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Capital Blue Medicare Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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Pennsylvania-based Capital Blue is a community health insurance company with a range of individual major medical and supplemental plans available. They provide Medicare Advantage and Supplement plans in a portion of the state.

About Capital Blue

Capital Blue, also known as Capital BlueCross, was founded in 1938 as Capital Hospital Service. The company’s headquarters is located in Harrisburg, Pennsylvania, and they started as a local insurance company before expanding to serve other counties.

Now operating as a licensee of Blue Cross Blue Shield, Capital Blue serves 21 counties in Central Pennsylvania and turned 80 years old in 2018. They write both HMO and PPO plans for individuals and families as well as for their Medicare Advantage selections.

Currently, Capital Blue writes both Advantage and Supplement plans in all of the 21 counties they serve. They do not offer a standalone Medicare Part D (prescription drug plan).

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Medicare Products

Capital Blue has a good selection of Medicare Advantage plans as well as Supplement plans to help cover out of pocket costs.

Medicare Advantage

The Advantage plans fall into three categories: HMO, PPO, and Special Care. In each category, there are several choices.

BlueJourney HMO is offered at three levels. All of the plans have a $0 deductible for both medical services and for prescription drugs. All three include routine care coverage for dental and vision as well as a fitness plan.

The Essential plan is the base plan, which is a $0 premium (above your regular Medicare premium) plan. This plan has copays of $5 for primary care visits, $30 for specialist visits, and $40 for urgent care. The plan covers hospital visits with a copay of $150 a day for days 1-8, and no charge thereafter. Prescription drugs start at $3 for preferred generics from an in-network pharmacy.

The Value plan has copays of $10 for primary care, $25 for specialists, and $35 for urgent care. Hospital visits have a copay of $100 a day for the first five days, no charge thereafter. Prescription drugs start at $4 for preferred generics.

The Essential Plan has copays of $10 for primary care, $20 for specialists, and $30 for urgent care. This plan has a $65 a day copay for the first five days of a hospital stay, after which it is covered in full. Prescription drug copays again start at $3 for preferred generics.

BlueJourney Alliance plans are designed for people with certain chronic conditions. While including all of the coverage of a regular Advantage plan, they also have coverage specifically coordinated to make treatment of the condition easier.

The two available plans are the Diabetes and Heart Care plan and the Lung Care plan. Both are PPO plans with a $0 in-network deductible. Both have copays of $10 for primary care, $30 for specialist care, and $40 for urgent care. The Heart & Diabetes plan has hospital coverage of $150 a day for the first eight days, while the Lung plan has hospital coverage at $170 a day for the first five days.

Both plans include routine dental and vision, as well as a fitness plan. The Heart & Diabetes plan has copays starting at $8 for prescriptions, and on the Lung plan, prescriptions start at $10. Both plans cover diabetes supplies with no copay.

BlueJourney PPO plans are offered at two levels. These plans provide access to a wider network of care than do the HMO plans. Both have a $0 deductible in-network for medical as well as for prescriptions. Both plans also include dental, vision, and fitness coverage.

The Classic plan has copays of $10 for primary care, $35 for specialist visits, and $45 for urgent care. Hospital stays are covered at $200 a day for the first five days. Prescriptions start at a $3 copay.

The Prime plan has copays of $10 for primary care, $25 for specialist visits, and $35 for urgent care. Hospital stays have a copay of $100 per day for the first seven days, and again prescriptions start at a $3 copay.

Medicare Supplement

BlueReliance is Capital Blue’s Medicare Supplement plan name, although they offer the same letter-coded standardized plans as all supplement providers.

Available form Capital Blue is a good selection of that list of letter-coded plans. They offer plans A, B, C, F, G, and N.

Plan A is the most basic plan, covering coinsurance amounts for Medicare Part A & B, and also covering the first three pints of blood each year. Plan F has the most coverage available, paying all out of pocket costs including coinsurance and deductibles and also including emergency coverage abroad. The remaining plans fall somewhere in between for coverage.

Rates

Capital Blue provides their rates for Medicare Advantage very clearly on their website. As with all Advantage plans, the monthly cost is on top of the regular Medicare Part A & B premium.

They have only one plan that is $0 premium, which is the Essential HMO plan. The Value plan is priced at $48 a month, and the Premier plan at $148 a month.

The PPO plans are priced at $62 a month for the Classic and $169 a month for the Prime. The Alliance plans are priced at $23 a month for the Heart and Diabetes plan and $33 a month for the Lung plan.

Medicare Supplement plans are priced based on a rate chart that goes by age. For a 65-year-old person, the least expensive plan is N at $92.30 a month. Plan A is priced at $107.90, and the most expensive is Plan F at $135.50 a month.

Since Capital Blue is a regional insurance company, we are unable to compare their rates to other companies serving different areas. Their rates do seem in line with what we see elsewhere for these types of plans. Somewhat unusual is the relatively low price offered on the Plan F option for Medicare Supplement; usually, we see a much wider gap between the base plan and the most comprehensive.

Claims

As with all medical insurance companies, Capital Blue handles claims directly with providers in most cases. PPO policyholders may sometimes need to be involved in the process if using an out-of-network provider, but this is rare.

We were unable to find any specific claims information on the company website, but this information is likely available to subscribers.

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Ratings and Consumer Reviews

Capital Blue has an A+ rating with the Better Business Bureau (BBB), with 17 complaints on file in the past three years and three closed in the past 12 months.

The government star rating for Capital Blue’s HMO plans is 4 stars overall and 3.5 stars overall for their PPO plans. That places both in the above average range for this rating system.

Yelp has only four reviews with an overall 1.5-star rating. The complaints are mainly about pricing and difficulty with paperwork or finding in-network providers. None of the reviews appear to be related to Medicare plans.

Overall, there is a low complaint volume and we are unable to see any red flags for this company.

The Bottom Line

Capital Blue has a good selection of Medicare options at reasonable prices. If you do not mind the limitations of an HMO network, those plans are both well priced and provide good coverage along with a better star rating than the PPO. If you are in search of Medicare coverage in Capital Blue’s areas of service, they are worth putting on the comparison list.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

1 Comment

  1. Is Chester County one of the PA counties serviced by Capital Blue Cross? I presently have their Medicare Advantage Plan called Blue Journy HMO Basic and live in Berks County.

    But I “may” be moving to affordable senior housing in Chester County in the next year or so. Just hoping I can keep the same health insurance when I move.

    TIA for getting back to me with an answer to my question.

    Reply

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