Both Blue Cross Blue Shield PPO and Cigna HSA offer comprehensive coverage with distinct advantages. BCBS PPO provides greater flexibility and access to care without needing a PCP or referrals. Cigna HSA, on the other hand, offers lower monthly premiums and tax advantages through the HSA, but comes with higher deductibles and requires eligibility. The best choice depends on individual healthcare needs, financial situation, and risk tolerance.
| Attribute | Blue Cross Blue Shield PPO | Cigna Health Savings Account (HSA) |
|---|---|---|
| Type of Plan | Preferred Provider Organization (PPO) | Health Savings Account (HSA) |
| In-network vs. Out-of-network Coverage | Offers two levels of coverage: in-network and out-of-network. Staying in-network results in the highest level of benefits and lower out-of-pocket costs. Some PPO plans might not cover out-of-network care, so it's important to check your specific plan details. | Covers both in-network and out-of-network healthcare professionals, but out-of-network facilities may be covered at a lower percentage. Using in-network providers generally results in lower out-of-pocket costs. |
| PCP Required | No PCP Required | Not available |
| Referrals | You don't need a referral to see a specialist. | You can typically see a specialist without a referral. |
| Prior Authorization | Prior authorization (or pre-approval) might be needed from BCBS for certain tests or services. | Some services, including inpatient services and certain specialty care treatments, may require prior authorization. |
| Balance Billing | Out-of-network providers may charge more than the approved amount, leading to balance billing. The "No Surprises Act" offers some protection against this. | Not available |
| Prescription Drug Coverage | Medications are typically organized into tiers. Your out-of-pocket cost depends on the drug's tier and your plan benefits. Lower tiers usually have lower costs. Some plans have 3, 4, 5, or even 6 tiers. Preventive drugs may be available at zero cost share. Beginning in 2025, the tiers for some weight loss drugs may change. | Generally included in Cigna HSA plans, and eligible expenses count towards satisfying your deductible and out-of-pocket maximum. Some preventive drugs are covered at 100% with no co-pay or deductible. |
| Telehealth Services | Members can access covered benefits through telehealth providers. Many members have access to telehealth vendors like MDLIVE. Telehealth services are often included in plans at no additional cost. Virtual visits are typically covered the same as in-office visits. Telehealth can be a convenient way to get support for mental and emotional well-being. | Provides access to telehealth services through Cigna Telehealth Connection, AmWell, and MDLIVE. Telehealth visits with Cigna Behavioral Health network providers typically cost the same as in-office visits. |
| Preventive Care Coverage | Many preventive care services are covered at 100% when received from an in-network provider. These services must be filed by your doctor as preventive care and identified as such under the Affordable Care Act (ACA). Examples of preventive care include annual check-ups, blood pressure and blood sugar tests, cholesterol tests, vaccinations, mammograms, and colonoscopies. | Generally covers in-network preventive care services at 100%. This includes annual physicals, routine immunizations, and screenings. |
| Mental Health Services | Most BCBS policies include coverage for mental health treatment. This often includes therapeutic services, psychoanalysis, residential treatment, emergency mental health outpatient treatment, and group therapy. To get coverage, it's generally necessary to select a mental health provider within the BCBS network. BCBS Telehealth services enable you to access mental health care remotely. | Allows you to use pre-tax funds for mental health services. Cigna covers a variety of mental health counseling services, including individual, group, and family therapy. |
| Wellness Programs & Incentives | BCBS plans often offer wellness programs and incentives to promote healthy behaviors. These may include discounts on health and wellness products and services. Some plans offer rewards for completing health assessments or meeting wellness goals. | Cigna offers wellness programs, including personal health coaches. The Cigna Healthcare Wellness Experience allows you and your covered spouse to earn rewards in the form of contributions to your HSA by completing health and wellness-related activities. |
| Traveling Coverage | BCBS coverage can often be used when traveling to Canada and Mexico. | Not available |
| Member Resources | MyBlue is an online account for members to view coverage, find doctors, track claims, and submit reimbursements. | Not available |
| HSA Eligibility | Not applicable | Must be covered under a qualified high-deductible health plan (HDHP), not be covered by other non-HDHP health insurance, not be enrolled in Medicare, and not be claimed as a dependent on someone else's tax return. |
| Employer Contribution | Not applicable | Employers can contribute to an employee's HSA. Some employers, like Loudoun County, VA, contribute to employee HSAs each pay period based on coverage level. For instance, Scottsdale contributes $500 annually for employee-only coverage and $1,000 for family coverage. Workday contributes $1,000 for employee-only and $2,000 for those also covering dependents. |
| Deductible Amount (Individual/Family) | Not available | Varies. Example: in-network deductible of $1,650 for individuals and $3,300 for families. Another example shows $1,500 for an individual and $3,000 for a family. |
| Out-of-Pocket Maximum (Individual/Family) | Not available | Varies. One plan has an in-network out-of-pocket maximum of $3,275 for individuals and $6,550 for families. Another example shows $2,400 for individuals and $4,800 for families within the network. |
| Co-insurance Percentage | Not available | After meeting the deductible, you typically pay a co-insurance. For instance, one plan has a 15% co-insurance for in-network services and 50% for out-of-network services. Another example shows a 20% co-insurance. |
| Monthly Premium Cost | Not available | Monthly premiums for Cigna HSA plans tend to be lower compared to traditional plans, as they are paired with higher deductibles. |