MyBlue Gold HMO℠ 804
Gold · HMO · Blue Cross and Blue Shield of Oklahoma · Oklahoma
At age 40 it costs $674.94 a month before any subsidy.
What CMS publishes about it
| Plan ID | 87571OK0510073 |
|---|---|
| Insurer | Blue Cross and Blue Shield of Oklahoma |
| Metal level | Gold |
| Plan type | HMO |
| Deductible (individual) | $1,000 |
| Deductible (family) | $2,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $10,600 |
| Family maximum | $21,200 |
| Primary care visit | No Charge |
| Specialist visit | 30% Coinsurance after deductible |
| Emergency room | $950 Copay with deductible and 30% Coinsurance after deductible |
| Inpatient stay | 30% Coinsurance after deductible |
| Generic drugs | No Charge |
| 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
7 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 |
|---|---|---|---|---|---|
| Creek County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Okmulgee County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Osage County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Pawnee County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Rogers County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Tulsa County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
| Wagoner County | $528.12 | $599.42 | $674.94 | $943.22 | $1,433.32 |
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.
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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.