Blue Cross Blue Shield of Arizona’s Most Comprehensive Plan

November 4th, 2011 | Arizona Health Insurance, Blue Cross Blue Shield of Arizona

Blue Cross Blue Shield of Arizona offers five different plans to individuals and families. As brokers, we can send you an official benefit summary for each plan available. However, we’ve noticed that it is easier to understand the benefits when they’re explained in much simpler terms first. In this post we will break down the BlueOptimum Plus plan, what it offers, it’s price point and its pros and cons.

For all Blue Cross Blue Shield of Arizona plans, preventative – or wellness – is covered at no charge. All plans also utilize the same network. It’s one of the largest networks in the state. It’s extremely likely your doctor is in it.

Deductible

BlueOptimum Plus is Blue Cross Blue Shield of Arizona’s most comprehensive plan. It’s their “Cadillac” plan, if you will. It is also their most expensive plan, depending on your deductible.

Here are the deductibles available on BlueOptimum Plus:

$250
$500
$1,000
$2,000
$3,000
$5,000
$7,500
$10,000

The deductible only applies to major services such as lab work, inpatient and outpatient, ambulance, and hospitalizations.

Copays To See a Doctor

For visits to your regular doctor, you’ll pay a $30 copay. That covers everything that happens during the visit. For visits to a specialist, it’s the same thing, however those visits are a $50 copay. If you need to go to urgent care, you’ll pay $60. If during any visit to a regular doctor, specialist, or urgent care center you are sent to get additional testing done at a separate location, the testing will fall under deductible and coinsurance.

Copays for BlueOptimum Plus:

$30 for Primary Care Physician
$50 for Specialist
$60 for Urgent Care

Coinsurance

The coinsurance on BlueOptimum Plus is 80/20 with an Out-Of-Pocket Maximum (OOPM) of $2,500. This means that after you’ve met your deductible, you are still required to pay 20% of all expenses until you’ve reached your OOPM. If you have a $500 deductible and ended up in a situation in which there was a very large bill, you would never pay more than $3,000 for the year. Any copays you may have paid do not contribute towards the deductible.

Prescriptions

If you need a prescription, BlueOptimum Plus has the richest offering. For generics you’ll pay the lesser of what the pharmacy charges or $15. For name brand prescriptions, what you’ll pay depends on the drug. It wall fall into either a Level 2 Drug for $40, a Level 3 Drug for $70, or a Level 4 Drug for $120. If you are on a certain drug and need to know which Level it is, give us a call and we can find out for you.

Copays for Prescriptions on BlueOptimum Plus:

$15 for Level 1 (Generic)
$40 for Level 2
$70 for Level 3
$120 for Level 4

Who is this plan for?

If you want unlimited copays for doctor visits, specialists, and urgent care, the best pricing for prescriptions, and a lower Out-of-Pocket Maximum, this is the plan for you. This plan is best for parents who want the most comprehensive coverage possible and don’t mind paying extra for it.

Why wouldn’t I want this plan?

This plan is expensive. In some cases, you end up paying more on this plan in the event of a major medical emergency. For example, using the example underneath the Coinsurance heading with a $500 deductible, 80/20 coinsurance and a $2,500 OOPM, you could be out $3,000 in the event of a major medical emergency. If you jump to a $1,000 deductible, that amount goes up to $3,500 ($1,000 deductible plus $2,500 OOPM). Compare that to Blue Cross Blue Shield’s BluePortfolio Plus 100/0 plan with a $3,000 deductible. For a family of four, BlueOptimum Plus’s monthly premium is $831 while BluePortfolio Plus’s is $446. You won’t get copays for doctor visits on BluePortfolio Plus, but most people aren’t spending $400 per month on doctor visits, which is what you would be saving. Also, BluePortfolio Plus is a 100% plan, meaning once you reach your deductible, there is no coinsurance left to pay.

Conclusion

BlueOptimum Plus is a great plan. It covers everything. It has a low Out-of-Pocket Maximum, generous 80/20 coinsurance, and unlimited copays for doctor visits and prescriptions. It might be the plan for you if you wish to pay more for the most comprehensive coverage Blue Cross Blue Shield of Arizona has to offer. However, what you gain in a comprehensive plan, you make up for in higher monthly premiums. Explore other plans before deciding if BlueOptimum Plus is the plan for you.