Anthem BlueCross BlueShield

Gold HMO BlueCare Prime

Links

    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $2,500
    • Family: $5,000
    • Per Person: $2,500
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: $30.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    Specialist
    • CoPay: $60.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: $60.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Non Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Generic Drugs
    • CoPay: $5.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Specialty Drugs
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.

    Inpatient Coverage

    Hospital Services
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Inpatient Services
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Emergency Room copay is waived if directly admitted to the hospital.
    Urgent Care Facility
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Pre and Postnatal Office Visit
    • CoPay: $0.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: $30.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 1
    • Limit Unit : Visit(s) per Year
    • Benefit Explanation: Limited reimbursement

    Major Dental Care

    Routine Dental Checkups for Children
    • CoPay: Not Applicable
    • CoInsurance: 0.00%
    • Covered: Covered
    • Limit Quantity: 2
    • Limit Unit : Visit(s) per Year
    Routine Dental Checkups for Adults
    • Covered: Not Covered
    Basic Dental Care - Adult
    • Covered: Not Covered
    Basic Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 40.00% Coinsurance after deductible
    • Covered: Covered
    Major Dental Care - Adult
    • Covered: Not Covered
    Major Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    Related Articles
    You may be interested in these relevant articles from across the HealthMarkets.com network.
    footer logo
    facebook logo

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86545CT1230027ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86545CT1230027ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86545CT1230027ACA1