Blue Cross Blue Shield vs. Ambetter in Texas
This has become a more common match-up in Texas over the last few years.
As we'll see below, it really speaks to doctor networks and of course pricing.
Benefits are standardized now after the 2014 ACA or Obamacare law so that makes perfect sense but let's get into the thick of how to compare the two!
We have guides on Ambetter of Texas or BCBS of Texas with much more detail but let's actually compare the two!
First our credentials as licensed Texas agents (zero cost to you!):
This is what we'll cover:
- How BCBS of Texas and Ambetter participate in the Texas individual family market
- Comparing BCBS of Texas and Ambetter's doctor networks
- Comparing BCBS of Texas and Ambetter's pricing
- Do BCBS of Texas and Ambetter offer the same plan benefits
- How to quote BCBS of Texas versus Ambetter
Let's get started. If you need any help at no cost, reach out:
How BCBS of Texas and Ambetter participate in the Texas individual family market
Let's lay out the rules of competition first.
In today's world, individual family plans in Texas all have the same rules and it's called many things: ACA, on-Exchange, Obamacare.
Don't get confused by the different terms, it's all the same thing now!
The same standardized benefits
You can't be declined based on health and no waiting period for pre-existing conditions
On and off exchange has the same networks, plans, and rates
Call it what you want but make sure to take advantage of this one piece.
There can be huge subsidies based on income that apply to either BCBS or Ambetter!
This is all driven by income estimates for this year; AGI on the 1040 tax form next April's filing.
We spend most of our day fine-tuning this estimate since it can mean $1000's per year in reduced premium.
We have a big guide to getting the most Texas health subsidy and even a deep dive on the income chart to qualify.
Reach out with any questions on this piece since it's where most people make mistakes that cause them to leave money on the table.
The important piece to remember when comparing Ambetter or BCBS of Texas is that they are both governed by this law now.
This makes comparing the actual plans much easier. A Gold plan is a Gold plan +/- 2% as we'll see below.
That then leaves networks and pricing! With the comparing of BCBS and Ambetter, it's really about the networks that we're comparing them at all!
After all, BCBS of Tx is the dominant carrier for individuals and families with roughly half the market.
So...why is Ambetter even in the conversation?
Comparing BCBS of Texas and Ambetter's doctor networks
So...if you're a smaller carrier, how do you gain any attention when BCBS is so dominant in the State?
You need to offer something different!
In Texas, since 2014, HMOs have been the dominant type of network for individuals and families.
This makes sense since they contain costs the best but there are trade-offs of course.
Care is more "managed" and networks are more restrictive. That's how they keep a lid on exploding health care costs.
The majority of the market is HMO now and will probably only grow with more time.
Ambetter decided to offer an EPO as an alternative.
The EPO works like a PPO but with no benefits out-of-network other than a true emergency.
We have a big guide on comparing Texas doctor Obamacare networks but let's compare this practically.
Here are the key differences aside from the actual doctors in each network:
- HMOs require a primary care doctor or medical group
- HMOs will require more authorizations and approvals for care and referrals
- HMOs are based on a given distance from your residence
- HMOs generally have more say-so over care received including medications
- HMOs generally have smaller networks (list of doctors you can see)
Of course, the trade-off is that they are cheaper monthly!
You can easily put your doctors in the quote engine below and it will show you if they are in BCBS and/or Ambetter's networks!
EPOs are more flexible on all these accounts but they're also more expensive.
How much more?
Comparing BCBS of Texas and Ambetter's pricing
Even with the subsidy applied, you're going to have to pay more for EPOs versus HMOs.
Here's a sample quote without subsidy (so final price might be much lower depending on income); age 54 person in Travis county. We quoted the silver plan since it's the most popular by far.
A few notes.
You can see the BCBS plan is $908 for the HMO. Ambetter has an HMO as well at $997. BCBS is the better option there (if doctors are in-network).
It's the EPO at $1194 that attracts people who want more control over medical care.
That's around 20% higher though at about $200/monthly.
Again, a tax credit based on income might bring these numbers way down especially if you're older but the $200 difference will likely still be there.
So...is $200/month in this case worth the extra flexibility?
That solely depends on the person and we see different outcomes every day.
Some people are coming from PPOs with their job insurance and moving to an HMO is out of the question!
It may also be a question of their doctor only taking Ambetter's EPO and not any HMOs. Even though ACA or Obamacare enrollment is exploding higher now, some doctors are still pushing back.
Enter your doctors into the quote system to double check if this is even a question.
Reach out with any questions on how the HMO and EPO really works here:
Do BCBS of Texas and Ambetter offer the same plan benefits
As we mentioned above, this is much easier to compare now. The ACA law established benchmark plan levels:
A given bronze plan can't differ from the benchmarks by more than 2% +/-.
That means a BCBS silver plans has to be pretty similar to an Ambetter silver plan by 2% up or down!
The Simple Pricing plans essentially reflect the benchmarks and here they are:
They're both bound by the same rules in terms of what is covered as well!
These days, it's more about picking a plan level than a given plan within that level.
Generally, go with the Simple Pricing or least expensive plan at a given level.
One note...if you're eligible for the silver 87 or 94 (see comparing Texas silver plans) based on income, those are really hard to beat! Look no further in most cases.
Happy to walk through the plans as well. Let's get to quotes now please.
How to quote BCBS of Texas versus Ambetter
We make this fast, free, and easy here:
- Income estimate is the AGI on the 1040 for this year; next April's filing
- Household is everyone on that 1040 tax form even if not enrolling
Income is tricky and people all sorts of different situations (marriages, job changes, etc).
We're happy to walk through this with you and it's really how we spend most of our time these days!
How can we help (at no cost to you!!)?
Enrollment is available right through the quote system and we recommend on-exchange for all enrollment since it's the only way we can get subsidies, richer silver plans, and a much simpler process.