BlueSelect Bronze 2139V ($50 PCP Visits / Adult Vision / Rewards)
Florida Blue (BlueCross BlueShield FL) · 2026 plan year
Expanded BronzeHSA eligible
- Ind. medical deductible
- $0
- Rx deductible (separate)
- $2,100
- Family deductible
- $0
- Ind. OOP max
- $9,900
- Family OOP max
- $19,800
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Expanded Bronze plans in FL
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Florida Blue (BlueCross BlueShield FL) plans in FL
Monthly premiums by age
Rating Area 60 — the lowest-priced of the 41 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $328 | $328 |
| 21 | $429 | $464 |
| 30 | $487 | $548 |
| 40 | $549 | $645 |
| 50 | $767 | $920 |
| 60 | $1,165 | $1,398 |
| 64 and over | $1,288 | $1,546 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | No charge |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $100.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $1,500.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $3000.00 Copay per Day |
| Outpatient Surgery Physician/Surgical Services | 50.00% |
| Urgent Care Centers or Facilities | $100.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $30.00 |
| Non-Preferred Brand Drugs | 47.00% Coinsurance after deductible |
| Off Label Prescription Drugs | 47.00% Coinsurance after deductible |
| Preferred Brand Drugs | $200.00 |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $3000.00 Copay per Day |
| Mental/Behavioral Health Outpatient Services | $75.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $100.00 |
| Acupuncture | Not covered |
| Allergy Testing | $100.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Transplant | $3,000.00 |
| Chemotherapy | $1,500.00 |
| Chiropractic Care | $100.00 |
| Congenital Anomaly, including Cleft Lip/Palate | $1,500.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $3,000.00 |
| Dental Anesthesia | $100.00 |
| Dental Check-Up for Children | Not covered |
| Diabetes Care Management | $100.00 |
| Diabetes Education | No charge |
| Dialysis | $1,500.00 |
| Durable Medical Equipment | No charge |
| Emergency Transportation/Ambulance | 50.00% |
| Eye Glasses for Children | No charge |
| Habilitation Services | $100.00 |
| Hearing Aids | Not covered |
| Home Health Care Services | No charge |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | $500.00 |
| Infertility Treatment | Not covered |
| Infusion Therapy | $1,500.00 |
| Inpatient Physician and Surgical Services | 50.00% |
| Laboratory Outpatient and Professional Services | $60.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutrition/Formulas | $100.00 |
| Nutritional Counseling | $100.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Osteoporosis | $100.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $100.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $1,500.00 |
| Outpatient Rehabilitation Services | $100.00 |
| Prenatal and Postnatal Care | $100.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | No charge |
| Radiation | $1,500.00 |
| Reconstructive Surgery | $1,500.00 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $100.00 |
| Rehabilitative Speech Therapy | $100.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $100.00 |
| Skilled Nursing Facility | 50.00% |
| Substance Abuse Disorder Inpatient Services | $3000.00 Copay per Day |
| Substance Abuse Disorder Outpatient Services | $75.00 |
| Transplant | $3,000.00 |
| Treatment for Temporomandibular Joint Disorders | $100.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $250.00 |
Plan rules
Service area
This plan covers 41 geographic areas.
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