MyBlue Health at a Glance
| Plan family | MyBlue Health HMO |
|---|---|
| Network type | HMO — in‑network only (no out‑of‑network coverage except emergencies) |
| Counties served | ~16 metro counties — DFW, Houston, Austin, San Antonio, El Paso, Waco, Corpus Christi (expanding to Fort Bend in 2026) |
| Network size | Approximately 230 hospitals and 61,719 providers |
| Metal tiers | Bronze, Silver, Gold |
| Premium level | Lowest in BCBSTX lineup |
| Referrals | Yes — HMO requires PCP and referrals to specialists |
| Cost‑sharing reductions | Available on Silver plans for eligible income levels |
| Best for | Budget‑focused shoppers in covered metro areas who have verified that their doctors and hospitals are in the MyBlue network |
⚠️ Verify your providers before enrolling
MyBlue Health has the narrowest network in the BCBSTX lineup — some Houston metro members have reported as few as 7 in‑network hospitals.
Before enrolling: confirm your doctor and hospital accept “MyBlue Health” specifically (not just “BCBS”). Use the Provider Finder below and search by your plan name.
MyBlue Health Metal Tiers
Each tier balances monthly premium vs. out‑of‑pocket cost differently. Pick based on how much medical care you expect to use in a year.
Bronze
Lowest Premium
- Lowest monthly cost in MyBlue family
- Highest deductible & out‑of‑pocket max
- Best for healthy members who rarely use care
- Pairs with HSA on HDHP variants
Silver
CSR Eligible
- Mid‑range monthly premium
- Cost‑sharing reductions kick in below ~250% FPL
- Best value tier for most subsidized shoppers
- Required tier to qualify for CSR savings
Gold
Lowest Deductible
- Higher monthly premium
- Lowest deductible & copays in MyBlue
- Best for members who use specialists or take regular medications
- Predictable out‑of‑pocket costs
Network Coverage
2026 MyBlue Plan Comparison
| Benefit Category | 🟫 Bronze Plans | 🟡 Gold Plans | ||
|---|---|---|---|---|
| Bronze 402 | Standard | Gold 403 | Standard | |
| Individual Deductible3 | $5,000 | $7,500 | $1,500 | $3,500 |
| Coinsurance | 50%4 | 50%4 | 20%4 | 20%4 |
| Out-of-Pocket Maximum (includes deductible)3 | $9,000 | $10,000 | $6,700 | $8,700 |
| Primary Care Office Visit | $0 / $605 | $50 copay | $20 copay | $35 copay |
| Specialist Office Visit | 50%4 | $100 copay | 20%4 | $60 copay |
| Mental Illness Treatment and Substance Use Disorder Rehabilitation Office Visit | 40%4 | $50 copay | 20%4 | $35 copay |
| Emergency Room | $1,000 per occurrence deductible, then 50%4 | 50%4 | $250 copay, then 20%4 | $500 copay, then 20%4 |
| Urgent Care | First two urgent care visits $0, then $160 copay for all visits after | $75 copay | $40 copay | $60 copay |
| Inpatient Hospital Services | $950 per occurrence deductible, then 50%4 | 50%4 | $250 per occurrence copay, then 20%4 | $500 per occurrence copay, then 20%4 |
| Outpatient Surgery6 | $600 per occurrence deductible, then 50%4 | 50%4 | $100 copay, then 20%4 | $200 copay, then 20%4 |
| Outpatient X-Rays and Diagnostic Imaging6 | 50%4 | 50%4 | 20%4 | 20%4 |
| Outpatient Imaging (CT/PET Scans/MRIs)6 | 50%4 | 50%4 | 20%4 | 20%4 |
| Network | MyBlue HealthSM | MyBlue HealthSM | MyBlue HealthSM | MyBlue HealthSM |
| HSA Eligible | Yes | Yes | Yes | Yes |
| Outpatient Prescription Drugs — Preferred Pharmacy7 | $0 / $20 / 30% / 35% / 45% / 50%8 | $25 / $50 / $100 / $5009 | $10 / $25 / 25% / 35% / 45% / 50%8 | $15 / $40 / $75 / $4009 |
| Outpatient Prescription Drugs — Non-Preferred Pharmacy7 | $20 / $30 / 35% / 40% / 45% / 50%8 | $25 / $50 / $100 / $5009 | $15 / $35 / 35% / 40% / 45% / 50%8 | $15 / $40 / $75 / $4009 |
Footnotes:
3 The standard per person deductible and out-of-pocket maximum for this plan are shown. You must pay all of the costs up to the deductible amount before your plan begins to pay for covered services you use.
4 After you meet your deductible, you pay this percentage of the cost.
6 Benefits are reduced when non-participating providers are used. This is a summary of benefit highlights only. All benefits shown include member cost-sharing responsibility.
7 For more information about network pharmacies, please check bcbstx.com.
8 Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through a preferred Specialty Pharmacy provider. Member Pay the Difference: When you choose a brand name drug over an available generic equivalent, you pay your usual share for the brand plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before you receive coverage for some medications, your doctor may need to obtain authorization from BCBSTX. You may need to meet certain criteria or try more cost-effective drugs first. 90-Day Supply: You may receive up to a 90-day supply of covered prescription drugs through home delivery or at select retail pharmacies, depending on your prescription drug benefit.
9 Four prescription drug payment level tiers: Generic / Preferred Brand / Non-Preferred Brand / Specialty. Costs are for outpatient retail pharmacy fills. Some prescription drugs through home delivery or select retail pharmacies.