Capital Blue Medicare Review

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Serving central Pennsylvania with a Blue Cross licensed assortment of individual and group health plans, Capital Blue is a locally targeted insurer. Since 1938 the company has been providing coverage through employers as well as direct to individuals. Today, that list has been expanded to include Medicare customers.

About Capital Blue

Also known as Capital Blue Cross, Capital Blue is a full-service insurance company that provides policies in 21 counties located in Pennsylvania. They are headquartered in Harrisburg, with locations throughout the service area.

The company was formed by the merger of two hospital service plans. One was Capital Hospital Service, which was founded in 1938. The second company’s roots go back a little further, to the Easton Hospital Association, created in 1933. Both offered assistance with hospital costs for a monthly premium. The Blue Cross name was first taken on by the latter in 1939, becoming Blue Cross of Lehigh Valley. In 1965 Capital also took on Blue Cross licensing. The two companies merged into one as Capital Blue Cross in 1985.

The company is active in supporting local communities, with a long list of financial sponsorships and partnerships. They are also a partner in the CHIP program, administering health benefits for uninsured children under 19.

Today, Capital Blue is active in all areas of health insurance; working with employers to provide group benefits, offering individual plans, and writing a variety of supplemental health plans. They write both Medicare Advantage and Supplement policies.

Capital Blue Medicare Plans

Capital Blue offers two choices for Medicare-eligible customers. There are Medicare Advantage Plans that include Part D drug coverage as well as Supplement Plans for those who are covered under original Medicare.

Medicare Advantage Plans

Capital Blue offers a good selection of Medicare Advantage options. There are three HMO and two PPO plans to choose from.

The BlueJourney HMO plans are available in three coverage levels: Essential, Value, and Premier.

Essential is a zero-premium plan that requires no additional payments above and beyond the Medicare Part B premium. The plan has no deductible, and co pays are $5 for office visits, $30 for specialist visits, and $40 for Urgent Care visits. Inpatient hospital stays are covered at $170 per day for days 1-8. There is a $75 co pay for emergency room visits, which is waived if you are admitted. Additional co pays are $250 for an ambulatory surgical center and $350 for outpatient surgery. This plan includes routine vision and dental services with $20 and $10 co pays respectively. Over the counter drugs are covered with a $25 monthly allowance. Hearing services are included as well.

BlueJourney Value is the next step up in coverage, with a higher premium. The office visit co pay is slightly higher, at $10, while specialist and Urgent Care co pays are $25 and $35 respectively. Inpatient hospital is covered at $100 per day for the first 5 days. Emergency care is the same co pay as the basic plan, but outpatient services are both $50 lower. There is no over the counter drug coverage, and the plan includes the same vision, hearing, and dental coverage. Overall, co pays and coinsurance are lower with this plan.

Finally, the highest level is the BlueJourney Premier. The premium is the highest, and co pays are $10 for office visits, $20 for specialists, and $30 for Urgent Care. Inpatient hospital is covered with only $65 per day for the first 5 days, while ambulatory surgical center care is a $100 co pay and outpatient surgery a $200 co pay. Emergency, vision, hearing, and dental benefits are the same.

All three plans have prescription drug coverage included with no deductible. Each level of coverage has slightly different co pays for drugs, starting at $3 to $4 for preferred generics.

There is an easy to read comparison chart for the three HMO plans on the Capital Blue website.

There are also two BlueJourney PPO plans. With wider access to a larger provider network, PPO plans generally have higher premiums. There is no zero-premium option for the PPO plans.

The Classic PPO has zero deductible in-network and $350 out of network. In-network co pays are $10 for office visits, $35 for specialists, and $45 for Urgent Care. Inpatient hospital is covered with a co pay of $200 per day for the first 7 days. Outpatient surgery has a $300 co pay. Most services are more expensive out of network, but Urgent Care and Emergency, which has a $75 co pay, are the same out of network. Hearing, vision, and dental are covered as with the HMO plans. This plan does have a $15 a month allowance for over the counter drugs.

The Prime PPO plan has the highest premium amount. Co pays are $10 for office visits, $25 for specialist, and $35 for Urgent Care, all in network. Inpatient hospital coverage is $100 per day for the first 7 days, outpatient surgery $200 co pay. Emergency coverage is the same as the Classic. Again, vision, dental, and hearing services are covered. There is no over the counter drug coverage. Co pays overall are lower with this plan.

Prescription drug benefits are included with both plans and are almost exactly alike with one slight co pay difference for the Prime over the Classic.

Again, there is an easy comparison chart for these two plans.

Medicare Supplement

Capital Blue offers Medicare Supplement Plans A, B, C, F, G, and N. Plan A is the most basic of the options and in most states – those with the standardized letter coded plans – require insurers to offer it.

Plan A covers Medicare coinsurance for Parts A & B, as well as hospice coinsurance and the first three pints of blood annually. From there, the various options add benefits that can be selected to suit the insured, such as emergency foreign travel coverage and deductible coverage.

Capital Blue offers a good selection of plans, where many insurance companies offer only a few choices. This allows the choice of premium and coverage to meet individual needs.

Capital Blue Rates

Capital Blue makes it very easy to obtain rates. The charts comparing their Medicare Advantage plans offer rates right at the top, so that it is easy to shop and compare.

The HMO plans start at $0 additional premium (on top of the Part B premium) and then go up in basic increments. Essential is the $0 premium plan, with Value at $50 a month and Premier at $150 a month.

The PPO plans are priced at $55 for the Classic and $175 for the Prime, monthly. Premium-wise, then the PPO Classic is worth comparing to the HMO Value plan for those deciding between the two choices.

The Medicare Supplement Plans are priced on a chart based on age, and they start at $102.80 for Plan A for a 65 year old. Shoppers can easily check the rate for their attained age to get a price comparison.

Because Capital doesn’t write policies outside of Pennsylvania, we are not able to compare their rates to national insurance companies. However, their pricing is simple and straightforward and does appear to be in line with other similar plans we have seen elsewhere.

Ratings and Reviews

Capital Blue ran into some problems with their Medicare plans a few years ago, and was banned for a time from enrolling new members. The ban took place in 2014; it has since been lifted and Capital is openly accepting new enrollment. This reinstatement indicates that the company has taken corrective action to alleviate any issues.

Currently, the company has an A+ rating with the Better Business Bureau, and there are 15 complaints filed in the past three years. Eight of those complaints were closed in the past 12 months.

Pissed Consumer has three complaints about the company, and there are two negative reviews on Yelp. Overall, the total number of complaints is low, even for a smaller local insurance company. Aside from the ban in 2014, we were not able to find anything relating directly to Medicare.

The Bottom Line

Capital Blue has a really good selection of Medicare Advantage and Supplement plans that are reasonably priced. With a long history in the area and the Blue Cross name to back the company, they are a stable choice for Medicare. Anyone shopping for coverage in the 21 Pennsylvania counties where Capital does business, is likely to find them an attractive option.

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

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Review Information

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Capital Blue Medicare
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