Blue Shield Versus Anthem Blue Cross of California

The battles of the Blues!

This request (for battle) comes up often and for good reason.

Both Blue Shield and Anthem Blue Cross are dominant PPO providers in almost every county through California.

Some people are even surprised they are separate carriers.

What is the relationship?

More importantly, which is better and why?

All good questions and answers are below!

When two of the biggest carriers in California square off in all three markets (Individual/Family, Small Business, and Senior), it's truly the heavy-weight bout of insurance.

We'll look at the carrier's strengths, weakness, pricing, networks, and more.

Who are we?  Better question.

We are licensed California health insurance agents and Certified Covered Ca agents with 25+ years experience dealing with both Blue Shield and Anthem Blue Cross across all three market.

Literally 10's of 1000's of Blue Shield and Anthem Blue Cross policies.  Don't take our word for it!

First...some credentials Please!....

Due to the size of their footprint in the market, we deal the carriers daily.

We know who easy to work with. And who is NOT!

We understand the pricing and network differences (big deal now) across the State.

Enough about us.

You can always run your Blue Cross and/or Blue Shield quote here:

Let's get to the main event.

Anthem Blue Cross versus Blue Shield Basics

"First, aren't they the same carrier??"

In almost every other State, they are.

In fact, they operate together at the government and large group level in California.

At the Individual/Family, Small Business, and Senior level,

they are SEPARATE competing carriers!

At each of these levels, they have their own plans, pricing, and network.

They compete!

Structure of two carriers

• Anthem Blue Cross is a publicly-trade, for profit company.
• Blue Shield of California is a non-profit.

The latter sounds all warm and fuzzy but you need to see to your interests first.

One carrier may be a better value for your area and demographic (age, family make-up, etc).

Apples and apples, we want to look at the value to you.

Keep in mind that all carriers must now spend 85% of total premium on health care (no admin) by law (the ACA law).

In the end, that keeps both for-profit and non-profits honest.

Where Anthem Blue Cross and Blue Shield of California are Similar

PPO!

Let's say that again.

PPO.

These two carriers really dominate the PPO model of insurance.

If you're unsure of what means, check out a good explanation of PPO versus HMO.

Anthem Blue Cross and Blue Shield used to be the only PPO providers (we date ourselves) but they still dominate it.

On the individual/family market, if you're looking for the broadest list of doctors, you're probably looking at either Anthem Blue Cross or Blue Shield.

The Individual/Family market has changed quite a bit since 2014.

Networks are much smaller now and PPO helps to offset this change.

We'll discuss more in the Individual Family comparison below.

Anthem Blue Cross and Blue Shield of California also offer HMO plans and they're slowly becoming cost-competitive with other carriers (Kaiser, Health Net, ie).

There are other day to day differences which we'll discuss by market since each segment is different.

Out of State Coverage - Blue Card

One great benefit to the PPO plans with either Anthem Blue Cross or Blue Shield is access to the Blue Card network.

On the individual family market, Anthem EPO/PPO has the Blue Card access starting in 2020 for ACA plans. Blue Shield will not (as of this date).

This allows you to see providers in other States under the nationwide Blue Cross Blue Shield network.

If you travel or split time between States, this is essential.

Where Anthem Blue Cross and Blue Shield of California differ

It's very interesting (to us, anyway).

The carriers tend to ebb and flow in terms of their management.

At least, these two have.

A quick history....

Anthem Blue Cross at one time was a pretty poorly run carrier (go back to early 90's). Leonard Schaeffer came in as CEO and basically righted the ship.

They went from bad to the best in a decade.

It's pretty impressive.

• They were a California-run carrier which was nimble and reactive to the California market (which is very different than any other State).
• They sat at that position and quickly ate up market share.

At that time, Blue Shield was difficult to deal with and slow to react to the market.

It was akin to the DMV of health insurance.

Oh things have changed.

In the past 5-7 years, Blue Shield of California has completely turned themselves around.

They have become much more responsive to the market with aggressive pushes into every aspect that a competitive market like California requires.

Blue Cross, on the other hand, has started to take marching orders from Indiana after Anthem (based in Indiana) purchased the company years back.

You can feel it.

California isn't Indiana. By a long shot.

You can't run a California carrier the way you can in other States (which are way behind the times..we had trouble getting online apps in Indiana!!).

Dealing with both carriers, it shows now.

The day to day is more difficult. The decisions make less sense.  That's a little true of all carriers since 2014 though as they try to compress costs!

Anthem Blue Cross is still a dominant carrier with roughly a 1/3rd market share.

They're not going away.

Maybe we're just missing the old Anthem which was so easy to deal with and so ahead of the rest of the market.

They led the market and innovated.

Indiana's not innovating.

That's a quick sketch of the history. How important is that?

Here's the deal.

Since the plans are standardized now, if the pricing and network are better with one of the carriers at a given benefit level (say Silver), that's what you should focus on.

You can quickly quote all of their plans here:

Anthem Blue Cross versus Blue Shield for Individual Family
Anthem Blue Cross versus Blue Shield for Small and Large Business Health
Anthem Blue Cross versus Blue Shield for Medicare

Network

Once upon a time, the carriers all had pretty much the same networks.

