100 things to know about Blue Cross Blue Shield

One in 3 Americans receives health coverage through one of 34 independent Blue Cross Blue Shield companies. 

Here are 100 things to know about BCBS' corporate structure, history and more. 

This story was first published in April 2023 and updated in April 2024. 

Structure 

1. The Blue Cross Blue Shield Association is made up of 33 independent BCBS companies. BCBS affiliates are locally owned and operated. 
2. BCBS affiliates operate in all 50 states, Washington, D.C., and Puerto Rico. 
3. As of 2023, BCBS companies had nearly 115 million members, accounting for 1 in 3 Americans. 
4. BCBS companies use different operating models. Some are nonprofits, or mutual companies owned by their members. Others operate as for-profit. 
5. Elevance Health, which operates 14 BCBS affiliates, is publicly traded.
6. Kim Keck became president and CEO of the BCBS Association in 2021. Prior to leading the association, she was president of BCBS Rhode Island. 
7. The BCBSA is headquartered in Chicago, with offices in Washington, D.C. 
8. The BCBSA has around 1,000 employees. 
9. BCBS affiliates employ more than 150,000 people nationwide, making it one of the top 20 employers in the United States. 
   
   

History 

10. The first hospital prepayment plan was founded in 1929 by Justin Ford Kimball, a vice president at Baylor School of Medicine. Mr. Kimball created a system for Dallas public school teachers to pay 50 cents a month for up to 21 days of hospitalization. 
11. The Baylor prepaid plan evolved into the first Blue Cross plan, and the model was picked up by other hospitals. 
12. The first Blue Cross plan to include a network of multiple hospitals was created in New Jersey in 1931. 
13. BlueCross BlueShield of Minnesota, founded in 1933, claims to be the first to use the Blue Cross name. 
14. Blue Shield plans started separately from Blue Cross plans, which only dealt with hospital services. 
15. The first Blue Shield plans evolved from employer-organized plans to treat loggers and miners in the Pacific Northwest. 
16. Blue Cross and Blue Shield plans grew through the 1930s and '40s, and the two companies began to merge. 
17. The Blue Cross Association and the Blue Shield Association began administering the Federal Health Employee Benefit contract in 1959. It is the largest single health plan group in the world. 
18. The Blue Cross Association and Blue Shield Association merged in 1982, creating the current BCBSA. 
19. All affiliates were required to operate as nonprofits until 1994, when the association allowed members to convert to for-profit status. 
    
    

Membership by the numbers

20. According to the BCBSA, as of 2023, BCBS companies had network agreements with 1.8 million physicians and hospitals across the country. 
21. BCBS companies pay about $600 billion in claims annually. 
22. BCBS companies contract with 79 of the Fortune 100 companies. 
23. In addition to group commercial plans, BCBS companies offer Medicare Advantage, Medicaid managed care, Medigap, Medicare Part D and individual exchange plans. 
24. In 2023, the BCBS companies had 5.8 million members in the Federal Employees Health Benefits Program,
25. 18 million members through labor unions, 
26. 6.8 million members through small business plans,
27. 7.4 million individual market members,
28. 13 million Medicaid members,
29. 4.6 million Medicare Advantage members,
30. 5.3 million Medicare Part D members, and
31. 4 million Medicare supplement, or Medigap, members. 
32. More than 81 million BCBS members have access to value-based care from 654,000 providers, as of 2023. 
33. Nonprofit Blue Cross Blue Shield plans accounted for 8 percent of the total Medicare Advantage market in 2024, according to a report from Chartis. 
    
    

