Obamacare 2023 Rates for Carroll County
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AultCare Insurance CompanyLocal: 1-330-363-6360 | Toll Free: 1-800-344-8858 | TTY: 1-171-1- |
Toc - Plan #1 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 5750 No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$433.65 $492.18 $554.19 $774.48 $1,176.90 |
$765.38 $823.91 $885.92 $1,106.21 |
$1,097.11 $1,155.64 $1,217.65 $1,437.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$867.30 $984.36 $1,108.38 $1,548.96 $2,353.80 |
$1,199.03 $1,316.09 $1,440.11 $1,880.69 |
$1,530.76 $1,647.82 $1,771.84 $2,212.42 |
Toc - Plan #2 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 5000 No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$538.79 $611.52 $688.57 $962.27 $1,462.27 |
$950.96 $1,023.69 $1,100.74 $1,374.44 |
$1,363.13 $1,435.86 $1,512.91 $1,786.61 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,077.58 $1,223.04 $1,377.14 $1,924.54 $2,924.54 |
$1,489.75 $1,635.21 $1,789.31 $2,336.71 |
$1,901.92 $2,047.38 $2,201.48 $2,748.88 |
Toc - Plan #3 AultCare Insurance Company | ||||||||||||||||||||
Gold
(PPO) AultCare Gold 1100 No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$678.56 $770.16 $867.20 $1,211.90 $1,841.60 |
$1,197.66 $1,289.26 $1,386.30 $1,731.00 |
$1,716.76 $1,808.36 $1,905.40 $2,250.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,357.12 $1,540.32 $1,734.40 $2,423.80 $3,683.20 |
$1,876.22 $2,059.42 $2,253.50 $2,942.90 |
$2,395.32 $2,578.52 $2,772.60 $3,462.00 |
Toc - Plan #4 AultCare Insurance Company | ||||||||||||||||||||
Catastrophic
(PPO) AultCare Catastrophic Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$210.29 $238.67 $268.74 $375.57 $570.71 |
$371.16 $399.54 $429.61 $536.44 |
$532.03 $560.41 $590.48 $697.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$420.58 $477.34 $537.48 $751.14 $1,141.42 |
$581.45 $638.21 $698.35 $912.01 |
$742.32 $799.08 $859.22 $1,072.88 |
Toc - Plan #5 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 5750 Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$332.15 $376.99 $424.49 $593.22 $901.45 |
$586.24 $631.08 $678.58 $847.31 |
$840.33 $885.17 $932.67 $1,101.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$664.30 $753.98 $848.98 $1,186.44 $1,802.90 |
$918.39 $1,008.07 $1,103.07 $1,440.53 |
$1,172.48 $1,262.16 $1,357.16 $1,694.62 |
Toc - Plan #6 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 5000 Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$411.74 $467.32 $526.20 $735.36 $1,117.45 |
$726.72 $782.30 $841.18 $1,050.34 |
$1,041.70 $1,097.28 $1,156.16 $1,365.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$823.48 $934.64 $1,052.40 $1,470.72 $2,234.90 |
$1,138.46 $1,249.62 $1,367.38 $1,785.70 |
$1,453.44 $1,564.60 $1,682.36 $2,100.68 |
Toc - Plan #7 AultCare Insurance Company | ||||||||||||||||||||
Gold
(PPO) AultCare Gold 1100 Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$519.43 $589.55 $663.82 $927.69 $1,409.72 |
$916.79 $986.91 $1,061.18 $1,325.05 |
$1,314.15 $1,384.27 $1,458.54 $1,722.41 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,038.86 $1,179.10 $1,327.64 $1,855.38 $2,819.44 |
$1,436.22 $1,576.46 $1,725.00 $2,252.74 |
$1,833.58 $1,973.82 $2,122.36 $2,650.10 |
Toc - Plan #8 AultCare Insurance Company | ||||||||||||||||||||
Catastrophic
(PPO) AultCare Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$277.58 $315.05 $354.74 $495.75 $753.34 |
$489.92 $527.39 $567.08 $708.09 |
$702.26 $739.73 $779.42 $920.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$555.16 $630.10 $709.48 $991.50 $1,506.68 |
$767.50 $842.44 $921.82 $1,203.84 |
$979.84 $1,054.78 $1,134.16 $1,416.18 |
Toc - Plan #9 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 5750 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$438.44 $497.62 $560.32 $783.05 $1,189.92 |
$773.84 $833.02 $895.72 $1,118.45 |
$1,109.24 $1,168.42 $1,231.12 $1,453.85 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$876.88 $995.24 $1,120.64 $1,566.10 $2,379.84 |
$1,212.28 $1,330.64 $1,456.04 $1,901.50 |
$1,547.68 $1,666.04 $1,791.44 $2,236.90 |
