Plans that Meet Member Needs and Budgets
BCBSTX offers three levels of health care plans – bronze, silver and gold – for both Blue Advantage HMO and Blue Advantage Plus HMO, all including required essential health benefits.
- Bronze-level plans will have the lowest monthly premium, but may also have the highest out-of-pocket costs. The plan typically covers 60 percent of the cost of covered services, and the member pays the remaining, approximately 40 percent.
- Silver-level plans have a slightly higher monthly premium than bronze, but have richer benefits. In many cases, the plan pays approximately 70 percent, and the member pays approximately 30 percent. Cost sharing reductions are only available on Silver-level plans.
- Gold-level plans have an even higher level of benefits than silver, but also a higher monthly premium. The plan pays approximately 80 percent, and the member pays approximately 20 percent.
Member premiums and out-of-pocket costs will vary depending on the health coverage options members choose. Many residents may also be eligible for federal subsidies to help offset health care costs. As of December 2015, 89 percent of on-exchange BCBSTX members received a subsidy to offset the total premium they pay. Consumers, if eligible, can calculate the estimated amount for which they may qualify, by visiting BCBSTX's subsidy estimator, available in both English and Spanish.
Added Benefits and Conveniences
All BCBSTX health coverage includes prescription drug coverage, featuring the preferred pharmacy network, which offers benefit designs with as low as $0 co-pays and includes more than 2,000 pharmacies across the state.
In addition, BCBSTX offers a variety of programs and resources to help members get the most value from their benefits and help reduce costs, including:
- BCBSTX Physician Extenders Program: Blue Advantage HMO and Blue Advantage Plus HMO members have the option to use an in-network physician assistant (PA) or Advanced Nurse Practitioner (ANP) as a primary care provider (PCP);
- Retail Shopping Cart: Helps consumers compare every health insurance option that we offer, shop by price and get help to find the plan that's right for them;
- BCBSTX Provider Finder®: Members are able to research and select an in-network provider for their needs based on location, as well as view industry-respected, third-party quality indicators, costs and patient-submitted reviews on the website;
- A 24/7 Nurseline: Members can speak with registered nurses about health concerns, common health information and receive tips and advice on where to go to receive necessary care;
- Blue Access for Members℠: Provides members access to information about their policy, including status of claims, alerts, temporary ID cards, and more. This also includes Blue Access Mobile℠, which allow members to find a doctor, hospital or urgent care facility in addition to benefit information;
- Lower urgent care co-pays that are the same amount as primary care provider co-pays for members who use urgent care clinics as opposed to emergency room visits, where applicable; and
- Lower out-of-pocket costs for using a freestanding outpatient facility instead of a hospital.
For additional information about plans and resources offered during 2017 open enrollment, visit www.bcbstx.com.
About Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas (BCBSTX) – the only statewide, customer-owned health insurer in Texas – is the largest provider of health benefits in the state, working with nearly 80,000 physicians and healthcare practitioners, and 500 hospitals to serve more than 5 million members in all 254 counties. BCBSTX is a Division of Health Care Service Corporation (HCSC) (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer, and fourth largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.
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SOURCE Blue Cross and Blue Shield of Texas