BlueCross BlueShield of Texas

Bronze Health Plans 2023

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.

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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 Bronze HMO 702	Blue Advantage Bronze HMO 704	Blue Advantage Bronze HMO 707
Summary of Benefits	View Full Details	View Full Details	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	$7,000	$9,100	$7,500
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)	$9,100	$9,100	$7,000	$7,000	$9,100	$9,000
Primary Care Office Visit	$45 copay	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	$50 copay
Specialist Office Visit	50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	$100 copay
Mental Illness Treatment and Substance Abuse Rehab Office Visit	50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	$50 copay
Emergency Room	$950 per occurrence copay, then 50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	50%
Urgent Care	$60 copay	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	$75 copay
Inpatient Hospital Service	$850 per occurrence copay, then 50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	50%
Outpatient Surgery	$600 per occurrence copay, then 50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	50%
Outpatient X-Rays and Diagnostic Imaging	50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	50%
Outpatient Imaging (CT/PET Scans/MRIs)	50%	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	No Charge After Deductible	50%
Network	Blue Advantage HMO
HSA Eligible	No	No	No	No	No	No
Outpatient Prescription Drugs – Preferred Pharmacy	$5/$15/30%/35%/45%/50%	No Charge After Deductible	No Charge After Deductible	$20/0%/0%/0%/0%/0%	No Charge After Deductible	$25/$50/$100/$500
Outpatient Prescription Drugs – Non-Preferred Pharmacy	$15/$25/35%/40%/45%/50%	No Charge After Deductible	No Charge After Deductible	$30/0%/0%/0%/0%/0%	No Charge After Deductible	$25/$50/$100/$500

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.

Plan Name	Blue Advantage Plus Bronze 201	Blue Advantage Plus Bronze 303	Blue Advantage Plus Bronze 305	Blue Advantage Plus Bronze 501	Blue Advantage Plus Bronze 704	Blue Advantage Plus Bronze 707	MyBlue Health 402
Summary of Benefits	View Full Details	View Full Details	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.	$4,500	$5,500	$6,100	$5,000	$9,100	$7,500	$7,400
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)	$7,000	$9,100	$9,100	$7,050	$9,100	$9,000	$9,100
Primary Care Office Visit	40%	$75 copay	40%	50%	No Charge after deductible	$50 copay	$0/$100
Specialist Office Visit	40%	50%	50%	50%	No Charge after deductible	$100 copay	50%
Mental Illness Treatment& Substance Abuse Rehab Office Visit	40%	50%	40%	50%	No Charge after deductible	$50 copay	40%
Emergency Room	$950 per occurrence deductible, then 40%	$950 per occurrence deductible, then 50%	$950 per occurrence deductible, then 50%	$950 per occurrence deductible, then 50%	No Charge after deductible	50%	$950 per occurrence deductible, then 50%
Urgent Care	40%	$60 copay	50%	50%	No Charge after deductible	$75 copay	First two urgent care visits $0; then $60 copay for all visits after
Inpatient Hospital Service	$850 per occurrence deductible, then 40%	$850 per occurrence deductible, then 50%	$850 per occurrence deductible, then 50%	$850 per occurrence deductible, then 50%	No Charge after deductible	50%	$850 per occurrence deductible, then 50%
Outpatient Surgery	$600 per occurrence deductible, then 40%	$600 per occurrence deductible, then 40%	$600 per occurrence deductible, then 40%	$600 per occurrence deductible, then 50%	No Charge after deductible	50%	$600 per occurrence deductible, then 50%
Outpatient X-Rays and Diagnostic Imaging	40%	50%	50%	50%	No Charge after deductible	50%	50%
Outpatient Imaging (CT/PET Scans/MRIs)	40%	50%	50%	50%	No Charge after deductible	50%	50%
Network	Blue Advantage HMO
HSA Eligible	Yes	No	No	Yes	No	No	No
Outpatient Prescription Drugs – Preferred Pharmacy	20%/25%/30% 35%/45%/50%	$5/$15/$130/ 35%/45%/50%	20%/25%/30% 35%/45%/50%	20%/25%/30% 35%/45%/50%	No Charge after deductible	$25/$50/$100/$500	$5/$15/30% 35%/45%/50%
Outpatient Prescription Drugs – Non-Preferred Pharmacy	25%/30%/35% 40%/45%/50%	$20/$30/$150/ 40%/45%/50%	25%/30%/35% 40%/45%/50%	25%/30%/35% 40%/45%/50%	No Charge after deductible	$25/$50/$100/$500	$15/$25/35% 40%/45%/50%

Prescription Drug Utilization Benefit Management Programs

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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.

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