BlueCross BlueShield of Texas

Bronze Health Plans 2021

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

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 2021, this is likely your best option.

 

 

Plan Name Blue Advantage Bronze HMO 204 (Two $40 PCP) Blue Advantage Bronze HMO 301 Blue Advantage Bronze HMO 302 Blue Advantage Plus Bronze 201
Summary of Benefits View Full Details View Full Details View Full Details View Full Details
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $6,000 $8,550 $6,900 $4,500
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 50% 100% 0% 40%
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) $8,550 $8,550 $6,900 $6,900
Primary Care Office Visit $40 (First two visits then 50%) 0%* 0%* 40% after deductible
Specialist Office Visit 50% 0%* 0%* 40% after deductible
Mental Illness Treatment and Substance Abuse Rehab Office Visit 50% 0%* 0%* 40% after deductible
Emergency Room $950 per occurrence copay, then 50% 0%* 0%* $950 per occurrence deductible, then 40%
Urgent Care $60 (Deductible does not apply) 0%* 0%* 40% after Deductible
Inpatient Hospital Service $850 per occurrence copay, then 50% 0%* 0%* $850 per occurrence deductible, then 40%
Outpatient Surgery $600 per occurrence copay, then 50% 0%* 0%* $600 per occurrence deductible, then 40%
Outpatient X-Rays and Diagnostic Imaging 50% 0%* 0%* 40% after Deductible
Outpatient Imaging (CT/PET Scans/MRIs) 40% 0%* 0%* 40% after Deductible
Network Blue Advantage HMO
HSA Eligible No No Yes Yes
Outpatient Prescription Drugs – Preferred Pharmacy $15/$25/$45 0%* 0%*

20%/25%/30%

35%/45%/50%

 

Outpatient Prescription Drugs – Non-Preferred Pharmacy $25/$35/$75 0%* 0%*

25%/30%/35%

40%/45%/50%

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.

 *100% of Allowable Amount, until Deductible is met.

 

 

 

Plan Name      Blue Advantage      Plus Bronze 303 Blue Advantage Plus Bronze 305 Blue Advantage Plus Bronze 501 MyBlue Health Bronze 402
Summary of Benefits View Full Details View Full Details View Full Details View Full Details
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $4,900 $5,000 $5,000 $7,400
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 50% 50% 50% 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) $8,550 $8,550 $6,900 $8,550
Primary Care Office Visit $55 copay 40% 50% $0/$90
Specialist Office Visit 50% 50% 50% 50%
Mental Illness Treatment and Substance Abuse Rehab Office Visit 50% 40% 50% 40%
Emergency Room $950 per occurrence deductible, then 50% $950 per occurrence deductible, then 50% $950 per occurrence deductible, then 50% $950 per occurrence deductible, then 50%
Urgent Care $60 copay 50% 50% $60 copay
Inpatient Hospital Service $850 per occurrence deductible, then 50% $850 per occurrence deductible, then 50% $850 per occurrence deductible, then 50% $850 per occurrence deductible, then 50%
Outpatient Surgery $600 per occurrence deductible, then 50% $600 per occurrence deductible, then 40% $600 per occurrence deductible, then 50% $600 per occurrence deductible, then 50%
Outpatient X-Rays and Diagnostic Imaging 50% 50% 50% 50%
Outpatient Imaging (CT/PET Scans/MRIs) 50% 50% 50% 50%
Network Blue Advantage HMO MyBlue Health
HSA Eligible No No Yes No
Outpatient Prescription Drugs – Preferred Pharmacy

$10/$15/$130

35%/45%/50%

20%/25%/30%

35%/45%/50%

20%/25%/30%

35%/45%/50%

$10/$20/30%

35%/45%/50%

Outpatient Prescription Drugs – Non-Preferred Pharmacy

$20/$30/$150

40%/45%/50%

25%/30%/35%

40%/45%/50%

25%/30%/35%

40%/45%/50%

$15/$30/$35%

40%/45%/50%

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.

Looking for 2021 coverage? Click Here.

BlueCross BlueShield Texas

Individual Plan Guides

 

 

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