IFP Home-Shop 2022 health plans | Blue Shield of CA

 Deductible & Out-Of-Pocket Maximum

Calendar year deductible $7,000 per individual / $14,000 per family
Calendar year pharmacy deductible N/A
Calendar year out-of-pocket maximum $7,000 per individual / $14,000 per family

 No Cost Preventive Care

Preventive Care $0
Well Baby Care $0
Prenatal Office Visits $0
Pediatric Dental Benefits: Preventive $0
Pediatric Vision Benefits: Exams $0

 No Cost Extras

24/7 Nurse Hotline No additional cost
Shield Concierge Not available
Health and Wellness Discounts (gym, weight loss programs, and more) No additional cost

 Prescription Drugs

Retail Prescription Drugs Before deductible:
  Tiers 1-4 = Full cost
   
  After deductible:
  Tiers 1-4: $0

 Physician & Medical Services

Office Visit - Primary Care (internal medicine, family practice, OB/GYN, pediatrics) Before deductible:
  Full cost
  After deductible:
  $0
Office Visit - Specialist Care Before deductible:
  Full cost
  After deductible:
  $0
Teladoc 0% after ded
Retail clinics Cost depends on the  service performed. Cost is the same as if the service was performed elsewhere. 
Acupuncture (from an American Specialty Health Plans network acupuncturist) Before deductible:
  Full cost
  After deductible:
  $0
Chiropractic (from an American Specialty Health Plans network chiropractor) Not covered

 Lab & X-ray Diagnostics

Laboratory Tests Before deductible:
  Full cost
  After deductible:
  $0
X-rays Before deductible:
  Full cost
  After deductible:
  $0
Imaging (CT / PET scan, MRI) from an outpatient radiology center Before deductible:
  Full cost
  After deductible:
  $0

 Urgent & Emergency Care

Urgent care Before deductible:
  Full cost
  After deductible:
  $0
Emergency Room Services Before deductible:
  Full cost
  After deductible:
  $0
Ambulance Before deductible:
  Full cost
  After deductible:
  $0

 Maternity Care

Maternity - Prenatal Office Visits $0
Maternity - Other professional services Before deductible:
  Full cost
  After deductible:
  $0
Maternity - hospital stay After deductible:
  $0
  Before deductible:
  Full cost

 Hospital & Outpatient

Outpatient Surgery Services Before deductible:
  Full cost
  After deductible:
  $0
Hospital Stays Before deductible:
  Full cost
  After deductible:
  $0

 Dental & Vision

Pediatric Dental Benefits: Preventive $0
Pediatric Dental Benefits: Restorative Procedures 20%
Pediatric Dental Benefits: Medically Necessary Orthodontics 50%
Pediatric Vision Benefits: Exams $0
Pediatric Vision Benefits: Eye Glasses 1 pair per year

COVERAGE HAS NEVER BEEN MORE AFFORDABLE

Extra financial help is available to help lower the cost of coverage. Check to see how much you could qualify for, and apply for a health plan today during open enrollment.

COVERAGE HAS NEVER BEEN MORE AFFORDABLE

Extra financial help is available to help lower the cost of coverage. Check to see how much you could qualify for, and apply for a health plan today during open enrollment.

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Let’s find your plan!

Important: This calculator is a tool for informational purposes only and does not confirm eligibility. It is not a contract. Covered California determines eligibility and the amount of the subsidy. Eligibility requirements are only partially described. It is not intended for personalized financial or legal advice.

A quality network is now within reach

Our health plans include affordable pricing with Trio HMO and the flexibility to choose your provider with a PPO. If you see a plan you like, call us at (888) 273-4540.

Explore 2023 Blue Shield of California health insurance plans

Plans at a glance

 

Platinum

You’ll pay a high monthly rate for your plan, and pay a low amount when you need care.

Great for those who see a doctor often

We pay 90% of covered medical expenses

$0 deductible

 
Blue Shield Platinum 90 PPO
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Blue Shield Platinum 90 Trio HMO
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Gold

You’ll pay a little more each month for your plan, and pay less when you get care.

Great for those who see a doctor often

We pay 80% of covered medical expenses

$0 deductible

 
Blue Shield Gold 80 PPO
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Blue Shield Gold 80 Trio HMO
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Silver

You’ll find an affordable balance between your monthly premiums and the cost when you see a doctor.

Great for those who want to be prepared for an emergency

Moderate deductible

We pay 70% of covered medical expenses after you pay the deductible

 
Blue Shield Silver PPO 70
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Blue Shield Silver 70 Trio HMO
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Blue Shield Silver 94 PPO
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Blue Shield Silver 94 Trio HMO
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Blue Shield Silver 87 PPO
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Blue Shield Silver 87 Trio HMO
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Blue Shield Silver 73 PPO
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Blue Shield Silver 73 Trio HMO
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Bronze

You’ll pay a low amount each month for your plan, and pay a high cost share when you get care.

Great for those who want coverage in case of emergencies but don’t expect to see a doctor often

Highest deductible

We pay 60% of covered medical expenses after you pay the deductible

 
Blue Shield Bronze PPO 60
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Blue Shield Bronze 60 HDHP PPO
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Blue Shield Minimum Coverage PPO
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Here's where to start:

Learn about the difference between HMO and PPO plans.

PPO plans overview

Preferred provider organization

Care on your terms

Enjoy the flexibility to see doctors in a larger network and ability to customize your care.

