Premium, age 40$436to $486 a month
Deductible$10,600$21,200 family
Out-of-pocket max$10,600$21,200 family
Having a baby$10,660CMS example
Blue Congaree Standard Gold
BlueCross BlueShield of South Carolina · Congaree Network
4 of 5CMS quality ratingMonthly premium, age 40
From $697
Up to $776 by area · before subsidies
Prices by age ›
Blue Congaree Standard Gold is a 2027 Gold HMO plan from BlueCross BlueShield of South Carolina, sold on HealthCare.gov in 3 of the 46 counties in South Carolina. Before subsidies, a 40-year-old pays $697 to $776 a month, depending on where they live. The deductible is $2,500 ($5,000 for a family), and the out-of-pocket maximum is $8,600 ($17,200 for a family); after the deductible, many covered services cost 25% coinsurance in network. As an HMO, it covers care from doctors and hospitals in its network only, except emergencies, and you don't need a referral to see a specialist. 5,020 South Carolina doctors and facilities are in its network, based on BlueCross BlueShield of South Carolina's directory from November 5, 2026.
Plan ID26065SC0720005
Plan year2027Sold on HealthCare.gov
Plan typeHMONo referral needed
Metal levelGoldPlan pays about 80% of costs
Deductible$2,500$5,000 family · what you pay before the plan pays
Out-of-pocket max$8,600$17,200 family · the most you pay in a year
HSA-eligibleNoCan’t be paired with a health savings account
Find a doctor in this plan
Where do you want to see a doctor?
What kind of doctor in ?
Loading doctors...
Listed in BlueCross BlueShield of South Carolina's provider directory. Directories can be out of date, so call the office to confirm they take this plan.
CMS quality rating
4 of 5CMS rates Marketplace plans from 1 to 5 stars using medical records and a survey of members. This rating covers every BlueCross BlueShield of South Carolina HMO plan in South Carolina for 2027.
Medical care
4 of 5
How often members get recommended care, like screenings and check-ups, and how well chronic conditions are managed.
Member experience
5 of 5
What members say in CMS's survey about getting care quickly, their doctors and the plan's customer service.
Plan administration
4 of 5
How well the plan is run: customer service, access to information, and how it manages care and costs.
Source: CMS Quality Rating System, plan year 2027 (ratings use data from earlier years). A rating is one factor; also compare the costs and whether your doctors are in the network.
What you pay with this plan
In-network costs for one person, from the CMS plan files for 2027. "After deductible" means you pay the full cost until you reach the $2,500 deductible.
Doctor visits
- Primary care visit
- $30
- Specialist visit
- $60
- Nurse practitioner or PA visit
- $30
- Preventive care and vaccines
- Free
- Urgent care
- $45
Prescription drugs
- Generic drugs
- $15
- Preferred brand drugs
- $30
- Non-preferred brand drugs
- $60
- Specialty drugs
- $250
Tests and imaging
- Lab work
- 25% after deductible
- X-rays
- 25% after deductible
- MRI, CT and PET scans
- 25% after deductible
Emergencies and hospital
- Emergency room
- 25% after deductible
- Ambulance
- 25% after deductible
- Hospital stay
- 25% after deductible
- Outpatient surgery (facility)
- 25% after deductible
Mental health
- Therapy and counseling visits
- $30
- Inpatient mental health care
- 25% after deductible
Pregnancy
- Prenatal and postnatal care
- 25% after deductible
- Delivery and hospital stay
- 25% after deductible
Other care
- Physical and occupational therapyLimit: 30 visits a benefit period
- $30
- Chiropractic care
- Not covered
- Eye exam for childrenLimit: 1 exam a year
- Free
- Glasses for childrenLimit: 1 item a year
- Free
- Adult dental
- Not covered
$5,070Having a baby (CMS example)
$2,220Managing type 2 diabetes for a year
$2,400A simple fracture
Every service in the plan file (67)
| Service | You pay | Limits and notes |
|---|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered | |
