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.
Recommended Plan
Blue Advantage Bronze HMO 707
The Best Bronze Plan
| Plan Name | Blue Advantage Bronze HMO 204 | Blue Advantage Bronze HMO 301 | Blue Advantage Bronze HMO 302 | Blue Advantage Bronze HMO 707 |
| Summary of Benefits | See Benefit Summary | See Benefit Summary | See Benefit Summary | See Benefit Summary |
| Deductible | $6,000 | $9,450 | $7,500 | $7,500 |
| Out-of-Pocket Maximum | $9,450 | $9,450 | $75000 | $9,400 |
| Primary Care Office Visit | $45/visit; deductible does not apply | No Charge After Deductible | No Charge After Deductible | $50/visit; deductible does not apply |
| Specialist Office Visit | 50% coinsurance | No Charge After Deductible | No Charge After Deductible | $100/visit; deductible does not apply |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 50% coinsurance for office visits; 40% coinsurance for other outpatient services |
No Charge After Deductible | No Charge After Deductible | $50/office visit; deductible does not apply; 50% coinsurance for other outpatient services |
| Emergency Room | $950/visit plus 50% coinsurance | No Charge After Deductible | No Charge After Deductible | 50% coinsurance |
| Urgent Care | $60/visit; deductible does not apply | No Charge After Deductible | No Charge After Deductible | $75/visit; deductible does not apply |
| Inpatient Hospital Service | Facility Fee: $850/visit plus 50% coinsurance | No Charge After Deductible | No Charge After Deductible | 50% |
| Outpatient Surgery | Freestanding Facility: $600/visit plus 40% coinsurance Hospital: $600/visit plus 50% coinsurance |
No Charge After Deductible | No Charge After Deductible | 50% coinsurance |
| Outpatient X-Rays and Diagnostic Imaging | Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
No Charge After Deductible | No Charge After Deductible | 50% coinsurance |
| Outpatient Imaging (CT/PET Scans/MRIs) | Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
No Charge After Deductible | No Charge After Deductible | 50% coinsurance |
| Network | Blue Advantage HMO | |||
| HSA Eligible | No | No | YES | No |
| Outpatient Prescription Drugs | ||||
| Generic Drugs (Preferred) | Retail – Preferred Participating – $5/prescription Participating – $15/prescription Mail – $15/prescription; deductible does not apply |
No Charge After Deductible | No Charge After Deductible | Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Generic Drugs (Non-Preferred) | Retail – Preferred Participating – $15/prescription Participating – $25/prescription Mail – $45/prescription; deductible does not apply |
No Charge After Deductible | No Charge After Deductible | Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Brand Drugs (Preferred) | Retail – Preferred Participating – 30% coinsurance Participating – 35% coinsurance Mail – 30% coinsurance |
No Charge After Deductible | No Charge After Deductible | Retail – Preferred Participating – $50/prescription Participating – $50/prescription Mail – $150/prescription |
| Brand Drugs (Non-Preferred) | Retail – Preferred Participating – 35% coinsurance Participating – 40% coinsurance Mail – 35% coinsurance |
No Charge After Deductible | No Charge After Deductible | Retail – Preferred Participating – $100/prescription Participating – $100/prescription Mail – $300/prescription |
| Specialty Drugs (Preferred) | 45% coinsurance | No Charge After Deductible | No Charge After Deductible | $500/prescription |
| Specialty Drugs (Non-Preferred) | 50% coinsurance | No Charge After Deductible | No Charge After Deductible | $500/prescription |
| Plan Name | Blue Advantage Plus Bronze 201 | Blue Advantage Plus Bronze 303 | Blue Advantage Plus Bronze 305 | Blue Advantage Plus Bronze 707 |
| Summary of Benefits | See Benefits Summary | See Benefits Summary | See Benefits Summary | See Benefits Summary |
| Deductible | $4,500 | $5,500 | $6,100 | $7,500 |
| Out-of-Pocket Maximum | $7,500 | $9,450 | $9,450 | $9,400 |
| Primary Care Office Visit | 40% coinsurance | $80/visit; deductible does not apply | 40% coinsurance | $50/visit; deductible does not apply |
| Specialist Office Visit | 40% coinsurance | 50% coinsurance | 50% coinsurance | $100/visit; deductible does not apply |
| Mental Illness Treatment& Substance Abuse Rehab Office Visit | 40% coinsurance for office visits; 30% coinsurance for other outpatient services |
