(31; DFW, TX) BCBS Advantage/Plus Plans?

(31; TX, 76103)

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Open enrollment; need help picking out a BCBS plan— trying to decide between Blue Advantage/Plus plans (Silver/Gold).

No income, been trying/failing to get on SSI, working with a lawyer, but dealing with the denial/appeal cycle for 2 years. Don’t qualify for Medicaid in Texas if/until they approve me.

However, my mom has been paying for my health coverage through the healthcare marketplace, so I have options.

The UTSW hospital lists the BCBS TX, Blue Advantage plan as an accepted ACA insurance plan on their website, which strongly factors into my choice to go with a BCBS plan.

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My Needs/Priorities

My medical care needs are highly complicated, tend to be expensive, requiring a lot of specialist care visits, exams, labs, scans, hospital care, and high-stakes/risk surgeries.

My top priorities for coverage in choosing a plan are:

• Quantity/quality of providers/hospitals

• Specialist & surgical care coverage

• Exams/scans/labs/other testing

• Emergency care coverage

• RX coverage

Any type of out-of-network coverage (but especially at a good rate) would be FANTASTIC— if there is a plan with that option, let me know— I know it’s unlikely, but worth asking.

Would prefer a plan that has:

• Lower out-of-pocket maximum

• Lower deductible

• With decent copay/coinsurance costs

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My Questions

1a. If a provider/hospital/etc. says they take Blue Advantage, would they likely accept Blue Advantage Plus, also?

1b. If yes, would you recommend one over the other?

2. Would you suggest I pick out a Silver or Gold plan?

3. Considering my coverage needs and priorities outlined above, which exact plans would you recommend to me?

Lastly,

4. I know off-exchange plans can be very sketchy, but are there any benefits to going that route? If so, what are they, and what should I keep in mind when I pick one out?

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Happy to clarify in comments if anything isn’t clear enough.

Thanks in advance!

EDIT: formatting