Blue Advantage HMO
Blue Advantage HMO
- Network Type: Health Maintenance Organization (HMO)
- Coverage Area: Statewide across Texas
- Provider Access: Members must use in-network providers for coverage, except in emergencies.
- Primary Care Physician (PCP): Selection of a PCP is required to coordinate care and provide referrals to specialists.
- Out-of-Network Coverage: Generally not covered, except for emergencies.
Blue Advantage Bronze
Bronze Plan Summaries:
Bronze plans may be for you if you have fewer medical needs, would rather have a low monthly payment, and don’t take prescription drugs regularly. Below is a quick summary of available Blue Advantage Plus bronze plans:
- Blue Advantage Bronze 204 – $6,000 individual deductible and 50% coinsurance
- Blue Advantage Bronze Standard – $7,500 individual deductible and 50% coinsurance
| Plan Name | Max Out-of-Pocket (Ind/Fam) | PCP Office / Virtual Visit | Prescription Drugs (Preferred) |
| Blue Advantage Bronze 204 | $10,150 / $20,300 | $45 / 50% | $5 / $15 / 30% / 35% / 45% / 50% |
| Blue Advantage Bronze Standard | $10,000/ $20,000 | $50 / $100 | $25 / $50 / $100 / $500 |
Blue Advantage Silver
Silver Plan Summaries:
Silver plans may be for you if you want to pay less out-of-pocket for care, qualify for a premium tax credit (also known as a subsidy), have a spouse/children on your health plan, or have regular medical needs. Below is a quick summary of available Blue Advantage Plus Silver Plans:
- Blue Advantage Silver 205– $1,450 individual deductible and 50% coinsurance
- Blue Advantage Silver 306 OFF – $1,600 individual deductible and 50% coinsurance
- Blue Advantage Silver 601 OFF – $2,500 individual deductible and 30% coinsurance
- Blue Advantage Silver Standard – $6,000 individual deductible and 40% coinsurance
| Plan Name | Max Out-of-Pocket (Ind/Fam) | PCP Office / Specialist | Prescription Drugs (Preferred) |
| Blue Advantage Silver 205 | $10,600 / $21,200 | $0 / 50% | $5 / $15 / 30% / 35% / 45% / 50% |
| Blue Advantage Silver 306 OFF | $10,150/ $20,300 | $15 / 50% | $0 / $5 / $75 / 35% / 45% / 50% |
| Blue Advantage Silver 601 OFF | $10,100/ $20,200 | $40 / $85 | $0 / $10 / $50 / $100 / $150 / $250 |
| Blue Advantage Silver Standard | $8,900 / $17,800 | $40 / $80 | $20 / $40 / $80 / $350 |
Blue Advantage Gold
Gold Plan Summaries:
Gold plans may be for you if you have more health care needs than most, have a spouse/children on your plan or want to grow your family soon, or prefer to pay more each month but have lower out-of-pocket expenses. Below is a quick summary of available Gold plans
- Blue Advantage Gold 206 – $550 individual deductible and 35% coinsurance
- Blue Advantage Gold 207 – $0 individual deductible and 0% coinsurance
- Blue Advantage Gold 603 – $1,000 individual deductible and 35% coinsurance
- Blue Advantage Gold Standard – $2,000 individual deductible and 25% coinsurance
| Plan Name | Max Out-of-Pocket (Ind/Fam) | PCP Office / Specialist | Prescription Drugs (Preferred) |
| Blue Advantage Gold 206 | $10,100/ $20,200 | $30 / $110 | $0 / $10 / $50 / 35% / 45% / 50% |
| Blue Advantage Gold 207 | $10,150/ $20,300 | $55 / $100 | $5 / $20 / $50 / $100 / 40% / 50% |
| Blue Advantage Gold 603 | $8,200 / $16,400 | $20 / $30 | $0 / $10 / $50 / 35% / 45% / 50% |
| Blue Advantage Gold Standard | $8,200 / $16,400 | $30 / $60 | $15 / $30 / $60 / $250 |
Popular Hospital Network Guide
| Market | MyBlue Health – HMO | Blue Advantage HMO / Blue Advantage Plus POS |
|---|---|---|
| Abilene | N / A | Hendrick Medical Center |
| Amarillo | N / A | Ardent Health Services, NW Tx Healthcare |
| Austin-Round Rock | HCA Southwest | Baylor Scott & White, HCA Southwest, Seton Healthcare |
| Beaumont-Port Arthur | Baptist Beaumont Hospital | CHRISTUS, Steward Health |
| Bryan-College Station-Lufkin | N / A | Baylor Scott & White, Catholic Health Initiatives |
| Corpus Christi | HCA Southwest | CHRISTUS, HCA Southwest |
| Dallas | HCA North, Methodist Health, THR | Baylor Scott & White, HCA North, Methodist Health |
| El Paso | Tenet | HCA Southwest, Tenet, University Medical Center El Paso |
| Fort Worth-Arlington | HCA North, Methodist Health, THR | Baylor Scott & White, HCA North, Methodist Health, Texas Health Resources |
| Greenville-Denton | N / A | Baylor Scott & White, CHRISTUS, HCA North, LifePoint, Texas Health Resources |
| Houston/Pasadena/Bellaire (Harris County only) |
Catholic Health Initiatives, Harris County Hospital District, HCA Southeast, Steward |
Catholic Health Initiatives, HCA Houston, Memorial Hermann, Steward** |
| Jefferson | Baptist Beaumont & CHRISTUS & Triangle Area Network and Legacy Community Health Systems Facilities* |
N/A |
| Killeen-Temple-Waco | N / A | Baylor Scott & White, Providence Health Alliance, Seton |
| Laredo | N / A | Doctors Hospital of Laredo, Laredo Medical Center |
| Brownsville-McAllen | Tenet (Cameron County), Universal Health System (Hidalgo County) | HCA Southwest, Prime, Tenet, Universal Health Systems |
| Lubbock | N / A | University Medical Center – Lubbock, Texas Tech Health Sciences Center, Lubbock Heart Hospital |
| Midland-Odessa-San Angelo | N / A | Midland Memorial Hospital, Medical Center Hospital – Odessa, Shannon Clinic, Steward |
| Nueces | HCA Southwest | Catholic Health Initiatives, HCA Southeast, Memorial Hermann UTMB |
| San Antonio | HCA Southwest | CHRISTUS, HCA Southwest, Tenet |
| Texarkana-Tyler-Longview | N / A | Baylor Scott & White, CHRISTUS, Steward UT Health East Texas |
| Victoria | N / A | Community Health Systems, Seton |
| Wichita Falls | N / A | United Regional, Kell West Regional Hospital, Momentum Specialty Surgery Center |
*N/A represents not offered in this county
** Blue Advantage HMO and Blue Advantage Plus POS (Catholic Health Initiatives, HCA Houston, Memorial Hermann, Steward): ONLY available in Houston
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.
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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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