Blue Cross and Blue Shield of Louisiana
Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits
Plan ID97176LA0340010
Plan year2027Sold on HealthCare.gov
Plan typePPONo referral needed
Metal levelSilverNot HSA-eligible
Sold inEvery countyStatewide
Deductible$3,300$9,900 family
Out-of-pocket max$11,000$22,000 family
Primary care visit$40in network
Generic drugs$15 after deductibleper prescription
26,441 Louisiana doctors and facilities in this plan's network · Directory updated Nov 5, 2026 · Monthly premiums are not shown: they depend on age, county and income. NPI Profile does not sell insurance; HealthCare.gov lists premiums and handles enrollment.
Find a doctor in this plan
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Listed in Blue Cross and Blue Shield of Louisiana's provider directory. Directories can be out of date, so call the office to confirm they take this plan.
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 $3,300 deductible.
Doctor visits
- Primary care visit
- $40
- Specialist visit
- $65
- Nurse practitioner or PA visit
- $40
- Preventive care and vaccines
- Free
- Urgent care
- $65
Prescription drugs
- Generic drugs
- $15 after deductible
- Preferred brand drugs
- 20% after deductible
- Non-preferred brand drugs
- 30% after deductible
- Specialty drugs
- 20% after deductible
Tests and imaging
- Lab work
- 50% after deductible
- X-rays
- 50% after deductible
- MRI, CT and PET scans
- 50% after deductible
Emergencies and hospital
- Emergency room
- 50% after deductible
- Ambulance
- 50% after deductible
- Hospital stay
- 50% after deductible
- Outpatient surgery (facility)
- 50% after deductible
Mental health
- Therapy and counseling visits
- $40
- Inpatient mental health care
- 50% after deductible
Pregnancy
- Prenatal and postnatal care
- $65
- Delivery and hospital stay
- 50% after deductible
Other care
- Physical and occupational therapy
- 50% after deductible
- Chiropractic care
- $40
- Eye exam for childrenLimit: 1 visit a year
- Free
- Glasses for childrenLimit: 1 item a year
- Free
- Adult dental
- Not covered
$6,770Having a baby (CMS example)
$1,870Managing type 2 diabetes for a year
$2,550A simple fracture
Every service in the plan file (75)
| Service | You pay | Limits and notes |
|---|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered | |
| Accidental Dental | 50% after deductible | |
| Acupuncture | Not covered | |
| Allergy Testing | 50% after deductible | |
| Attention Deficit Disorder | $65 | |
| Bariatric Surgery | Not covered | |
| Basic Dental Care - Adult | Not covered | |
| Basic Dental Care - Child | 50% after deductible | |
| Chemotherapy | 50% after deductible | |
| Chiropractic Care | $40 | |
| Clinical Trials | $65 | The following services are not covered: a. Non-healthcare services provided as part of the clinical trial;b. Costs for managing research data associated with the clinical trial;c. Investigational drugs or devices; and/ord. Services, treatment or supplies not |
| Congenital Anomaly, including Cleft Lip/Palate | 50% after deductible | |
| Cosmetic Surgery | Not covered | |
| Delivery and All Inpatient Services for Maternity Care | 50% after deductible | |
| Dental Anesthesia | 50% after deductible | |
| Dental Check-Up for Children | Free | 1 visit every 6 months |
| Diabetes Care Management | 50% after deductible | |
| Diabetes Education | 50% after deductible | |
| Dialysis | 50% after deductible | |
| Durable Medical Equipment | 50% after deductible | Exclusions are but not limited to: hairpieces, wigs, hair growth, and/or hair implants; Personal comfort, personal hygiene and convenience items including, but not limited to, air conditioners, humidifiers, personal fitness equipment, or alterations to a |
| Emergency Room Services | 50% after deductible | |
| Emergency Transportation/Ambulance | 50% after deductible | No benefits are available if transportation is provided for the Member's comfort or convenience, or when a hospital transports members between parts of its own campus. |
| Eye Glasses for Children | Free | 1 item a year |
| Generic Drugs | $15 after deductible | Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions. |
| Habilitation Services | 50% after deductible | Other exclusions include but not limited to: Visual therapy; lifestyle/habit changing clinics and/or programs; recreational therapy; primarily to enhance athletic abilities; and/or inpatient pain rehabilitation and inpatient pain control programs |
| Hearing Aids | 50% after deductible | 1 item every 3 years Certain exclusion apply - Please see the contract book. Benefits are available for hearing aids for covered Members when obtained from a Network Provider or another Provider approved by Us. This Benefit is limited to one hearing aid, per |
| Home Health Care Services | 50% after deductible | |
| Hospice Services | 50% after deductible | |
| Imaging (CT/PET Scans, MRIs) | 50% after deductible | |
| Infertility Treatment | Not covered | |
| Infusion Therapy | 50% after deductible | |
| Inherited Metabolic Disorder - PKU | 50% after deductible | Exclusions are but not limited to: food or food supplements, formulas and medical foods, including those used for gastric tube feedings. |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50% after deductible | |
| Inpatient Physician and Surgical Services | 50% after deductible | |
| Laboratory Outpatient and Professional Services | 50% after deductible | |
| Long-Term/Custodial Nursing Home Care | Not covered | |
| Major Dental Care - Adult | Not covered | |
| Major Dental Care - Child | 50% after deductible | |
| Mental/Behavioral Health Inpatient Services | 50% after deductible | |
| Mental/Behavioral Health Outpatient Services | $40 | Coverage for treatment of Mental Disorders does NOT include counseling services such as career counseling, marriage counseling, divorce counseling, parental counseling and job counseling.Education services and supplies including training or re-training for a |
| Non-Emergency Care When Traveling Outside the U.S. | 50% after deductible | |
