Bluecare Summary Of Benefits And Coverage And Plan Brochure
If more than one plan name is listed here, select the appropriate BlueCare plan to view the product brochure or Summary of Benefits and Coverage document for your chosen plan.
Guide to numbered plan variants1 = 73% cost share reduction2 = 87% cost share reduction3 = 94% cost share reduction4 = Native American at greater than 300% of the federal poverty level 5 = Native American at or below 300% of the federal poverty level
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Blue Cross Select Gold
– Calendar Year Deductible: $850 Individual / $1,700 Family
– Out-of-Pocket Maximum: $6,000 Individual / $12,000 Family
– Convenient Phone & Video Consultations through Teladoc?
BENEFIT REQUIREMENTSIn Alabama, you must be referred to a specialist by your primary care select physician. If no referral, no benefits are payable under the plan.
Third Party Website Disclaimer
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To continue to the HealthEquity website, click “Accept.” If you want to stay on Blue Cross’ website, click “Cancel.”
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Blue Cross Select Gold Accordion Plan Overview
- Each member must designate a Primary Care Select Physician
- We Pay:
- $300 copay per day
- We Pay:
- 0% after meeting the calendar year deductible
- We Pay:100% after meeting the calendar year deductible
Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.
For complete coverage details see the Prescription Drug List for this plan.
Is The Covered California Gold Plan Right For Me
If you dont like deductibles, then lets talk more. Not everyone has extra savings lying around to cover a deductible, but would rather pay a little more per month for a plan with copayments they can afford. If you are the kind of person who doesnt want a plan with a deductible, i.e. the Minimum Coverage, Bronze or Silver plan, and you dont like the price tag of the more expensive Platinum plan, then the Gold may be just right for you.
You need specific medical services. Advanced lab work such as an MRI, CT, or PET can be pricey on a plan with a deductible. If you anticipate the need for these services, have a scheduled surgery, or are at high risk for occasional hospital visits then this plan should be up for serious consideration.
If you only frequent the doctors office, typically take generic drugs, and are not exposed to risk that takes you to the hospital often, then you may want to look closer at the Silver Plan to see which plan is going to be to your advantage. Remember, if you can pay the deductible on the Silver plan if needed, then the savings in premium per month is extra money in your pocket.
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Blue Cross Blue Shield Health Insurance Review
- Regional companies finding a local servicer can be a challenge
- Overall out-of-pocket costs can be higher compared to other companies
Find Cheap Health Insurance Quotes in Your Area
- Regional companies finding a local servicer can be a challenge
- Overall out-of-pocket costs can be higher compared to other companies
Blue Cross Blue Shield companies are part of the Blue Cross Blue Shield Association , an alliance of separate health insurance businesses covering members in each state. Policyholders can use a Blue Cross Blue Shield insurance card almost anywhere in the U.S., subject to provider participation and plan benefits.
Each Blue Cross Blue Shield private insurance company is locally owned and independently operated. Individual BCBS companies sell and service health insurance relative to their “home” states or regions. As such, customers rate and report on interactions with their home BCBS plan, rather than the association as a whole. While some customers reported concerns related to payment and service, the companies we reviewed received overall positive marks from the Better Business Bureau and other reporting entities.
Reviews And Customer Complaints
BCBS is an established health insurance company with widespread availability and a large provider network. BCBS insurance plans include multiple coverage options with rates comparable to or sometimes higher than rates from other companies. Overall, BCBS has received positive ratings from reporting agencies such as the Better Business Bureau and the National Association of Insurance Commissioners .
BCBS companies are separate entities but often have similar names. As a result, customers have reported challenges in finding the correct department to address their servicing needs.
Customers reported concerns with both BCBS of Illinois and BCBS of Michigan relative to claim payments and servicing, including issues with hold times, lack of follow-through and inaccurate information. However, in calculating ratings, the Better Business Bureau considers the number of complaints and how promptly they are addressed, along with a companys size relative to complaint totals and its time in business. With all factors combined, the Better Business Bureau gave BCBS of Illinois and BCBS of Michigan ratings of A- and A+, respectively.
Editorial Note: The content of this article is based on the authors opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.
