BlueCross BlueShield of Texas 2025 Plan Guide

On and Off Exchange Plans Available

 

BCBSTX is proud to be the only carrier that has offered multiple qualified health plans in every county across Texas for 12 years of ACA open enrollment

 

BCBSTX 2025 Highlights

  • MyBlue Health is expanding to include Jefferson and Nueces counties
  • New BlueCare Dental 1D plan features lowest rates

BCBSTX Access:

  • Health plans on and off exchange in every county
  • Comprehensive, year-round coverage
  • High-quality, efficient networks with focus on preventive care

Affordability:

  • Affordable plan options to fit every budget
  • Monthly payments as low as $0 for qualified on exchange applicants
  • 4 out of 5 customers can find a plan for $10 or less per month with financial help

Stability:

  • Serving Texas communities for more than 90 years.
  • In the 12 years of ACA open enrollment, BCBSTX has been proud to offer multiple qualified health plans in every county across Texas.

 

BCBSTX Offers 3 Networks: Blue Advantage, Blue Advantage Plus, and MyBlue Health 

Key Differences: 

  • Network Size: Blue Advantage and Blue Advantage Plus offer broader networks compared to the more focused MyBlue Health network.
  • Out-of-Network Coverage: Only Blue Advantage Plus provides out-of-network coverage, albeit at a higher cost.
  • Cost Structure: MyBlue Health plans typically have lower premiums and copays, especially for visits to select PCPs.
  • Geographic Availability: MyBlue Health is limited to specific counties, whereas the other two networks are available statewide.

HMO Plans

  • HMOs help keep upfront costs low
  • Tax credits and cost-sharing assistance may be available to help lower premiums and out-of-pocket costs
  • Managed care on a personalized level with care coordinated by one doctor
  • Physician care extenders – allows physician assistants and advanced registered nurse practitioners to be PCPs

Perks

 

Helpful Resources 24/7
  • Cost Estimator Tool on Blue Access for Members
  • SmartER Care Options – member education campaign on choices for non-emergency care
Mobile App
  • Easy-to-use BCBSTX App – find a doctor, see payment options, access electronic ID card and more
  • Access your claims, coverage and deductible information
  • Access your temporary digital member ID card
  • Secure login with Face ID (iOS only) and Fingerprint ID
Blue365
  • Blue365 member discount program – members save on health club and gym memberships, weight loss programs, dental products and much more
Blue Advantage & Blue Advantage Plus Plan Info

View Catastrophic Plan

Blue Advantage HMO Plans:

Statewide

4 Bronze, 5 Silver, and 4 Gold

  • Network: Blue Advantage HMO (BAV)
  • Approximately 378 hospitals and 105,743 providers
  • Helps keep costs lower and more predictable
  • Personalized with a primary care provider (PCP) who coordinates all health care

Blue Advantage Plus:

Statewide

Plan summaries can be found here

4 Bronze, 4 Silver, and 3 Gold

  • Network: Blue Advantage HMO
  • Approximately 378 hospitals and 105,743 providers
  • Greater flexibility
  • Leverages the HMO network
  •  

*Estimates as of 6/1/2021

**Estimates as of 6/20/23. Hospital counts are acute care unique parent PFINs (Practice Locations) –does not count satellite locations billed under another entity. During open enrollment, members who enroll in MyBlue Health plan will be able to choose their Select PCP for 2024 through Provider finder.