| Accidental Dental | 25% after deductible | |
| Acupuncture | Not covered | |
| Allergy Testing | 25% after deductible | |
| Bariatric Surgery | Not covered | |
| Basic Dental Care - Adult | Not covered | |
| Basic Dental Care - Child | Not covered | |
| Chemotherapy | 25% after deductible | |
| Chiropractic Care | Not covered | |
| Cosmetic Surgery | Not covered | |
| Delivery and All Inpatient Services for Maternity Care | 25% after deductible | |
| Dental Check-Up for Children | Not covered | |
| Diabetes Education | 25% after deductible | |
| Dialysis | 25% after deductible | |
| Durable Medical Equipment | 25% after deductible | |
| Emergency Room Services | 25% after deductible | |
| Emergency Transportation/Ambulance | 25% after deductible | |
| Eye Glasses for Children | Free | 1 item a year |
| Generic Drugs | $15 | |
| Habilitation Services | $30 | 30 visits a benefit period |
| Hearing Aids | Not covered | |
| Home Health Care Services | 25% after deductible | 60 visits a benefit period |
| Hospice Services | 25% after deductible | 6 months a episode |
| Imaging (CT/PET Scans, MRIs) | 25% after deductible | |
| Infertility Treatment | Not covered | |
| Infusion Therapy | 25% after deductible | |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25% after deductible | |
| Inpatient Physician and Surgical Services | 25% after deductible | |
| Laboratory Outpatient and Professional Services | 25% after deductible | |
| Long-Term/Custodial Nursing Home Care | Not covered | |
| Major Dental Care - Adult | Not covered | |
| Major Dental Care - Child | Not covered | |
| Mental/Behavioral Health Inpatient Services | 25% after deductible | |
| Mental/Behavioral Health Outpatient Services | $30 | |
| Non-Preferred Brand Drugs | $60 | |
| Nutritional Counseling | 25% after deductible | |
| Orthodontia - Adult | Not covered | |
| Orthodontia - Child | Not covered | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30 | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25% after deductible | |
| Outpatient Rehabilitation Services | $30 | 30 visits a benefit period |
| Outpatient Surgery Physician/Surgical Services | 25% after deductible | |
| Preferred Brand Drugs | $30 | |
| Prenatal and Postnatal Care | 25% after deductible | |
| Preventive Care/Screening/Immunization | Free | |
| Primary Care Visit to Treat an Injury or Illness | $30 | |
| Private-Duty Nursing | Not covered | |
| Prosthetic Devices | 25% after deductible | |
| Radiation | 25% after deductible | |
| Reconstructive Surgery | 25% after deductible | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30 | 30 visits a benefit period |
| Rehabilitative Speech Therapy | $30 | 30 visits a benefit period |
| Routine Dental Services (Adult) | Not covered | |
| Routine Eye Exam (Adult) | Not covered | |
| Routine Eye Exam for Children | Free | 1 exam a year |
| Routine Foot Care | Not covered | |
| Skilled Nursing Facility | 25% after deductible | 60 days a benefit period |
| Specialist Visit | $60 | |
| Specialty Drugs | $250 | |
| Substance Abuse Disorder Inpatient Services | 25% after deductible | |
| Substance Abuse Disorder Outpatient Services | $30 | |
| Transplant | 25% after deductible | |
| Treatment for Temporomandibular Joint Disorders | Not covered | |
| Urgent Care Centers or Facilities | $45 | |
| Weight Loss Programs | Not covered | |
| Well Baby Visits and Care | Free | |
| X-rays and Diagnostic Imaging | 25% after deductible |
How this plan works
HMO: You pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies.
- Referral for specialists
- Not required
- Coinsurance
- 25% after the deductible
- Works with an HSA
- No
- Network
- Congaree Network (SCN005)
- Sold in
- 3 South Carolina countiesKershaw County, Lexington County, Richland County
Summary of Benefits and Coverage (PDF) Plan brochure Covered drugs (formulary)
Other BlueCross BlueShield of South Carolina plans on the same network
The same doctors and hospitals, with different costs.
