Capital Blue Medicare Insurance Review & Complaints: Health Insurance (2023)

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.

This review will help you to decide if the company’s Medicare plans are right for you. We’ll look at how to get Capital BlueCross Medicare quotes, the company’s plans, and coverage, and how they rate.

After reading this review, you may decide to buy Capital BlueCross Medicare insurance, but before you do, compare rates.

Enter your ZIP code to see quotes from top Medicare companies.

What is Capital Blue?

Capital Blue, also known as Capital BlueCross, was founded in 1938 as Capital Hospital Service. The health insurer’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 Bluecross 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, the insurer writes both Advantage and Supplement health plans in all of the 21 counties they serve. They do not offer a standalone Medicare Part D (prescription drug plan).

What Medicare Plans are Offered?

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

What is the Medicare Advantage Plan?

The Advantage health plans fall into three categories: HMO, PPO, and Special Care. In each category, there are several choices. The network you choose will determine which network of Medicare providers you can see with your coverage.

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 Capital Blue Medicare PPO plans are offered at three 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 Select plan has copays of $5 for primary care and $40 for specialists. Urgent care is a $45 copay, and hospital stays have a copay of $335 per stay.

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.

All of the Capital Health Medicare OTC drug coverage limits are $25 a month.

What Medicare Supplement Plans are Offered?

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

Available from Capital Blue is a good selection of the list of letter-coded plans. They offer plans A, B, C, D, 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.

What are the Medicare Rates?

The company provides its 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 $51 a month, and the Premier plan at $106 a month.

The PPO plans are priced at $62 a month for the Classic and $169 a month for the Prime. The Select plan is a $0 premium PPO option. 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 $101.20 a month. Plan A is priced at $118.30, and the most expensive is Plan F at $148.60 a month.

Since the company is a regional insurance company, we are unable to compare rates of its health insurance products 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.

How are Medicare Claims Filed?

As with all medical insurance companies, Capital 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.

Are the Company’s Reviews and Ratings Positive?

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 the company’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.

What’s the Bottom Line?

Capital BlueCross 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 the company’s areas of service, they are worth putting on the comparison list.

It may turn out that an affordable Capital Blue Medicare plan is the right choice for you, but you can’t be sure until you compare.

Enter your ZIP code for fast, free Medicare quotes.