Blue Cross Blue Shield Association 2020 Medicare .

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SENIOR MARKETS2020Medicare Advantageand Prescription Drug PlansOffered by Blue Crossand Blue Shield CompaniesUpdated November 2019Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.17-XXX-W20

2020 Medicare Advantage PlansOffered by Blue Cross and Blue Shield CompaniesKey:PPO Preferred Provider OrganizationHMO Health Maintenance OrganizationPFFS Private Fee-For-ServiceCost Cost ContractSNP Special Needs PlanHMO-POS – HMO with Point-Of-Service OptionStateRegionalPPOMedicare Advantage organizations must include the Medicare prescriptiondrug coverage in at least one of their MA benefit options (except for privatefee for service and cost plans where it is optional). Regional PPOs andSNPs must offer drug coverage in all of their options.LocalHMOHMOPFFS CostPPOPOSBlue Cross and BlueShield Plan SponsorProduct NameXBlue Cross andBlue Shield of AlabamaBlue Advantage Complete(Local PPO)XBlue Cross andBlue Shield of AlabamaBlue Advantage Premier(Local PPO)XBlue Cross and Blue Shieldof ArizonaBlue Medicare AdvantageClassic (HMO)XBlue Cross and Blue Shieldof ArizonaBlue Medicare AdvantagePlus (HMO)XBlue Cross and Blue Shieldof ArizonaBlue Medicare AdvantageStandard (HMO)Blue Cross and Blue Shieldof ArizonaBlueJourney (PPO)XBlue Cross and Blue Shieldof ArizonaBluePathway Plan 2 (HMO)XBlue Cross and Blue Shieldof ArizonaBluePathway Plan 3 (HMO)XArkansas Blue Crossand Blue ShieldMedi-Pak Advantage(HMO)XArkansas Blue Crossand Blue ShieldAR Blue Cross - Medi-PakAdvantage MA (PFFS)XArkansas Blue Crossand Blue ShieldAR Blue Cross - Medi-PakAdvantage MA-PD (PFFS)Anthem Blue CrossAnthem MediBlue Access(PPO)XAnthem Blue CrossAnthem MediBlue Breathe(HMO C-SNP)XAnthem Blue CrossAnthem MediBlue Care OnSite (HMO I-SNP)XAnthem Blue CrossAnthem MediBlue Connect(HMO D-SNP)SNPAlabamaArizonaXArkansasXCalifornia2

StateRegionalPPOLocalHMOHMOPFFS CostPPOPOSBlue Cross and BlueShield Plan SponsorProduct NameXAnthem Blue CrossAnthem MediBlue ConnectPlus (HMO)XAnthem Blue CrossAnthem MediBlueCoordination Plus (HMO)XAnthem Blue CrossAnthem MediBlue Diabetes(HMO C-SNP)XAnthem Blue CrossAnthem MediBlue DualAccess (PPO D-SNP)XAnthem Blue CrossAnthem MediBlue DualAdvantage (HMO D-SNP)XAnthem Blue CrossAnthem MediBlue Dual Plus(HMO D-SNP)XAnthem Blue CrossAnthem MediBlue ESRD(HMO C-SNP)XAnthem Blue CrossAnthem MediBlue ESRD(PPO C-SNP)Anthem Blue CrossAnthem MediBlue Extra(HMO)Anthem Blue CrossAnthem MediBlue Heart(HMO C-SNP)XAnthem Blue CrossAnthem MediBlue Plus(HMO)XAnthem Blue CrossSNPXXCalifornia(cont.)XAnthem MediBlue Select(HMO)Anthem Blue CrossAnthem MediBlueStartSmart Plus (HMO)Anthem Blue CrossAnthem MediBlue ValuePlus (HMO)XBlue Shield of CaliforniaBlue Shield 65 Plus (HMO)XBlue Shield of CaliforniaBlue Shield 65 Plus ChoicePlan (HMO)XBlue Shield of CaliforniaBlue Shield Inspire (HMO)Blue Shield of CaliforniaBlue Shield Medicare(PPO)XBlue Shield of CaliforniaBlue Shield PromiseAdvantageOptimum Plan(HMO)XBlue Shield of CaliforniaBlue Shield PromiseAdvantageOptimum Plan 1(HMO)XX3