| Non-Preferred Brand Drugs | 30% after deductible | Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions. |
| Nutritional Counseling | 50% after deductible | |
| Orthodontia - Adult | Not covered | |
| Orthodontia - Child | 50% after deductible | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $40 | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 50% after deductible | |
| Outpatient Rehabilitation Services | 50% after deductible | Other exclusions include but not limited to:Visual therapy lifestyle/habit changing clinics and/or programs; recreational therapy; primarily to enhance athletic abilities; and/or inpatient pain rehabilitation and inpatient pain control programs |
| Outpatient Surgery Physician/Surgical Services | 50% after deductible | Exclusions include but not limited to:a. rhinoplasty;b. blepharoplasty services identified by CPT codes 15820, 15821, 15822, 15823; brow ptosis identified by CPT code 67900; or any revised or equivalent codes;c. gynecomastia;d. breast enlargement or |
| Preferred Brand Drugs | 20% after deductible | Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions. |
| Prenatal and Postnatal Care | $65 | |
| Prescription Drugs Other | 50% after deductible | |
| Preventive Care/Screening/Immunization | Free | Any services not included in the following Non-Grandfathered Preventive Care Services Brochure link is excluded: https://www.lablue.com/preventive |
| Primary Care Visit to Treat an Injury or Illness | $40 | |
| Private-Duty Nursing | 50% after deductible | |
| Prosthetic Devices | 50% after deductible | |
| Radiation | 50% after deductible | |
| Reconstructive Surgery | 50% after deductible | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 50% after deductible | |
| Rehabilitative Speech Therapy | 50% after deductible | |
| Routine Dental Services (Adult) | Not covered | |
| Routine Eye Exam (Adult) | Not covered | |
| Routine Eye Exam for Children | Free | 1 visit a year |
| Routine Foot Care | Not covered | |
| Skilled Nursing Facility | 50% after deductible | |
| Specialist Visit | $65 | |
| Specialty Drugs | 20% after deductible | Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions. |
| Substance Abuse Disorder Inpatient Services | 50% after deductible | |
| Substance Abuse Disorder Outpatient Services | $40 | |
| Transplant | 50% after deductible | Exclusions are but not limited to: any costs of donating an organ or tissue for transplant when a Member is a donor; the transplant of any non-human organ or tissue; or bone marrow transplants and stem cell rescue (autologous and allogeneic) are not covered |
| Treatment for Temporomandibular Joint Disorders | Not covered | |
| Urgent Care Centers or Facilities | $65 | |
| Weight Loss Programs | Not covered | |
| Well Baby Visits and Care | Free | |
| X-rays and Diagnostic Imaging | 50% after deductible |
How this plan works
PPO: Care outside the network is covered at a higher cost. Referrals are usually not needed.
- Referral for specialists
- Not required
- Coinsurance
- 50% after the deductible
- Works with an HSA
- No
- Network
- PPO Vision Dental (LAN001)
- Sold in
- Every Louisiana county
Summary of Benefits and Coverage (PDF) Plan brochure Covered drugs (formulary)
Other Blue Cross and Blue Shield of Louisiana plans on the same network
The same doctors and hospitals, with different costs.
| Plan | Metal | Deductible | Out-of-pocket max |
|---|---|---|---|
| Blue Max 80/60 $1500 with 2 $0 PCP Virtual Visits PPO | Gold | $1,500 | $10,000 |
| Blue Max Copay (PCP) 75/55 $2500 Standardized PPO | Gold | $2,500 | $8,700 |
| Blue Saver 90/70 $3700 HSA Eligible PPO | Silver | $3,700 | $8,700 |
| Blue Saver 60/40 $6100 HSA Eligible PPO | Expanded Bronze | $6,100 | $8,700 |
| Blue Max Copay (PCP) 60/40 $6400 Standardized PPO | Silver | $6,400 | $10,300 |
| Blue Max 70/50 $6700 with 2 $0 PCP Virtual Visits HSA Eligible PPO | Bronze | $6,700 | $12,000 |
| Blue Max Copay (PCP) 50/50 $7500 Standardized HSA Eligible PPO | Expanded Bronze | $7,500 | $12,000 |
Questions about Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits
Does Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits 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 Blue Cross and Blue Shield of Louisiana 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 Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits?
It is a PPO plan: care outside the network is covered at a higher cost. Referrals are usually not needed. It is a Silver plan.
How much is a doctor visit with Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits?
A primary care visit costs $40. A specialist visit costs $65. These are in-network costs for one person. "After deductible" means you pay the full cost until you reach the $3,300 deductible.
Where is Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits sold?
It is sold to people who live in every Louisiana county, through HealthCare.gov.
Why is there no monthly premium on this page?
Premiums depend on your age, county, household size and income, and most people get a subsidy, so a single price would mislead. HealthCare.gov shows the price for your household.
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 costs, covered services, coverage examples and the counties where it is sold | Plan year 2027 |
| Blue Cross and Blue Shield of Louisiana's provider directory | The doctors and facilities listed in this plan's network. Only providers with an address in Louisiana are counted. | Updated November 5, 2026 |
| NPPES NPI registry | Provider names, practice addresses and primary specialties | Matched November 8, 2026 |
- Costs are for the standard version of the plan, for one person, in network. People who qualify for cost-sharing reductions pay less.
- Monthly premiums are not shown: they depend on age, county, household and income. HealthCare.gov lists them for your household.
- Confirm costs in the plan documents and with the insurer, and confirm with the doctor's office that they take this plan.
