Texas Plans
On and Off Exchange
What’s new in 2021:
- Increased $0 deductible and copay options on certain CSR qualified plans
- Member access to covered benefits through providers with telehealth services
- Health plans on and off exchange in every county
- Comprehensive, year-round coverage
- High-quality, efficient networks with focus on preventive care
- Affordable plan options
- Monthly payments as low as $0 for qualified on exchange applicants
- Serving Texas communities for more than 90 years.
- In the eight years of ACA open enrollment, BCBSTX has been proud to offer multiple qualified health plans in every county across Texas.
Blue Advantage HMO & Blue Advantage Plus plans/networks are available statewide
HMO Plans
Just like 2020, and continuing an industry-wide trend (no major carriers offer PPO plans in Texas), BCBSTX only offer HMO plans in 2021. However, Blue Advantage Plus plans offer some out of network benefits, unlike traditional HMOs.
- HMOs help keep upfront costs low
- Tax credits and cost-sharing assistance may be available to help lower premiums and out-of-pocket costs
- Managed care on a personalized level with care coordinated by one doctor
- Physician care extenders – allows physician assistants and advanced registered nurse practitioners to be PCPs
- HMOs help keep upfront costs low
- Tax credits and cost-sharing assistance may be available to help lower premiums and out-of-pocket costs
- Managed care on a personalized level with care coordinated by one doctor
- Physician care extenders – allows physician assistants and advanced registered nurse practitioners to be PCPs
Perks
Helpful Resources 24/7
- Cost Estimator Tool on Blue Access for Members
- Easy-to-use BCBSTX App – find a doctor, see payment options, access electronic ID card and more, just text BCBSTXAPP to 33633 Blue365®
- Blue365 member discount program – members save on health club and gym memberships, weight loss programs, dental products and much more
- Health and Wellness Tools – BCBSTX provides tools and resources like Well onTarget® to help guide you toward your health and wellness goals. You can also access the portal through the AlwaysOn app.
- COVID-19 Friendly Resources
- 24/7 Virtual Visits powered by MDLIVE
- 24/7 Nurseline (English and Spanish)
- Telehealth – Some primary care and other doctors may offer phone and online services which are covered at the same member share as a regular office visit or in-person equivalent.
Health Plans
Blue Advantage HMO:
3 Bronze, 2 Silver, 2 Gold
- Network: Blue Advantage HMO (BAV)
- Approximately 476 hospitals, 73,981 providers
- Helps keep costs lower and more predictable
- Personalized with a primary care provider (PCP) who coordinates all health care
Blue Advantage Plus:
4 Bronze, 2 Silver, 1 Gold
- Network: Blue Advantage HMO
- Approximately 476 hospitals, 73,981 providers*
- Greater flexibility
- Leverages the HMO network
- Some out-of-network benefits available
MyBlue Health:
1 Bronze, 1 Silver, 1 Gold
- Network: MyBlue HealthSM (BFT)
- Approximately 29 hospitals, 6,116 providers*
- $0 copay for primary care in-person and primary care telehealth appointments at Sanitas Medical Centers – exclusively for Blue Cross and Blue Shield members
- Neighborhood access to primary and urgent care medical centers (4 locations in Dallas County and 6 locations in Harris County)
- Local, face-to-face BCBSTX Customer Service
Dental Plans:
Current BCBSTX members changing medical plans MUST re-enroll to keep their dental plan in 2021.
Pharmacy:
BCBSTX continues to use a 6 tier formulary
BCBSTX continues to use a 6 tier formulary
• Six prescription benefit tiers for most plans – generic, brand and specialty drugs now have preferred and non-preferred benefit levels
• All plans include a drug list and Preferred Pharmacy Network (CVS Pharmacy is considered a non-network pharmacy)
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