BCBS companies to know 

34. Each state BCBS affiliate has its own CEO: Here are the leaders in every state. 
35. Health Care Service Corp. owns BCBS affiliates in Illinois, Texas, New Mexico, Oklahoma and Montana. It is the largest member-owned insurer in the United States and covered nearly 18 million members in 2022. 
36. Elevance Health operates 14 state BCBS affiliates under the Anthem Blue Cross Blue Shield brand. Anthem offers plans in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin, California and New York. Elevance Health had 31.4 million commercial members in 2022. 
37. Highmark operates BCBS affiliates in Pennsylvania, Delaware, New York and West Virginia. Highmark Health Plan is part of parent organization Highmark Health, which also owns Pittsburgh-based Allegheny Health Network. Highmark Health Plan has around 7 million members. 
38. CareFirst Blue Cross Blue Shield offers health plans in Maryland, Washington, D.C., and parts of Virginia. The payer has 3.5 million members. 
39. Premera BlueCross offers plans in Washington, Oregon and Alaska. Premera has over 2 million members. 
40. Cambia Health Solutions operates Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueShield of Washington and Regence BlueShield of Utah. As of 2022, Cambia affiliates had 3.4 million members. 
41. Wellmark Blue Cross Blue Shield offers plans in Iowa and South Dakota. The company has more than 2 million members. 
42. Blue Cross Blue Shield of Alabama serves 2.8 million members across the state. 
43. Blue Shield of California, a nonprofit payer, has 4.8 million members in the Golden State. 
44. Florida Blue serves more than 5 million healthcare members. 
45. Blue Cross Blue Shield of Massachusetts, headquartered in Boston, has 3 million members. 
46. Blue Cross Blue Shield of Kansas City has nearly 1 million members in 30 Northwest Missouri counties and two Kansas counties. 
47. Blue Cross Blue Shield of Michigan has 3.9 million members in Michigan and 1.3 million members in other states. 
48. Blue Cross Blue Shield of North Dakota has 310,000 members. 
49. Blue Cross Blue Shield of South Carolina is the largest commercial insurer in the state. 
50. BlueCross BlueShield of Tennessee has more than 3.5 million members. The company has received several "Best Place to Work" awards. 
51. Capital BlueCross serves 21 counties in Central Pennsylvania. It is the largest commercial insurer in the state. 
52. The Hawaii Medical Services Association serves more than half of the state's population. 
53. Horizon Blue Cross Blue Shield of New Jersey has more than 3.8 million members. 
54. Independence Blue Cross operates in the Philadelphia region, serving 8 million people nationwide through its affiliates. 
55. Blue Cross Blue Shield of Arizona has more than 2 million customers. 
56. Blue Cross and Blue Shield of Arkansas is the second largest commercial insurer in the state. 
57. Blue Cross of Idaho has over 600,000 members. It is separate from Regence BlueShield of Idaho. 
58. Blue Cross Blue and Shield of Kansas serves 932,000 members. 
59. Blue Cross and Blue Shield of Louisiana serves 1.9 million members. The company was due to be acquired by Elevance Health, but the deal has stalled. 
60. Blue Cross Blue Shield of Minnesota has 2.5 million members.
61. Blue Cross Blue Shield of Mississippi is the second-largest commercial insurer in the state.  
62. Blue Cross and Blue Shield of Nebraska is the second-largest commercial insurer in the state and the second largest Medicare Advantage provider. 
63. Excellus BlueCross BlueShield has 1.5 million members in upstate New York. 
64. Blue Cross and Blue Shield of North Carolina has 4.3 million members. 
65. Blue Cross and Blue Shield of Vermont has 250,000 members. 
66. Blue Cross Blue Shield of Wyoming had over 138,000 members as of 2020. 
    
    

Prime Therapeutics and prescription drugs

67. Nineteen Blue Cross Blue Shield plans own Prime Therapeutics, a pharmaceutical benefit manager. 
68. BCBS Nebraska and BCBS Minnesota created the PBM in 1998, and more plans joined as co-owners. Health Care Service Corp. joined as an equity owner in 2004. 
69. In December 2022, Prime Therapeutics acquired MagellanRx from Centene in a $1.5 billion deal. 
70. In January 2023, the BCBSA and several Blues companies formed Synergie Medication Collective, a contracting organization aimed at bringing down the price of specialty drugs. 
    
    