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What Does Health Insurance Value Mean
The actuarial value tells you what percentage of covered healthcare expenses a plan is expected to pay for its membership as a whole. This doesnt mean that you, personally, will have exactly 80% of your healthcare costs paid by your gold plan . You might have more or less than 80% of your expenses paid depending on how you use your gold health plan. The value is an average spread across all of a plans members.
This is best illustrated with an example: Consider a person with a gold plan who only has one doctor visit during the year, and some lab work. Perhaps his copay is $35 per visit, and his insurance pays another $100 for the office visit. But the lab work is counted towards his deductible, so he has to pay the full bill, which ends up being $145 after the network negotiated discount. When it’s all said and done, he’s paid $180, and his insurance has paid $100. So his insurance only paid about 36% of his costs .
But now consider the same person, with the same gold plan, developing cancer during the year. He has several office visits at $35 each, meets his $2,500 deductible soon after the diagnosis, and hits his $3,500 out-of-pocket maximum before he even starts chemo. After that, his insurance pays for everything, as long as he stays in-network. At the end of the year, his insurance has paid $230,000 and he’s paid $3,500. So his insurance has covered more than 98% of his costs.
Blue Cross Blue Shield Medical Insurance: Our Thoughts
Blue Cross Blue Shield insurance offers a variety of coverage types including dental, vision, short-term medical and individual major medical. Specifically, BCBS provides Affordable Care Act major medical plans for new enrollees in all but three states: Mississippi, Nebraska and South Dakota. Existing members may be able to continue their current coverage in these three states.
Some BCBS companies do business in multiple states. For example, a BCBS entity called CareFirst covers Maryland, Virginia and the District of Columbia. Other BCBS businesses, such as Horizon Blue Cross and Blue Shield of New Jersey, operate in a single state.
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Covered California Gold 80 Plan: Gold Is Golden
The Gold plan shines with its $0 deductible, reasonable copayments, and a price tag that is softer than the top of the line Platinum. Typical services will range from a $30-$65 copay. Should you ever need to visit the hospital or have a lot of medical needs, the most you would need to pay for covered services in a year would be $7,800 per individual or $15,600 for a family.
Save With Blue Advantage
Blue Cross members can save on medical care, vision care and many other products and services offered by participating providers across Canada.
No receipts to submit save right away when you purchase at a pharmacy or other health provider.
Simply present your Blue Cross identification card to the participating provider and mention the program.
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Blue Ppo Gold Plan Costs
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments, and coinsurance. Here is what you can expect with Gold® plans:
- Individual in-network deductibles ranging from $1,000 to $3,250
- $10 or $30 office visit copayments
- $0 or $10 copayments for generic prescription drugs
- Coinsurance of 100% to 80% percent of services provided in-network, after deductible and copayments are met
- Annual out-of-pocket maximum of $3,250 and $3,500 for individuals and $9,750 or $10,500 for families, depending on the plan
What Will You Have To Pay
Youll pay monthly premiums for the health plan. Gold plan premiums tend to be more expensive than plans with lower actuarial value because gold plans pay more toward your healthcare bills than silver or bronze plans do. Gold plan premiums will usually be cheaper than platinum plan premiums because gold plans pay a lower percentage of healthcare expenses than platinum plans pay.
But those intuitive pricing guidelines don’t necessarily apply anymore in the individual market. The normal pricing scalebronze plans generally being least expensive, followed by silver, then gold, then platinumhasn’t necessarily held true in recent years.
Because the cost of cost-sharing reductions has been added to silver plan premiums in most states since 2018, it’s possible to find gold plans in many areas that are less expensive than silver plans. This does not apply in the small group market, however, because CSR benefits aren’t available on small group plans .
In addition to premiums, youll also have to pay cost-sharing like deductibles, coinsurance, and copays when you use your health insurance. How each plan makes members pay their 20% share of overall healthcare expenses will vary. For example, one gold plan might have a high $2,500 deductible paired with a low 10% coinsurance. A competing gold plan might have a lower deductible paired with a higher coinsurance or more copays.
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Why Choose A Gold Plan
In choosing a health plan, if you dont mind paying higher premiums to have a greater percentage of your healthcare costs paid by your health insurer, a gold-tier plan might be a good choice for you. If the idea of having to pay lower out-of-pocket costs when you use your health planin trade for potentially higher premiumsappeals to you, then a gold plan could be a good match.