MyBlue Health Plan Info

MyBlue Health:

Bexar, Cameron, Collin, Comal, Dallas, Denton, El Paso, Harris, Hidalgo, Jefferson, McLennan, Nueces, Rockwall, Tarrant, Travis, and Williamson Counties

2 Bronze, 3 Silver, 2 Gold

  • Network: MyBlue HealthSM (BFT)
  • Approximately 85 hospitals and 40,541 providers**
  • TWO new counties including: Jefferson and Nueces counties
  • Retail members who choose a Select PCP will have a $0 copay for any scheduled PCP visit

Using PCP’s vs Select PCP’s

  • Members must choose an in-network PCP. These include:
    • Participating Physician (family practitioner, internist, obstetrician/gynecologist, pediatrician)
    • Physician Assistant (PA)
    • Advanced Practice Registered Nurse (APRN)
    • Advanced Practice Nurse (APN)
  • When using in-network Non-Select PCPs, members will access care at
    standard benefit level
  • Members may choose a Select PCP within designated
    Practice Groups, which results in a $0 office visit copayment for
    scheduled PCP office visits

*Estimates as of 6/1/2021

**Estimates as of 6/20/23. Hospital counts are acute care unique parent PFINs (Practice Locations) –does not count satellite locations billed under another entity. During open enrollment, members who enroll in MyBlue Health plan will be able to choose their Select PCP for 2024 through Provider finder.

BCBSTX - 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
Contracted Health Systems by Network
Market Name / BCBSTX Network Blue Advantage Network MyBlue health hmo
Abilene Hendrick Medical Center N/A
Amarillo Ardent Health Services N/A
Austin-Round Rock Baylor Scott & White, HCA Southwest, Seton Healthcare HCA Southwest
Beaumont-Port Arthur CHRISTUS, Steward Health N/A
Bryan-College Station-Lufkin Baylor Scott & White, Catholic Health Initiatives N/A
Corpus Christi CHRISTUS, HCA Southwest N/A
Dallas Baylor Scott & White, HCA North, Methodist HCA North, Methodist, THR
El Paso HCA Southwest, Tenet, University Medical Center El Paso Tenet
Forth Worth-Arlington Baylor Scott & White, HCA North, Methodist,
Texas Health Resources
HCA North, Methodist, THR
Greenville-Denton Baylor Scott & White, CHRISTUS, HCA North,
LifePoint, Texas Health Resources
N/A
Houston Catholic Health Initiatives, HCA Houston, Memorial Hermann, Steward Catholic Health Initiatives, Harris County Hospital District, HCA Southeast, Steward (includes /Pasadena/Bellaire)
Kileen-Temple-Waco Baylor Scott & White, Providence Health Alliance, Seton N/A
Laredo-Brownsville – McAllen Doctors Hospital of Laredo, Laredo Medical Center, HCA Southwest, Prime, Tenet, Universal Health Systems Tenet (Cameron County), Universal Health System (Hidalgo County) (Brownsville and McAllen)
Lubbock University Medical Center –Lubbock, Texas Tech Health Sciences Center, Lubbock Heart Hospital N/A
Midland-Odessa-San Angelo Midland Memorial Hospital, Medical Center Hospital –Odessa, Shannon Clinic, Steward N/A
Pasadena-Bellaire Catholic Health Initiatives, HCA Southeast, Memorial Hermann UTMB Catholic Health Initiatives, HCA Southeast
San Antonio CHRISTUS, HCA Southwest, Tenet HCA Southwest
Texarkana-Tyler-Longview Baylor Scott & White, CHRISTUS, Steward
UT Health East Texas
N/A
Victoria Community Health Systems, Seton N/A
Wichita Falls United Regional, Kell West Regional Hospital, Momentum Specialty Surgery Center N/A
BCBSTX Dental/Vision Plans

BlueCare Dental 

Dental care is vital to your overall health. That is why Blue Cross and Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, offers BlueCare Dental and BlueCare Dental 4 Kids SM. Our dental plans provide you with coverage for preventive services like checkups, cleanings and basic X-rays, as well as procedures like fillings, bridges and crowns.

BCBSTX offers a variety of plans to fit your family’s needs and budget with four plans for adults and three for children.

