Blue FocusCare – 2024 Plans
Blue FocusCare Plans are good for individuals that don’t mind limited networks. If you do not make frequent hospital visits and only need to have your basic needs covered this may be the cost efficient choice for you. If you can accept some reduced hospital and physician choice, Blue FocusCare may be a great option for you. All Blue FocusCare plans offer the same set of essential health benefits, quality and amount of care.
The differences are how much your premium costs each month, what portion of the bill you pay for things like hospital visits or prescription medications, and how much your total out-of-pocket costs are.
There are 3 Blue FocusCare Plans:
- Blue FocusCare Bronze HMO 209 – $7,400 individual deductible, 50% coinsurance, $65 PCP/$105 specialist copays
- Blue FocusCare Silver HMO 210 – $2,500 individual deductible, 30% coinsurance, $25 PCP/$50 specialist copays
- Blue FocusCare Gold HMO 211 – $750 individual deductible, 30% coinsurance, $20 PCP/$40 specialist copays
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.
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Deductibles
| Bronze 209 | Silver 210 | Gold 211 | |
| Overall Deductible Individual/Family | $7,400 / $14,800 | $2,500 / $5,000 | $750 / $2,250 |
| Are there services covered before you meet deductible | Yes. | Yes. | Yes. |
| Are there other deductibles for specific services | No. | No. | No. |
| Out-of-pocket limit Individual/Family** | $9,450 / $18,900 | $9,450 / $18,900 | $9,100 / $18,200 |
| Will you pay less if you use network provider? | Yes. | Yes. | Yes. |
| Referral to see a specialist? | Yes. | Yes. | Yes. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| Bronze 209 | Silver 210 | Gold 211 | |
| Primary Care for injury/illness | $65/visit | $25/visit | $20/visit |
| Specialist visit | $105/visit | $50/visit | $40/visit |
| Preventative care/screening | No Charge | No Charge | No Charge |
| Diagnostic test (xray, blood) | $100/lab, $150/xray | $50/test | $40/test |
| Imaging (CT/PET/MRI) | $300/test | $250/test | $250/test |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Generic / Brand / Specialty Drug Comparison
If you need Drugs to treat your illness or condition. For information on whether or not deductibles apply, please download the plan summaries
| Bronze 209 | Silver 210 | Gold 211 | |
| Generic Drugs (Preferred) | 10% | 10% | 10% |
| Generic Drugs (Non Preferred) | 15% | 15% | 15% |
| Brand drugs (Preferred) | 20% | 20% | 20% |
| Brand Drugs Non Preferred | 30% | 30% | 30% |
| Specialty Drugs Preferred | 40% | 40% | 40% |
| Specialty Drugs Non Preferred | 50% | 50% | 50% |
Outpatient Surgery / Emergency Comparison
| Bronze 209 | Silver 210 | Gold 211 | |
| Facility Fee Freestanding | $300/visit + 50% | $300/visit + 30% | $300/visit + 30% |
| Facility fee Hospital | N/A | N/A | N/A |
| Physician/surgeon Fee | $150/visit | $100/visit | $40/visit |
| Emergency Room Care | $1,00/visit + 50% | $1,000/visit + 30% | $1,000/visit + 30% |
| Emergency Medical Transportation | 50% | 30% | 30% |
| Urgent Care | $105/visit | $50/visit | $40/visit |
Hospital Stay / Health Services / Pregnancy
| Bronze 209 | Silver 210 | Gold 211 | |
| Facility Fee for hospital stay | $850/day | $750/day | $750/day |
| Physician/surgeon Fees | No Charge | No Charge | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $65 office / 50% other | $25 office / 30% other | $20 office / 30% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | $850/day | $750/day | $750/day |
| If you are pregnant – office visit | Primary: $65 / Specialist: $105 | Primary: $25 / Specialist: $50 | Primary: $20 / Specialist: $40 |
| Childbirth/delivery/professional services | No Charge | No Charge | No Charge |
| Childbirth/delivery facility services | $850/day | $750/day | $750/day |
Help recovering / other special needs
| Bronze 209 | Silver 210 | Gold 211 | |
| Home Health Care | No Charge | No Charge | No Charge |
| Rehabilitation Services | $65/visit | $25/visit | $40/visit |
| Habilitation services | $65/visit | $25/visit | $40/visit |
| Skilled nursing care | $500/day | $500/day | $500/day |
| Durable medical equipment | No Charge | No Charge | No Charge |
| Hospice services | 50% | 30% | 30% |
Childrens Dental / Eye care
| Bronze 209 | Silver 210 | Gold 211 | |
| Children’s eye exam | No Charge | No Charge | No Charge |
| Children’s Glasses | No Charge | No Charge | No Charge |
| Children’s Dental check-up | Not Covered | Not Covered | Not Covered |
Excluded & Other Covered Services
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
| Bronze 209 | Silver 210 | Gold 211 | |
| Acupuncture | ✓ | ✓ | ✓ |
| Dental Care (Adult) | ✓ | ✓ | ✓ |
| Long-term Care | ✓ | ✓ | ✓ |
| Non-emergency care when traveling outside of US | ✓ | ✓ | ✓ |
| Routine eye care (adult) | X | X | X |
| Weight loss programs | ✓ | ✓ | ✓ |
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
| Bronze 209 | Silver 210 | Gold 211 | |
| Abortion care | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ |
| Routine Eye Care | ✓ | ✓ | ✓ |
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