Toc - Plan #10 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 5000 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$543.50 $616.86 $694.58 $970.68 $1,475.04 |
$959.27 $1,032.63 $1,110.35 $1,386.45 |
$1,375.04 $1,448.40 $1,526.12 $1,802.22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,087.00 $1,233.72 $1,389.16 $1,941.36 $2,950.08 |
$1,502.77 $1,649.49 $1,804.93 $2,357.13 |
$1,918.54 $2,065.26 $2,220.70 $2,772.90 |
Toc - Plan #11 AultCare Insurance Company | ||||||||||||||||||||
Gold
(PPO) AultCare Gold 1100 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$685.64 $778.20 $876.25 $1,224.55 $1,860.83 |
$1,210.15 $1,302.71 $1,400.76 $1,749.06 |
$1,734.66 $1,827.22 $1,925.27 $2,273.57 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,371.28 $1,556.40 $1,752.50 $2,449.10 $3,721.66 |
$1,895.79 $2,080.91 $2,277.01 $2,973.61 |
$2,420.30 $2,605.42 $2,801.52 $3,498.12 |
Toc - Plan #12 AultCare Insurance Company | ||||||||||||||||||||
Catastrophic
(PPO) AultCare Catastrophic No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$274.56 $311.63 $350.89 $490.36 $745.16 |
$484.60 $521.67 $560.93 $700.40 |
$694.64 $731.71 $770.97 $910.44 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$549.12 $623.26 $701.78 $980.72 $1,490.32 |
$759.16 $833.30 $911.82 $1,190.76 |
$969.20 $1,043.34 $1,121.86 $1,400.80 |
Toc - Plan #13 AultCare Insurance Company | ||||||||||||||||||||
Gold
(PPO) AultCare Gold 1100 Select No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$514.06 $583.46 $656.97 $918.11 $1,395.15 |
$907.31 $976.71 $1,050.22 $1,311.36 |
$1,300.56 $1,369.96 $1,443.47 $1,704.61 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,028.12 $1,166.92 $1,313.94 $1,836.22 $2,790.30 |
$1,421.37 $1,560.17 $1,707.19 $2,229.47 |
$1,814.62 $1,953.42 $2,100.44 $2,622.72 |
Toc - Plan #14 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 5000 Select No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$408.18 $463.28 $521.64 $729.00 $1,107.78 |
$720.43 $775.53 $833.89 $1,041.25 |
$1,032.68 $1,087.78 $1,146.14 $1,353.50 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$816.36 $926.56 $1,043.28 $1,458.00 $2,215.56 |
$1,128.61 $1,238.81 $1,355.53 $1,770.25 |
$1,440.86 $1,551.06 $1,667.78 $2,082.50 |
Toc - Plan #15 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 5750 Select No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$328.52 $372.86 $419.84 $586.73 $891.59 |
$579.83 $624.17 $671.15 $838.04 |
$831.14 $875.48 $922.46 $1,089.35 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$657.04 $745.72 $839.68 $1,173.46 $1,783.18 |
$908.35 $997.03 $1,090.99 $1,424.77 |
$1,159.66 $1,248.34 $1,342.30 $1,676.08 |
Toc - Plan #16 AultCare Insurance Company | ||||||||||||||||||||
Catastrophic
(PPO) AultCare Catastrophic Select No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$208.00 $236.08 $265.82 $371.49 $564.51 |
$367.12 $395.20 $424.94 $530.61 |
$526.24 $554.32 $584.06 $689.73 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$416.00 $472.16 $531.64 $742.98 $1,129.02 |
$575.12 $631.28 $690.76 $902.10 |
$734.24 $790.40 $849.88 $1,061.22 |
Toc - Plan #17 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 6850 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$478.98 $543.64 $612.13 $855.45 $1,299.94 |
$845.40 $910.06 $978.55 $1,221.87 |
$1,211.82 $1,276.48 $1,344.97 $1,588.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$957.96 $1,087.28 $1,224.26 $1,710.90 $2,599.88 |
$1,324.38 $1,453.70 $1,590.68 $2,077.32 |
$1,690.80 $1,820.12 $1,957.10 $2,443.74 |
Toc - Plan #18 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 6850 Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$362.86 $411.85 $463.73 $648.07 $984.80 |
$640.45 $689.44 $741.32 $925.66 |
$918.04 $967.03 $1,018.91 $1,203.25 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$725.72 $823.70 $927.46 $1,296.14 $1,969.60 |
$1,003.31 $1,101.29 $1,205.05 $1,573.73 |
$1,280.90 $1,378.88 $1,482.64 $1,851.32 |
Toc - Plan #19 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 6850 No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$473.88 $537.85 $605.62 $846.35 $1,286.11 |
$836.40 $900.37 $968.14 $1,208.87 |
