BlueCross BlueShield of Texas

Silver Health Plans 2019

BCBSTX Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up.  Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.

Recommended Plan

The Best Silver 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 Silver Plus HMO 202 Blue Advantage Silver HMO 306 Blue Advantage Silver HMO 205 (Two $25 PCP Visits) Blue Advantage Plus Silver 102 (Three $0 PCP Visits)
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $1,000 (In-network) $3,300 (Out-of-network) $2,000 (In-network) $15,000 (Out-of-network) $1,900 $3,250
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30%-50% 30%-50% 35%-50% 20%
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 $7,900 $7,900 $6,850
Primary Care Office Visit $10 (deductible does not apply) $25 (deductible does not apply) $25 First two visits, then 50% First three visits $0, then 20%
Specialist Office Visit 50% Coinsurance Up to 100% if referred 50% 20%
Mental Illness Treatment and Substance Abuse Rehab Office Visit 50% Coinsurance 50% $30 $0
Emergency Room $950 + 50% coinsurance $950 + 50% coinsurance $850 + 50% coinsurance $600 per occurrence copay, then 20%
Urgent Care $15 (Deductible does not apply) $50 (Deductible does not apply) $50 (Deductible does not apply) $20
Inpatient Hospital Service $850 per occurrence copay, then 50% $850 per occurrence copay, then 50% $850 per occurrence copay, then 50% $400 per occurrence copay, then 40%
Outpatient Surgery $300 per occurrence copay, then 30% $600 per occurrence copay, then 40% $600 per occurrence copay, then 40% $300 per occurrence copay, then 40%
Outpatient X-Rays and Diagnostic Imaging 50% 40% 40% $2,750
Outpatient Imaging (CT/PET Scans/MRIs) 30% 40%-50% 20% 40%
Network Blue Advantage HMO
HSA Eligible No Yes No No
Outpatient Prescription Drugs – Preferred Pharmacy $5/$10/$15 $5/$10/$15 $15/$15/$50/$100/40% $0/$10/$50/$100/30%
Outpatient Prescription Drugs – Non-Preferred Pharmacy $15/$25/$45 $15/$25/$45 $15/$15/$50/$100/40% $5/$15/$60/$110/30%
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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