BlueCross BlueShield of South Carolina
Blue Congaree Standard Expanded Bronze
4 of 5CMS quality rating
Premium, age 40$440to $489 a month
Deductible$7,500$15,000 family
Out-of-pocket max$12,000$24,000 family
Having a baby$10,070CMS example
Premium, age 40$442to $492 a month
Deductible$5,900$11,800 family
Out-of-pocket max$12,000$24,000 family
Having a baby$9,270CMS example
BlueCross BlueShield of South Carolina
Blue Congaree Standard Expanded Bronze Saver +
4 of 5CMS quality rating
Premium, age 40$482to $537 a month
Deductible$7,500$15,000 family
Out-of-pocket max$12,000$24,000 family
Having a baby$10,070CMS example
Premium, age 40$632to $704 a month
Deductible$6,400$12,800 family
Out-of-pocket max$10,300$20,600 family
Having a baby$8,970CMS example
Premium, age 40$635to $707 a month
Deductible$7,000$14,000 family
Out-of-pocket max$10,500$21,000 family
Having a baby$9,870CMS example
Premium, age 40$639to $711 a month
Deductible$5,700$11,400 family
Out-of-pocket max$8,800$17,600 family
Having a baby$8,860CMS example
Premium, age 40$672to $748 a month
Deductible$250$500 family
Out-of-pocket max$10,000$20,000 family
Having a baby$6,520CMS example
Questions about Blue Congaree Standard Gold
Does Blue Congaree Standard Gold cover my doctor?
Use "Find a doctor in this plan" on this page: choose the city, then the kind of doctor. The list shows providers BlueCross BlueShield of South Carolina lists in this plan's network for 2027. Directories can be out of date, so call the office to confirm before your visit.
What kind of plan is Blue Congaree Standard Gold?
It is an HMO plan: you pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies. It is a Gold plan.
How much is a doctor visit with Blue Congaree Standard Gold?
A primary care visit costs $30. A specialist visit costs $60. These are in-network costs for one person. "After deductible" means you pay the full cost until you reach the $2,500 deductible.
Where is Blue Congaree Standard Gold sold?
It is sold to people who live in 3 South Carolina counties, through HealthCare.gov. The counties: Kershaw County, Lexington County, Richland County. BlueCross BlueShield of South Carolina's directory can also list providers outside these counties, such as pharmacies and specialists, but the plan itself is only for people who live in its area.
What is Blue Congaree Standard Gold's quality rating?
CMS gives it 4 out of 5 stars for 2027. The rating covers every BlueCross BlueShield of South Carolina HMO plan in South Carolina and combines medical care, member experience and plan administration, using medical records and a survey of members.
How much does Blue Congaree Standard Gold cost a month?
Before subsidies (premium tax credits), Blue Congaree Standard Gold costs $697 to $776 a month for a 40-year-old in 2027, depending on where in South Carolina you live. A 21-year-old pays $545 to $607 and someone 64 or older $1,635 to $1,821. Tobacco users pay more. Most people who enroll through HealthCare.gov qualify for a subsidy (premium tax credit) that lowers the monthly price, and HealthCare.gov shows your price after any subsidy.
About this data
These pages combine public files from CMS and from insurers. NPI Profile does not contract with insurers and does not decide who is in network.
| Source | What it provides here | Source date |
|---|---|---|
| CMS Marketplace public use files (Plan Attributes, Benefits and Cost Sharing, Rate, Service Area) | This plan's premiums, costs, covered services, coverage examples and the counties where it is sold | Updated October 20, 2026 · plan year 2027 |
| BlueCross BlueShield of South Carolina's provider directory | The doctors and facilities listed in this plan's network. Only providers with an address in South Carolina are counted. | Updated November 5, 2026 |
| NPPES NPI registry | Provider names, practice addresses and primary specialties | Updated weekly |
| CMS Quality Rating System (Quality PUF) | This plan's star ratings: overall, medical care, member experience and plan administration | Ratings for plan year 2027 |
- Costs are for the standard version of the plan, for one person, in network. People who qualify for cost-sharing reductions pay less.
- Premiums are the full monthly price before subsidies (premium tax credits). They depend on age, tobacco use and where you live (the plan's rating area). HealthCare.gov shows your price after any subsidy.
- Confirm costs in the plan documents and with the insurer, and confirm with the doctor's office that they take this plan.
