BlueCross BlueShield of Texas

Bronze Health Plans 2022

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 2022, this is likely your best option.

 

 

Plan Name Blue Advantage Bronze HMO 204 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
Deductible a specified amount of money that the insured must pay before an insurance company will pay a claim. $6,000 $8,700 $7,000 $4,500
Out-of-Pocket Maximum An 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) $8,700 $8,700 $7,000 $7,000
Primary Care Office Visit $45 No Charge After Deductible No Charge After Deductible 40% 
Specialist Office Visit 50% No Charge After Deductible No Charge After Deductible 40%
Mental Illness Treatment and Substance Abuse Rehab Office Visit 50% No Charge After Deductible No Charge After Deductible 40% 
Emergency Room $950 per occurrence copay, then 50% No Charge After Deductible No Charge After Deductible $950 per occurrence deductible, then 40%
Urgent Care $60 (Deductible does not apply) No Charge After Deductible No Charge After Deductible 40% after Deductible
Inpatient Hospital Service $850 per occurrence copay, then 50% No Charge After Deductible No Charge After Deductible $850 per occurrence deductible, then 40%
Outpatient Surgery Freestanding Facility: $600/visit plus 40%
coinsurance
Hospital: $600/visit plus 50% coinsurance
No Charge After Deductible No Charge After Deductible Freestanding Facility: $600/visit plus 30%
coinsurance
Hospital: $600/visit plus 40% coinsurance
Outpatient X-Rays and Diagnostic Imaging Freestanding Facility: 40% coinsurance
Hospital: 50% coinsurance
No Charge After Deductible No Charge After Deductible Freestanding Facility: 30% coinsurance
Hospital: 40% coinsurance
Outpatient Imaging (CT/PET Scans/MRIs)

Freestanding Facility:

40% coinsurance
Hospital: 50% coinsurance

No Charge After Deductible No Charge After Deductible Freestanding Facility: 30% coinsurance
Hospital: 40% coinsurance
Network Blue Advantage HMO
HSA Eligible No No Yes Yes
Outpatient Prescription Drugs – Preferred Pharmacy $5/$15/30%/35%/45%/50% No Charge After Deductible No Charge After Deductible

20%/25%/30%

35%/45%/50%

 

Outpatient Prescription Drugs – Non-Preferred Pharmacy $15/$25/35%/40%/45%/50% No Charge After Deductible No Charge After Deductible

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 Blue Advantage Security HMO 200 (Catastrophic Plan)
Summary of Benefits View Full Details 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. $5,500 $5,000 $5,000 $7,400 $8,700
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) $8,700 $8,550 $7,050 $8,700 $8,700
Primary Care Office Visit $75 copay 40% 50% $0/$100 First 3 visits – $20 each, then $0
Specialist Office Visit 50% 50% 50% 50% $0
Mental Illness Treatment& Substance Abuse Rehab Office Visit 50% 40% 50% 40% No Charge after deductible
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% No Charge after deductible
Urgent Care $60 copay 50% 50% $60 copay No Charge after deductible
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% No Charge after deductible
Outpatient Surgery $600 per occurrence deductible, then 50% $600 per occurrence deductible, then 40% $600 per occurrence deductible, then 40% $600 per occurrence deductible, then 40% No Charge after deductible
Outpatient X-Rays and Diagnostic Imaging Freestanding Facility: 30% coinsurance
Hospital: 50% coinsurance
Freestanding Facility: 40% coinsurance
Hospital: 50% coinsurance
Freestanding Facility: 40% coinsurance
Hospital: 50% coinsurance
Freestanding Facility: 40% coinsurance
Hospital:50%
coinsurance
In Office: Certain X-Rays, Ultrasounds, and
ECGs: $0
No Charge after deductible
Outpatient Imaging (CT/PET Scans/MRIs) Freestanding Facility: 30% coinsurance
Hospital: 50% coinsurance
Freestanding Facility: 40% coinsurance
Hospital: 50% coinsurance
Freestanding Facility: 40% coinsurance
Hospital: 50% coinsurance
Freestanding Facility:40% coinsurance
Hospital:50% coinsurance
No Charge after deductible
Network Blue Advantage HMO MyBlue Health Blue Advantage HMO
HSA Eligible No No Yes No No
Outpatient Prescription Drugs – Preferred Pharmacy

$5/$15/$130

35%/45%/50%

20%/25%/30%

35%/45%/50%

20%/25%/30%

35%/45%/50%

$10/$20/30%

35%/45%/50%

No Charge after deductible

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%

No Charge after deductible

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 2022 coverage? Click Here.

BlueCross BlueShield Texas

Individual Plan Guides

 

 

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