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BlueCross BlueShield of AZ AdvanceHealth Silver 6 Plan
This is a BlueCross BlueShield Marketplace plan. Marketplace plans include an annual physical and many preventative services for free, include prescription benefits, cover maternity, and mental health visits. They also cover preexisting conditions without a waiting period. Based on your household size, zip code and income; you may receive subsidies to pay for a portion of your premium. This is an HMO plan which means that you must use in-network doctors and hospitals, except for emergencies. They have a very large network of doctors to choose from, be aware that you do not need a referral to see a specialist.
Carrier
BlueCross BlueShield
Plan Year
2026
Plan State
Arizona
Deductible
$800
Individual
$1,600
Family
Maximum Out of Pocket
$800
Individual
$1,600
Family
Doctor Visits
Doctor visit costs are what you pay each time you see a provider—whether it’s a primary care doctor, specialist, or mental health professional. Most plans charge a copay, with lower amounts for primary care and higher amounts for specialty care. Copays usually apply before your deductible, meaning you pay them upfront. However, some high deductible and HSA plans require you to pay the full cost of visits until you’ve met your deductible. Always review your plan details so you know what’s covered and how in-person and virtual visits are billed.
Primary Care Visit
No charge first 4 visits, then no charge after deductible
Specialty Care Visit
No Charge after deductible
Mental Health Visit
No charge after deductible
Virtual Visits*
$5 copay
*Virtual visits may only cover specific types of services like primary care visits or mental health visits. Please check the full summary of benefits or with your local agent to verify coverage.
Emergency and Urgently Needed Services
Emergency care is for life-threatening situations such as heart attacks, severe injuries, or sudden serious illnesses that require immediate attention. Urgent care covers conditions that aren’t life-threatening but still need prompt treatment to prevent complications. Most health insurance plans cover ER visits and ambulance services, even if you’re treated at an out-of-network facility—ensuring you can get critical care when you need it most.
Urgent Care Visit
No charge after deductible
Emergency Room Visit
No charge after deductible
Ground Ambulance
No charge after deductible
Prescription Coverage
Prescription medications are prescribed by healthcare providers to treat various medical conditions. They play a crucial role in managing health, and their cost can vary significantly based on factors such as the drug's brand or generic status, dosage, and insurance coverage. If you're looking for information about the cost of your prescription drugs and how they are covered by your insurance plan, a local agent at Utah Avenue Insurance can provide assistance and help you understand the specifics of your medication coverage.
Preferred Generic
No charge
Extra Benefits for Children
Many health insurance plans offer extra benefits for kids under 18 to ensure their well-being. These benefits often include coverage for pediatric services such as well-child visits, immunizations, vision and dental care, and preventive screenings. Additionally, some plans might provide access to specialized pediatric care and therapies, ensuring that children receive comprehensive healthcare tailored to their developmental needs. It's important to review your insurance policy to understand the specific extra benefits available for kids and their coverage details.
Children's Eye Exam
No Charge
Children's Glasses
No charge after deductible
Children's Dental Check Up
No charge after deductible
Full Summary of Benefits and Helpful Links
Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right doctors and hospitals that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.
Helpful Links
Schedule a consultation with a local health insurance agent
We're here to assist you with your health insurance needs, whether you'd prefer to meet in person, virtually, or over the phone. Our team can guide you through health insurance options both on and off the Marketplace, as well as Medicare Advantage and supplements, dental, vision, life, and accident plans. Thank you for trusting us as your advocate. Best of all, our services are always at no cost to you!
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Please note that the costs and copays mentioned are subject to change based on the terms set by your health insurance provider. Utah Avenue Insurance strives to provide accurate information, but we cannot guarantee the exact costs or benefits outlined in your specific plan. It is important to review your policy details directly with your insurance company. Utah Avenue Insurance is not liable for any discrepancies or changes in coverage, copays, or other plan details.