Quick answer
Blue Cross Blue Shield isn’t a single company. It’s a system of 33 independent, locally run insurers that together cover about 118 million people nationwide, and each one sets its own Marketplace prices, plans and 2027 changes. That means there’s no single answer to whether BCBS is good; you have to look at the specific Blue plan available where you live. The Blues have also settled a long-running antitrust lawsuit over claims that they divided up territory, with payouts still going out in 2026.
Key takeaways
- The Blue Cross Blue Shield Association oversees 33 independent, community-based companies covering about 118 million members in all 50 states, Washington, D.C. and Puerto Rico.
- Because each Blue company files its own rates, 2027 changes run from an approved 6.7% for Regence BlueShield in Washington to an approved 33.4% for Keystone Health Plan Central in Pennsylvania.
- Elevance Health, the largest investor-owned Blue licensee, operated Anthem-branded plans in 18 states for 2026 and projected about 1.2 million individual-Marketplace members by mid-2026.
- A 2020 antitrust settlement over alleged territory-division practices among Blue plans totals $2.67 billion to individuals and employers, with distributions that began in May 2026, plus a separate $2.8 billion settlement with health care providers.
- Financial-strength ratings vary by Blue company. Health Care Service Corporation, which runs the Blue plans in Illinois, Texas, Oklahoma, New Mexico and Montana, was rated A+ (Superior) by AM Best in its October 2024 review.
On this page
What “Blue Cross Blue Shield” actually is
The name Blue Cross Blue Shield covers 33 separate, independently run insurance companies, each licensed by the Blue Cross Blue Shield Association to use the Blue name and logo in its own territory. Some are nonprofit mutuals, like Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield of Illinois, Texas, Oklahoma, New Mexico and Montana. Others are part of Elevance Health (NYSE: ELV), a publicly traded company that runs Anthem-branded Blue plans in multiple states. A third group, like Highmark or CareFirst, are their own regional nonprofits. Together the system covers about 118 million members and contracts with more than 2 million doctors and hospitals, but no single leadership team sets one nationwide price or plan design.
Why BCBS quality and prices depend on your state
Because each Blue company is a separate insurer, its Marketplace participation, plan types and 2027 rate changes are set independently. Elevance’s Anthem-branded plans sold in 18 states in 2026 and newly entered Washington that year; the company projected roughly 1.2 million individual-Marketplace members by mid-2026, alongside a broader shift among its members toward bronze-tier plans after enhanced premium tax credits expired at the start of 2026. HCSC’s Blue Cross and Blue Shield of Illinois is one of seven insurers continuing to sell there for 2027. In Georgia, Anthem Blue Cross and Blue Shield is one of the insurers staying in Georgia Access for 2027 even as Cigna and UnitedHealthcare leave. None of that tells you what a Blue plan looks like in a state not listed here, so see how much Blue Cross Blue Shield costs per month for more on pricing, and see why health insurance rates differ between insurance companies for the underlying reasons Blue plans aren’t priced the same everywhere.
2027 rate changes: a sample across Blue plans
Rate filings below show how much these can vary even within the same company family.
| Blue plan (state) | 2027 rate change | Status |
|---|---|---|
| Regence BlueShield (Washington) | +6.7% | Approved (lowest of WA’s 12 insurers) |
| Horizon BCBS (New Jersey) | +15.4% | Proposed (lowest of NJ’s 5 insurers) |
| Highmark Inc (Pennsylvania) | +14.5% | Approved |
| Keystone Health Plan Central (Pennsylvania) | +33.4% | Approved |
| Blue Cross and Blue Shield of Illinois (HCSC) | +14.9% | Proposed |
If you’re comparing a Blue plan against other insurers, look at what’s different between bronze, silver, gold and platinum plans as well as price, and check how to lower your Marketplace premium if the sticker price is more than you expected.
