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Blue Cross Blue Shield of Wisconsin

BlueCross BlueShield of Wisconsin is the largest health insurance company in the state with over 5 million members in all 254 Wisconsin counties. They offer health plans that can be customized for individuals, children, and families that include consumer-directed plans, Health Savings Accounts, and Medicare Supplements.

BCBSWI no longer offers PPOs on the individual market; however, Advantage Plus plans offer the added option of using providers other than Blue Advantage network providers, while still having some of the costs covered.

Blue Cross Gold Plans

All Blue Advantage Gold HMO Plans offer the same set of essential health benefits, quality and amount of care as the Blue Advantage Silver and Gold HMO Plans. The Blue Advantage Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans.

Blue Advantage Gold HMO Plans may be right for you if you are an individual or family who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • Requires regular prescription medication

There are deductibles for this plan, and this is an HMO plan. You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

Plan Name Blue Advantage Gold HMO 101 Blue Advantage Gold HMO 111* Blue Advantage Plus Gold 101
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $500 $0 $2,750
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30% 0% 20%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $5,250 $7,150 $3,500
Primary Care Office Visit $20 $50 $10
Specialist Office Visit $40 $75 $20
Mental Illness Treatment and Substance Abuse Rehab Office Visit $20 $50 $10
Emergency Room $500 per occurrence copay, then 30% $750 $400 per occurrence copay, then 20%
Urgent Care $20 $50 $10
Inpatient Hospital Service $300 per occurrence copay, then 30% $1,500 $200 per occurrence copay, then 20%
Outpatient Surgery $200 per occurrence copay, then 50% $500 $200 per occurrence copay, then 40%
Outpatient X-Rays and Diagnostic Imaging 50% $100 40%
Outpatient Imaging (CT/PET Scans/MRIs) 50% $250 40%
Network Blue Advantage HMO
HSA Eligible No No No
Outpatient Prescription Drugs – Preferred Pharmacy $0/$10/$50/$100/30% $0/$10/$50/$100/30% $0/$10/$50/$100/30%
Outpatient Prescription Drugs – Non-Preferred Pharmacy $5/$15/$60/$110/30% $5/$15/$60/$110/30% $5/$15/$60/$110/30%
Prescription Drug Utilization Benefit Management Programs Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.

*Not available on the health exchange marketplace (not subsidy eligible)

Blue Cross Silver Plans

BlueCross BlueShield Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays. Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up.  Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.

 

Plan Name Blue Advantage Silver HMO 102 Blue Advantage Silver HMO 103 Advantage Silver HMO 107 Blue Advantage Plus Silver 102 (Three $0 PCP Visits)
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $3,000 $3,750 3,500 $3,250
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30% 0% 20% 20%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $7,150 $3,750 $7,150 $6,850
Primary Care Office Visit $40 $30 100% after deductible First three visits $0, then 20%
Specialist Office Visit $60 100% after deductible $65 20%
Mental Illness Treatment and Substance Abuse Rehab Office Visit $40 40% $30 $0
Emergency Room $600 per occurrence copay, then 30% 40% $400 copay after deductible $600 per occurrence copay, then 20%
Urgent Care $40 100% after deductible 100% after deductible $20
Inpatient Hospital Service $500 per occurrence copay, then 30% 100% after deductible 20% $400 per occurrence copay, then 40%
Outpatient Surgery $300 per occurrence copay, then 50% 100% after deductible $20% $300 per occurrence copay, then 40%
Outpatient X-Rays and Diagnostic Imaging 50% $100 40% $2,750
Outpatient Imaging (CT/PET Scans/MRIs) 30% 100% after deductible 20% 40%
Network Blue Advantage HMO
HSA Eligible No Yes No No
Outpatient Prescription Drugs – Preferred Pharmacy $0/$10/$50/$100/30% 100% after deductible $15/$15/$50/$100/40% $0/$10/$50/$100/30%
Outpatient Prescription Drugs – Non-Preferred Pharmacy $5/$15/$60/$110/30% 100% after deductible $15/$15/$50/$100/40% $5/$15/$60/$110/30%
Prescription Drug Utilization Benefit Management Programs Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.

Blue Cross Bronze Plans

BlueCross BlueShield of Wisconsin Bronze plans are ideal for individuals looking for low-cost plans. Bronze plans have higher out of pocket costs, but two plans (the 106 and 104) also have HSA options for those looking for tax savings. These plans are ideal for those who do not have regular medications or visit the doctor outside of their yearly check-up (included as preventative care on all plans.)