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)Regional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorStateProduct NameXBlue Shield of CaliforniaBlue Shield PromiseAdvantageOptimum Plan 2(HMO)XBlue Shield of CaliforniaBlue Shield PromiseCoordinated Choice Plan (HMO)Blue Shield of CaliforniaBlue Shield Promise TotalDualPlan (HMO D-SNP)XBlue Shield of CaliforniaBlue Shield Trio Medicare(HMO)XBlue Shield of CaliforniaBlue Shield Vital (HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Care On Site(HMO I-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue Diabetes(HMO C-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Cross and BlueShieldAnthem MediBlue Plus (HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Care On Site(HMO I-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue DualAdvantage (HMO D-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue DualAdvantage Select (HMO D-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue ESRD (HMOPOS C-SNP)XAnthem Blue Cross and BlueShieldAnthem MediBlue Extra (HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Plus(HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Prime(HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Select (HMO)Florida BlueBlueMedicare Choice (RegionalPPO)XFlorida BlueBlueMedicare Classic (HMO)XFlorida BlueBlueMedicare Classic Plus(HMO)Florida BlueBlueMedicare Complete (HMOD-SNP)Florida Blue(Health Options, Inc.)BlueMedicare Premier aXXBlue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.17-XXX-W20

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorFlorida Blue(Health Options, Inc.)BlueMedicare Saver (HMO)XFlorida Blue(Health Options, Inc.)BlueMedicare Select (PPO)XFlorida Blue(Health Options, Inc.)BlueMedicare Value (PPO)XFlorida Blue(Florida Blue Preferred HMO)Capital Health Plan AdvantagePlus (HMO)XFlorida Blue(Florida Blue Preferred HMO)Capital Health Plan PreferredAdvantage (HMO)XFlorida Blue(Florida Health Care Plans)FHCP Medicare FlaglerAdvantage (HMO)XFlorida Blue(Florida Health Care Plans)FHCP Medicare PremierAdvantage (HMO)XFlorida Blue(Florida Health Care Plans)FHCP Medicare Premier Plus(HMO)XFlorida Blue(Florida Health Care Plans)FHCP Medicare Rx (HMO)Florida Blue(Florida Health Care Plans)FHCP Medicare Rx Plus (HMOPOS)Florida Blue(Florida Health Care Plans)FHCP Medicare Rx Savings(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Access Basic(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Essential(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Extra (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XHMSAHMSA Akamai AdvantageComplete (PPO)XHMSAHMSA Akamai AdvantageComplete Plus (PPO)HMSAHMSA Akamai Advantage DualCare (PPO D-SNP)XHMSAHMSA Akamai AdvantageStandard (PPO)XHMSAHMSA Akamai AdvantageStandard Plus (PPO)XHMSAHMSA Essential Advantage(HMO)XThe Regence GroupRegence St. Luke's HealthPartners Align (HMO)XThe Regence GroupRegence St. Luke's HealthPartners Align No Rx (HMO)XFlorida(cont.)XXXGeorgiaHawaiiProduct NameXIdaho5