  • Coverage for cleanings, preventive services and much more
  • Preventive dental services deductible waived
  • Pediatric and family plans available
  • Lower individual deductibles on all dental plans

Downloadable Summary of Benefits

BlueCare 1A

BlueCare 1B

BlueCare 2A

BlueCare 1C

 

BlueCare Vision Basic:

  • Coverage Plus Central platform
    • Platform used to enroll new members into these plans
  • BlueCare Vision Effective Dates
    • Policy length is 12 months from the effective date
      Updated policy: enrollment can now be completed anytime during the
      month to be effective the 1st day of the next month
  • BlueCare Vision Cancellation
    • Members who wish to cancel can do so online on the Coverage Plus Central platform or call the Trionfo customer service number

 

BlueCare Vision Premier

BlueCare Vision Standard

  • $10 copayment for an eye exam with dilation
    $200 allowance for frames, with 20% off balance over $200
  • $20 copayment for most lenses, with no copayment for most lens options (i.e., tint, coating, scratch standard polycarbonate)
  • $200 allowance for contact lens (in lieu of lenses) with 15% off the balance over $200
  • $10 copayment for an eye exam with dilation
  • $130 allowance for frames, with 20% off balance over $130
  • $20 copayment for most lenses, with no copayment for some lens options (i.e., tint, scratch coating)
  • $130 allowance for contact lens (in lieu of lenses) with 15% off the balance over $130

Pediatric Vision Benefit

Blue 365

Blue365 is just one more advantage of being a Blue Cross and Blue Shield of Texas (BCBSTX), a division of Health Care Service Corporation, member. With this program, you may save money on health and wellness products and services from top retailers that are not covered by insurance. There are no claims to file and no referrals or pre-authorizations. Once you sign up for Blue365 at blue365deals.com/BCBSTX, weekly “Featured Deals” will be emailed to you. These deals offer special savings for a short period of time.

Below are some of the ongoing deals offered to Blue365 members:

Davis VisionSM | TruVision®
You may save on eyeglasses as well as contact lenses, exams and accessories. Davis Vision is made up of national and regional retail stores as well as local eye doctors. You may get possible savings on laser vision correction through the TLC/TruVision group.

TruHearing® | Beltone™
You may get possible savings on hearing tests, evaluations and hearing aids. Discounts may also be available for your immediate family members.

Procter & Gamble (P&G) Dental Products
You may get savings on dental packages with Oral B® power toothbrushes and Crest® products. Packages may include items such as an electric toothbrush, mouth rinse, teeth whiteners and floss.

Dental Solutions
You may get dental savings with Dental Solutions. You may receive a dental discount card that provides access to discounts of up to 50 percent at more than 61,000 dentists and more than 185,000 locations.*

CORD:USE® | CorCell®
You can protect your family’s cord blood at a state-ofthe- art laboratory using high-quality cord blood banking practices and technologies. Cord blood contains stem cells (like those in bone marrow) that have the ability to develop into additional cells and can be used to treat possible life-threatening diseases in the future. You may save on cord blood processing and storage fees. Jenny Craig® | Seattle Sutton’s® | Nutrisystem®. You may reach your weight loss goals with savings from leading programs. You may save on healthy meals, membership fees (where applicable), nutritional products and services.

Retrofit
Receive 15 percent off Retrofit’s online, private weight loss coaching sessions. Retrofit includes the use of a wireless Fitbit® device and smart scale, one-on-one
videoconferencing with a personal team of experts and unlimited online support. You will enjoy flexibility in scheduling and the ability to meet with coaches anywhere there is an Internet connection. Reebok | SKECHERS® Reebok, a trusted brand for more than 100 years, makes top athletic equipment for all people, from professional athletes to kids playing soccer. SKECHERS, an award winning leader in the footwear industry, offers exclusive pricing on select Performance, Sport, Work and Corporate Casual styles. You will enjoy 20 percent off plus free shipping for your online orders.

Life Time Fitness®
Life Time Fitness offers total health fitness to fit your level, interests, schedule and budget. For new members, Life
Time Fitness offers a $0 online signup fee.**

SeniorLink Care™
With SeniorLink Care, you may find support to help your aging family members or friends lead fulfilling and comfortable lives. From planning care to helping
caregivers, SeniorLink Care assists older adults and their loved ones in finding the programs and services they may need most. You can save on a three- or 12-month membership.

