Getting The Most From Your Options PPO Plan

If you’re enrolled in a Blue Cross Blue Shield Options PPO plan, you may have noticed it’s not your typical PPO. This plan includes 3 tiers of providers: Choice, PPO, PPO, and out-of-network. Costs vary by tier, with the Choice Tier providing the most savings. In this, we’ll break down how the tiers work, what the difference is between Tier 1 and Tier 2, and how to get the most value from your coverage by understanding deductibles, out-of-pocket maximums, and provider networks.

The Options PPO plan provides access to the entire Blue Cross Blue Shield network, but it offers lower copays and deductibles for the Tier 1 (Blue Choice) network. Here's a quick breakdown of the three tiers:

• Tier 1: Choice Network has the lowest deductibles and out-of-pocket costs

• Tier 2: PPO Network has higher deductibles and costs than Tier 1, but still counts as in-network

• Tier 3: Out-of-Network – The highest costs, and feels like no coverage

This setup is designed to steer you toward Tier 1 providers for better savings without compromising access to your preferred care. Blue Cross incentivizes the use of Tier 1 providers with:

• Lower deductibles

• Lower out-of-pocket maximums

• Lower copays 

The care might be similar, but the costs aren’t. In the Chicagoland area, Tier 1 includes major networks such as Advocate, NorthShore/Endeavor, Northwestern, Amita, Rush, Duly, Loyola, and Edwards.

By contrast, using Tier 2 providers means you’ll pay more for your deductible and out-of-pocket max. Tier 2 notably includes the University of Chicago and Lurie’s Children’s Hospital. While both are considered in-network using Tier 2 means higher costs across the board.

Now that you know Tier 1 providers are lower-cost, how can you make sure your doctor is Tier 1? You can search providers specifically in the Choice network when using the Blue Cross Blue Shield provider finder tool. If you’re looking by name, it will be indicated on the right-hand side if the individual is in Tier 1. If they are in Tier 2, they will only be listed as “in-network.” Need help finding a doctor? Reach out to our team or check out our guide here on how to find in-network providers.

How do deductibles and out-of-pocket maximums work if you need to use both Tier 1 and Tier 2 in the same year? The deductibles and out-of-pocket maximums are embedded, meaning Tier 1 spending counts towards Tier 2 spending and Tier 2 spending counts towards Tier 1 spending. If you meet your Tier 1 deductible, but then switch to Tier 2 care, you’ll still owe the difference between the two deductibles. Once you meet the Tier 2 deductible and out-of-pocket max, you’ve met them for the whole plan and have 100% coverage for the remainder of the year. 

To get the most out of your Options PPO plan, aim to use Tier 1, or “Choice,” providers whenever possible. You’ll enjoy lower deductibles, copays, and out-of-pocket costs. If you need help identifying Tier 1 providers or want to make sure your preferred doctors and hospitals are in-network, we’re here to help! Reach out to us anytime for doctor look-ups or with any questions.