We offer Pennsylvania BlueCare Direct Select health insurance plans at the lowest published rates. Easily, you can review about and apply for the best plans offered for single persons, families or small businesses. This coverage is issued by Blue Cross of Northeastern Pennsylvania and is an underwritten plan, so medical questions must be answered before a policy is approved. Along with Aetna and HealthAmerica, it has become very popular in this part of the state.
This policy is a comprehensive plan that offers 100% coverage for common preventative care services, such as childhood immunizations, routine gynecological exams and preventive exams. Other included preventive care services are screening mammograms, colorectal cancer screenings, prostrate screenings and bone density screenings.
There is no coinsurance, copay or deductible to meet when using this portion of the policy. Maternity benefits are included along with the standard inpatient and outpatient coverage. By staying “in-network,” you’ll pay less for covered services and receive substantial negotiated discounts. PPO plans allow out-of-network treatment, but with higher out-of-pocket expenses.
Regular office visits are also not subject to a deductible. A $30 copay applies to primary care visits and a $50 copay applies to specialty care visits. Unlike BlueCare Direct, BlueCare Direct Select plans do not have a limitation on the number of covered office visits per year. This includes both primary care and specialist visits. Also, 45 therapy sessions are covered which is very unique for these types of plans. Both inpatient and outpatient therapy (individual and group) are covered.
NOTE: For persons age 65 or older that are typically eligible for Medicare, an affordable Pa Medigap plan should be considered. Although there are no Obamacare federal subsidies, the cost of Medicare Supplement or Advantage plans is quite reasonable. Advantage contracts require utilizing network providers, and also may provide dental, vision, or hearing benefits.
Prescription drug coverage is included, with copays ranging from $0 to $65. Most prescriptions will be covered with a copay of $35 or less. If a 90-day mail order method is used, out-of-pocket expenses will reduce. And unlike most plans, there is no deductible to meet for the RX coverage.
Tier 1 drugs are very common (and typically cheap and generic) and have no out of pocket cost to any person covered on the policy. Other more expensive medications will have higher copays. Of course, if possible, request non-generic drugs to pay a lower copay. Often, your copay may be $10 or less.
Also available are $0 deductible options for the major medical coverage. Additional deductibles range from $500 to $1,500. For example, the monthly rate (20% coinsurance) for a 34 year-old male would be $172 with no deductible and $122 with a $1,500 deductible. Female rates are higher for most ages under age 55.
For additional information regarding plan details, comparing plans or applying for coverage, please call or email us. We can explain the specific details of the plan and discuss how the policy compares to other carriers. NOTE: The NEPA Alliance offers research and information services to the seven counties in Northeastern Pa.
Pittsburgh-based Highmark and NE Blue Cross will be combined into one company, if the proposed agreement is approved. Between 500,000 and 600,000 members will become part of Highmark.
However, there are restrictions regarding the number of employees that can be terminated at 18-month and 48-month intervals. Although efficiency (and hopefully rates) are expected to improve, job-loss is a major concern. The entire process could take about a year to complete.New plan designations will be likely named in the future.
The BlueCare Direct Select plan is no longer offered, since it is does not meet the ACA Legislation guidelines, and is not available on the Marketplace. However, as a grandfathered plan, you can keep coverage if you purchased the policy before the Spring of 2010. You may also purchase a new policy during Open Enrollment that may be eligible for a subsidy.
Listed below are popular Blue Cross of Northeastern Pennsylvania plans:
Myblue Access $6,350 – Catastrophic option. Must be under age 30 or show financial hardship.
Myblue Access LP $4,500 – $4.500 deductible. Cheapest Bronze-tier option.
Myblue Access $2,500 – Lower deductible that does not apply to prescriptions.
Myblue Care Silver – $1,000 deductible with low $20 and $40 copays on primary-care-physician (pcp) and specialist visits.
Myblue Care Gold – $500 deductible with low office visit copays ($15 and $30).
Myblue Care Platinum – $100 deductible with maximum out-of-pocket maximum of only $500.
The number of Northeastern Pennsylvania residents without health insurance decreased in 2014, which also matched a national trend. For example, Monroe County’s percentage of uninsured dropped from 12.8% to 10.4%, which provided coverage to about 4,000 more persons.
Luzerne County also experienced a significant reduction as more than 4,000 persons added coverage, which dropped the percentage of persons without qualified coverage from 9.6% to 8.3%. Lackawanna County added many new enrollments including about 600 for Scranton.