BlueCross BlueShield of Texas
Bronze Health Plans 2019
When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care.
The Best Bronze Plan
This HSA Eligible plan has a lower deductible and OOP max, meaning you can save for the expenses you do incur and still have a higher level of protection in the event of unexpected health costs. The Blue Advantage Plus plans also offer some out of network benefits even though this is still technically an HMO, so if your doctor isn’t in any individual plan network for 2019, this is likely your best option.
|Plan Name||Blue Advantage Bronze HMO 204 (Two $40 PCP)||Blue Advantage Bronze 201||Blue Advantage Plus Bronze 303||Blue Advantage Plus Bronze 305|
|Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.||$6,000||$3,150||$3,900||$15,000|
|CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max||50%||40%||40%||50%|
|Out-of-Pocket MaximumAn out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services (includes deductible)||$7,900||$6,650||$6,650||$7,900|
|Primary Care Office Visit||$40 (First two visits then 50%)||40%||40%||40%|
|Specialist Office Visit||50%||40%||$40||50%|
|Mental Illness Treatment and Substance Abuse Rehab Office Visit||50%||40%||$30||40%|
|Emergency Room||$950 per occurrence copay, then 50%||$950 per occurrence copay, then 40%||$950 per occurrence copay, then 40%||$950 per occurrence copay, then 50%|
|Urgent Care||$60 (Deductible does not apply)||40%||$60 (Deductible does not apply)||50%|
|Inpatient Hospital Service||$850 per occurrence copay, then 50%||$850 per occurrence copay, then 40%||$850 per occurrence copay, then 40%||$850 per occurrence copay, then 50%|
|Outpatient Surgery||50%||$600 per occurrence copay, then 30%||$600 per occurrence copay, then 30%||$600 per occurrence copay, then 40%|
|Outpatient X-Rays and Diagnostic Imaging||40%||30%||50%||40%|
|Outpatient Imaging (CT/PET Scans/MRIs)||40%||30%||50%||40%|
|Network||Blue Advantage HMO|
|Outpatient Prescription Drugs – Preferred Pharmacy||$15/$25/$45||30%||$10/$20/$30||30%|
|Outpatient Prescription Drugs – Non-Preferred Pharmacy||$25/$35/$75||35%||$15/$30/$45||30%|
|Prescription Drug Utilization Benefit Management Programs||Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSTX and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.|
*Percentages represent amount of coinsurance
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