BCBS Health Plan Expands Medicare Advantage Drug, Mental Health Benefits

Blue Cross Blue Shield of Massachusetts (Blue Cross) introduced prescription drug benefits and mental healthcare benefits to its preferred provider organization (PPO) and health maintenance organization (HMO) Medicare Advantage plans.

“We know older adults in Massachusetts want affordable Medicare options that meet their individual needs from a plan they can trust,” said Eddie Walker, vice president of Medicare Product at Blue Cross.

“As the health plan that insures the most Medicare beneficiaries across Massachusetts and has deep roots in the community, we offer enhanced benefits in areas that matter most to older adults—including lower prescription drug costs and increased access to mental health services—coupled with an unparalleled local service experience.”

The Medicare Advantage plans may offer a zero-dollar copay on certain services and products, including primary care visits, certain prescription drugs, dental visits, and vision and hearing exams. The payer also announced a new benefit in which members have a zero-dollar copay for labwork.

For other products or services, members may see a zero-dollar deductible, such as the zero-dollar deductible for brand name drugs which is a new feature.

Individuals with certain mental health conditions—such as anxiety, depression, or insomnia—may have access to Learn to Live for free. Individuals in need of other types of therapy—such as physical therapy, occupational therapy, and speech therapy—may have coverage for telehealth visits for these services.

The new benefits also include an allowance for over-the-counter health care purchases, equaling as much as $260. Additionally, members can receive insulin for a $35 copay, a widely-adopted move which started under the Trump administration.

The payer expanded dental benefits. Blue Cross Medicare Advantage members now have access to $1,000 annually in dental coverage for dental exams and procedures like fillings and crowns.

Members who want to improve their fitness routine can be reimbursed for a wider array of fitness costs. They may receive reimbursement for using pool-only facilities to exercise, purchasing fitness equipment, or attending virtual classes.

The payer also retained more traditional supplemental benefits such as allowances for eyewear, hearing aid benefits, and post-discharge meal deliveries.

Both the zero-dollar premium Medicare PPO Blue SaverRx and the zero-dollar premium Medicare HMO Blue SaverRx plans cover additional dental, hearing, vision, over-the-counter drug, and fitness benefits.

Under the PPO Medicare Advantage plan, members may access in- and out-of-network providers without a referral.

For plan year 2023, Blue Cross received more than a four-star rating for its Medicare Advantage PPO and Medicare Advantage HMO plans. The average ratings for Medicare Advantage plans with prescription drug coverage and Part D plans for plan year 2023 were 4.15 stars and 3.25 stars, respectively.

Some major payers noted that inflation was a driving force behind their 2023 Medicare Advantage updates, with many embracing or bolstering zero-dollar copays for certain services or zero-dollar premiums for entire Medicare Advantage plans.