 

Plan Name Blue Advantage Bronze HMO 006 Blue Advantage Bronze HMO 105 Blue Advantage Plus Bronze 103 Blue Advantage Plus Bronze 104
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $6,500 $6,850 $6,600 $5,000
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max None (Member pays 0% after deductible) 30% 20% 40%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $6,500 $7,150 $7,150 $6,550
Primary Care Office Visit 0% after deductible First 2 visits $40, then 30% First visit $0, then 20% 40%
Specialist Office Visit 0% after deductible 30% 20% 40%
Mental Illness Treatment and Substance Abuse Rehab Office Visit 0% after deductible $0 $0 40%
Emergency Room 0% after deductible 30% $950 per occurrence copay, then 20% 40%
Urgent Care 0% after deductible $40 100% after deductible $20
Inpatient Hospital Service 0% after deductible 30% $750 per occurrence copay, then 20% 40%
Outpatient Surgery 0% after deductible 50% $400 per occurrence copay, then 40% 50%
Outpatient X-Rays and Diagnostic Imaging 0% after deductible 50% $80 per occurrence copay, then 40% 50%
Outpatient Imaging (CT/PET Scans/MRIs) 0% after deductible 50% $600 per occurrence copay, then 40% 50%
Network Blue Advantage HMO
HSA Eligible Yes No No Yes
Outpatient Prescription Drugs – Preferred Pharmacy 0% after deductible 20%/20%/30%/40%/50% $15/30%/40%/45%/50% 30%/30%/40%/50%/50%
Outpatient Prescription Drugs – Non-Preferred Pharmacy 0% after deductible 25%/25%/40%/50%/50% $20/35%/50%/50%/50% 35%/35%/50%/50%/50%
Prescription Drug Utilization Benefit Management Programs Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.

Multi-State Plans

The Multi-State Plan (MSP) Program, established under the Affordable Care Act, directs the Federal Office of Personnel Management  to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans. There are no major differences between multi-state plans and other plans, and it does NOT mean these plans provide out of state benefits, just that benefits meet minimum requirements from state to state. Always check the doctor’s networks for each individual plans, and remember that emergency care is covered within the continental US.

 

Plan Name Blue Cross Blue Shield Premier 101 Blue Cross Blue Shield Solution 102 Blue Cross Blue Shield Basic 103
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $1,000 $3,750 $6,250
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 20% 20% 30%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $5,800 $6,500 $7,150
Primary Care Office Visit First 3 visits $15, then 20% First 2 visits $0, then 20% First visit $0, then 30%
Specialist Office Visit 20% 20% 30%
Mental Illness Treatment and Substance Abuse Rehab Office Visit $0 $0 $0
Emergency Room $600 per occurrence copay, then 20% $750 per occurrence copay, then 20% $1,000 per occurrence copay, then 30%
Urgent Care $15 $15 $15e
Inpatient Hospital Service 20% 20% 30%
Outpatient Surgery 40% $300 per occurrence copay, then 40% $400 per occurrence copay, then 50%
Outpatient X-Rays and Diagnostic Imaging 40% 40% 50%
Outpatient Imaging (CT/PET Scans/MRIs) 40% 40% $500 per occurrence copay, then 50%
Network Blue Advantage HMO
HSA Eligible No No No
Outpatient Prescription Drugs – Preferred Pharmacy $0/$10/$50/$100/30% $0/$10/$50/$100/30% 20%/20%/30%/40%/50%
Outpatient Prescription Drugs – Non-Preferred Pharmacy $5/$15/$60/$110/30% $5/$15/$60/$110/30% 25%/25%/40%/50%/50%

Prescription Drug Utilization Benefit Management ProgramsSpecialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.

HSA Plan Comparison

Health Savings Accounts can reduce your out of pocket costs as well as your tax burden. BCBSWI offers the only HSAs in Wisconsin. Learn more at our HSA Guide.

 

Plan Name Blue Advantage Bronze HMO 006 Blue Advantage Plus Bronze 104 Blue Advantage Silver HMO 103
Plan Brochure Plan Details Plan Details Plan Details
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $6,500 $5,000 $3,750
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max None (Member pays 0% after deductible) 40% 0%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $6,500 $6,550 $3,750
Primary Care Office Visit 0% after deductible 40% $30
Specialist Office Visit 0% after deductible 40% 100% after deductible
Mental Illness Treatment and Substance Abuse Rehab Office Visit 0% after deductible 40% 40%
Emergency Room 0% after deductible 40% 40%
Urgent Care 0% after deductible $20 100% after deductible
Inpatient Hospital Service 0% after deductible 40% 100% after deductible
Outpatient Surgery 0% after deductible 50% 100% after deductible
Outpatient X-Rays and Diagnostic Imaging 0% after deductible 50% $100
Outpatient Imaging (CT/PET Scans/MRIs) 0% after deductible 50% 100% after deductible
Network Blue Advantage HMO
HSA Eligible Yes Yes Yes
Outpatient Prescription Drugs – Preferred Pharmacy 0% after deductible 30%/30%/40%/50%/50% 100% after deductible
Outpatient Prescription Drugs – Non-Preferred Pharmacy 0% after deductible 35%/35%/50%/50%/50% 100% after deductible
Prescription Drug Utilization Benefit Management Programs Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.
Blue Advantage Gold Plans

Our Rating: 

See All Gold Plans

All Blue Advantage Gold HMO Plans offer the same set of essential health benefits, quality and amount of care as the Blue Advantage Silver and Gold HMO Plans.  The Blue Advantage Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans.

