Pros Explained
- High-quality health plans: Excellus Medicare Advantage plans earned an average of 4.5 out of 5.0 Stars from CMS.
- One of the largest Medicare Advantage plans in New York: Excellus has deep roots in upstate New York, resulting from the merger of several local BlueCross and BlueShield plans founded there in the 1930s.
- Offers many Medicare Advantage options: Excellus offers more Medicare Advantage plans in its service area compared to some competitors.
- Members can access Blue365 discounts: As a BlueCross BlueShield plan, Excellus offers its members access to Blue365 discounts on a range of health- and wellness-related services and products.
Cons Explained
- Limited geography: Excellus is only available in parts of New York.
- Plans are highly rated, but health plan ratings are lower: Excellus plans perform well on quality measures but worse on NCQA scores that are specific to members’ experiences with the health plan.
- No stand-alone prescription drug plans: Excellus offers Medicare Advantage HMO and PPO plans with and without prescription drug coverage, but it doesn't offer stand-alone prescription drug plans for people who may just need drug coverage.
Available Plans
Excellus offers numerous insurance plans in four categories.
Medicare Advantage Plans
Excellus offers HMO, HMO-POS, and PPO Medicare Advantage plans. Some of these plans include preventive dental care, such as cleanings and X-rays, but members can also buy extra coverage for restorative and major dental care with a maximum $1,000 benefit.
Some Excellus Medicare Advantage HMO, HMO-POS, and PPO plans offer discounts on insulin: a $25 copayment for a 30-day supply at preferred pharmacies, or $30 for a 30-day supply at standard pharmacies. Members can also get a 90-day supply of insulin for $50 at preferred pharmacies or for $60 at standard pharmacies.
HMO and HMO-POS Plans
Excellus offers 72 HMO plans with prescription drug coverage and 13 without. Like most HMO plans, Excellus’s HMOs usually require that members use in-network hospitals, other health care providers, and pharmacies. Members may be able to see providers who are not in the network on some HMO-POS plans.
PPO Plans
Excellus has 75 PPO plans with prescription drug coverage and 24 without. These plans tend to be more flexible. Seeing in-network providers for covered services may cost less than going out-of-network, but PPO members can see providers who participate in Medicare but are not in the Excellus network. PPO members must generally use pharmacies in the Excellus network to fill prescriptions for covered Part D medications.
Medicare Supplement Insurance (Medigap) Plans
Medicare Supplement Insurance plans, also called Medigap, help Medicare members pay some of the out-of-pocket costs that Original Medicare doesn’t cover. There are 10 standard Medigap plan types, each with set benefits across all insurers. Only the premium or other costs and benefits vary depending on the insurer. Not every insurer offers all 10 plan types. Excellus offers six Medigap plans, including:
- Plan A: This plan covers hospital coinsurance not covered by Medicare Part A, helps pay some Medicare Part B expenses, and pays the 20% coinsurance for Medicare-eligible expenses after you meet the Medicare Part B deductible.
- Plan B: This plan covers everything that Plan A covers plus the Medicare Part A deductible.
- Plan C: This plan covers the basic benefits of Plan A plus coverage for skilled nursing coinsurance, the Medicare Parts A and B deductibles, and overseas travel emergency care.
- Plan F: This plan covers everything included in Plan B as well as help paying for skilled nursing coinsurance, the Medicare Part B deductible, and 100% of additional covered physician services and overseas travel emergency care.
- Plan F+: This plan offers the same coverage as Plan F with lower premiums and a $2,700 deductible in 2023.
- Plan G: This plan covers the part A deductible. It offers no copays for doctor visits, offers some nursing support, and provides for foreign travel benefits.
- Plan N: This plan covers everything included in Plan B plus coverage for skilled nursing coinsurance and overseas travel emergency care. It covers services with up to $20 for office visits and up to $50 for emergency room visits after you've met the Medicare Part B deductible.
Extra Benefits
Most Medicare health plans include extra benefits beyond core medical coverage. These extras typically include dental, vision, hearing, fitness, and other benefits.
Many Excellus plans include fitness, hearing, vision, and dental benefits. Excellus members can also get the Blue365 discounts, which include additional discounts on fitness programs and products, eye exams and eyeglass frames, nutrition programs and products, hearing screening and hearing aids, and other wellness-related benefits.
Customer Service
- Prospective members: Call 800-671-6081 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday; available seven days a week between Oct. 1 and Dec. 30.
- Current members: Call 877-883-9577 (TTY/TDD: 800-662-1220), 8 a.m. to 8 p.m. ET, Monday through Friday; available seven days a week between Oct. 1 and March 31.
Members can use a drug cost lookup tool online and a cost estimator that gives them information on average costs for more than 1,600 treatments and more than 400 procedures. Members can find doctors, track deductibles and spending, and view or request a new member ID card with online accounts or the mobile app.
Customer Satisfaction
The National Association of Insurance Commissioners (NAIC) evaluates health insurers based on the number of complaints against them compared to their share of premiums. A complaint index of 1.0 or less indicates that the company had fewer than expected complaints relative to its market share. A complaint index of greater than 1.0 means the company had a disproportionate number of complaints relative to its market share.
