When it comes to health insurance in Michigan, Priority Health and Blue Cross Blue Shield of Michigan (BCBSM) are two of the biggest players. Both companies offer group and individual health plans, but there are some key differences between them.
This comprehensive guide examines Priority Health and BCBSM’s provider networks, plan options, costs, customer service, and more to help you determine which may be a better fit for your needs.
A Brief Comparison Table
| Category | Priority Health | Blue Cross Blue Shield of Michigan |
| Headquarters | Grand Rapids, MI | Detroit, MI |
| Year Founded | 1986 | 1939 |
| Number of Members | 1 million | 4.5 million |
| Ownership | Not-for-profit, owned by Spectrum Health | Nonprofit mutual insurer |
| Provider Network | 44,000 doctors, 100 hospitals primarily in western and central Michigan | 90,000+ doctors, all major MI hospitals |
| Plan Types | HMO, PPO, EPO, POS, Medicare Advantage | PPO, HMO, EPO, PPO ESA, Medicare Advantage, Medicare Supplement |
| Average Monthly Premiums | PPO: $380 individual<br>HMO: $340 individual | PPO: $430 individual<br>HMO: $390 individual |
| Prescription Drug Coverage | Varies by plan | Varies by plan |
| Customer Service Reputation | Highly rated, <30 sec average phone wait | Mixed reviews, longer average waits |
| Claims Processing Time | 90% in under 30 days | Average 14 days |
Overview Of Priority Health And BCBSM
Priority Health is a Michigan-based health insurance company founded in 1986. It offers HMO, PPO, Medicare, and Medicaid plans. Priority Health has about 1 million members and partners with Michigan’s Spectrum Health system.
BCBSM is a large regional Blue Cross Blue Shield affiliate founded in 1939. It offers PPO, HMO, POS, Medicare Advantage, and other plans. BCBSM is the largest health insurer in Michigan with over 4.5 million members. It’s an independent licensee of the national Blue Cross Blue Shield Association.
Both companies have extensive doctor and facility networks in Michigan. But there are some network differences discussed below.
Also Read: Differences Between Humana And Florida Blue.
Provider Network Coverage
A provider network consists of the doctors, hospitals, clinics, and pharmacies covered under an insurance plan. Networks vary between Priority Health and BCBSM plans.
Priority Health’s Network
Priority Health has a provider network of over 44,000 doctors and 100 hospitals in Michigan. Its network is more concentrated in western and central Michigan where its Spectrum Health partnership operates.
Some key providers in Priority’s network include:
- Spectrum Health – A major integrated health system and Priority’s largest partner.
- Michigan Medicine – The health system affiliated with University of Michigan.
- Mercy Health – Operates hospitals and medical centers primarily in western Michigan.
- Bronson Healthcare – Another system in southwest Michigan.
- Sparrow Health System – A Lansing-based network.
- Henry Ford Health System – A major southeast Michigan health provider.
BCBSM’s Network
BCBSM has an expansive provider network of over 90,000 providers throughout Michigan. Its Blue Care Network HMO also includes about 170,000 providers nationwide through the BlueCard program.
Notable providers in BCBSM’s state network include:
- Beaumont Health – Michigan’s largest health system.
- Henry Ford Health System
- Michigan Medicine
- Ascension – Operates hospitals across Michigan.
- Genesys – A health system in Flint/Grand Blanc area.
So in summary, BCBSM has a larger in-state network, while Priority Health’s network focuses more on west/central Michigan. Those localized to Grand Rapids may find Priority’s coverage more than sufficient.
Plan Options
Both insurers offer extensive plan choices for individuals and employer groups. Here’s an overview of the major plan types available:
Priority Health Plan Types
- HMO – Requires a primary care physician (PCP) referral to see specialists. Must use network providers. Lower premiums than PPOs.
- PPO – See any doctor without referrals. Out-of-network coverage but higher costs. Higher premiums than HMO.
- EPO – Like an HMO but no out-of-network coverage. Lower premiums than PPO.
- POS – Combines HMO and PPO features. See in-network doctors without referrals.
- Medicare Advantage – Medicare plans administered through private insurers.