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorXThe Regence GroupRegence St. Luke's HealthPartners Align Plus (HMO)XThe Regence GroupRegence Blue MedAdvantageHMO (HMO)XThe Regence GroupRegence Blue MedAdvantageHMO Plus (HMO)XThe Regence GroupRegence MedAdvantage Basic(PPO)XThe Regence GroupRegence MedAdvantage RxClassic (PPO)XThe Regence GroupRegence MedAdvantage RxEnhanced (PPO)XThe Regence GroupRegence MedAdvantage RxPrimary (PPO)XBlue Cross of IdahoSecure Blue no Rx (PPO)XBlue Cross of IdahoTrue Blue no Rx (HMO)XBlue Cross of IdahoTrue Blue Rx (HMO)XBlue Cross of IdahoTrue Blue Rx Gem (HMO)XBlue Cross of IdahoTrue Blue Rx Option I (HMO)XBlue Cross of IdahoTrue Blue Rx Option II (HMO)XBlue Cross of IdahoTrue Blue Rx Preferred (HMO)Blue Cross of IdahoTrue Blue Special Needs Plan(HMO D-SNP)XBlue Cross of IdahoTrue Blue Rx St Luke's HealthPartners (HMO)XBlue Cross andBlue Shield of IllinoisBlue Cross Medicare AdvantageBasic (HMO)Blue Cross andBlue Shield of IllinoisBlue Cross Medicare AdvantageBasic Plus (HMO-POS)XBlue Cross andBlue Shield of IllinoisBlue Cross Medicare AdvantageChoice Plus (PPO)XBlue Cross andBlue Shield of IllinoisBlue Cross Medicare AdvantageChoice Premier (PPO)Blue Cross andBlue Shield of IllinoisBlue Cross Medicare AdvantagePremier Plus (HMO-POS)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Basic(Regional PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Plus(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MediBlue Extra (HMO)Idaho(cont.)XXIllinoisXXXIndianaProduct NameXXX6

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorIndiana(cont.)Anthem Blue Crossand Blue Shield hemAnthem MediBlue Plus (HMO)XBlue Cross andBlue Shield of KansasBlue Medicare Advantage (PPO)XBlue Cross andBlue Shield of Kansas CityBlue Medicare AdvantageAccess (PPO)Blue Cross and Blue Shield ofKansas CityBlue Medicare AdvantageCompleteXBlue Cross and Blue Shield ofKansasBlue Medicare AdvantageComprehensive (PPO)XBlue Cross and Blue Shield ofKansas CityBlue Medicare AdvantageEssential (PPO)Blue Cross and Blue Shield ofKansas CityBlue Medicare Advantage Plus(HMO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Basic(Regional PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XBlue Cross Blue Shield ofLouisianaBlue Advantage (HMO)Blue Cross Blue Shield ofLouisianaBlue Advantage (PPO)Blue Cross Blue Shield ofLouisiana (Healthy Blue)Healthy Blue Dual Advantage(HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MaineHealthAdvantage Choice (HMO-POS)Anthem Blue Crossand Blue ShieldAnthem MaineHealthAdvantage Dual Plus (HMO DSNP)Anthem Blue Crossand Blue ShieldAnthem MaineHealthAdvantage Extra (HMO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Choice (HMOPOS)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XBlue Cross Blue Shieldof MassachusettsMedicare PPO Blue PlusRx(Local PPO)XBlue Cross Blue Shieldof MassachusettsMedicare PPO Blue SaverRx(Local PPO)XBlue Cross Blue Shieldof MassachusettsMedicare PPO Blue ValueRx(Local sachusettsProduct Name7

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameXBlue Cross Blue Shieldof MassachusettsMedicare HMO Blue PlusRx(HMO)XBlue Cross Blue Shieldof MassachusettsMedicare HMO Blue ValueRx(HMO)Blue Cross Blue Shieldof MassachusettsMedicare HMOBlue FlexRx(HMO POS)XBlue Cross Blue Shieldof MassachusettsMedicare HMO Blue SaverRx(HMO)XBlue Cross Blue Shieldof MichiganBCN Advantage HMOConnectedCare (HMO)XBlue Cross Blue Shieldof MichiganBCN Advantage HMOHealthySaver (HMO)XBlue Cross Blue Shieldof MichiganBCN Advantage HMOHealthyValue (HMO)XBlue Cross Blue Shieldof MichiganBCN Advantage HMO MyChoiceWellness (HMO)XBlue Care Network(Blue Cross Blue Shieldof Michigan)BCN Advantage HMO-POSBasic (HMO-POS)XBlue Care Network(Blue Cross Blue Shieldof Michigan)BCN Advantage HMO-POSClassic (HMO-POS)XBlue Care Network(Blue Cross Blue Shieldof Michigan)BCN Advantage HMO-POSElements (HMO-POS)XBlue Care Network(Blue Cross Blue Shieldof Michigan)BCN Advantage HMO-POSPrestige (HMO-POS)XBlue Care Network(Blue Cross Blue Shieldof Michigan)Medicare Plus Blue PPO Assure(PPO)XBlue Care Network(Blue Cross Blue Shieldof Michigan)Medicare Plus Blue PPO Assure(PPO)XBlue Care Network(Blue Cross Blue Shieldof Michigan)Medicare Plus Blue PPOEssential (PPO)XBlue Care Network(Blue Cross Blue Shield ofMichigan)Medicare Plus Blue PPOSignature (PPO)XBlue Cross and Blue Shield ofMinnesotaBlue Cross Medicare AdvantageChoice (PPO)XBlue Cross and Blue Shield ofMinnesotaBlue Cross Medicare AdvantageChoice MA Only (PPO)XBlue Cross and Blue Shield ofMinnesotaBlue Cross Medicare AdvantageComplete (PPO)XBlue Cross and Blue Shield ofMinnesotaBlue Cross Medicare AdvantageCore (PPO)Massachusetts(cont.)XMichiganMinnesotaXBlue Cross and Blue Shield of Blue Cross Strive MedicareMinnesotaAdvantage Choice (HMO-POS)XBlue Cross and Blue Shield ofMinnesotaBlue Cross Strive MedicareAdvantage Complete (HMOPOS)8

