Quick Links
- Preventive Services List
- No-Cost Preventive Drug List – included on all BCBSIL ACA plans
- 2024 6-Tier formulary – (all plans)
Individual Health Insurance Plans
Blue Cross Blue Shield of Illinois is offering 4 different individual plan networks for plans effective January 1st, 2024: Blue Choice Preferred PPO network, Blue Precision HMO network, BlueCare Direct w/ Advocate, or Blue FocusCare plans.
What is the difference between PPO and HMO?
PPO, or Preferred Provider Organization, plans usually carry a higher monthly premium while having access to a larger network of doctors and hospitals to choose from.
HMO, or Health Maintenance Organization, plans usually have lower monthly premiums than PPO’s and may help keep your costs lower and more predictable. A Primary Care Physician (PCP) will coordinate your health care.
Individual / Family Plans
Group / Medicare / Dental
Additional Resources
Why Choose BlueCross BlueShield of Illinois?
Access
- Health plans on and off exchange in every county
- Comprehensive, year-round coverage
- High-quality, efficient networks with focus on preventive care
- Affordable plan options to fit every budget
- Monthly payments as low as $0 for qualified on-exchange applicants
- Serving Illinois communities for 85 years.
- In the nine years of ACA open enrollment, BCBSIL has been proud to offer multiple qualified health plans in every county across Illinois.
- Virtual Visits for Blue Choice Preferred PPO members
- 24/7 Nurseline (English and Spanish) for PPO members
- Cost Estimator Tool on Blue Access for Members
- SmartER Care Options – member education campaign on choices for non-emergency care
- Easy to use – find a doctor, see payment options, access electronic member ID card and more
- Blue365 member discount program – members save on health club and gym memberships, weight loss programs, dental products and much more
| Plan Name | Plan Tier | Deductible | Max Out-of-Pocket |
| Blue Choice Preferred Silver PPO 801 – Rx Copays | Silver PPO | $6,200 | $9,450 |
| BlueCare Direct Bronze 802 w/ Advocate | Bronze HMO | $7,500 | $9,400 |
| BlueCare Direct Silver 803 w/ Advocate | Silver HMO | $5,900 | $9,100 |
| BlueCare Direct Gold 804 w/ Advocate | Gold HMO | $1,500 | $8,700 |
| Discontinued Plan Name | Plan Tier | Deductible | Max Out-of-Pocket |
| Blue Choice Preferred Bronze PPO 302 (Will map to Bronze 202) | Bronze PPO | $6,350 | $7,000 |
| Blue Choice Preferred Bronze PPO 502 (Will map to Bronze 202) | Bronze PPO | $5,000 | $7,050 |
| Blue Choice Preferred Bronze PPO 705 (Will map to Bronze 708) | Bronze PPO | $9,100 | $9,100 |
Hospital Network Guide
Key Hospitals accepting the Blue Choice Preferred PPO Plans in 2024:
- Amita Health Hospitals
- Edwards Memorial
- Alexian Brothers
- Loyola Hospital Systems
- Elmhurst Memorial
- Galesburg Cottage Hospital
- Northwestern Hospital Systems
- Northshore Hospital
- Swedish Covenant Hospital
- OSF Hospital System
- Presence Hospital Systems
- University of Illinois Chicago
- Rush University Hospital
- St. Francis Medical Center
- St. Mary Medical Center (OSF Hospital Systems)
- UnityPoint Health Methodist
Key Hospitals NOT accepting the Blue Choice Preferred PPO Plans in 2024
- Northshore Hospital Systems (accepting BluePrecision HMO Plans, Ambetter, United Healthcare, Aetna marketplace plans only)
- Rush Hospital Systems – accepted by 2024 Aetna Health PPO plans
- University of Chicago – accepted by 2024 Aetna Health PPO plans
Effective Jan. 1, 2020: Methodist First Choice #457 will participate in the Blue Precision HMO provider network. The details: Current members of Methodist First Choice will be able to choose doctors that are in the Blue Precision HMO network. Review a list of participating providers
for members impacted by this change.
Hospital Network Guide
| BCBSIL Plan Network | ||||
| Network Name | Blue Preferred PPO | Blue Precision HMO | BlueCare Direct Advocate | Blue Focus |
| Network Hospital Lists | Hospital List | Hospital List | Hospital List | Hospital List |
| Northwestern | ✓ | ✓ | X | X |
| Loyola | ✓ | ✓ | X | X |
| Rush | ✓ | X | X | X |
| Advocate | ✓ | ✓ | ✓ | X |
| Northshore | ✓ | ✓ | X | X |
| Presence Hospitals | ✓ | ✓ | X | X |
| U of C | X | ✓** | X | X |
| UIC | ✓ | ✓ | X | X |
| Edward/Elmhurst | ✓ | ✓ | X | X |
**Specialty care only with referral; No primary care
The BCBSIL 2024 individual health plan options include HMO Plans, Health Savings Accounts, and PPO Plans. The different plans are described below.
Illinois Plans Overview:
Blue FocusCare HMO: 1 Bronze, 1 Silver, 1 Gold
- Network: BlueFocus CareSM (BFC)
- Approximately 15 hospitals, 1,806 providers*
- Micro network for Cook County
- Lower-cost HMO plan
BlueCare Direct w/ Advocate: 2 Bronze, 2 Silver, 2 Gold
- Network: BlueCare DirectSM (BHD)
- Approximately 11 hospitals, 4,083 providers*
- In collaboration with Advocate Health Care1
- Competitive HMO plan with low out-of-pocket costs
- Call today, be seen today by primary care doctors
Blue Precision HMO: 3 Bronze, 4 Silver, 3 Gold
- Network: Blue Precision HMO SM (BAV)
- Approximately 66 hospitals, 17,467 providers*
- Helps keep costs low and predictable
- Personalized with a primary care physician (PCP), who coordinates health care
- Flexibility to change medical group
Blue Choice Preferred PPO: 5 Bronze, 4 Silver, 2 Gold
- Network: Blue Choice Preferred PPO (BCE)
- Approximately 176 hospitals, 73,027 providers*
- New Silver plan –
- Blue Choice Preferred Silver PPO 801 – Rx Copays
- Greater flexibility and array of product options
- Available in all counties
- Virtual Visits available via phone, video or mobile app
- Electronic prescriptions, when appropriate, can be sent to member’s pharmacy of choice
Dental
BlueCare Dental
- Coverage for cleanings, preventive services and much more
- Preventive dental services deductible waived
Prescription and Pharmacy
- Six prescription payment level tiers for all ACA plans – generic, brand and specialty have preferred and non-preferred benefit levels
- All plans include a drug list. PPO includes Preferred Pharmacy Network – Walgreens, Walmart, Sam’s Club, Albertsons and select Independent Pharmacies
*Estimates as of 6/1/2021
1. An independently contracted provider.
2. A “preferred” or “participating” pharmacy has a contract with BCBSIL’s pharmacy benefit manager (Prime Therapeutics) to provide pharmacy services at a negotiated rate. A pharmacy benefit manager administers prescription drug benefits for a health plan. The terms “preferred” and “participating” should not be construed as a recommendation, referral or any other statement as
Discontinued Plans
SelectTemp PPO plans are not available at this time – United HealthOne short term plans are an available alternative.
BlueChoice Preferred Gold Plan 101 (Discontinued January 1, 2017)
Blue PPO Gold Plans (Discontinued January 1, 2016)