Gold plans are likely to appeal to people who expect to use their health insurance, who fear being responsible for high out-of-pocket costs when they need care, or who can afford to pay a bit more each month for a little extra peace of mind than theyd have with a silver or bronze plan.
But as noted above, it may make more sense for individual market shoppers in some areas to buy a gold plan simply because it’s less expensive than a silver plan, despite offering better coverage. This has been the case since 2018, when the cost of CSR started to be added to silver plan premiums, resulting in disproportionately large premiums for silver plans.
And in the final Benefit and Payment Parameters for 2021, 2022, and 2023 , HHS did not mention anything about changing the rules regarding silver loading. So for the time being, silver plan premiums are likely to continue to be disproportionately large .
But for people who don’t qualify for cost-sharing reductions , a gold plan will provide better coverage and may have lower premiums, depending on the area.
What To Know About Gold Plan Health Insurance
Lisa Sullivan, MS, is a nutritionist and health and wellness educator with nearly 20 years of experience in the healthcare industry.
A gold plan is a type of individual/family or small group health insurance that pays, on average, 80% of covered healthcare expenses for a standard population. Plan members pay the other 20% of healthcare expenses with their copayments, coinsurance, and deductible payments. This article will explain what you need to know about gold plans, and tips for deciding which metal level plan will best fit your needs.
To make it easy to compare the value youre getting for the money you spend on health insurance premiums, the Affordable Care Act created new coverage categories for individual/family and small group plans . These plans are divided into levels, or tiersplatinum, gold, silver, and bronzebased on their actuarial value.
All of the health plans of a given level offer roughly the same overall value. For gold-tier plans, the value is 80%. Platinum plans offer a 90% value, silver a 70% value, and bronze a 60% value. In each case, there’s an acceptable actuarial value range of -4/+2 for silver, gold, and platinum plans, and -4/+5 for bronze plans .
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Blue Cross Blue Shield Of Michigan Silver Hmo Quotes Vs Competitor Silver Hmos
To maintain focus, we narrowed our review of competitor insurance products to a single state. The graph below compares individual rates for a Blue Cross Blue Shield of Michigan Silver health insurance plan to similar Silver HMOs offered by Priority Health and McLaren Health Plan Community.
Find Cheap Health Insurance in Your Area
Deductible amounts for the sample plans range from a low of $2,400 for Priority Health to a high of $3,700 for McLaren Health Plan Community. Out-of-pocket maximums are similar between the three options, ranging from $8,150 for McLaren to $8,550 for Priority Health.
Deductibles, coinsurance and copays are assessed differently among the plans. For example, only BCBS of Michigan applies prescription costs to the annual deductible, meaning prescriptions are not covered until the deductible is met.
The plans also vary in how they handle emergency room services. BCBS of Michigan and Priority Health both assess a $250 copay per ER visit after the annual deductible is met, plus 30% coinsurance. McLaren charges 20% coinsurance after the $3,700 deductible is met but no ER copay.
In a scenario where you received ER services totaling $5,000 before meeting any portion of your deductible, your combined out-of-pocket expense would be your full deductible, copay and coinsurance for the remaining amount. The cost calculation for each plan is shown below.
Member Resources And Unique Benefits
As part of the BCBS Association, many BCBS plans provide access to additional health-related resources like those listed here. It is important to remember that these are not health insurance benefits.
- A 24/7 nurse line
- Blue365 for discounts on health and fitness clubs, weight loss programs and other health-related products
- A mobile app and a separate member website
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Important Notices And Disclaimers
- The information shown here is a summary of benefits for informational purposes only. Review the official plan documents for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
- The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company’s provider network.
- The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
- Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
- The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
- The Summary of Benefits & Coverage can be found at healthcare.gov. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.
How Much Will It Cost
For any plan, your monthly premium will be based on several factors including:
- Your age
- Whether or not you smoke
- Where you live
- How many people are enrolling with you
- Your insurance company
Since your states Marketplace allows various private insurers to offer plans, a Silver plan from one company may cost more or less than the same plan offered by a different insurer. Plans offered by the same company, however, will increase in price as the actuarial value and the amount the plan pays go up.
As discussed above, the federal limit for annual out-of-pocket expenses for individuals is $8,550 the family cap is $17,100. Certain plans may have even lower out-of-pocket caps.
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