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorMinnesota(cont.)Product NameXBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Choice Plan(Cost)XBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Choice Plan withRx (Cost)XBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Complete Plan(Cost)XBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Complete Planwith Rx (Cost)XBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Core Plan (Cost)XBlue Cross and Blue Shield ofMinnesotaPlatinum Blue Core Plan with Rx(Cost)XBlue Cross and Blue Shield ofSecureBlue (HMO D-SNP)MinnesotaXAnthem Blue Crossand Blue ShieldAnthem MediBlue Access(PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Access Basic(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)Blue Cross and Blue Shield ofKansas CityBlue Medicare AdvantageAccess (HMO)Blue Cross and Blue Shield ofKansas CityBlue Medicare AdvantageComplete (HMO)Blue Cross and Blue Shield ofKansas CityBlue Medicare AdvantageEssential (PPO)Blue Cross and Blue Shield ofKansas CityBlue Medicare Advantage Plus(HMO)XBlue Cross andBlue Shield of MontanaBlue Cross Medicare AdvantageClassic (PPO)XBlue Cross andBlue Shield of MontanaBlue Cross Medicare AdvantageOptimum (PPO)XBlue Cross andBlue Shield of NebraskaBlue Cross Blue ShieldNebraska MA Access (PPO)Blue Cross andBlue Shield of NebraskaBlue Cross Blue ShieldNebraska MA Choice(HMO-POS)Blue Cross Blue Shield ofNebraskaBlue Cross Blue ShieldNebraska MA Core (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Breathe(HMO C-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Care On Site(HMO I-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Diabetes(HMO C-SNP)XXMissouriXXXXMontanaXNebraskaXNevada9

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorAnthem Blue Crossand Blue ShieldAnthem MediBlue Heart (HMOC-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Value Plus(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue SmartStartPlus (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Connect Plus(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue CoordinationPlus (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue CoordinationPlus (HMO)XAnthem Blue Cross and BlueShieldAnthem MediBlue Select (HMO)Horizon Blue Cross BlueShield of New JerseyHorizon Medicare Blue Select(HMO-POS)XHorizon Blue Cross BlueShield of New JerseyHorizon Medicare Blue Value(HMO)XHorizon Blue Cross BlueShield of New JerseyHorizon Medicare Blue Value w/Rx (HMO)XHorizon Blue Cross BlueShield of New JerseyHorizon Medicare Blue Choicew/Rx (HMO)XHorizon Blue Cross BlueShield of New JerseyHorizon Medicare BlueAdvantage (HMO)Horizon Blue Cross BlueShield of New JerseyHorizon Medicare Blue (PPO)Horizon Blue Cross BlueShield of New JerseyHorizon NJ TotalCare (HMO DSNP)Blue Cross and Blue Shield ofNew MexicoBlue Cross Medicare AdvantageChoice Plus (Local PPO)XBlue Cross and Blue Shield ofNew MexicoBlue Cross Medicare AdvantageDual Care (HMO D-SNP)XBlue Cross and Blue Shield ofNew MexicoBlue Cross Medicare AdvantageDual Care Plus (HMO D-SNP)XNevada(cont.)NewHampshireXXNew JerseyProduct NameXXXNew MexicoXBlue Cross and Blue Shield of Blue Cross Medicare AdvantageNew MexicoSelect (HMO)XBlue Cross and Blue Shield ofNew MexicoBlue Cross Medicare AdvantageBasic (HMO)XHealthNowBlueCross BlueShield BlueSaver(HMO)HealthNowBlueCross BlueShield ForeverBlue 751 (PPO)New YorkX10