Workforce

71. Several BCBS companies are embracing remote and hybrid work models and cutting back on office space. 
72. Elevance Health is among the employers offering the most remote jobs in 2024. 
73. BlueCross BlueShield of Tennessee committed to permanent remote work for most of its 6,300 employees in September 2022. 
74. Several BCBS companies were named among Forbes' top midsize and large employers in 2024, including BCBS Tennessee, BCBS Michigan, Health Care Service Corp., Excellus BCBS, BCBS North Carolina, Arkansas BCBS, BCBS Alabama, Horizon BCBS, Premera Blue Cross, Wellmark BCBS, BCBS Nebraska, BCBS Minnesota and BCBS Kansas City. 
75. Elevance Health and Health Care Service Corp. were named among Fortune's most innovative companies in 2024. 
76. Many BCBS companies are investing in workforce development programs, particularly in cybersecurity and information technology. 
77. The BCBSA is partnering with Cyversity, an organization that works to increase the number of women and underrepresented minorities in cybersecurity, to create a mentorship and training program for future cybersecurity professionals. 
78.  BlueCross BlueShield of Tennessee's BlueSky Institute, a college degree and training program aimed at fostering IT talent for the payer, has achieved a 100 percent retention rate in its first year. 
79. Blue Cross and Blue Shield of Nebraska plans to grow its new program that trains students to take on IT roles at the company. 
80. Blue Cross Blue Shield of North Carolina is sponsoring an insurance pre-licensing academy as part of the payer's efforts to create a more diverse workforce in the insurance industry. 
81. Wellmark Blue Cross Blue Shield partnered with the University of Iowa on a risk management and insurance degree program.
    
    

Antitrust actions

82. The BCBSA and individual BCBS companies have faced legal challenges alleging the companies limit competition. 
83. In August 2022, a federal judge approved a final $2.67 billion settlement agreement with BCBS companies after a decadelong court battle. 
84. As part of the settlement, insurers must drop a BCBS Association rule that requires two-thirds of national net revenues from health plans and related services to come from Blue-branded products. 
85. The settlement also struck down a rule requiring large employers to work with the Blue insurer that offers coverage where the employer is located so that BCBS companies could avoid competing with one another for large contracts.
86. The settlement is being appealed on behalf of six objectors, including Home Depot. 
87. In December 2022, a federal judge dismissed a lawsuit against BCBS Michigan from the Anesthesia Associates of Ann Arbor over an alleged decadeslong scheme to control the state's anesthesia market.
88. In April, Home Depot asked the Supreme Court to consider its challenge to the $2.67 billion settlement. 
    
    

Recent news to note

Here are some of the notable BCBS company developments Becker's has reported in the last year. 

89. In April, a federal judge ruled that the Blue Cross Blue Shield Association and BCBS Michigan must face a lawsuit from Ford Motor Co. over an alleged antitrust conspiracy among Blues plans to fix healthcare prices, thereby overcharging Ford for health insurance provided to its employees.
90. Blue Cross Blue Shield of Louisiana put plans to be acquired by Elevance Health on pause in February after the proposed sale faced scrutiny from physicians and state officials.
91. HCSC will acquire Cigna's Medicare Advantage business in a $3.3 billion deal. The sale will nearly quadruple HCSC's Medicare Advantage membership. 
92. Blue Cross and Blue Shield of North Carolina purchased more than 50 North Carolina locations of FastMed, a national chain of urgent care clinics.
93. Blue Cross and Blue Shield of Minnesota incorrectly imposed a state provider tax on self-funded health plan customers and violated its fiduciary duties under the Employee Retirement Income Security Act of 1974, the Labor Department alleged in a lawsuit filed in January. 
94. The BCSBA allowed federal employees' sensitive medical information to be obtained by third-party technology companies, including TikTok, plaintiffs alleged in a lawsuit filed in November 2023 in a federal court in Chicago.
95. Blue Cross Blue Shield of Michigan reached a deal with 1,000 employees after an 11-week strike. 
96. Vermont regulators approved Blue Cross Blue Shield of Vermont becoming a subsidiary of Blue Cross Blue Shield of Michigan.
97. In January 2023, North Carolina awarded Aetna its $17.5 billion state employee health plan contract, previously held by BCBS North Carolina for nearly 40 years. The deal is still being challenged in court. 
98. Blue Shield of California chose Mark Cuban Cost Plus Drug Co. and Amazon Pharmacy as its preferred pharmacy partners, limiting its yearslong partnership with CVS Caremark. The insurer said the new deal will result in annual savings of $500 million. 
99. North Carolina Gov. Roy Cooper approved Blue Cross Blue Shield of North Carolina to reorganize as a nonprofit holding company. The legislation allowed Blue Cross NC to create a new deregulated holding company to which it can move assets. This will allow the parent holding company to invest and acquire other healthcare companies with less oversight from the state insurance department. 
100. In June 2023, a court blocked a challenge from a nonprofit and a nurses union seeking to prevent Horizon Blue Cross Blue Shield in New Jersey from reorganizing as a nonprofit mutual holding company.