BLUE ADVANTAGE

North Carolina Health Plans

Blue Advantage®

Blue Advantage® is a good option if you want a broad choice of doctors, specialists and hospitals along with flexibility in how much you pay for doctor visits and prescription drugs.

Blue Advantage® offers:

  • Over 92% of physicians and 98% of the hospitals in North Carolina in-network1
  • More pharmacy options
  • Two ways to pay for medical expenses: a plan with predictable copayments or deductible and coinsurance

Blue Advantage is ideal for those who want choices: choices in which provider to see and choices for how much to pay for doctor visits and prescription drugs.

blue-advantage-map

The blue shaded area on the map represents the network coverage for the Blue Advantage network.

Benefit Choices

Blue Advantage offers a variety of benefit choices to give you options for how much you pay for medical expenses: copayments, and deductible and coinsurance plans.

Copayment plans are what most people think of as traditional plans. They offer a fixed copayment for things like primary care office visits and prescriptions. While you’ll know what you’re going to pay with copayment plans, they come at a higher premium. These plans are ideal for someone who wants predictable costs and doesn’t mind paying more in premiums.

Deductible and coinsurance plans have lower premiums than copayment plans. If you don’t expect a lot of medical expenses and want to save money on premiums, these may be the plans for you. For these plans, you pay the full cost of your medical expenses until you meet your medical deductible. Then you pay a coinsurance percentage, sharing the cost with Blue Cross and Blue Shield of North Carolina (BCBSNC) until you reach your out-of-pocket limit. After that, BCBSNC pays all covered costs.

Two of  BCBSNC’s Blue Advantage deductible and coinsurance plans have a $0 deductible. That means you start paying toward coinsurance rather than meeting a deductible. From Day 1 BCBSNC shares your expenses until you reach your out-of-pocket limit.

For more options for your budget and your needs, some plans offer a combination of copayments, and deductible and coinsurance.

Health Savings Account (HSA)

Certain plans are also eligible for an HSA.

  • The money you contribute to your HSA is tax-deductible.2
  • When you need to pay for eligible medical services, you can pay for them with your HSA funds.
  • Your HSA rolls over from year to year. That means you keep what you put into it. It’s your HSA – it’s your money.

Metallic Levels

Blue Advantage plans are available in all metallic levels: bronze, silver, gold and platinum. The levels differ by how much of your medical costs a plan will pay on average. They are based on approximate values for standard medical expenses.3,4

  • Bronze plans pay 60% of medical costs on average
  • Silver plans pay 70% of medical costs on average
  • Gold plans pay 80% of medical costs on average
  • Platinum plans pay 90% of medical costs on average

All plans have a maximum out-of-pocket (OOP) limit of $6,850.

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1. Consortium Health Plans, Inc., MarketQuest Network Compare, March 2015. Percentages indicated represent BCBSNC’s PPO network. Note: Not all plans are available in all areas.
2. HSA contribution amounts are limited to the amount established by the IRS for each year for single or family coverage.
3. The Center for Consumer Information and Insurance Oversight. Centers for Medicare and Medicaid Services. “Actuarial Value and Cost-Sharing Reductions Bulletin.” http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf. Accessed April 29, 2013.
4. These are approximate values with a +/- 2% variation.
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