Handstand Kids
Handstand Kids brings the family together in the kitchen, spending more time cooking and eating healthy, delicious meals. The Handstand Kids Cookbook series features the languages and cuisines of Italy, Mexico, China and many other countries. Every book also introduces the language and culture of each country. You may save up to 25 percent on cooking accessories and Cookbook Kits.

Prescription & Pharmacy

BCBSTX switched from a 4 tier formulary to a 6 tier formulary in 2019.

• Most plans have six prescription drug payment level tiers: preferred generic, non-preferred generic, preferred brand, non-preferred brand, preferred specialty, non-preferred specialty
• Standardized plans have four prescription drug payment level tiers: generic, preferred brand, non-preferred brand, and specialty
• All plans include a drug list and Preferred Pharmacy Network**

BCBSTX also offers ways for you to save time and money on your prescriptions.

  • Cost savings: You may pay less when you choose generic medicines from our drug list. You also may save when you get up to a 30-day supply of a covered prescription drug from an in-network pharmacy. Talk to your doctor about what is right for you
  • Time savings: Maintenance medications are those drugs you take on a regular basis. You can have up to a 90-day supply of these medications delivered directly to you through the mail order program or at a retail preferred pharmacy participating in the Preferred Pharmacy Network.5
  • Online resources: You can search the drug list, find a pharmacy, see your claims, order home delivery, and get an estimate of your costs for a medication 24/7 by logging in to Blue Access for MembersSM (BAMSM) at bcbstx.com.

*Estimates as of 7/31/2022

**A “preferred” or “participating” pharmacy has a contract with BCBSTX’s pharmacy benefit manager (Prime Therapeutics) to provide pharmacy services at a negotiated rate. A pharmacy benefit
manager administers prescription drug benefits for a health plan. The terms “preferred” and “participating” should not be construed as a recommendation, referral or any other statement as
to the ability or quality of such pharmacy.

New 4 Tier Benefit Design

  • New requirement for CMS Standardized Plan Offerings
  • Available to On-Exchange plans
  • Drug lists are exactly the same for 4 Tiers and 6 Tier prescription plans
  • Some brands may be placed in generic Tiers and some generics may be placed in brand Tiers
  • 87.3% of prescriptions filled (2022 YTD) fall into Tiers 1 and 2 of a 6 Tier benefit structure
  • 43% of all medications on the formulary are in the first two Tiers of a 6 Tier benefit structure

Pharmacy Networks 

  • Contains a tiered network structure that categorizes in-network pharmacies into two buckets: Preferred and Non-Preferred
  • Members may pay a lower copay/coinsurance at an in-network Preferred pharmacy vs. using an in-network Non-Preferred pharmacy
  • Members can get up to a 90-day supply of medication from a Preferred pharmacy or a 30-day supply of medication from a Non-Preferred pharmacy
  • 90-day supplies are 3 times the 30-day retail copay via Preferred pharmacies and mail order through Express Scripts® Pharmacy
  • Select Independent Pharmacies may be included in a Preferred Pharmacy Network

Specialty Pharmacy Program

Specialty medications are used to treat conditions such as Multiple Sclerosis, Rheumatoid Arthritis, Cancer, and Cystic Fibrosis. Drugs may have special handling/storage requirements.

  • Medications are limited to a 30-day supply due to high cost and to prevent waste Self-administered products are standardly covered under the pharmacy benefit while physician-administered products are covered under the medical benefit
  • We deliver savings on specialty drugs for our clients and member through Prime’s Specialty Network offering
  • Accredo, our specialty pharmacy partner, has pharmacies across the country that allows drugs to be dispensed from the pharmacy location closest to the patient

 

Contact Us
Phone: (312) 726-6565 Email: [email protected]

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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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