BCBS Essential Plan: Overview of Health Benefits and Services

The BCBS Essential Plan is a type of health insurance plan designed to provide affordable coverage to individuals and families. It's a great option for those who can't afford the more comprehensive plans.

BCBS Essential Plan benefits include preventive care services, such as annual physicals, vaccinations, and screenings. These services are often covered at 100% with no out-of-pocket costs.

Preventive care services are essential for maintaining good health and catching potential health issues early. By taking advantage of these services, you can stay on top of your health and avoid costly medical bills down the line.

BCBS Essential Plan coverage also includes emergency services, such as hospital stays and ambulance rides.

To be eligible for the BCBS Essential Plan, you must be a New York State resident, lawfully present in the U.S., and between 19-64 years old. You also can't be eligible for Medicaid or Child Health Plus, and you must meet the annual income requirements.

Here's a breakdown of the income requirements for each household size:

If you're currently enrolled in a Qualified Health Plan and are now eligible for the Essential Plan, you may have questions about how this change will affect you. Don't worry, you don't have to take any action unless you want to change health insurers.

The BCBS Essential Plan is designed to provide affordable health insurance to individuals and families who may not qualify for other plans. It's a great option for those who want to save money on premiums.

The plan has a lower premium cost compared to other plans, making it more accessible to those with limited budgets. This is because the Essential Plan has a higher deductible and copays.

You'll have access to a network of healthcare providers who accept the BCBS Essential Plan, ensuring you can get the care you need. However, it's essential to check the provider network in your area before enrolling.

Plan 2 with Dental & Vision offers a comprehensive package that goes beyond basic medical coverage. This plan includes dental and vision benefits.

Essential Plan 2 with Dental and Vision provides coverage for a range of dental services, from routine cleanings to more complex procedures. The plan also covers eye exams, glasses, and contact lenses.

As outlined in the Member Handbook - Essential Plan 2 (English), the dental and vision services are designed to be accessible and affordable. The plan's coverage includes a variety of services, such as fillings, extractions, and oral surgery.

The Member Handbook specifies that members are responsible for paying a copayment for dental services, which can help manage costs. This copayment is a small fee that members pay directly to the provider.

The plan's dental and vision benefits are designed to work together to provide a complete picture of a member's overall health. By covering both dental and vision services, the plan helps members stay healthy and avoid more costly problems down the line.

With your BCBSNM health plan, you'll always have access to MDLIVE Virtual Visits, which allows you to consult with a doctor remotely.

MDLIVE operates separately from BCBSNM and is responsible for its own operations and those of its contracted providers.

You can use MDLIVE Virtual Visits to consult with a doctor from the comfort of your own home, 24/7.

With your BCBS Essential Plan, you'll have access to a wide range of health benefits and services. You'll always have coverage for essential health benefits, including emergency care, hospitalizations, maternity care, and more.

Some of the covered services include primary care provider visits, immunizations, specialist visits, urgent care, and lab services. You'll also have coverage for preventive care services, like screenings, vaccines, and wellness programs, with no out-of-pocket costs when you get this care in-network.

Your plan may also include dental and vision services, with coverage for teeth cleanings, oral exams, X-rays, and more. If you have a prescription plan, you'll have coverage for a wide range of prescription drugs and over-the-counter (OTC) drugs, with copays varying depending on your plan.

Here are some of the specific services covered under your plan:

Preventive care services are an essential part of maintaining your overall health and well-being.

Many preventive care services, like screenings, vaccines, and wellness programs, are covered under BCBSNM plans.

You won't pay out-of-pocket costs when you get this care in-network.

This means you can focus on staying healthy without worrying about additional expenses.

BCBSNM covers preventive care services, so take advantage of them to stay on top of your health.

Prescriptions are an essential part of staying healthy, and your plan has got you covered. You can get coverage for a wide range of prescription drugs, including those for common conditions like allergies, high blood pressure, and diabetes.

Your plan also includes over-the-counter (OTC) drugs for Essential Plan 3 and 4 members. This means you can get coverage for things like pain relievers, cold medicines, and antacids without needing a prescription.

If you need to fill a prescription, be sure to check your handbook for information about copays. Different plans may have different copay amounts, so it's a good idea to know what to expect.

To find a pharmacy near you and see if your medicine is on the Preferred Drug List (PDL), visit the pharmacy page. This can help you save money on your prescriptions and make sure you're getting the best possible care.

Here are some of the prescription services you can expect from your plan:

These services are all part of your comprehensive plan, and you can count on getting the care you need when you need it.

Our health plans cover a wide range of prescription drugs, and once you've met your plan's deductible, you'll either pay a set dollar amount (copay) or a percentage of your drug costs (coinsurance).

You can visit the pharmacy page to find a pharmacy near you and check if your medicine is on the Preferred Drug List (PDL).

If your plan includes Essential Plan 3 or 4, you'll also have coverage for over-the-counter (OTC) drugs.

To get an estimate of your out-of-pocket costs for prescription drugs, use our Treatment Cost Calculator.

Here's a breakdown of the prescription drug coverage you can expect:

Remember to check your handbook for information about copays, as they may vary depending on your plan.

The BCBSNM 24/7 Nurseline is a valuable resource for members who need medical advice or guidance outside of regular doctor's hours. You can talk to a registered nurse at any time, and they'll help you with concerns like dizziness, headaches, or fevers.

The nurseline is available 24/7, so you can call whenever you need help.

To keep your health insurance, you may need to take action each year. This is especially true for Essential Plan renewals.

You can learn more about the process by checking the information provided on Essential Plan renewals. This will help you stay informed and ensure a smooth transition.

You can choose from a range of services with an Anthem Essential Plan, which comes in four versions. Each plan may have varying benefits, so it's essential to review the details.

The Blue Essentials HMO offers a wide range of benefits without financial surprises, including a predictable copayment, no deductible, and no claims or other paperwork to file. This plan is available in all 254 counties.

With the Blue Essentials HMO, you'll have access to a large network of providers, including over 550 hospitals and 85,000 providers statewide. This network is one of the largest in the state.

The Blue Essentials product requires you to choose a Primary Care Physician (PCP) from a network of contracting doctors. Your PCP will coordinate your care and help you make informed decisions about your health.

The Blue Essentials HMO includes Away From Home Care (AFHC) Guest Membership coverage for members living out of the service area for at least 90 consecutive days. This means you'll still have health coverage even when you're away from home.

Renewals can be a hassle, but they're a necessary part of keeping your health insurance in place.

You may need to take action each year to keep your Essential Plan. Learn more about Essential Plan renewals.

Some plans require renewal every year, while others may have a longer or shorter renewal cycle.

The BCBS Essential Plan offers a range of benefits and services, but it's essential to understand the plan documents that contain important information.

The Summary of Benefits and Coverage (SBC) document outlines how you and the plan share costs for covered services. This is a crucial document to review to understand your financial responsibilities.

You can access the SBC document for each Essential Plan level by clicking on the corresponding link in the plan documents table.

The Member Contract is a legal document that has complete information about the benefits and services included in that plan. It's essential to read and understand this document to know what's covered and what's not.

Here are the plan documents for each Essential Plan level:

*Note: You must be a lawfully present immigrant to enroll in Essential Plan 3 or 4.