Blue Advantage Silver PPO℠ 204
Silver · PPO · Blue Cross and Blue Shield of Oklahoma · Oklahoma
At age 40 it costs $822.58 a month before any subsidy.
What this Silver plan costs if your income qualifies
Below certain incomes the marketplace improves a Silver plan's cost sharing automatically — you do not apply for it, and it happens on Silver and on no other metal level. The premium does not change; the deductible and what you pay at the doctor do.
| If your income is | Deductible | Most you could pay in a year | Primary care | Generic drugs |
|---|---|---|---|---|
| Above 250%, or not applied for | $1,025 | $10,150 | $35 | 20% Coinsurance after deductible |
| up to 150% of the federal poverty level | $0 | $1,175 | $5 | No Charge |
| 150% to 200% | $200 | $3,250 | $20 | No Charge after Deductible |
| 200% to 250% | $1,025 | $7,500 | $35 | 20% Coinsurance after deductible |
CMS calls these cost-sharing reductions. The percentages are actuarial values, not discounts. HealthCare.gov works out which one you get from the income you report when you apply.
What CMS publishes about it
| Plan ID | 87571OK0350090 |
|---|---|
| Insurer | Blue Cross and Blue Shield of Oklahoma |
| Metal level | Silver |
| Plan type | PPO |
| Deductible (individual) | $1,025 |
| Deductible (family) | $2,050 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $10,150 |
| Family maximum | $20,300 |
| Primary care visit | $35 |
| Specialist visit | 50% Coinsurance after deductible |
| Emergency room | $950 Copay with deductible and 50% Coinsurance after deductible |
| Inpatient stay | $400 Copay per Stay with deductible and 50% Coinsurance after deductible |
| Generic drugs | 20% Coinsurance after deductible |
| Preferred brand drugs | 30% Coinsurance after deductible |
| Specialty drugs | 45% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | No |
| Share of premium buying essential health benefits | 100.00% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-866-520-2507 · TTY 1-800-942-5837 |
Where it is sold, and what it costs there
60 counties. The premium is the price before any tax credit; what you pay depends on your income.
| County | At 21 | At 30 | At 40 | At 50 | At 60 |
|---|---|---|---|---|---|
| Adair County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Alfalfa County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Atoka County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Beaver County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Beckham County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Blaine County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Bryan County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Caddo County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Carter County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Cherokee County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Choctaw County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Cimarron County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Coal County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Cotton County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Craig County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Custer County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Delaware County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Dewey County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Ellis County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Garfield County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Garvin County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Grant County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Greer County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Harmon County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Harper County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Haskell County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Hughes County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Jackson County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Jefferson County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Johnston County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Kay County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Kingfisher County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Kiowa County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Latimer County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Love County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Major County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Marshall County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Mayes County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| McCurtain County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| McIntosh County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Murray County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Muskogee County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Noble County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Nowata County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Okfuskee County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Ottawa County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Payne County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Pittsburg County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Pontotoc County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Pottawatomie County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Pushmataha County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Roger Mills County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Seminole County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Stephens County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Texas County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Tillman County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Washington County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Washita County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Woods County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
| Woodward County | $643.65 | $730.54 | $822.58 | $1,149.56 | $1,746.87 |
Open enrollment for 2026 coverage runs 1 November 2025 to 15 January 2026 in most states. Outside that window you need a qualifying life event — losing other coverage, moving, marrying, having a child — to enrol.
Get told when this changes
When this plan’s price or benefits change.
Double opt-in, one click to unsubscribe. We never sell or share the list, and we are not an insurance agent or broker: this is a notification about published data, not a sales call. Privacy.
Premiums, deductibles, out-of-pocket maximums and cost sharing are reproduced from the HealthCare.gov Qualified Health Plan landscape file published by the Centers for Medicare & Medicaid Services for plan year 2026. Nothing on this page is calculated by us. This is not a complete list of your options and it is not advice: to see every plan and to enrol, use HealthCare.gov or call 1-800-318-2596.