Coverage Options - Blue Cross Blue Shield

1 S E N I O R M A R K E T S 2021 medicare Advantage and Prescription Drug Plans Offered by blue Cross and blue Shield Companies UPDATED NOVEMBER 2020 2 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies Key: PPO = Preferred Provider Organization HMO = Health Maintenance Organization PFFS = Private Fee-For-Service Cost = Cost Contract SNP = Special Needs Plan MSA = Medical Savings Account POS HMO with Point-Of-Service Option medicare Advantage plans must include the medicare prescription drug Coverage in at least one of their MA benefit Options (except for private fee for service and cost plans where it is optional). Regional PPOs and SNPs must offer drug Coverage in all of their Options .

2 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name Alabama blue Cross and blue Shield of Alabama blue Advantage Complete (Local PPO) blue Cross and blue Shield of Alabama blue Advantage Premier (Local PPO) Arizona blue Cross and blue Shield of Arizona blue medicare Advantage Classic (HMO) blue Cross and blue Shield of Arizona blue medicare Advantage Plus (HMO) blue Cross and blue Shield of Arizona blue medicare Advantage Standard (HMO) blue Cross and blue Shield of Arizona BlueJourney (PPO) blue Cross and blue Shield of Arizona BluePathway Plan 1 (HMO) blue Cross and blue Shield of Arizona BluePathway Plan 2 (HMO) blue Cross and blue Shield of Arizona BluePathway Plan 3 (HMO) Arkansas Arkansas blue Cross and blue Shield BlueMedicare Premier (HMO) Arkansas blue Cross and blue Shield Health Advantage blue Classic (HMO) Arkansas blue Cross and blue Shield Health Advantage blue Premier (HMO) Arkansas blue Cross and blue Shield BlueMedicare Premier Choice (PPO) Arkansas blue Cross and blue Shield BlueMedicare Saver Choice (PPO) Arkansas blue Cross and blue Shield BlueMedicare Value Choice (PPO) Arkansas blue Cross and blue Shield BlueMedicare Preferred (PFFS)

3 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies 3 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name Arkansas blue Cross and blue Shield BlueMedicare Value (PFFS) California Anthem blue Cross Anthem MediBlue Access (PPO) Anthem blue Cross Anthem MediBlue Care On Site (HMO I-SNP) Anthem blue Cross Anthem MediBlue Care To You (HMO I-SNP) Anthem blue Cross Anthem MediBlue Connect (HMO D-SNP) Anthem blue Cross Anthem MediBlue Connect Plus (HMO) Anthem blue Cross Anthem MediBlue Coordination Plus (HMO) Anthem blue Cross Anthem MediBlue Diabetes (HMO C-SNP) Anthem blue Cross Anthem MediBlue Diabetes Care (HMO C-SNP) Anthem blue Cross Anthem MediBlue Diabetes Care Plus (HMO C-SNP) Anthem blue Cross Anthem MediBlue Dual Access (PPO D-SNP) Anthem blue Cross Anthem MediBlue Dual Advantage (HMO D-SNP) Anthem blue Cross Anthem MediBlue Dual Plus (HMO D-SNP) Anthem blue Cross Anthem MediBlue ESRD Care (HMO C-SNP) Anthem blue Cross Anthem MediBlue ESRD Care (PPO C-SNP) Anthem blue Cross Anthem MediBlue Heart (HMO C-SNP) Anthem blue Cross Anthem MediBlue Heart Care (HMO C-SNP) Anthem blue Cross Anthem MediBlue Lung (HMO C-SNP)

4 Anthem blue Cross Anthem MediBlue Lung Care (HMO C-SNP) Anthem blue Cross Anthem MediBlue Extra (HMO) Anthem blue Cross Anthem MediBlue Plus (HMO) 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies 4 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name Anthem blue Cross Anthem MediBlue Select (HMO) Anthem blue Cross Anthem MediBlue StartSmart Plus (HMO) Anthem blue Cross Anthem MediBlue Value (HMO) Anthem blue Cross Anthem MediBlue Value Plus (HMO) California (cont.) blue Shield of California blue Shield 65 Plus (HMO) blue Shield of California blue Shield 65 Plus Choice Plan (HMO) blue Shield of California blue Shield 65 Plus Plan 2 (HMO) blue Shield of California blue Shield AdvantageOptimum Plan (HMO) blue Shield of California blue Shield AdvantageOptimum Plan 1 (HMO) blue Shield of California blue Shield AdvantageOptimum Plan 2 (HMO) blue Shield of California blue Shield Coordinated Choice Plan (HMO) blue Shield of California blue Shield Inspire (HMO) blue Shield of California blue Shield Inspire (PPO) blue Shield of California blue Shield Vital (HMO)

