If you will never be eligible for a health insurance subsidy through Covered California, Blue Shield of California offers several plans off-exchange. All Silver plans are less expensive off-exchange, direct from Blue Shield. There is even a Bronze HMO plan that is a good value.
Less Expensive Blue Shield PPO and HMO plans
Covered California is known as the health insurance marketplace exchange. When you enroll direct with an insurance company or health plan, you are going off-exchange. The health plan rates, by age and region, are the same for the Bronze, Gold, and Platinum health plans on or off exchange. The Silver plans on Covered California are artificially inflated by 5 or 10 percent depending on the carrier.
Consequently, Silver 70 plans will always be less expensive off-exchange if you are never eligible for Premium Tax Credit subsidy through Covered California.
If you are eligible for an enhanced Silver plan 73, 87, or 94 through Covered California, you should enroll into it. Note that the rates for all the Silver plans (70, 73, 87, 94) are exactly the same through Covered California. But the Silver 70 Off-Exchange plans, PPO or HMO, are always less expensive direct from the carrier.
California has 19 different regions. The rates for a specific plan can be dramatically different depending on the region and age. While Blue Shield PPO plans are offered throughout the entire state, the HMO plans are not available in all regions.
Silver Off-Exchange Plans
Blue Shield also offers some plans not offered through Covered California. The Silver 2600 is a High Deductible Health Plan and is Health Savings Account compliant. After you have received $2,600 in health care services, remaining services and prescription medications are subject to 35 percent coinsurance. When the deductible plus coinsurance equals $7,350, you have met your maximum out-of-pocket annual amount.
The Blue Shield Silver 1750 has many routine health services subject to a set copayment before and after you have met the $1,750 deductible. Some services are subject to 35 percent coinsurance after you have met the deductible such as X-rays, hospitalization, emergency room, ambulance, and maternity services. Once the copays, deductible, and coinsurance equal $9,250 you have met the maximum out-of-pocket amount.
Blue Shield Bronze 7500 Plan
The Blue Shield Bronze 7500 Trio HMO is not offered through Covered California. Unlike the tradition Bronze 60 plan, there are several routine health care services subject to a set copayment such as PCP visits, specialist visits, urgent care, labs, and X-rays. Other services will require you to mee the $7,500 deductible before the health plan will share 50 percent of the cost such as hospitalization and maternity services.
Health Insurance Rates
While you can’t really compare HMO and PPO plan rates, but the Bronze 7500 HMO can be substantially less expensive than Bronze PPO plan. Again, the Bronze HMO is offered in all regions.
The Silver 1750 and Silver 2600 PPO plans are less expensive than the Silver 70 plan. For additional documents and the rates sheets visit Blue Shield IFP web page.
YouTube video review Blue Shield off-exchange plans.
