South Carolina health plan · 2025

Blue Cooper Silver 1 · 26065SC0700002

BlueCross BlueShield of SC offers this marketplace health insurance plan (Plan ID 26065SC0700002) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 94% AV Level Silver Plan Issuer: BlueCross BlueShield of SC
Telehealth Data pending HSA eligible No Dental Not listed Vision Child

CMS AV Calculator output: 94.06% (5.94% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$274 – $1285

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$1,100

$2200 per group

Review MOOP rules

Office visits

Primary care $10.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $20.00

View formulary tiers

$376 / mo before subsidies

≈ $4506 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1214 / mo before subsidies

≈ $14569 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1490 / mo before subsidies

≈ $17874 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$916 / mo before subsidies

≈ $10990 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

$300.00, 25.00%

Durable Medical Equipment

No Charge, 25.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in South Carolina). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 94% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

$300.00, 25.00%

Durable Medical Equipment

No Charge, 25.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in South Carolina N/A
PCPs in South Carolina N/A
Telehealth support Data pending
Nationwide providers N/A
Providers South Carolina All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

6,674 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 3,129
NON-PREFERRED-BRAND 2,094
NON-PREFERRED-BRAND-SPECIALTY 1,184
GENERIC-SPECIALTY 267
Prior authorization Drugs
Required 1,573
Not Required 5,101
Step therapy Drugs
Required 188
Not Required 6,486
Quantity limits Drugs
Has Limit 1,426
No Limit 5,248

Customer highlights

What stands out for members

  • Issuer: BlueCross BlueShield of SC · Plan ID 26065SC0700002 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 26065SC0700002-06 (94% AV Silver Plan ) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$25.00

Diabetes Education

No Charge, 25.00%

Home Health Care Services

No Charge, 25.00%

Laboratory Outpatient and Professional Services

No Charge, 25.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$10.00

Preventive Care/Screening/Immunization

No Charge, No Charge

Primary Care Visit to Treat an Injury or Illness

$10.00

Rehabilitative Occupational and Rehabilitative Physical Therapy

No Charge, 25.00%

Rehabilitative Speech Therapy

No Charge, 25.00%

Specialist Visit

$40.00

Urgent Care Centers or Facilities

$20.00

X-rays and Diagnostic Imaging

No Charge, 25.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

No Charge, 25.00%

Delivery and All Inpatient Services for Maternity Care

No Charge, 25.00%

Dialysis

No Charge, 25.00%

Durable Medical Equipment

No Charge, 25.00%

Emergency Room Services

$300.00, 25.00%

Emergency Transportation/Ambulance

No Charge, 25.00%

Hospice Services

No Charge, 25.00%

Inpatient Hospital Services (e.g., Hospital Stay)

No Charge, 25.00%

Inpatient Physician and Surgical Services

No Charge, 25.00%

Mental/Behavioral Health Inpatient Services

No Charge, 25.00%

Mental/Behavioral Health Outpatient Services

$10.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

No Charge, 25.00%

Outpatient Rehabilitation Services

No Charge, 25.00%

Outpatient Surgery Physician/Surgical Services

No Charge, 25.00%

Radiation

No Charge, 25.00%

Skilled Nursing Facility

No Charge, 25.00%

Substance Abuse Disorder Inpatient Services

No Charge, 25.00%

Substance Abuse Disorder Outpatient Services

$10.00

Transplant

No Charge, 25.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Hearing Aids

Coverage details pending

Major Dental Care - Child

Coverage details pending

Prenatal and Postnatal Care

No Charge, 25.00%

Routine Eye Exam for Children

$25.00

Well Baby Visits and Care

No Charge, No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00

Non-Preferred Brand Drugs

$150.00

Preferred Brand Drugs

$20.00

Specialty Drugs

No Charge, 25.00%

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

No Charge, 25.00%

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

Coverage details pending

Infusion Therapy

No Charge, 25.00%

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

No Charge, 25.00%

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

Coverage details pending

Prosthetic Devices

No Charge, 25.00%

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

No Charge, 25.00%

Bariatric Surgery

Coverage details pending

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

$50.00

Gender Affirming Care

Coverage details pending

Habilitation Services

No Charge, 25.00%

Imaging (CT/PET Scans, MRIs)

No Charge, 25.00%

Infertility Treatment

Coverage details pending

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

Coverage details pending

Reconstructive Surgery

No Charge, 25.00%

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

Coverage details pending

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Variant attributes

Blue Cooper Silver 1 · Variant 26065SC0700002-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

26065SC070

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

26065SC0700002-06

Plan Marketing Name

Blue Cooper Silver 1

Plan Variant Marketing Name

Blue Cooper Silver 1

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

26065

Issuer Marketplace Marketing Name

BlueCross BlueShield of South Carolina

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

SCN003

Out of Country Coverage

No

Out of Country Coverage Description

Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

Service Area ID

SCS002

State Code

SC

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.940625766080966

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,100

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$300

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$1,100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

25.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$2200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$1100 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$1,100

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

SCF013

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-02-19 01:01:54

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

26065SC0700002

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in South Carolina?

Blue Cooper Silver 1 (26065SC0700002) is a Silver HMO from BlueCross BlueShield of SC in South Carolina for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Cooper Silver 1 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Cooper Silver 1 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Cooper Silver 1 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Cooper Silver 1?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Blue Cooper Silver 1?

No, out-of-country services are not covered for this plan. Details: Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

Does Blue Cooper Silver 1 cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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