$1,198.92 $1,262.89 $1,330.66 $1,571.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$947.76 $1,075.70 $1,211.24 $1,692.70 $2,572.22 |
$1,310.28 $1,438.22 $1,573.76 $2,055.22 |
$1,672.80 $1,800.74 $1,936.28 $2,417.74 |
Toc - Plan #20 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Silver 6850 Select No Pediatric Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$359.00 $407.46 $458.80 $641.17 $974.32 |
$633.63 $682.09 $733.43 $915.80 |
$908.26 $956.72 $1,008.06 $1,190.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$718.00 $814.92 $917.60 $1,282.34 $1,948.64 |
$992.63 $1,089.55 $1,192.23 $1,556.97 |
$1,267.26 $1,364.18 $1,466.86 $1,831.60 |
Toc - Plan #21 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 6850 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$447.44 $507.84 $571.82 $799.12 $1,214.34 |
$789.73 $850.13 $914.11 $1,141.41 |
$1,132.02 $1,192.42 $1,256.40 $1,483.70 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$894.88 $1,015.68 $1,143.64 $1,598.24 $2,428.68 |
$1,237.17 $1,357.97 $1,485.93 $1,940.53 |
$1,579.46 $1,700.26 $1,828.22 $2,282.82 |
Toc - Plan #22 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 6850 Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$338.97 $384.73 $433.20 $605.39 $919.95 |
$598.28 $644.04 $692.51 $864.70 |
$857.59 $903.35 $951.82 $1,124.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$677.94 $769.46 $866.40 $1,210.78 $1,839.90 |
$937.25 $1,028.77 $1,125.71 $1,470.09 |
$1,196.56 $1,288.08 $1,385.02 $1,729.40 |
Toc - Plan #23 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 6850 No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.62 $502.37 $565.66 $790.51 $1,201.26 |
$781.22 $840.97 $904.26 $1,129.11 |
$1,119.82 $1,179.57 $1,242.86 $1,467.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.24 $1,004.74 $1,131.32 $1,581.02 $2,402.52 |
$1,223.84 $1,343.34 $1,469.92 $1,919.62 |
$1,562.44 $1,681.94 $1,808.52 $2,258.22 |
Toc - Plan #24 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 6850 Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$335.32 $380.58 $428.53 $598.87 $910.04 |
$591.84 $637.10 $685.05 $855.39 |
$848.36 $893.62 $941.57 $1,111.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$670.64 $761.16 $857.06 $1,197.74 $1,820.08 |
$927.16 $1,017.68 $1,113.58 $1,454.26 |
$1,183.68 $1,274.20 $1,370.10 $1,710.78 |
Toc - Plan #25 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Standard Bronze Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$279.53 $317.26 $357.23 $499.23 $758.63 |
$493.37 $531.10 $571.07 $713.07 |
$707.21 $744.94 $784.91 $926.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$559.06 $634.52 $714.46 $998.46 $1,517.26 |
$772.90 $848.36 $928.30 $1,212.30 |
$986.74 $1,062.20 $1,142.14 $1,426.14 |
Toc - Plan #26 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8250 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.16 $425.80 $479.45 $670.03 $1,018.17 |
$662.15 $712.79 $766.44 $957.02 |
$949.14 $999.78 $1,053.43 $1,244.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.32 $851.60 $958.90 $1,340.06 $2,036.34 |
$1,037.31 $1,138.59 $1,245.89 $1,627.05 |
$1,324.30 $1,425.58 $1,532.88 $1,914.04 |
Toc - Plan #27 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8250 Select |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284.21 $322.58 $363.22 $507.60 $771.34 |
$501.63 $540.00 $580.64 $725.02 |
$719.05 $757.42 $798.06 $942.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$568.42 $645.16 $726.44 $1,015.20 $1,542.68 |
$785.84 $862.58 $943.86 $1,232.62 |
$1,003.26 $1,080.00 $1,161.28 $1,450.04 |
Toc - Plan #28 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8250 No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.97 $421.05 $474.10 $662.55 $1,006.81 |
$654.76 $704.84 $757.89 $946.34 |
$938.55 $988.63 $1,041.68 $1,230.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.94 $842.10 $948.20 $1,325.10 $2,013.62 |
$1,025.73 $1,125.89 $1,231.99 $1,608.89 |
$1,309.52 $1,409.68 $1,515.78 $1,892.68 |
Toc - Plan #29 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8250 Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.04 $318.98 $359.17 $501.93 $762.74 |
$496.03 $533.97 $574.16 $716.92 |
