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For many people, Anthem Blue Cross and Anthem Blue Shield are simply one company. And this is partially true and partially the cause of much confusion, especially for California residents. 

The trade names for the Blue Cross Blue Shield companies vary in certain states. For example, according to their website, Anthem Blue Cross is the trade name of Blue Cross of California. 

And, as explained by another source

In California, Anthem Blue Cross and Blue Shield are actually different companies and are competitors.   In most other states, they are the same company and formed an association, the Blue Cross Blue Shield Association.  Anthem Blue Cross is a for profit company in California, and Blue Shield is a non-profit. Both insurance companies have large networks and very good doctors. 

In California, Anthem Blue Cross is the biggest health insurance carrier.  They have the most volume of health insurance applications and also have the most members.”

While Anthem Blue Cross and Blue Shield of California do compete on many levels in California, the deciding factor for most members is usually their available networks.

As an article at HealthforCalifornia.com website illustrates,

“Blue Shield of California has Sutter in their network. Anthem does not. Regarding Stanford, Anthem offers coverage through the hospital but not the medical group. Blue Shield has both.”

See the Tp 5 Health Insurance Companies in the US

 

Other Factors for Individual Plans

With these two health insurance California competitors, their premiums tend to be very comparable. Depending on your region, the cheapest California health plan might be offered by Anthem Blue Cross or by Blue Shield of California. However, the rates tend to be about the same. The big difference is, as we’ve noted, the network.

When it comes to the availability of Anthem Blue Cross and Blue Shield of California through Covered California, both are included in the state’s health exchange program and both offer affordable individual plans.

Nationally, customers have rated various Blue Cross Blue Shield companies less than 3.5 stars on Consumer Affairs. The complaints include difficulty in getting medical procedures approved, coverage denials, and limited PPO choices.

Here is an overview of each provider:

Anthem Blue Cross

In California Anthem Blue Cross is the trade name of Blue Cross of California. Anthem is also the second-largest medical insurance provider in the United States by total members, with over 40 million lives covered.

With over 8 million members just in California, Anthem Blue Cross provides coverage for more Californians than any other carrier in the state. Anthem has been a part of California’s health exchange, Covered California, since the start of Obamacare in 2014.

There are many policy options and there is a plan available no matter how much coverage you may want.

Anthem Blue Cross offers HMO, PPO, EPO, and a Health Savings Account (HSA) plans for small groups, large groups, and seniors.  Anthem insures more PPO members in California than any other insurance company and their PPO networks are very extensive and include most doctors and hospitals.

Blue Shield of California

Based in San Francisco, Blue Shield of California has been providing health coverage to California residents since 1939. Blue Shield of California is one of only two preferred provider organizations that offers plans to all California ZIP codes and counties.

Blue Shield is a nonprofit health plan provider, and in 2011, they pledged to take only 2% of their net income as revenue and give the rest back to their members and community. Since making this pledge, Blue Shield has returned as much as $560 million.

Blue Shield of California serves over 4 million members and is California’s third-largest health plan. It is a not-for-profit corporation that operates exclusively in California and offers coverage for individuals, small and large groups, and Medicare supplemental plans and Medicare Advantage plans.

 

Anthem Blue Cross Blue Shield of California Quality

The State of California’s Office of the Patient Advocate (OPA) Health Care Quality Report Cards are a service provided for consumers. These include a Health Plan Report Card for each provider doing business in the state of California. 

Here are the results of the OPAs report card for Blue Shield of California – HMO 2020-21 Edition

  • OVERALL QUALITY OF MEDICAL CARE Good
  • Appropriate Use of Tests, Treatments and Procedures Good
  • Asthma and Lung Disease Care Fair
  • Diabetes Care Good
  • Heart Care Good
  • Maternity Care Good
  • Behavioral and Mental Health Care Good
  • Preventive Screenings Very Good
  • Treating Adults Excellent
  • Treating Children Good

In addition, the state’s report card includes a patient rating scorecard:

  • PATIENTS RATE OVERALL EXPERIENCE Good
  • Getting Care Easily Poor
  • Satisfaction with Plan Services Good
  • Satisfaction with Plan Doctors Good

Blue Shield ranked relatively well across the board and quite well in particular service areas. 

And these are the results of the OPAs report card for Anthem Blue Cross – HMO 2020-21 Edition

  • QUALITY OF MEDICAL CARE Good
  • Appropriate Use of Tests, Treatments and Procedures Good
  • Asthma and Lung Disease Care Fair
  • Diabetes Care Very Good
  • Heart Care Good
  • Maternity Care Good
  • Behavioral and Mental Health Care Fair
  • Preventive Screenings Very Good
  • Treating Adults Excellent
  • Treating Children Good

The patient rating scorecard results were similar to Blue Shield’s:

  • PATIENTS RATE OVERALL EXPERIENCE Good
  • Getting Care Easily Poor
  • Satisfaction with Plan Services Good
  • Satisfaction with Plan Doctors Good

The OPAs scorecard results for the Anthem Blue Cross PPO plan was not quite as high with diabetes care and heart care each only ranking as “Fair.”

Remember that in an HMO plan you can only see doctors in your HMO’s network. You will have a primary care doctor and a medical group who refers and coordinates your care to specialists when needed.

With PPO plans, you can choose to see out-of-network doctors. However, you are responsible to manage and pay the cost for out-of-network visits.

The bottom line is that both Blue Cross Blue Shield providers are well-rated, affordable, and have extensive coverage in California.

 

Your Local Experts for California Health Insurance

JC Lewis Insurance offers California health insurance plans only from the leading health insurance carriers licensed to do business in California. In addition, we are a local, family-owned firm of expert brokers based in Sonoma County.

Not only are we expert brokers, but we are also licensed and certified by each of these insurance carriers to offer coverage to individuals, families, and small group employers in addition to Medicare supplemental and prescription drug plans for seniors.

If you are self-employed, or your employer doesn’t provide health benefits, an individual or family plan may be the best option for you or you and your family.

And if you’re looking to purchase medical insurance for you and your family, you will likely have many questions and concerns. Bring your questions about health coverage insurance and you can be confident that JC Lewis Insurance Services will help you find the right solution.

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