50% coinsurance for office visits; 30% coinsurance for other outpatient services |
50% coinsurance for office visits; 40% coinsurance for other outpatient services |
$50/office visit; deductible does not apply; 50% coinsurance for other outpatient services |
| Emergency Room | $950/visit plus 40% coinsurance | $950/visit plus 50% coinsurance | $950/visit plus 50% coinsurance | 50% coinsurance |
| Urgent Care | 40% coinsurance | $120/visit; deductible does not apply | 50% coinsurance | $75/visit; deductible does not apply |
| Inpatient Hospital Service | Facility Fee: $850/visit plus 40% coinsurance | Facility Fee: $850/visit plus 50% coinsurance | Facility Fee: $850/visit plus 50% coinsurance | 50% coinsurance |
| Outpatient Surgery | Freestanding Facility: $600/visit plus 30% coinsurance Hospital: $600/visit plus 40% coinsurance |
Freestanding Facility: $600/visit plus 30% coinsurance Hospital: $600/visit plus 50% coinsurance |
Freestanding Facility: $600/visit plus 40% coinsurance Hospital: $600/visit plus 50% coinsurance |
50% coinsurance |
| Outpatient X-Rays and Diagnostic Imaging | Freestanding Facility: 30% coinsurance Hospital: 40% coinsurance |
Freestanding Facility: 30% coinsurance Hospital: 50% coinsurance |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
50% coinsurance |
| Outpatient Imaging (CT/PET Scans/MRIs) | Freestanding Facility: 30% coinsurance Hospital: 40% coinsurance |
Freestanding Facility: 30% coinsurance Hospital: 50% coinsurance |
Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
50% coinsurance |
| Network | Blue Advantage HMO | |||
| HSA Eligible | Yes | No | No | No |
| Outpatient Prescription Drugs | ||||
| Generic Drugs (Preferred) | Retail – Preferred Participating – 20% coinsurance Participating – 25% coinsurance Mail – 20% coinsurance |
Retail – Preferred Participating – $5/prescription Participating – $20/prescription Mail – $15/prescription; deductible does not apply |
Retail – Preferred Participating – 20% coinsurance Participating – 25% coinsurance Mail – 20% coinsurance |
Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Generic Drugs (Non-Preferred) | Retail – Preferred Participating – 25% coinsurance Participating – 30% coinsurance Mail – 25% coinsurance |
Retail – Preferred Participating – $15/prescription Participating – $30/prescription Mail – $45/prescription; deductible does not apply |
Retail – Preferred Participating – 25% coinsurance Participating – 30% coinsurance Mail – 25% coinsurance |
Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Brand Drugs (Preferred) | Retail – Preferred Participating – 30% coinsurance Participating – 35% coinsurance Mail – 30% coinsurance |
Retail – Preferred Participating – $130/prescription Participating – $150/prescription Mail – $390/prescription; deductible does not apply |
Retail – Preferred Participating – 30% coinsurance Participating – 35% coinsurance Mail – 30% coinsurance |
Retail – Preferred Participating – $50/prescription Participating – $50/prescription Mail – $150/prescription |
| Brand Drugs (non-Preferred) | Retail – Preferred Participating – 35% coinsurance Participating – 40% coinsurance Mail – 35% coinsurance |
Retail – Preferred Participating – 35% coinsurance Participating – 40% coinsurance Mail – 35% coinsurance |
Retail – Preferred Participating – 35% coinsurance Participating – 40% coinsurance Mail – 35% coinsurance |
Retail – Preferred Participating – $100/prescription Participating – $100/prescription Mail – $300/prescription |
| Specialty Drugs (Preferred) | 45% coinsurance | 45% coinsurance | 45% coinsurance | $500/prescription |
| Specialty Drugs (Non-preferred) | 50% coinsurance | 50% coinsurance | 50% coinsurance | $500/prescription |
| Plan Name | MyBlue Health 402 | MyBlue Health 806 |
| Summary of Benefits | See Benefits Summary | See Benefits Summary |
| Deductible | $7,400 | $7,500 |
| Out-of-Pocket Maximum | $9,450 | $9,400 |
| Primary Care Office Visit | Select PCP: No Charge; deductible does not apply. All other providers: $105/visit; deductible does not apply |
$50/visit; deductible does not apply |
| Specialist Office Visit | 50% coinsurance | $100/visit; deductible does not apply |
| Mental Illness Treatment& Substance Abuse Rehab Office Visit | 40% coinsurance | $50/office visit; deductible does not apply; 50% coinsurance for other outpatient services |
| Emergency Room | $950/visit plus 50% coinsurance | 50% coinsurance |