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorHealthNowBlueCross BlueShield ForeverBlue Value (PPO)XHealthNowBlueCross BlueShield SeniorBlue 601 (HMO)XHealthNowBlueCross BlueShield SeniorBlue 651 (HMO)XHealthNowBlueCross BlueShield SeniorBlue Select (HMO)HealthNowBlueShield Forever Blue 770(PPO)XHealthNowBlueShield Freedom Plus (HMO)XHealthNowBlueShield Freedom Premier(HMO)XHealthNowBlueShield Freedom Value(HMO)XHealthNowBlueShield Senior Blue 652Empire BlueCross BlueShieldEmpire MediBlue Access (PPO)Empire BlueCross BlueShieldEmpire MediBlue Choice(HMO-POS)XEmpire BlueCross BlueShieldEmpire MediBlue Core (HMO)XEmpire BlueCross BlueShieldEmpire MediBlue Core Select(HMO)XEmpire BlueCross BlueShieldEmpire MediBlue DualAdvantage (HMO D-SNP)XEmpire BlueCross BlueShieldEmpire MediBlue DualAdvantage Select (HMO D-SNP)XEmpire BlueCross BlueShieldEmpire MediBlue Extra (HMO)XEmpire BlueCross BlueShieldEmpire MediBlue Plus (HMO)XEmpire BlueCross BlueShieldEmpire MediBlue Select (HMO)XExcellusBlueCross BlueShieldMedicare Bassett (HMO-POS)XExcellusBlueCross BlueShieldMedicare Blue Choice Advanced(HMO-POS)XExcellusBlueCross BlueShieldMedicare Blue Choice Optimum(HMO-POS)XExcellusBlueCross BlueShieldMedicare Blue Choice Platinum(HMO-POS)XExcellusBlueCross BlueShieldMedicare Blue Choice Select(HMO)XExcellusBlueCross BlueShieldMedicare Blue Choice Value(HMO)ExcellusBlueCross BlueShieldMedicare Blue Choice ValuePlus (HMO-POS)XXXXNew York(cont.)Product NameX11

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorNew York(cont.)Product NameXExcellusBlueCross BlueShieldMedicare BlueBasic (PPO)XExcellusBlueCross BlueShieldMedicare BlueClassic (PPO)XExcellusBlueCross BlueShieldMedicare BlueEnhanced (PPO)XExcellusBlueCross BlueShieldMedicare BlueEssential (PPO)XExcellusBlueCross BlueShieldMedicare BluePlus (PPO)XExcellusBlueCross BlueShieldMedicare BlueSecure (PPO)ExcellusBlueCross BlueShieldUnivera SeniorChoice Advanced(HMO-POS)ExcellusBlueCross BlueShieldUnivera SeniorChoice Basic(HMO)XExcellusBlueCross BlueShieldUnivera SeniorChoice Secure(HMO-POS)XExcellusBlueCross BlueShieldUnivera SeniorChoice Select(HMO-POS)ExcellusBlueCross BlueShieldUnivera SeiorChoice Value(HMO)ExcellusBlueCross BlueShieldUnivera SeniorChoice ValuePlus (HMO-POS)XBlue Cross andBlue Shield of North CarolinaBlue Medicare Choice (HMO)XBlue Cross andBlue Shield of North CarolinaBlue Medicare Enhanced (HMO)XBlue Cross andBlue Shield of North CarolinaBlue Medicare Essential (HMO)XBlue Cross andBlue Shield of North CarolinaBlue Medicare Essential Plus(HMO)XBlue Cross andBlue Shield of North CarolinaBlue Medicare Medical Only(HMO)Blue Cross andBlue Shield of North CarolinaBlue Medicare PPO Enhanced(PPO)Blue Cross andBlue Shield of North Carolina(Experience Health)Experience Health MedicareAdvantage (HMO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Core(Regional PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Plus(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue Access Basic(Regional PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MediBlue Essential(HMO)XXXXNorthCarolinaXXXXXOhioXXX12

