Blue Plus Metro MN Gold Rx Copay Plan 455
HMO Minnesota dba Blue Plus · 2027 plan year
Gold
- Ind. deductible
- $1,300
- Family deductible
- $3,900
- Ind. OOP max
- $7,600
- Family OOP max
- $15,200
Compare with other Gold plans in MN
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More HMO Minnesota dba Blue Plus plans in MN
Monthly premiums by age
Rating Area 8
| Age | Individual |
|---|---|
| Under 15 | $365 |
| 21 | $410 |
| 30 | $465 |
| 40 | $523 |
| 50 | $732 |
| 60 | $1,112 |
| 64 and over | $1,229 |
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 | 25.00% Coinsurance after deductible |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | 25.00% Coinsurance after deductible |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | 25.00% Coinsurance after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $25.00 |
| Non-Preferred Brand Drugs | $225.00 |
| Preferred Brand Drugs | $75.00 |
| Specialty Drugs | $675.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 25.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | 25.00% Coinsurance after deductible |
| Accidental Dental | 25.00% Coinsurance after deductible |
| Allergy Testing | 25.00% Coinsurance after deductible |
| Chemotherapy | 25.00% Coinsurance after deductible |
| Chiropractic Care | 25.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Diabetes Education | 25.00% Coinsurance after deductible |
| Dialysis | 25.00% Coinsurance after deductible |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | 25.00% Coinsurance after deductible |
| Habilitation Services | 25.00% Coinsurance after deductible |
| Hearing Aids | 25.00% Coinsurance after deductible |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | 25.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 25.00% Coinsurance after deductible |
| Nutritional Counseling | 25.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | 25.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 25.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 25.00% Coinsurance after deductible |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 25.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 25.00% Coinsurance after deductible |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 25.00% Coinsurance after deductible |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 25.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Service area
This plan covers 9 geographic areas.
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