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With practical experience running his own IT business and an education in the liberal arts, Matthew Klammer had become well-accustomed to the difficulties of research. From providing POS systems to small tourist shops to data security and account management Matthew has provided business solutions to many individuals.
Our Take
Excellus BlueCross BlueShield is a nonprofit plan based in upstate New York. It earns high-quality marks and offers a good selection of Medicare Advantage HMO and PPO plans. Members have the option of buying enhanced dental and vision coverage as well. Excellus plans include standard extra benefits as well as access to the Blue365 discount program. It's a high-quality option for Medicare beneficiaries in Excellus’s service area.
Excellus BlueCross BlueShield is a nonprofit health plan based in Rochester, New York. Excellus was formed as a holding company through the merger of BlueCross BlueShield plans of Rochester and Central New York, which were founded in 1935 and 1936 respectively.
Excellus’s parent company, The Lifetime Healthcare Companies, offers health insurance in upstate New York and long-term care insurance across the country. Overall, the company serves 1.5 million members.
Excellus offers insurance in 31 counties in New York State, including the Central New York, Central New York Southern Tier, Rochester, and Utica regions. The company maintains regional offices in each area.
Excellus offers numerous insurance plans in four categories.
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.
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.
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 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:
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.
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.
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.
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).
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.
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.
Excellus’s Medicare Advantage plans price ranges included the following options in 2022.
HMO plans with prescription drug coverage:
HMO plans without prescription drug coverage:
PPO plans with prescription drug coverage:
PPO plans with prescription drug coverage:
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.
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 |
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.
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.
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.
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.
Excellus BlueCross BlueShield is a nonprofit holding company based in Rochester, New York. It was created in 1996 by the mergers of the Blue Cross Blue Shield plans there and in Central New York.
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.