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorXAnthem Blue Crossand Blue ShieldAnthem MediBlue Extra(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Prime Select(HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Preferred(HMO)XBlue Cross and Blue Shieldof OklahomaBlue Cross Medicare AdvantageBasic (HMO)XRegence BlueCrossBlueShield of OregonRegence BlueAdvantage HMO(HMO)XRegence BlueCrossBlueShield of OregonRegence BlueAdvantage HMONo Rx (HMO)XRegence BlueCrossBlueShield of OregonRegence BlueAdvantage HMOPlus (HMO)XRegence BlueCrossBlueShield of OregonRegence MedAdvantage RxClassic (PPO)XRegence BlueCrossBlueShield of OregonRegence MedAdvantage RxEnhanced (PPO)XRegence BlueCrossBlueShield of OregonRegence MedAdvantage RxPrimary (PPO)XRegence BlueCrossBlueShield of OregonRegence MedAdvantage Basic(PPO)XCapital BlueCrossBlueJourney Alliance AssistedCare (HMO I-SNP)XCapital BlueCrossBlueJourney Alliance Heart andDiabetes Care (HMO C-SNP)XCapital BlueCrossBlueJourney Alliance Lung Care(HMO C-SNP)Capital BlueCrossBlueJourney Classic (PPO)XCapital BlueCrossBlueJourney Essential (HMO)XCapital BlueCrossBlueJourney Premier (HMO)Capital BlueCrossBlueJourney Prime (PPO)XCapital BlueCrossBlueJourney Value (HMO)XHighmark Inc.Community Blue Medicare HMOPrestige (HMO)XHighmark Inc.Community Blue Medicare HMOSignature (HMO)Highmark Inc.Community Blue Medicare PlusPPO Distinct (PPO)Ohio(cont.)OklahomaOregonProduct NameXPennsylvaniaXX13

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameXHighmark Inc.Community Blue Medicare PlusPPO Signature (PPO)XHighmark Inc.Community Blue Medicare PPODistinct (PPO)XHighmark Inc.Community Blue Medicare PPOSignature (PPO)XHighmark Inc.Freedom Blue PPO Basic (PPO)XHighmark Inc.Freedom Blue PPO Classic(PPO)XHighmark Inc.Freedom Blue PPO Deluxe(PPO)XHighmark Inc.Freedom Blue PPO Select(PPO)XHighmark Inc.Freedom Blue PPO Standard(PPO)XHighmark Inc.Freedom Blue PPO ValueRx(PPO)Independence Blue CrossKeystone 65 Basic Rx (HMO)Independence Blue CrossKeystone 65 Focus Rx (HMOPOS)XIndependence Blue CrossKeystone 65 Preferred MedicalOnly (HMO)XIndependence Blue CrossKeystone 65 Preferred Rx(HMO)XIndependence Blue CrossKeystone 65 Select MedicalOnly (HMO)XIndependence Blue CrossKeystone 65 Select Rx (HMO)Independence Blue CrossKeystone First VIP Choice(HMO D-SNP)XIndependence Blue CrossPersonal Choice 65 MedicalOnly (PPO)XIndependence Blue CrossPersonal Choice 65 Prime RxPPO (PPO)XIndependence Blue CrossPersonal Choice 65 Rx (PPO)XHighmark Inc.Security Blue HMO-POS Basic(HMO-POS)XHighmark Inc.Security Blue HMO-POS Deluxe(HMO-POS)XHighmark Inc.Security Blue HMO-POSStandard (HMO-POS)XHighmark Inc.Security Blue HMO-POSValueRx (HMO-POS)XXPennsylvania(cont.)X14