Especially the two Blues.

That still holds true for Business health and Senior but it's NOT the case for individual/family (including Covered California).

The networks are very different now and you really need to check for your doctors.

You can use the online directory available through the quote above.

We can also track down doctor participation for you since we know which list to look at.

It's confusing now.

Make sure to ask "What COVERED CALIFORNIA plans do you take"?  if asking a doctor for individual/family coverage (not group or senior).

They all know how to answer that and the networks are all the same on or off exchange for IFP (individual family plans).

Hospitals networks for Blue Shield and Anthem Blue Cross

We're seeing big differences with hospitals as well.

After Jan 2014, the carriers signed semi-exclusive deals with hospital chains (think UC's, Sutter, Dignity, etc).

It's important to double-check this since it's not uncommon for either Anthem Blue Cross or Blue Shield to contract with a hospital..but not both!

You can bring up the Provider Search for any plan right through online quote.

Here's a great guide to California doctor networks for additional help.

Formulary

Important note...the medication benefits will be very similar from carrier to carrier at a certain benefit level.

The lists of accepted drugs (formulary) however, have changed.

The drug formularies are available through the quotes as well.

What we're seeing is that when comparing apples and apples, the Blue Shield of California formulary is broader than Anthem Blue Cross for Individual/Family and maybe even Small Business.

Anthem made the move to a more limited drug list for their group business which was unprecedented.  Senior is a whole different ballgame...more on that below!

The carriers are all more strict now about asking for exceptions so it's important to take a look at the formulary when comparing the two carriers.

You can check drug benefits through the quote here:

Blue Shield of California - Anthem Blue Cross Individual/Family
Blue Shield of California - Anthem Blue Cross Small and Large Business

The Take Away When Comparing Blue Cross and Blue Shield

So...how do we compare the two for what really matters?

Here's what we do by Market Segment...

First, run your quote. (Individual/Family, Business, Medicare - will open in separate window).

Now...on to the finer points by segment.

Individual and Family

Use the Silver plan (Individual or Group) as a benchmark since it's the most popular blend of benefits and cost.

Compare the PPO option for both carriers at the Silver to get the rate difference.

It may be little...or it may be huge!

Depending on your area and age.

That's your first consideration (and maybe the only one depending on health and budget!)

Next, look at the doctors that participate. You can access the provider directories right through the quote.

Make sure to check your desired hospitals since both carriers will have many doctors in a given area.

• For example, if you want Cedar Sinai and UCLA, that's probably Blue Shield of California
• They split Scripps and Sharp's providers down south.
• This network difference is huge depending on the area!

Okay.

We have price. Check.
We have doctors. Check.

Next, look at the drug formulary if you have ongoing medications.

We now have drug list. Check!

That's the best approach.

Keep in mind that if you're eligible for a tax credit through Covered California, it will apply evenly to either Anthem Blue Cross or Blue Shield.

If eligible based on income, we definitely want to enroll through the Exchange. Call us at 800-320-6269 to enroll online.

If not, we'll probably still enroll this way since it's a simpler process.

Small and Large Business Comparison

For Business owners, it's more a question of pricing since both carriers offer a full suite of plans, networks, and medication coverage.

We'll run a full quote across the Silver plan to establish which carrier is priced better.

The silver is the most popular plan on the market now.

That reduced drug formulary with Anthem Blue Cross may be a deciding factor if the pricing is comparable between the two.

The networks are very comparable for the Business market.

We can quote across both carriers and all other carriers in the Small Business market with one entry here.

Senior

Two almost completely different markets here.  Medicare Advantage and Supplements (really the first decision).

Learn more about the trade-offs between Advantage and Supplements or How to Pick the Best Medicare Plan.

Medicare supplements are a little easier.

The networks are identical...if the provider accepts Medicare, you're golden.

The drug list is separate since that's a function of Part D which is a different plan.

It's pricing and price stability.

Both carriers have long track records with Medicare supplements so the stability is not an issue.

It's pricing!

Right now, Blue Shield has the better pricing.

Look at the G plan as a benchmark since it's the most popular plan across the market.

You can compare Medicare Supplements versus Advantage Plans separately.

You can quote both types of plans here (we'll send link for doctor/RX and "opt-in" required by law to quote Advantage plans):

Now...for Advantage plans (and Part D for medication), that's a whole different ballgame.

After you enter your doctor/RX info and "opt in", we'll send a full quote of all the plans in your areas!  Even ones we don't contract with.

The networks, benefits, and rates can all be different with Advantage plans so check out our How to Compare Advantage plans or our Insider's Guide to Advantage plans to learn more.

Our services are 100% free to you as licensed California agents and Certified Covered California agents.

We have helped 10's of 1000's of Californians across the State make this same comparison.

We're getting pretty good at it!

 Quote both Blue Shield of California and Anthem Blue Cross to view rates and plans side by side for both carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!

Call 800-320-6269 or email us at help@calhealth.net