myBlue Silver 26M02-04E ($5 PCP Visits / $5 Labs / Adult Dental & Vision / Rewards)
Florida Blue HMO (a BlueCross BlueShield FL company) · 2026 plan year
Silver
- Ind. deductible
- $9,500
- Family deductible
- $19,000
- Ind. OOP max
- $10,150
- Family OOP max
- $20,300
Compare with other Silver plans in FL
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Florida Blue HMO (a BlueCross BlueShield FL company) plans in FL
Monthly premiums by age
Rating Area 30 — the lowest-priced of the 7 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $415 | $415 |
| 21 | $542 | $586 |
| 30 | $616 | $693 |
| 40 | $693 | $814 |
| 50 | $969 | $1,162 |
| 60 | $1,472 | $1,766 |
| 64 and over | $1,627 | $1,953 |
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 | $70.00 Copay after deductible |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 50.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | No charge |
| Urgent Care Centers or Facilities | $70.00 Copay after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $35.00 Copay after deductible |
| Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
| Off Label Prescription Drugs | 50.00% Coinsurance after deductible |
| Preferred Brand Drugs | $70.00 Copay after deductible |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | No charge |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Accidental Dental | $70.00 Copay after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $70.00 Copay after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | 50.00% Coinsurance after deductible |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Testing | 50.00% Coinsurance after deductible |
| Chemotherapy | 50.00% Coinsurance after deductible |
| Chiropractic Care | $70.00 Copay after deductible |
| Congenital Anomaly, including Cleft Lip/Palate | 50.00% Coinsurance after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 50.00% Coinsurance after deductible |
| Dental Anesthesia | $70.00 Copay after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Care Management | $70.00 Copay after deductible |
| Diabetes Education | No charge |
| Dialysis | 50.00% Coinsurance after deductible |
| Durable Medical Equipment | No charge |
| Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | $70.00 Copay after deductible |
| Hearing Aids | Not covered |
| Home Health Care Services | No charge |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | 50.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 50.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | No charge |
| Laboratory Outpatient and Professional Services | $5.00 |
| Major Dental Care - Adult | 50.00% Coinsurance after deductible |
| Major Dental Care - Child | Not covered |
| Nutrition/Formulas | 50.00% Coinsurance after deductible |
| Nutritional Counseling | $70.00 Copay after deductible |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Osteoporosis | $70.00 Copay after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $70.00 Copay after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 50.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $70.00 Copay after deductible |
| Prenatal and Postnatal Care | $70.00 Copay after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | No charge |
| Radiation | 50.00% Coinsurance after deductible |
| Reconstructive Surgery | 50.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $70.00 Copay after deductible |
| Rehabilitative Speech Therapy | $70.00 Copay after deductible |
| Routine Dental Services (Adult) | No charge |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $70.00 Copay after deductible |
| Skilled Nursing Facility | $1000.00 Copay per Stay |
| Substance Abuse Disorder Inpatient Services | 50.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | No charge |
| Transplant | 50.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | $70.00 Copay after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | No charge |
Plan rules
Service area
This plan covers 7 geographic areas.
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