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameTriple-S AdvantageBasic (HMO)Triple-S AdvantageBrillante (HMO-POS)Triple-S AdvantageContigo Plus (HMO C-SNP)Triple-S AdvantageEnlace (HMO)XTriple-S AdvantageÓptimo (PPO)XTriple-S AdvantageÓptimo Plus (PPO)Triple-S AdvantageMagno (HMO POS)XTriple-S AdvantagePlatino Advance (HMO D-SNP)XTriple-S AdvantagePlatino Blindao (HMO D-SNP)XTriple-S AdvantagePlatino Enlace (HMO D-SNP)XTriple-S AdvantagePlatino Plus (HMO D-SNP)XTriple-S AdvantagePlatino Ultra (HMO D-SNP)Triple-S AdvantageRoyal (HMO)Triple-S AdvantageRoyal Plus (HMO POS)Blue Cross & Blue Shieldof Rhode IslandHealthMate for Medicare (PPO)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Advance(HMO)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Core(HMO)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Plus(HMO)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Standardwith Drugs (HMO)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Extra(HMO-POS)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for MedicarePreferred (HMO-POS)XBlue Cross & Blue Shieldof Rhode IslandBlueCHiP for Medicare Value(HMO-POS)BlueCross BlueShieldof South CarolinaBlueCross Total (PPO)BlueCross BlueShieldof South CarolinaBlueCross Secure (HMO)BlueCross BlueShieldof Tennessee, Inc.BlueAdvantage Diamond (PPO)XXXXPuerto RicoXXXXRhode IslandXSouthCarolinaTennesseeXX15

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameXBlueCross BlueShieldof Tennessee, Inc.BlueAdvantage Emerald (PPO)XBlueCross BlueShieldof Tennessee, Inc.BlueAdvantage Garnet (PPO)XBlueCross BlueShieldof Tennessee, Inc.BlueAdvantage Ruby (PPO)XBlueCross BlueShieldof Tennessee, Inc.BlueAdvantage Sapphire (PPO)XBlueCross BlueShieldof Tennessee, Inc.BlueCare Plus (HMO D-SNP)XBlueCross BlueShieldof Tennessee, Inc.BlueCare Plus Choice (HMO DSNP)XBlueCross BlueShieldof Tennessee, Inc.BlueEssential (HMO C-SNP)Blue Cross andBlue Shield of TexasBlue Cross Medicare AdvantageChoice Premier (Local PPO)Blue Cross andBlue Shield of TexasBlue Cross Advantage Basic(HMO)Blue Cross andBlue Shield of TexasBlue Cross Medicare AdvantageDual Care Plus (HMO D-SNP)Blue Cross andBlue Shield of TexasBlue Cross Medicare AdvantageValue (HMO)XRegence BlueCrossBlueShield of UtahRegence MedAdvantage Basic(PPO)XRegence BlueCrossBlueShield of UtahRegence MedAdvantage RxPrimary (Local PPO)XRegence BlueCrossBlueShield of UtahRegence MedAdvantage RxClassic (Local PPO)XRegence BlueCrossBlueShield of UtahRegence MedAdvantage RxEnhanced (Local PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Care On Site(HMO I-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue COPD (HMO CSNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Diabetes (HMOC-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Dual Advantage(HMO D-SNP)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Extra (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Local (HMO)Tennessee(cont.)XXTexasXXUtahVirginia16

