Blue Advantage Bronze HMO 204 - Two $40 PCP Visits Plan Details for 2021- HealthPocket

Blue Advantage Bronze HMO 204 - Two $40 PCP Visits

$288.60/mo

Apply For This Plan

Zip Code79936
Applicant11/24/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Advantage Bronze HMO 204 - Two $40 PCP Visits
Plan IDqhp-33602TX0460709
Plan Year2020
Insurance ProviderBlueCross BlueShield of Texas
Metal LevelBronze
Plan TypeHMO
Deductible$6,000
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness50% Coinsurance after deductible
Specialist Visit50% Coinsurance after deductible
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Deductible - Family$16300
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs30% Coinsurance after deductible
Non-Preferred Brand Drugs35% Coinsurance after deductible
Specialty Drugs45% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://public.hcsc.net/providerfinder/search.do?corpEntCd=TX1&residencestate=TX&product=BAV&entryPt=MKT

Hospital services

Emergency Room Services50% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50% Coinsurance after deductible
Inpatient Physician and Surgical Services50% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care50.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Urgent Care Centers or Facilities
Home Health Care Services
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Reconstructive Surgery
Prescription Drugs Other
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Bariatric Surgery
Cosmetic Surgery
Abortion for Which Public Funding is Prohibited
Nutritional Counseling
PremiumPlan NameDeductible
from $336
Ambetter Balanced Care 201 HSA (2021)
$5,800.00Select
from $352
Ambetter Balanced Care 201 HSA (2021) + Vision + Adult Dental
$5,800.00Select
from $470
Community Standard Silver 12 (No deductible PCP, Urgent Care &
$6,000.00Select
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  • Phone Number
    (915) 225-3807
  • Office Locations
    11351 James Watt Dr
    El Paso, TX 79936
11351 James Watt Dr El Paso TX, 79936
  • What is a bronze plan?

    Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.

  • How are Bronze Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.

  • How much does a Bronze Plan cost?

    The monthly premium for a Bronze Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.

  • When Can I Enroll in a Bronze Plan?

    The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.

    In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.