| Urgent Care | $160/visit; deductible does not apply | $75/visit; deductible does not apply |
| Inpatient Hospital Service | Facility Fee: $850/visit plus 50% coinsurance | Facility Fee: 50% coinsurance |
| Outpatient Surgery | Freestanding Facility: $600/visit plus 40% coinsurance Hospital: $600/visit plus 50% coinsurance |
50% coinsurance |
| Outpatient X-Rays and Diagnostic Imaging | Freestanding Facility (including bloodwork performed by a Select PCP): 40% coinsurance Hospital (including bloodwork): 50% coinsurance In Office: (Certain X-Rays, Ultrasounds, and ECGs ordered by Select PCP): No Charge; deductible does not apply |
50% coinsurance |
| Outpatient Imaging (CT/PET Scans/MRIs) | Freestanding Facility: 40% coinsurance Hospital: 50% coinsurance |
50% coinsurance |
| Network | MyBlue Health | MyBlue Health |
| HSA Eligible | No | No |
| Outpatient Prescription Drugs | ||
| Generic Drugs (Preferred) | Retail – Preferred Participating – $10/prescription Participating – $20/prescription Mail – $30/prescription; deductible does not apply |
Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Generic Drugs (Non-Preferred) | Retail – Preferred Participating – $20/prescription Participating – $30/prescription Mail – $60/prescription; deductible does not apply |
Retail – Preferred Participating – $25/prescription Participating – $25/prescription Mail – $75/prescription; deductible does not apply |
| Brand Drugs (Preferred) | Retail – Preferred Participating – 30% coinsurance Participating – 35% coinsurance Mail – 30% coinsurance |
Retail – Preferred Participating – $50/prescription Participating – $50/prescription Mail – $150/prescription |
| Brand Drugs (non-Preferred) | Retail – Preferred Participating – 35% coinsurance Participating – 40% coinsurance Mail – 35% coinsurance |
Retail – Preferred Participating – $100/prescription Participating – $100/prescription Mail – $300/prescription |
| Specialty Drugs (Preferred) | 45% coinsurance | $500/prescription |
| Specialty Drugs (Non-preferred) | 50% coinsurance | $500/prescription |
| 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. | ||
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Popular Hospital Network Guide
| Hospital | Included in Advantage HMO Network? |
|---|---|
| Doctors Hospital At Renaissance (Edinburg) | YES |
| University Health System (San Antonio) | NO |
| Medical City Hospital (Dallas) | YES |
| Memorial Hermann Hospital (Sugar Land) | YES |
| Mother Frances Hospital (Tyler) | NO |
| Scott & White Hospital (Round Rock) | NO |
| North Austin Medical Center (Austin) | YES |
| Seton Medical Center (Austin) | YES |
| Hill Country Memorial Hospital (Fredericksburg) | YES |
| Texas Health Harris Methodist (Fort Worth) | YES |
| UT Southwestern Medical Center (Dallas) | NO |
| Memorial Hermann Texas Medical Center (Houston) | YES |
| St. Lukes Episcopal Hospital (Houston) | YES |
| Baylor University Medical Center (Dallas) | YES |
| The Methodist Hospital (Houston) | YES |
BCBSTX Dental Plans
Dental Plans Brochure Application With the BCBSTX dental plan, you’ll get dental coverage on day one with no deductible deductible required for check-ups, cleanings and other preventive services. Most important, costs are typically reduced when you receive care from any of our participating network dentists. However, you also have the option to see any dentist not in the network, but your out-of-pocket costs may be higher. Some highlights of Dental Indemnity USA coverage:
- Coverage can be used to provide dental benefits to an individual, spouse, children or any combination of dependents.
- A $50 deductible, based on fee schedule allowances, applies for dental procedures or services received by a covered individual during each benefit year.
- Maximum deductible amount of $150 for family coverage.
- Deductibles do not apply to oral exams, cleanings, fluoride treatments, sealants and X-rays.
- $1,000 orthodontia benefit for children under 19 years old
For more information on coverage and benefits, view the Dental Outline of Coverage You must enroll in a BCBSTX health plan in order to enroll in the dental plan (you have up to 31 days from the effective date of your policy to enroll). Shop for a plan now.
Ryan Kennelly authorized agent for Blue Cross and Blue Shield of Texas Blue Cross and Blue Shield of Texas: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
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