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameXAnthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Prime (HMO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Smart Fit (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Alpine (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Charter Rx (HMO)XPremera Blue CrossPremera Blue Cross MedicareClassic (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Classic Plus (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Core (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Core Plus (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Peak Rx * (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Sound Rx * (HMO)XPremera Blue CrossPremera Blue Cross MedicareAdvantage Total Health (HMO)XRegence BlueShieldRegence Align (HMO)XRegence BlueShieldRegence Align Plus (HMO)XRegence BlueShieldRegence BlueAdvantage HMO(HMO)XRegence BlueShieldRegence BlueAdvantage HMONo Rx(HMO)XRegence BlueShieldRegence BlueAdvantage HMOPlus (HMO)XRegence BlueShieldRegence MedAdvantage Basic(PPO)XRegence BlueShieldRegence MedAdvantage RxClassic (PPO)XRegence BlueShieldRegence MedAdvantage RxEnhanced (PPO)XRegence BlueShieldRegence MedAdvantage RxPrimary (PPO)XHighmark Inc.Freedom Blue PPO Distinct(Local PPO)XHighmark IncFreedom Blue PPO Standard(PPO)Virginia(cont.)WashingtonWest Virginia17

2020 Medicare Advantage Plans Offered by Blue Cross and Blue Shield Companies (continued)StateRegional LocalHMOBlue Cross and BlueHMOPFFS Cost SNPPPOPPOPOSShield Plan SponsorProduct NameXAnthem Blue Crossand Blue ShieldAnthem MediBlue Access (PPO)XAnthem Blue Crossand Blue ShieldAnthem MediBlue Access Core(PPO)Anthem Blue Crossand Blue ShieldAnthem MediBlue DualAdvantage (HMO D-SNP)Anthem Blue Crossand Blue ShieldAnthem MediBlue Plus (HMO)WisconsinXX18

2020 Standalone Prescription Drug Plans by StateOffered by Blue Cross and Blue Shield CompaniesStateBasicEnhancedBlue Cross and Blue Shield Plan SponsorXBlueRx EssentialXAlabamaBlue Cross and Blue Shield of AlabamaXBlue MedicareRx ValueXBlue Cross Blue Shield of ArizonaXBlue MedicareRx EnhancedBlue MedicareRx EssentialXMediPak Rx BasicArkansas Blue Cross and Blue ShieldArkansasXMediPak Rx PremierAnthem Blue Cross MediBlue RxStandardXXAnthem Blue CrossAnthem Blue Cross MediBlue RxPlusAnthem Blue Cross MediBlue RxEnhancedXCaliforniaBlueRx EnhancedBlueRx Enhanced PlusXArizonaProduct NameXBlue Shield Rx Plus (PDP)Blue Shield of CaliforniaXBlue Shield Rx Enhanced (PDP)XJourney Rx StandardMII Life*XJourney Rx ValueAnthem Blue MedicareRxStandardXColoradoXAnthem Blue Cross and Blue ShieldAnthem Blue MedicareRx PlusAnthem Blue MedicareRxEnhancedXXBlue MedicareRx Value PlusThe New England Joint Enterprise**ConnecticutXBlue MedicareRx PremierBlue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.17-XXX-W20

2020 Standalone Prescription Drug Plans by State Offered by Blue Cross and Blue Shield Companies (continued)StateBasicEnhancedBlue Cross and Blue Shield Plan SponsorXProduct NameBlueMedicare Premier Rx (PDP)Florida BlueFloridaXBlueMedicare Complete Rx (PDP)XAnthem MediBlue Rx StandardXGeorgiaAnthem Blue Cross and Blue ShieldXAnthem MediBlue Rx PlusAnthem MediBlue Rx EnhancedXRegence Medicare Script BasicXThe Regence GroupRegence Medicare ScriptEnhancedIdahoXRegence Medicare Script SaverXBlue Cross MedicareRx BasicXIllinoisHealth Care Service CorporationXBlue Cross MedicareRx ValueXAnthem MediBlue Rx StandardXIndianaBlue Cross MedicareRx PlusAnthem Blue Cross and Blue ShieldXAnthem MediBlue Rx PlusAn

Blue Shield 65 Plus Choice Plan (HMO) X Blue Shield of California Blue Shield Inspire (HMO) X Blue Shield of California Blue Shield Medicare (PPO) Blue Shield Promise X Blue Shield of California AdvantageOptimum Plan (HMO) Blue Shield Promise X Blue Shield of California AdvantageOpt

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