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Shop Plans Blue Advantage Plan

Our Blue Advantage® plans for individuals and families give you access to our largest nationwide network of doctors, specialists, and hospitals.

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Plan highlights

With our Blue Advantage plan options from Blue Cross and Blue Shield of North Carolina (Blue Cross NC), you can get:

  • More in-network providers in North Carolina, with over 92% of doctors and 97% of hospitals in-network1
  • Fewer restrictions on which providers you can see
  • Nationwide access to in-network providers through BlueCard®2
  • Emergency services covered at the in-network benefit level regardless of where you go for care
Availability

Blue Advantage plans are available in most North Carolina counties.3  Use our plan finder tool to see if Blue Advantage plans are available in your area.
Limitations and Exclusions Understanding metallic plan levels

Blue Cross NC offers health plans in 3 metallic levels. The Affordable Care Act (ACA) created metallic levels to help show the value of coverage within different plan offerings and give you a way to compare them.
Bronze level

Bronze plans typically pay 60% of covered medical costs on average, and you pay 40%.
Silver level

Silver plans usually pay 70% of covered medical costs on average, and you pay 30%.
Gold level

Gold plans generally pay 80% of covered medical costs on average, and you pay 20%.
Blue Advantage bronze plan options
PlansBronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide doctorsBronze Standard | Nationwide doctorsBronze Complete | $60 PCP | $20 Tier 1 Rx | Nationwide doctorsBronze HSA Eligible4 | Integrated | Nationwide Doctors5, 6
Individual deductible (family = 2x)7$7,000$7,500$4,000$8,300
Individual out-of-pocket limit (family = 2x)7$9,200$9,200$9,200$8,300
Coinsurance850%50%50%0%
Primary care provider (PCP)9 3 x $0 / $10010$50$60Ded / 0%
Specialists9and urgent care11$150$100 / $75$120Ded / 0%
Prescription drug deductible12Integrated13Integrated13$1,000Integrated13
Prescription drug benefit$2014/ 50% / 50% / 50% / 50%$2514/ $50 / $100 / $500$2014/ $25 / $75 / $150 / 50%0% after deductible
Blue Advantage silver plan options
PlansSilver Access | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors6Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide DoctorsSilver Standard | Nationwide DoctorsSilver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors
Individual deductible (family = 2x)7$1,400$1,575$5,000$3,000
Individual out-of-pocket limit (family = 2x)7$9,200$9,200$8,000$9,200
Coinsurance850%50%40%50%
Primary care provider (PCP)93 x $0 / $25103 x $0 / $5510$403 x $0 / $4510
Specialists9and urgent care11$150$110$80 / $60$90
Prescription drug deductible12$300Integrated13Integrated13$250
Prescription drug benefit$1514 / $25 / $60 / $120 / 50%$1014/ 50% / 50% / 50% / 50%$2014/ $4014/ $80 / $350$1514/ $30 / $40 / $80 / 50%
Blue Advantage gold plan options
PlansGold Premier | 3 Free PCP | $10 Tier 1 Rx | Nationwide DoctorsGold Standard | Nationwide Doctors
Individual deductible (family = 2x)7 $1,800$1,500
Individual out-of-pocket limit (family = 2x)7 $9,100$7,800
Coinsurance8 30%25%
Primary care provider (PCP)9 3 x $0 / $1010 $40
Specialists9 and urgent care11 $40$60 / $45
Prescription drug deductible12 $400$0
Prescription drug benefit$1014 / $25 / $40 / $80 / 50%$1514 / $3014 / $60 / $250
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Disclosures:

Benefits and premium depend on plan selected.

  1. Blue Cross NC Provider Internal Data; percentages indicated represent Blue Cross NC's Network as of April 7, 2025.

  2. BlueCard® coverage varies for each Blue Cross Blue Shield (BCBS) Plan. For more complete details, including benefits, limitations and exclusions, please refer to your certificate of coverage.

  3. Blue Advantage is available on and off Marketplace to residents in all North Carolina counties except the following, where it is available only off Marketplace: Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person, Wake.

  4. All covered services are subject to the deductible and coinsurance, unless otherwise noted.

  5. Members on a family HSA plan will have an individual deductible and a family total deductible. Any member of the family will only have to pay the individual amount to meet their deductible.

  6. Bronze HSA Eligible | Integrated | Nationwide Doctors and Silver Access | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors are available off Marketplace only.

  7. Out-of-network (OON) deductible is two times the in-network deductible. OON out-of-pocket maximum (OOPM) is two times the in-network OOPM.

  8. Member pays 30% more coinsurance when seeking services out-of-network (OON).

  9. Out-of-network (OON) primary care provider (PCP) and specialist visit is subject to the plan’s OON deductible and coinsurance.

  10. Primary care provider (PCP) step down benefits: 3 x $0 for PCP office visits, followed by standard PCP benefit (at the member level).

  11. Out-of-network (OON) urgent care copay is two times the amount of the in-network (INN) urgent care copay.

  12. Prescription drug deductible must be met before your plan begins to pay for prescriptions except when indicated otherwise.

  13. Prescription drug costs are subject to the medical deductible, coinsurance, and out-of-pocket (OOP) limit.

  14. Prescription drug costs are not subject to the deductible.

How to pick a health insurance plan: The health plan categories: Bronze, Silver, Gold & Platinum (healthcare.gov)

The Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Utilization Management (UM) program works to ensure you get the care you need in the appropriate health care setting. Find more details about our UM processes, how you can appeal a denied service, and information about transparency in coverage.

Blue Cross NC offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor, or personal physician as applicable throughout your health care experience.

NGFPPO-I, 5/24; U47288, 3/25

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.