GoldPPO

BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)

Florida Blue (BlueCross BlueShield FL)

Starting at

$1148

/month before subsidy

Key facts

BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) is a 2026 Gold PPO health insurance plan from Florida Blue (BlueCross BlueShield FL), sold on the ACA Marketplace in Florida under plan ID 16842FL0260012. The monthly premium starts at $1,148 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $1,500 ($3,000 for a family), and the individual out-of-pocket maximum is $6,450 ($12,900 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is not HSA-eligible.

Plan ID
16842FL0260012
Plan year
2026
State
Florida
Metal level
Gold
Plan type
PPO
HSA-eligible
No

Individual Deductible

$1,500

Family: $3,000

Out-of-Pocket Max

$6,450

Family: $12,900

Coinsurance

20%

You pay after deductible

Network Type

PPO

FLN001

Cost Sharing
What you pay for common services (after deductible unless noted)

Medical Services

Primary Care VisitNo Charge
Specialist Visit$75.00
Urgent Care$75.00
Emergency Room$500.00

Prescription Drugs

Generic Drugs$20.00
Brand Name Drugs47.00%
Specialty Drugs50.00%
What you'd typically pay
Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$2,860

your estimated cost

Deductible
$1,500
Copays
$200
Coinsurance
$1,100

Managing type 2 diabetes

A year of routine care

$2,100

your estimated cost

Deductible
$0
Copays
$2,100
Coinsurance
$0

A simple fracture

ER visit + follow-up

$1,600

your estimated cost

Deductible
$900
Copays
$700
Coinsurance
$0
Is your medication or doctor covered?
Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.
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Official Plan Documents
Published by Florida Blue (BlueCross BlueShield FL). These are the authoritative source for coverage details.
Who This Plan Is Best For

This Gold PPO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

  • Have ongoing health conditions requiring regular care
  • Take multiple prescription medications
  • Prefer lower costs at the time of service
  • Want peace of mind with comprehensive coverage

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost
What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,686/month

Annual Premium

$13,776

OOP Maximum

$6,450

💡 What this means:

With a $1,500 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $6,450 total. Then insurance covers everything else for the year.

More plans from Florida Blue (BlueCross BlueShield FL) in Florida

View all Marketplace plans in Florida

Frequently asked questions about BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)

How much does BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) cost per month?

BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) from Florida Blue (BlueCross BlueShield FL) starts at $1,148 per month before any subsidy in Florida. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)?

The individual medical deductible is $1,500, and the family deductible is $3,000. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)?

The most you would pay in a year for covered in-network care is $6,450 for an individual and $12,900 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) HSA-eligible?

No. BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) use?

BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) is a PPO plan. PPO plans let you see specialists without a referral and use out-of-network providers (at higher cost), offering the most flexibility.

Understand what you'd actually pay

Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.