Blue Advantage Gold HMO Plans may be right for you if you are an individual or family who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • Requires regular prescription medication

There are deductibles for this plan, and this is an HMO plan. You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

Blue Advantage Silver Plans

 

Our Rating: 

See All Silver Plans

Recommended plan: Blue Advantage Silver HMO 102

All Blue Advantage Silver plans offer a higher level of coverage than Bronze plans, and those who purchase on-exchange may also be eligible for cost-sharing reductions based on income, lowering deductibles and co-pays.

Silver plans are ideal for people who have regular medications or utilize specialist or doctors visits more often than their included yearly check-up.  Silver plans are a good “middle of the road” option for people who might need to utilize their healthcare options more but may not be able to afford higher premium payments.

Blue Advantage Silver HMO Plans may be right for you if you are an individual or family who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Qualifies for cost sharing reductions on the marketplace
  • Requires regular prescription medication

There are deductibles for this plan, and this is an HMO plan. You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

Blue Advantage Bronze Plans

BlueCross BlueShield of Wisconsin Bronze plans are ideal for individuals looking for low-cost plans. Bronze plans have higher out of pocket costs, but two plans (the 106 and 104) also have HSA options for those looking for tax savings. These plans are ideal for those who do not have regular medications or visit the doctor outside of their yearly check-up (included as preventative care on all plans.)

Blue Advantage Bronze HMO Plans may be right for you if you are an individual or family who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Seeks lower cost coverage
  • Does not regularly have doctor visits
  • Would like an HSA compatible plan

There are deductibles for this plan, and this is an HMO plan. You must select a Blue Advantage HMO Primary Care Physician (PCP) when enrolling in this plan.

BCBSWI Dental Plans

BCBSWI Health

 Dental Plans Brochure

 Application

With the BCBSWI dental plan, you’ll get dental coverage on day one with no deductible deductible required for check-ups, cleanings and other preventive services. Most important, costs are typically reduced when you receive care from any of our participating network dentists. However, you also have the option to see any dentist not in the network, but your out-of-pocket costs may be higher.

Some highlights of Dental Indemnity USA coverage:

  • Coverage can be used to provide dental benefits to an individual, spouse, children or any combination of dependents.
  • A $50 deductible, based on fee schedule allowances, applies for dental procedures or services received by a covered individual during each benefit year.
  • Maximum deductible amount of $150 for family coverage.
  • Deductibles do not apply to oral exams, cleanings, fluoride treatments, sealants and X-rays.
  • $1,000 orthodontia benefit for children under 19 years old

For more information on coverage and benefits, view the Dental Outline of Coverage 

You must enroll in a BCBSWI health plan in order to enroll in the dental plan (you have up to 31 days from the effective date of your policy to enroll). Shop for a plan now.

Plan Brochures

Product Name

Benefit Highlights
Blue Advantage Bronze HMO 006 View
Blue Advantage Bronze HMO 105 – Two $40 PCP visits View
Blue Advantage Silver HMO 102 View
Blue Advantage Silver HMO 103 View
Blue Advantage Silver HMO 107 View
Blue Advantage Gold HMO 101 View
Blue Advantage Gold HMO 111 View
Blue Advantage Security HMO 100 View
Blue Advantage Plus Bronze 103 – One $0 PCP visit View
Blue Advantage Plus Bronze 104 View
Blue Advantage Plus Silver 102 – Three $0 PCP visits View
Blue Advantage Plus Gold 101 View
Contact Us

Phone: (312) 726-6565
Email: help@ihealthagents.com

Popular Hospital Network Guide
Hospital Included in Advantage HMO Network?
Doctors Hospital At Renaissance (Edinburg) YES
University Health System (San Antonio) NO
Medical City Hospital (Dallas) YES
Memorial Hermann Hospital (Sugar Land) YES
Mother Frances Hospital (Tyler) NO
Scott & White Hospital (Round Rock) NO
North Austin Medical Center (Austin) YES
Seton Medical Center (Austin) YES
Hill Country Memorial Hospital (Fredericksburg) YES
Wisconsin Health Harris Methodist (Fort Worth) YES
UT Southwestern Medical Center (Dallas) NO
Memorial Hermann Wisconsin Medical Center (Houston) YES
St. Lukes Episcopal Hospital (Houston) YES
Baylor University Medical Center (Dallas) YES
The Methodist Hospital (Houston) YES

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Find Every Plan In Your Area

Calculate Your Subsidy

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