5 blue Shield of California blue Shield Inspire (HMO D-SNP) blue Shield of California blue Shield Total Dual Plan (HMO D-SNP) Colorado Anthem blue Cross and blue Shield Anthem MediBlue Care On Site (HMO I-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Diabetes Care (HMO C-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Dual Advantage (HMO D-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Plus (HMO) 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies 5 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name Connecticut Anthem blue Cross and blue Shield Anthem MediBlue Care To You (HMO I-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Dual Advantage (HMO D-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Dual Advantage Select (HMO D-SNP) Anthem blue Cross and blue Shield Anthem MediBlue ESRD Care (HMO-POS C-SNP) Anthem blue Cross and blue Shield Anthem MediBlue Extra (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Plus (HMO)

6 Anthem blue Cross and blue Shield Anthem MediBlue Prime (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Select (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Access Select (PPO) Florida Florida (cont.) Florida blue BlueMedicare Classic (HMO) Florida blue BlueMedicare Premier (HMO) Florida blue BlueMedicare Saver (HMO) Florida blue (Capital Health Plan) Capital Health Plan Advantage Plus (HMO) Florida blue (Capital Health Plan) Capital Health Plan Preferred Advantage (HMO) Florida blue (Capital Health Plan) Capital Health Plan Silver Advantage (HMO) Florida blue (Florida Health Care Plans) FCHP medicare Flagler Advantage (HMO) Florida blue (Florida Health Care Plans) FCHP medicare Premier Advantage (HMO) Florida blue (Florida Health Care Plans) FCHP medicare Premier Plus (HMO)

7 Florida blue (Florida Health Care Plans) FCHP medicare Rx (HMO) Florida blue (Florida Health Care Plans) FCHP medicare Rx Savings (HMO) Florida blue (Florida Health Care Plans) FHCP medicare Choice (HMO-POS) Florida blue (Florida Health Care Plans) FHCP medicare Rx Plus (HMO-POS) Florida blue BlueMedicare Select (PPO) Florida blue BlueMedicare Value (PPO) 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies 6 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name Florida blue BlueMedicare Patriot (PPO) Florida blue BlueMedicare Choice (Regional PPO) Florida blue BlueMedicare Complete (HMO D-SNP) Georgia Anthem blue Cross and blue Shield Anthem MediBlue Essential (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Extra (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Plus (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Core (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Access (PPO) Anthem blue Cross and blue Shield Anthem MediBlue Access Basic (PPO) Anthem blue Cross and blue Shield Anthem MediBlue Dual Advantage (HMO D-SNP) Hawaii HMSA HMSA Akamai Advantage Complete (PPO)

8 HMSA HMSA Akamai Advantage Complete Plus (PPO) HMSA HMSA Akamai Advantage Standard (PPO) HMSA HMSA Akamai Advantage Standard Plus (PPO) HMSA HMSA Akamai Advantage Dual Care (PPO D-SNP) The Regence Group Regence | St. Luke's Health Partners Align (HMO) The Regence Group Regence | St. Luke's Health Partners Align Plus (HMO) The Regence Group Regence blue MedAdvantage HMO (HMO) The Regence Group Regence blue MedAdvantage HMO Plus (HMO) The Regence Group Regence | St. Luke's Health Partners Align No Rx (HMO) The Regence Group Regence MedAdvantage + Rx Classic (PPO) The Regence Group Regence MedAdvantage + Rx Enhanced (PPO) The Regence Group Regence MedAdvantage + Rx Primary (PPO) The Regence Group Regence Valiance (PPO) blue Cross of Idaho True blue Rx (HMO) Idaho 2021 medicare Advantage Plans Offered by blue Cross and blue Shield Companies 7 State Regional PPO Local PPO HMO HMO- POS PFFS Cost SNP blue Cross and blue Shield Plan Sponsor Product Name blue Cross of Idaho True blue Rx | St.

9 Luke's Health Partners (HMO) blue Cross of Idaho True blue Rx Essentials (HMO) blue Cross of Idaho True blue Rx Gem (HMO) blue Cross of Idaho True blue Rx Option I (HMO) blue Cross of Idaho True blue Rx Option II (HMO) blue Cross of Idaho True blue Rx Preferred (HMO) blue Cross of Idaho True blue no Rx (HMO) blue Cross of Idaho True blue Special Needs Plan (HMO D-SNP) Illinois blue Cross and blue Shield of Illinois blue Cross medicare Advantage Basic (HMO) blue Cross and blue Shield of Illinois blue Cross medicare Advantage Basic Plus (HMO-POS) blue Cross and blue Shield of Illinois blue Cross medicare Advantage Premier Plus (HMO-POS) blue Cross and blue Shield of Illinois blue medicare Advocate Health (HMO) blue Cross and blue Shield of Illinois blue Cross medicare Advantage Choice Plus (PPO) blue Cross and blue Shield of Illinois blue Cross medicare Advantage Choice Premier (PPO) blue Cross and blue Shield of Illinois blue Cross medicare Advantage Classic (PPO) Indiana Anthem blue Cross and blue Shield Anthem MediBlue Extra (HMO) Anthem blue Cross and blue Shield Anthem MediBlue Plus (HMO) Anthem blue Cross and blue Shield Anthem MediB