid plan

Even though both are called Blue Cross Blue Shield, the two plans operate under different rules and have different costs. A Medicare plan is for people age 65 and older or those with certain disabilities who have already enrolled in Medicare. A Medicaid plan is for people with low income, regardless of age. The income limits and may be able to access rules are completely different.

The monthly premium, copays, and deductibles are also different. Medicare plans have federal rules about what they must cover and what they can charge. Medicaid plans follow state rules, which vary. A Blue Cross Blue Shield plan in one state might cover something that a Blue Cross Blue Shield Medicaid plan in another state does not. The doctor networks are often different too — your Medicare plan's doctors might not be the same as your Medicaid plan's doctors.

The way you enroll is different as well. Medicare enrollment happens through Medicare.gov or by calling 1-800-MEDICARE. Medicaid enrollment happens through your state's Medicaid office. If you are may be able to access for both programs (a situation called "dual may be able to access"), you would enroll in each one separately, and you might end up with two different Blue Cross Blue Shield plans.

Which Blue Cross Blue Shield plan you might see

When you are shopping for coverage, the enrollment system will tell you which program the plan belongs to. If you are on Medicare.gov looking at plans, any Blue Cross Blue Shield plan you see is a Medicare plan. If you are on your state's Medicaid website or portal, any Blue Cross Blue Shield plan you see is a Medicaid plan. The two systems do not mix — you will not see a Medicaid plan on Medicare.gov, and you will not see a Medicare plan on your state's Medicaid portal.

If you are not sure which program you are in, check your insurance card. It will say "Medicare" or "Medicaid" on it. If you have both, you will have two separate cards. You can also call the customer service number on your card to confirm which program your plan is part of.

Availability of Blue Cross Blue Shield plans in your state

Blue Cross Blue Shield does not offer plans in every state, and the plans available change each year. In some states, Blue Cross Blue Shield offers only Medicare plans. In others, it offers only Medicaid plans. In some states, it offers both. A few states have no Blue Cross Blue Shield plans at all.

To find out what is available in your state, visit Medicare.gov if you are looking for Medicare coverage, or contact your state's Medicaid office if you are looking for Medicaid coverage. Both websites let you search by state and see which insurers, including Blue Cross Blue Shield, offer plans in your area. Availability can change, so it is worth checking each year during the enrollment period.

What to do if you are unsure which plan you have

If you already have a Blue Cross Blue Shield plan and you are not sure whether it is a Medicare or Medicaid plan, the fastest way to find out is to look at your insurance card. The card will clearly state which program it is. You can also call the customer service number on the back of your card and ask directly — the representative can tell you in seconds.

If you are shopping for a new plan and you want to know whether a specific Blue Cross Blue Shield plan is a Medicare or Medicaid plan, the enrollment website will tell you. On Medicare.gov, all plans shown are Medicare plans. On your state's Medicaid portal, all plans shown are Medicaid plans. If you are still unsure, you can call Blue Cross Blue Shield directly — the phone number is usually on the plan's information page — and ask which program the plan is part of.

Frequently Asked Questions

Can I have both a Blue Cross Blue Shield Medicare plan and a Blue Cross Blue Shield Medicaid plan at the same time?

Yes, if you are may be able to access for both Medicare and Medicaid (called "dual may be able to access"), you can enroll in both programs and potentially have two separate Blue Cross Blue Shield plans. You would enroll in each one through its own system — Medicare through Medicare.gov and Medicaid through your state. The two plans would work together, with Medicare as the primary payer and Medicaid as the secondary payer.

Does Blue Cross Blue Shield offer plans in every state?

No. Blue Cross Blue Shield availability varies by state and by program. Some states have Blue Cross Blue Shield Medicare plans but no Medicaid plans, or vice versa. Some states have neither. Availability also changes year to year. Check Medicare.gov or your state's Medicaid website to see what is available in your area.

If I switch from a Blue Cross Blue Shield Medicare plan to a Blue Cross Blue Shield Medicaid plan, will my doctors stay the same?

Not necessarily. Even though both plans carry the Blue Cross Blue Shield name, they have different doctor networks. A doctor who is in your Medicare plan's network might not be in your Medicaid plan's network, or vice versa. Always check the plan's provider directory before you enroll to see which doctors are included.

How do I know if a Blue Cross Blue Shield plan I am looking at is Medicare or Medicaid?

The enrollment website will tell you. If you are shopping on Medicare.gov, the plan is a Medicare plan. If you are shopping on your state's Medicaid portal or website, the plan is a Medicaid plan. You can also look at the plan's information page — it will state which program it is part of.

What if Blue Cross Blue Shield does not offer plans in my state?

Other insurance companies offer Medicare and Medicaid plans in every state. Visit Medicare.gov to see which Medicare plans are available in your area, or contact your state's Medicaid office to see which Medicaid plans you can choose from. You will have other options even if Blue Cross Blue Shield is not one of them.