Blue Cross and Blue Shield of Kansas City Exiting Medicare Advantage Marketplace
Key Points – Blue Cross and Blue Shield of Kansas City Exiting Medicare Advantage Marketplace
- Blue Cross and Blue Shield of Kansas City Will Leave the Medicare Advantage Marketplace in 2025
- What Went into Blue KC’s Decision
- How Will This Impact People Who Have Blue KC Medicare Advantage Plans?
- 3-Minute Read | 17-Minute Watch
Do You Have a Medicare Advantage Plan through Blue Cross and Blue Shield of Kansas City?
There are some changes that we want to make sure that you’re aware of if you have a Blue Cross and Blue Shield of Kansas City (Blue KC) Medicare Advantage plan. Blue Cross and Blue Shield of Kansas City’s Medicare Advantage Plan will cease to exist after December 31, 2024.1 Modern Wealth Management Director Dean Barber was joined by Medicare Consultant Tom Allen to break down the implications of the changes for those who have this plan.
You will need a new Medicare Advantage Plan in 2025 if you’ve had one via Blue KC. If you have a Blue KC Medicare Supplement Plan, your coverage will continue after 2024.
We also want to be clear that this pertains to Blue Cross and Blue Shield of Kansas City, not Blue Cross and Blue Shield of Kansas or Anthem Blue Cross and Blue Shield Missouri. Blue KC covers these 32 counties in the KC metro area and Northwest Missouri.
Why Is Blue Cross and Blue Shield of Kansas City Leaving the Marketplace?
There were several factors that went into Blue KC’s decision to pull out of the Marketplace. Tom attests that Blue Cross and Blue Shield of Kansas City’s Medicare Advantage product was extremely popular. However, he believes there were three things that led to its demise.
- They’re regional
- There’s a new cap on prescription copays
- The star rating by the Centers for Medicare & Medicaid Services
Let’s dive into each of those points. Medicare Advantage Plans covered about 3% of their book of business. The fact that Blue KC only covers 32 counties and isn’t a national insurance company means that the options they offer are limited.
Tom believes another component of this decision stems from the Inflation Reduction Act. One of the Inflation Reduction Act’s provisions that will take effect in 2025 is that the out-of-pocket maximum for prescription copays is capped at $2,000 for people with Medicare Advantage Plans.2 It was $7,400 in 2023 and is $3,300 in 2024.
Medicare Advantage programs are also given a star rating by CMS. Tom shares that CMS plans to reduce the star ratings on many plans, which would reduce the amount of money they would receive.
“They want to reduce the amount of money that the insurance company gets, reduce the maximum out-of-pocket expense for the individual, and expect the insurance companies to just eat it. It doesn’t make sense.” – Dean Barber
What’s Next for People with Blue KC Medicare Advantage Plans?
Blue KC sent letters to everyone who is Medicare Advantage insured in late June about the decision to leave the Marketplace. October 15 is the beginning of the Annual Open Enrollment Period. That’s when people who are Blue Cross and Blue Shield of Kansas City Medicare Advantage insured can start looking at programs and carriers on the Marketplace.
“Coincidentally, there’s a new Medicare Advantage carrier coming to Kansas City in 2025. I can’t give details as far as benefits and so forth because they haven’t been released, but they’re a large East coast carrier that’s expanding to Kansas City. That new option gives me comfort, along with the standard group of carriers we’ve been able to choose from in the past.” – Tom Allen
Those who are Blue KC Medicare Advantage insured can expect another letter that explains their options in early October. That letter will include a certificate of credible coverage, which can be provided to their new carrier with no underwriting.
The Annual Open Enrollment Period is normally October 15-December 7, but there are special considerations when a carrier ceases operation. If that’s the case for you, the end date will be December 31. By December 31, you’ll need to have another Medicare Advantage product in place or go back to a Medicare Supplement Plan without underwriting. If you don’t select either of those options, you’ll convert back to Traditional Medicare without a prescription drug card.
Have Any Questions?
If you have any questions about how Blue KC leaving the Medicare Advantage Marketplace will impact you, you can contact Tom at tom@tomalleninsurance.com or start a conversation with our team below. We want to make sure that you have health insurance coverage that meets your specific needs.
Other Sources
[1] https://www.bluekc.com/press-release/blue-kc-to-exit-medicare-advantage-market-in-2025/
[2] https://www.cms.gov/inflation-reduction-act-and-medicare
[3] https://www.kff.org/medicare/issue-brief/medicare-advantage-2024-spotlight-first-look/
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