What is the Difference Between Blue Shield Trio and Access+ HMO Plans?

Blue Shield of California offers a variety of health insurance plans to meet the diverse needs of individuals, families, and employers across the state. Two of their most popular HMO (Health Maintenance Organization) plans are the Trio HMO and Access+ HMO. But what exactly is the difference between these two plans?

In this comprehensive guide, we’ll compare the Trio and Access+ HMO plans side-by-side so you can understand the key differences and determine which option may be better for your health and budget needs.

Trio HMO Plan Overview

The Trio HMO plan was designed by Blue Shield to provide affordable coverage by offering $0 copayments for many services. Here are some key highlights of the Trio HMO plan:

• Available in 26 counties across Central and Northern California
• Provides access to around 17,000 doctors and specialists within the Access+ HMO network
• Lower monthly premiums than Access+ HMO plans
• $0 copay for many services like primary care visits, specialists, and Teladoc virtual care
• Valuable additional benefits like free hearing aids

Some of the main benefits of the Trio HMO plan include:

Affordable $0 Copays

The Trio HMO features $0 copayments for office visits with your primary care doctor, specialists, and Teladoc virtual care. This helps reduce your out-of-pocket costs.

Hearing Aid Coverage

The plan includes a $0 copay for hearing exams and up to $1,000 allowance every 3 years for hearing aids.

Meal Delivery and Transportation

If recovering from a serious illness, you can get meals delivered and transportation to medical appointments for $0 copays if you qualify.

Large Pharmacy Network

Fill prescriptions at major chains like CVS, Costco, and Safeway/Vons pharmacies.

Self-Referral to Specialists

You can self-refer to in-network specialists without needing a referral from your primary care doctor first.

Access+ HMO Plan Overview

The Access+ HMO is Blue Shield’s broad network HMO plan available statewide. Here are some key features:

• Offered in all 58 California counties
• Gives access to 44,000+ doctors and 370 hospitals in-network
• Slightly higher premiums than Trio HMO
• Low copays for many services like $15 for office visits
• Wide range of standard health benefits

Some of the core benefits of the Access+ HMO include:

Large Statewide Network

With over 44,000 doctors and 370 hospitals, it offers access to care across California.

Low Copays

You’ll pay low fixed copays like $15 for office visits and $50 for emergency room visits.

Self-Referral to Specialists

You can self-refer to specialists within your designated medical group.

Mental Health Benefits

Coverage is included for inpatient and outpatient mental health services.

Urgent Care Access

Pay just $15 for urgent care visits within your medical group’s network.

Key Differences Between the Plans

Now that you understand the basics of each plan, let’s compare them head-to-head across some key categories:

Network Size

• Trio: 17,000 doctors within 26 counties
• Access+: 44,000+ doctors available statewide

The Access+ has a significantly larger network, giving you access to more doctors and hospitals across all of California.

Monthly Premium Cost

• Trio: Lower monthly premiums
• Access+: Slightly higher premium costs

The Trio HMO typically has lower monthly premiums, making it a more budget-friendly choice.

Copays

• Trio: Mainly $0 copays
• Access+: Mostly $15 or $50 copays

With its $0 copay structure, the Trio HMO helps minimize out-of-pocket costs for many common services. The Access+ HMO has slightly higher copays.

Plan Availability

• Trio: 26 counties
• Access+: Available statewide

The major limitation of the Trio plan is that it’s only available in certain Northern and Central California counties. Access+ has statewide availability.

Additional Benefits

• Trio: Hearing aids, meal delivery, transportation
• Access+: More limited ancillary benefits

Some of the extra benefits like hearing aids and meal delivery make the Trio plan stand out. Access+ has more standard benefits.

Out-of-Pocket Maximum

• Both plans: $1,500 per member, $3,000 per family

The two plans share the same out-of-pocket maximums, limiting how much you’d pay for covered care.

Which Plan Is Right for You?

So when trying to choose between Blue Shield’s Trio vs Access+ HMO plans, there are several important factors to consider:

• Where you live – The Trio plan is only available in certain regions, so make sure it’s offered in your county. Access+ is available statewide.

• Provider choice – Do you want broad provider access or are you comfortable with a smaller regional network? Access+ offers the most choice.

• Budget – The lower premiums and copays of the Trio plan make it the more affordable choice for many.

• Health needs – Review the benefits to see which option provides the coverage you expect to need.

• Additional benefits – The Trio plan includes valuable extras like hearing aid benefits.

For many Californians, the Trio HMO represents an extremely affordable option with $0 copays and extras like hearing aid coverage. But for those who want expansive provider choice or who live outside the Trio service area, Access+ is a solid selection as well.

By understanding the key differences between these two plans, you can determine which Blue Shield HMO option fits your healthcare and financial needs. Consult with a Blue Shield agent or broker if you need help making a decision.