BCBSIL Individual & Family ACA Health Plans

Quick Links

• Preventive Services List
• No-Cost Preventive Drug List, included on all BCBSIL ACA plans
• 2026 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, 2026: 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.

Choosing Metallic Level: Find a Balance Between Your Premium and Your Health Care Bills

Each plan level is different in how much you’ll pay each month, how much of your health care bill is covered for things like doctor or hospital visits and prescriptions and how much your out-of-pocket costs are. Each metal tier also offers different premium prices. Premiums can vary widely member-to-member based on things like location, family size, annual income and premium tax credit savings.

Hospital Network Guide

Key Hospitals NOT accepting the Blue Choice Preferred PPO Plans in 2026

• Endeavor Health (formerly Advocate Hospitals) (accepting Bluecare Direct Plans, Ambetter, Cigna, UnitedHealthcare®, marketplace plans only)
  
• University of Chicago: accepted by MyBlue Plus POS

Effective Jan. 1, 2020: Methodist First Choice #457 participates 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

The BCBSIL 2026 individual health plan options include HMO Plans, Health Savings Accounts, and PPO Plans. The different plans are described below.

Illinois Plans Overview

Blue FocusCare HMO1 Bronze, 1 Silver, 1 Gold

• Network: BlueFocus Care^SM (BFC)
• Approximately 15 hospitals, 1,806 providers*
• Micro network for Cook County
• Lower-cost HMO plan

BlueCare Direct w/ Advocate2 Bronze, 2 Silver, 2 Gold

• Network: BlueCare Direct^SM (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 HMO3 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 PPO5 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