Get primary, urgent, or emergency care statewide
Preventive care covered at 100%
Connect with doctors inside or outside the network
Get primary, urgent, or emergency care statewide
Preventive care covered at 100%
Connect with doctors inside or outside the network

*HMO not available in all areas *Los planes HMO no están disponibles en todas las áreas.

Health maintenance organization

Guided care with your doctor

Partner with a doctor in your local area to coordinate your care at lower costs.

Access a quality network of providers
Preventive care covered at 100%
Feel protected with emergency care inside and outside your network
Access a quality network of providers
Preventive care covered at 100%
Feel protected with emergency care inside and outside your network

Which plan is right for you?

Here are the details about each plan to help make your decision.

PPO plans overview

Here are the details about each plan to help make your decision.

Trio HMO
PPO
What you pay per month (premium) 1
lower premium
medium premium
See a specialist without a doctor referral
yes
In-state doctors and hospitals that accept your insurance
17,902 doctors 303 hospitals
56,212 doctors 329 hospitals
Emergency care available worldwide
Non-emergency care access
Local
yes
yes
California
yes
yes
United States
What you pay per visit 2
lower premium
medium premium
Virtual doctor and telehealth appointments 3
yes $0 copay
yes $0 copay
Tax-savings options to help pay for care 4
yes
Preventive care covered at 100%
yes
yes
Access to a wellness platform to manage your health
yes
yes
Additional support & Benefits
24/7 access to registered nurses, doctors, and mental health support
yes
yes
Dedicated support line to help you navigate your care (Shield Concierge)
yes
Discounts at local business 5
yes
yes
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Choose the level of coverage that's right for you

Each plan includes the same benefits, but your cost depends on how you use your plan.

 

Platinum Plan

You’ll pay a high monthly rate for your plan, and pay a low amount when you need care.

Great for those who see a doctor often

We pay 90% of covered medical expenses

$0 deductible

 

Gold Plan

You’ll pay a little more each month for your plan, and pay less when you get care.

Great for those who see a doctor often

We pay 80% of covered medical expenses

$0 deductible

 

Silver Plans

You’ll find an affordable balance between your monthly premiums and the cost when you see a doctor.

Great for those who want to be prepared for an emergency

Moderate deductible

We pay 70% of covered medical expenses after you pay the deductible

 

Bronze Plans

You’ll pay a low amount each month for your plan, and pay a high cost share when you get care.

Great for those who want coverage in case of emergencies but don’t expect to see a doctor often

Highest deductible

We pay 60% of covered medical expenses after you pay the deductible

Ready to shop now

Explore doctors and hospitals

It’s important to know which doctors and hospitals are included in your plan’s provider network before you choose a plan. Use our Find a Doctor tool to determine if your preferred doctors and hospitals are included in our PPO and/or Trio HMO networks.

Learn about Blue Shield plan options and federal financial help

Watch this video to learn more!

Learn about Blue Shield plan options and federal financial help

Watch this video to learn more!

Don’t forget dental, vision, and life insurance coverage.

Good health includes your dental and vision health, too. We’ve got you covered with a variety of dental and vision plans, as well as individual life insurance and Accidental Death and Dismemberment Coverage*.

 

Don’t forget dental, vision, and life insurance coverage.

Good health includes your dental and vision health, too. We’ve got you covered with a variety of dental and vision plans, as well as individual life insurance and Accidental Death and Dismemberment Coverage*.

 

Dental coverage

Protect your smile with one of our PPO or HMO dental plans.

 

Vision coverage

Vision plans starting at only $6.90 per month.

 

Life insurance coverage

Protect your loved ones’ financial security.

Learn more about health insurance Show all FAQs

  • How does health insurance work?

    A health insurance policy determines the types of medical services or benefits you are covered for, which doctors you can see, and what hospitals you can visit. Your plan also determines what you pay for care and services. 

    After purchasing a health plan, you can then visit a doctor or hospital in the Blue Shield of California network. A network is a group of doctors, hospitals, and healthcare providers that work with a health plan like Blue Shield. That means you only have to pay a certain amount for healthcare services instead of the full cost. By using in-network doctors and hospitals, you can keep your costs lower. 

    Health insurance is for preventive and event-based care – meaning you don’t have to wait until you’re sick to see a doctor. Preventive services like annual exams and flu shots are available to you at no additional cost. 

     

  • Coinsurance

    A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.

  • Copayment

    A fixed amount you pay for benefits such as doctor’s visits or any wellness services. This is usually after you’ve met your deductible if your plan has one.

  • Deductible

    The amount you pay each calendar year for most benefits before Blue Shield begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.

  • HMO

    A health plan where you choose a primary care physician (PCP) who treats you regularly. This includes preventive visits and referrals to specialists. You’ll need to see only other doctors or specialists in your PCP’s medical group. There is no coverage for services received from doctors who are outside your PCP’s network. 

  • Network

    A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with Blue Shield to provide benefits for a specified amount.

  • Out-of-pocket maximum

    The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.

  • PPO

    A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.

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Disclosures

  1. The average premium of all Trio HMO plans for 2021 is lower than the average premium of all PPO plans.
  2. The average out-of-pocket cost of all Trio HMO plans for 2021 is lower than the average out-of-pocket cost of all PPO plans.
  3. Primary care and behavioral health consultations provided remotely via virtual doctor and telehealth appointments available through Teladoc.
  4. Blue Shield does not offer tax advice. For information or questions, consult a financial or tax advisor.
  5. Discounts are not covered services or benefits under a Blue Shield of California health plan.

* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company