Blue Advantage Bronze HMO℠ 204

Blue Cross and Blue Shield of Texas · 2026 plan year

Expanded BronzeHSA eligible

Ind. deductible: $6,000
Family deductible: $12,000
Ind. OOP max: $10,150
Family OOP max: $20,300

Compare with other Expanded Bronze plans in TX

Side by side: deductibles, out-of-pocket limits and copays.

Wellpoint Essential Bronze 6000 Adult Dental/Vision ($0 Virtual PCP+$0 Select Drugs)WellPoint · Deductible $6,000 · Out-of-pocket max $10,600
Connect Bronze DFW 6000 Indiv Med DeductibleCigna Healthcare · Deductible $6,000 · Out-of-pocket max $10,600
Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives)WellPoint · Deductible $6,000 · Out-of-pocket max $10,600

Compare 4 plans Browse all Expanded Bronze plans in TX

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Bronze Off Exchange Plan Zero Cost Sharing Plan Variation

More Blue Cross and Blue Shield of Texas plans in TX

Blue Advantage Plus Bronze℠ 305 Blue Advantage Plus Bronze℠ Standard

Monthly premiums by age

Rating Area 5

Age	Individual	Individual + tobacco
Under 15	$264	$264
21	$345	$345
30	$391	$444
40	$441	$568
50	$616	$814
60	$936	$1,202
64 and over	$1,034	$1,329

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	$45.00

Specialist

Benefit	In-network
Specialist Visit	50.00% Coinsurance after deductible

Hospital

Benefit	In-network
Emergency Room Services	$1000.00 Copay with deductible + 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$950.00 Copay per Stay with deductible + 50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	$200.00 Copay with deductible + 50.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$60.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	30.00% Coinsurance after deductible
Specialty Drugs	45.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$950.00 Copay per Stay with deductible + 50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	50.00% Coinsurance after deductible

Other

Benefit	In-network
Acupuncture	Not covered
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	50.00% Coinsurance after deductible
Allergy Testing	50.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	50.00% Coinsurance after deductible
Chiropractic Care	50.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	$950.00 Copay with deductible + 50.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	50.00% Coinsurance after deductible
Dialysis	50.00% Coinsurance after deductible
Durable Medical Equipment	50.00% Coinsurance after deductible
Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	50.00% Coinsurance after deductible
Hearing Aids	50.00% Coinsurance after deductible
Home Health Care Services	50.00% Coinsurance after deductible
Hospice Services	50.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	40.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	$100.00
Inpatient Physician and Surgical Services	50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	Not covered
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	$600.00 Copay with deductible + 40.00% Coinsurance after deductible
Outpatient Rehabilitation Services	50.00% Coinsurance after deductible
Prenatal and Postnatal Care	$45.00
Private-Duty Nursing	Not covered
Prosthetic Devices	50.00% Coinsurance after deductible
Radiation	50.00% Coinsurance after deductible
Reconstructive Surgery	50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	50.00% Coinsurance after deductible
Rehabilitative Speech Therapy	50.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	$950.00 Copay per Stay with deductible + 50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	50.00% Coinsurance after deductible
Transplant	50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	50.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	40.00% Coinsurance after deductible