Blue Cross Blue Shield New York City Blue Cross Blue Shield New York City: Fill & Download for Free

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PDF Editor FAQ

I moved from Chicago to New York City last year and informed Blue Cross Blue Shield of Illinois. I called and they said I could continue my coverage while living here. This doesn't seem like it should be possible, is it?

Definitely. You're most likely on a PPO (Participating Provider Organization) type of policy which allows for out-of-network benefits. Some plans also have travel benefits specifically for employees who live or travel out-of-network on a regular basis. Call the number for customer service on your card or the insurer's website for details specific to your coverage.

Did you ever have a restaurant meal “on the house”? What was the reason?

Yes. When I worked for Blue Cross Blue Shield health insurance in New York City, many of our customers were the top restaurants. Whenever I had business appointments with them, they always offered meals “on the house”. That’s when BCBS was considered the premiere insurance. Unfortunately, I was fresh out of college and did not appreciate the tremendous access that job gave me to NYC’s most elite Who’s Who.Ahhh, youth…

What is the best Obamacare plan in New York City for 2017/18, and why?

I assume with “Obamacare plan” you mean Qualified Health Plans sold on the exchange and open to everyone, with subsidies for people in certain income ranges. (New York also has Essential Health Plans, which are also sold on the exchange but only available to people making less than 200% FPL.)When you say “best”, what criteria do you care about? Network size? Ease of using the plan? Cheap premiums? Low cost-sharing? Do you want any particular physicians or medical centers in the plan network?The simplest proxy for how “good” a plan may be for a generic person is how popular it was in the prior year. That measure already incorporates a trade-off between premiums and benefits. The 2017 Open Enrollment Report has a list of plan enrollment by plan and county starting at page 37: https://info.nystateofhealth.ny.gov/sites/default/files/NYSOH%202017%20Open%20Enrollment%20Report.pdfSummed over all 5 boroughs, the most popular plans were:Healthfirst (29% of enrollment)Fidelis Care (23%)Oscar (12%)Empire Blue Shield Blue Cross (10%)MetroPlus (9%)Emblem Health (9%)United Healthcare (4%)CareConnect (2%, discontinued for 2018)Affinity Health Plan (2%, discontinued for 2018)One good proxy for network size is whether the major (typically more expensive) hospitals in an area are covered. (If there’s a particular type of provider you need, I would encourage you to check the provider directory for that type of provider directly instead.)The following Exchange plans DO NOT cover New York Presbyterian Hospital: Oscar and FidelisHospital Participating PlansThe following Exchange plans DO NOT cover Mount Sinai Hospital: Fidelis, MetroPlus, United Healthhttp://www.mountsinaihealth.org/static_files/MSHL/Files/Feb16ContractedPayersMSH-MSHq.pdfOnly one Exchange plan DOES cover Memorial Sloan Kettering Cancer Center: Emblem Health. The other issuers may have excluded one of the top cancer centers in the nation from their provider network specifically to discourage expensive cancer patients from enrolling in their plan. Not cool.Insurance InformationIf you believe the star ratings of the exchange plans available in NYC, none of the plans are great. They all scored 2–3 stars out of 5 overall rated on quality of care, ease of access and affordability.Personally, I try my hardest to avoid HMOs because getting care approved can be a nightmare. I also tend to avoid EPOs (which don’t have out-of-network benefits) because it’s way too easy to find yourself at an out-of-network provider. Just image you have an emergency and the ambulance takes you to the emergency room of an out-of-network hospital, where doctors admit you for inpatient treatment. Your insurance is legally required to pay for the ER (because emergency), but not the inpatient treatment at the out-of-network hospital.I personally stick to PPOs. Unfortunately, it appears that there are no PPO plans available in NYC on the New York Exchange.The following NYC Exchange plans are HMOs: HealthFirst, Emblem Health, MetroPlus, Fidelis Care, United HealthThe following NYC Exchange plans are EPOs: Oscar, Empire Blue Shield Blue CrossThat all said, cheap HMOs and narrow-network plans are fine for the vast majority of people who don’t have unusual or expensive health needs. Alas, there’s always the possibility that something unexpected will happen next year and you’ll wish you had opted for a more generous plan.

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