Financial strength and how to check complaints
Ratings also differ by company. AM Best affirmed HCSC’s Financial Strength Rating of A+ (Superior) with a stable outlook in October 2024, and it publishes ratings for other Blue companies at ambest.com. On complaints, KFF’s 2024 analysis of ACA claims denials names Blue Cross Blue Shield of Arizona for one detail: 97% of that plan’s denials were coded as prior-authorization or referral issues, which describes the type of denial, not an overall denial rate. For your own state’s Blue plan, look up its star rating on HealthCare.gov while you shop and check its complaint history through the NAIC’s Consumer Insurance Search.
The antitrust settlement, explained
A long-running antitrust case, consolidated in 2013 as In re Blue Cross Blue Shield Antitrust Litigation, alleged that Blue-branded plans had agreed not to compete with each other in each other’s territories and to limit how much non-Blue business a licensee could do, roughly covering 2008 through 2020. The case settled rather than went to a verdict: a $2.67 billion payment to individuals and employers who had BCBS coverage during that period was reached in October 2020, approved by the court in 2022, upheld on appeal in 2023, and left in place when the Supreme Court declined to hear a further appeal in 2024; payments to class members began on May 11, 2026. A related $2.8 billion settlement with health care providers received preliminary court approval in December 2024. As part of the settlement, BCBS dropped the rule requiring licensees to earn two-thirds of their revenue from Blue-branded products and the rule limiting large multi-state employers to their headquarters-region Blue plan, and added an option for large employers to solicit a second, competing bid from another Blue plan. Separately, in February 2026 physician-staffing groups filed new antitrust claims alleging continuing market-allocation and price-fixing conduct; these are new, unproven allegations and a different case from the settled 2008-2020 litigation.
Pros and cons
Pros
- Broad reach: some Blue-licensed plan is sold in every state, D.C. and Puerto Rico, so it’s almost always one of your options.
- Large local provider networks in most regions, since Blue companies have operated in their territories for decades.
- In many states the local Blue plan is the biggest Marketplace insurer, as in Alabama and South Carolina, so its network tends to be well established.
Cons
- No single national brand standard: your experience depends entirely on which of the 33 companies serves your state.
- The settled antitrust litigation and new 2026 claims mean the system has faced repeated competition-law scrutiny.
- Some Blue companies filed among the biggest 2027 increases in their states, like Keystone Health Plan Central’s 33.4% in Pennsylvania.
Other insurer guides: Ambetter, Cigna, Kaiser Permanente, Molina, Oscar and UnitedHealthcare. See also the best health insurance companies.
See 2027 Blue Cross Blue Shield plans and prices for your area: compare quotes by ZIP code.
Frequently asked questions
Is Blue Cross Blue Shield one company?
No. It’s 33 independent, locally operated companies licensed to use the Blue Cross Blue Shield name, each setting its own plans, prices and provider networks in its own territory.
Is Blue Cross Blue Shield good?
It depends on which of the 33 Blue companies serves your state. Check your specific plan’s star rating on HealthCare.gov, its network, and its 2027 rate change rather than judging the brand as a whole.
What was the Blue Cross Blue Shield lawsuit about?
A long-running antitrust case alleged Blue-branded plans agreed not to compete in each other’s territories from roughly 2008 to 2020. It settled for $2.67 billion to individuals and employers and a separate $2.8 billion to providers; the allegations were not proven in court.
Why do Blue Cross Blue Shield rates vary so much by state?
Because each Blue company is a separate insurer with its own costs, provider contracts and regulatory filings. A 2027 increase can be under 7% in one state’s Blue plan and over 30% in another company’s plan in a different state.
Sources
- BCBS Association: About us, the Blue Cross Blue Shield system
- Becker’s Payer Issues: The $2.67B BCBS antitrust settlement payout, 6 things to know
- AHA News: Court issues preliminary approval of $2.8 billion Blue Cross Blue Shield provider settlement
- InsuranceNewsNet (AM Best): AM Best affirms credit ratings of Health Care Service Corporation
- Fierce Healthcare: Elevance Health raises 2026 outlook as it posts $1.8B Q1 profit
- KFF: Claims denials and appeals in ACA Marketplace plans in 2024
This article is general information, not insurance or legal advice. Plan availability, pricing and legal matters vary by the specific Blue Cross Blue Shield company in your state; the 2026 antitrust claims described are unproven allegations. Last reviewed September 2026.