BCBSM Plan Types
- PPO
- HMO/HMO-POS – Blue Care Network plans
- BCN Advantage – Medicare Advantage HMO plans
- EPO
- PPO ESA – Plans compatible with health savings accounts
- Medicare Supplement – Supplemental coverage to original Medicare.
Both carriers also offer extensive selections of group health plans for employers.
When it comes to plan flexibility and options, BCBSM may have an edge with its different types of PPO and HMO offerings. But Priority’s plans still cover the main bases.
Costs And Premiums
Health insurance premiums and out-of-pocket costs can vary significantly between Priority Health and BCBSM plans. On average, Priority Health premiums tend to be lower for comparable plan types:
Average Monthly Premiums:
- Priority Health PPO: $380 per individual
- BCBSM PPO: $430 per individual
- Priority Health HMO: $340 per individual
- BCBSM HMO: $390 per individual
However, Priority Health’s network is smaller so plans may cover fewer providers and facilities. Make sure your preferred doctors are in-network with Priority Health if considering this insurer.
With both companies, premiums and cost sharing will depend on factors like:
- Plan type
- Deductible and out-of-pocket maximum
- Health and age
- Zip code
Getting quotes from both can determine which offers the optimal balance of premiums and network coverage for your situation. Those who utilize healthcare minimally and prioritize low premiums may find Priority Health fits their needs at a lower price point.
Also watch the video!
Customer Service Reputation
Customer service and claims processing are also important factors when evaluating insurers.
Priority Health has a strong customer service reputation with both members and doctors. It offers extensive online resources in its member portal. Priority states its average wait time for customer service is under 30 seconds. Members can also schedule in-person appointments at Priority’s Michigan offices.
Priority Health says it processes 90% of claims in under 30 days. Doctors have reported positive experiences working with Priority as well.
BCBSM also offers 24/7 customer support and an online member account. However, reviews indicate BCBSM’s customer service wait times may be longer than Priority’s.
BCBSM says it processes claims within an average of 14 days. It provides real-time claim updates to members. But some complaints note issues with claims denials and delays.
So, Priority Health appears to have an edge when it comes to service quality based on reviews. But both carriers offer varied ways to get assistance and check coverage details online.
Also Read: Choose Between Amerigroup And Superior Health Plan.
Frequently Asked Questions (FAQ)
Priority Health is owned by Spectrum Health, which is a Michigan-based not-for-profit integrated health system. Although part of Spectrum, Priority Health operates as its own separate insurance company.
Some major competitors of BCBSM in the Michigan health insurance market include:
Priority Health, Aetna, Cigna, Humana, UnitedHealthcare, McLaren Health Plan, Meridian.
As the largest insurer, BCBSM has a very high market share. But it still faces competition from sizable national carriers and local companies like Priority Health.
BCBSM is generally considered good health insurance and offers robust plan options. Benefits of BCBSM coverage include:
Large provider network in Michigan
Range of plan types like PPOs and HMOs
National coverage through Blue Cross Blue Shield partners
Strong financial ratings
Extensive selection of group health plans
Drawbacks compared to other insurers can include higher premiums for some plans and mixed customer service reviews. But overall BCBSM offers comprehensive medical insurance to fit many needs.
No, Priority Health and Cigna are separate health insurance companies. Priority Health is based in Michigan and is not affiliated with Cigna. Cigna is a large national insurer that offers plans in many states.
Both insurers have their own provider networks and plan offerings. Priority Health is focused in Michigan while Cigna has a broader reach across the U.S.
Also Read: Comparison Between Amerigroup And UnitedHealthcare.
The Verdict
When choosing between Priority Health and BCBSM consider:
- Coverage area – Ensure your locations and doctors are in-network. Compare provider directories.
- Cost – Get quotes for your situation. Priority may offer savings if its coverage works for you.
- Plan choice – Shop plans to fit preferences on copays, deductibles, prescription drugs etc.
- Service – Go with the carrier that offers access and responsiveness you prefer.
- Company size – Larger insurers like BCBSM may have more resources. But Priority still has extensive capabilities.
Either company can be a solid option for coverage. Weigh your specific healthcare needs and financial considerations to decide if Priority Health or BCBSM is a better fit.