Excellus’s complaint index in the individual accident and health category was well below 1.0 for 2021 (0.21), the last year for which NAIC data has been posted. It was 0.11 in 2020 and 0.11 in 2019. Excellus’s complaint index in 2021 was 3.4 in the Medicare supplement category, although that score was based on just one complaint that year.
Third-Party Ratings
Financial Strength
Excellus is not rated by AM Best, the credit rating agency that assesses insurance companies’ financial strength. The company reports that Standard and Poor’s gave it a financial strength rating of “BBB+” (Stable).
NCQA
The National Committee for Quality Assurance (NCQA) is one of the accrediting bodies for health insurance plans. NCQA reviews and rates accredited health plans each year. Excellus had eight plans rated by NCQA in 2022. Four Excellus HMO plans scored 4.5 out of 5.0 overall, a good indication of how satisfied members are with the health plan services. Four Excellus PPO plans scored 4.0 overall.
Medicare Star Ratings
The Centers for Medicare and Medicaid Services (CMS) rates Medicare plans based on a five-star rating system. Star Ratings evaluate a range of customer experience and health care quality measures. Excellus had two plans that were included in CMS 2022 Star Ratings. Both plans earned 5.0 out of 5.0 stars.
Cost
Excellus’s Medicare Advantage plans price ranges included the following options in 2022.
HMO plans with prescription drug coverage:
- Monthly premiums range from $0 to $302, averaging $47 and 37 plans carry premiums of less than $100 per month, including 22 plans with no premiums.
- Deductibles range from $0 to $480, averaging $198. About half have no deductible.
- Annual out-of-pocket maximums for in-network services range from $4,500 to $7,550, averaging $7,017.
HMO plans without prescription drug coverage:
- These plans do not have annual deductibles.
- Annual out-of-pocket maximums for in-network services are $4,500.
PPO plans with prescription drug coverage:
- Monthly premiums range from $0 to $298, averaging $38, but 34 plans have no premiums.
- Deductibles range from $0 to $480, averaging $205.
- Annual out-of-pocket maximums for in-network services range from $3,400 to $7,550, averaging $6,521.
PPO plans with prescription drug coverage:
- There are no annual deductibles.
- Annual out-of-pocket maximums for in-network services are $4,500.
Some Excellus premiums are higher than competitors, but those higher premiums may be offset by lower out-of-pocket costs, such as deductibles and annual out-of-pocket maximums.
Competition: Excellus BlueCross BlueShield vs. Aetna
Excellus and Aetna are among the largest Medicare plans in New York. Excellus generally has more Medicare Advantage plans to choose from in the 17 counties where both operate, but Aetna has more types of coverage, such as special needs plans and stand-alone prescription drug plans.
Aetna’s Medicare Advantage tends to have lower premiums and higher out-of-pocket maximums on average. Excellus plans have a wider range of deductibles, but the average deductibles are lower than Aetna’s.
Choosing one of these plans based on cost requires identifying the type of costs you care about most. Aetna works better if lowering your monthly cost is most important, but you might spend more overall if you use a lot of health care services.
Excellus is only available in parts of New York, so it may not be ideal for people who travel domestically or live in another state part of the year. But Excellus wins for quality and selection of Medicare Advantage plans.
| Excellus BlueCross BlueShield | Aetna | |
|---|---|---|
| Number of States Available | 1 | 50 |
| Medicare Plans | 4 | 7 |
| Customer Service Options | Telephone, online, live online seminar, one-on-one in-person meeting | Telephone, email (through website) |
| AM Best Rating | Not rated | A (Excellent) |
| Average CMS Star Rating | 5.0 | 3.7 |
Final Verdict
Excellus BlueCross BlueShield is one of New York’s largest Medicare Advantage plans, offering a wide variety of Medicare Advantage options and an average of 5.0 stars from CMS. Some plans may cost more in monthly premiums than competitor plans, but out-of-pocket costs may be lower. Excellus is a popular choice for a good reason for Medicare enrollees in upstate New York.
FAQs
What is Excellus Medicare Advantage?
Medicare Advantage plans, often referred to as "Part C" plans, are provided by private insurers that have been approved by Medicare and they operate under Medicare Rules. These plans combine your hospital insurance (Plan A) and your health insurance (Plan B) coverage. Excellus offers numerous Medicare Advantage plan options that have earned 4.5 out of 5.0 stars from the Centers for Medicare and Medicaid Services.
What is the difference between Anthem and Excellus?
Excellus and Anthem are both part of the Blue Cross Blue Shield network. They're separate entities, but they both provide Medicare health benefits. Anthem changed its name to Elevance Health in 2022 and was ranked the second-largest health insurance company in the U.S. in 2023. Excellus came in at 28th, but the company only offers health insurance in upstate New York.
How do I cancel Excellus?
Most people can only unenroll from Excellus during the fall Medicare open enrollment period from Oct. 15 to Dec. 7 each year, but some exceptions exist. Your unenrollment will become official on Jan. 1 of the new year if you take action during this time. You’ll have to submit a signed and dated written disenrollment request in some cases, such as if you’re not enrolling in another Medicare prescription drug plan. You can call Excellus customer service at 1-877-883-9577 for more guidance.
Is Excellus not for profit?
Excellus BlueCross BlueShield is a nonprofit holding company based in Rochester, New York. It wascreated in 1996 by the mergers of the Blue Cross Blue Shield plans there and in Central New York.
Methodology
Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.