$711.02 $748.96 $789.15 $931.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$562.08 $637.96 $718.34 $1,003.86 $1,525.48 |
$777.07 $852.95 $933.33 $1,218.85 |
$992.06 $1,067.94 $1,148.32 $1,433.84 |
Toc - Plan #30 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.22 $414.51 $466.74 $652.27 $991.18 |
$644.61 $693.90 $746.13 $931.66 |
$924.00 $973.29 $1,025.52 $1,211.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$730.44 $829.02 $933.48 $1,304.54 $1,982.36 |
$1,009.83 $1,108.41 $1,212.87 $1,583.93 |
$1,289.22 $1,387.80 $1,492.26 $1,863.32 |
Toc - Plan #31 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8550 Select |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.68 $314.03 $353.59 $494.14 $750.90 |
$488.34 $525.69 $565.25 $705.80 |
$700.00 $737.35 $776.91 $917.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$553.36 $628.06 $707.18 $988.28 $1,501.80 |
$765.02 $839.72 $918.84 $1,199.94 |
$976.68 $1,051.38 $1,130.50 $1,411.60 |
Toc - Plan #32 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8550 No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$361.16 $409.91 $461.56 $645.02 $980.17 |
$637.44 $686.19 $737.84 $921.30 |
$913.72 $962.47 $1,014.12 $1,197.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$722.32 $819.82 $923.12 $1,290.04 $1,960.34 |
$998.60 $1,096.10 $1,199.40 $1,566.32 |
$1,274.88 $1,372.38 $1,475.68 $1,842.60 |
Toc - Plan #33 AultCare Insurance Company | ||||||||||||||||||||
Bronze
(PPO) AultCare Bronze 8550 Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.61 $310.54 $349.66 $488.65 $742.56 |
$482.92 $519.85 $558.97 $697.96 |
$692.23 $729.16 $768.28 $907.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.22 $621.08 $699.32 $977.30 $1,485.12 |
$756.53 $830.39 $908.63 $1,186.61 |
$965.84 $1,039.70 $1,117.94 $1,395.92 |
Toc - Plan #34 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 7000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.19 $417.89 $470.54 $657.58 $999.26 |
$649.85 $699.55 $752.20 $939.24 |
$931.51 $981.21 $1,033.86 $1,220.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.38 $835.78 $941.08 $1,315.16 $1,998.52 |
$1,018.04 $1,117.44 $1,222.74 $1,596.82 |
$1,299.70 $1,399.10 $1,504.40 $1,878.48 |
Toc - Plan #35 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 7000 Select |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.94 $316.59 $356.47 $498.17 $757.02 |
$492.32 $529.97 $569.85 $711.55 |
$705.70 $743.35 $783.23 $924.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.88 $633.18 $712.94 $996.34 $1,514.04 |
$771.26 $846.56 $926.32 $1,209.72 |
$984.64 $1,059.94 $1,139.70 $1,423.10 |
Toc - Plan #36 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 7000 No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.16 $413.32 $465.39 $650.38 $988.32 |
$642.74 $691.90 $743.97 $928.96 |
$921.32 $970.48 $1,022.55 $1,207.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.32 $826.64 $930.78 $1,300.76 $1,976.64 |
$1,006.90 $1,105.22 $1,209.36 $1,579.34 |
$1,285.48 $1,383.80 $1,487.94 $1,857.92 |
Toc - Plan #37 AultCare Insurance Company | ||||||||||||||||||||
Expanded Bronze
(PPO) AultCare Bronze 7000 Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$275.88 $313.12 $352.57 $492.71 $748.72 |
$486.92 $524.16 $563.61 $703.75 |
$697.96 $735.20 $774.65 $914.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$551.76 $626.24 $705.14 $985.42 $1,497.44 |
$762.80 $837.28 $916.18 $1,196.46 |
$973.84 $1,048.32 $1,127.22 $1,407.50 |
Toc - Plan #38 AultCare Insurance Company | ||||||||||||||||||||
Gold
(PPO) AultCare Standard Gold Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$498.57 $565.87 $637.17 $890.44 $1,353.11 |
$879.97 $947.27 $1,018.57 $1,271.84 |
$1,261.37 $1,328.67 $1,399.97 $1,653.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$997.14 $1,131.74 $1,274.34 $1,780.88 $2,706.22 |
$1,378.54 $1,513.14 $1,655.74 $2,162.28 |
$1,759.94 $1,894.54 $2,037.14 $2,543.68 |
Toc - Plan #39 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Standard Silver Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.47 $388.69 $437.67 $611.64 $929.44 |
$604.45 $650.67 $699.65 $873.62 |
$866.43 $912.65 $961.63 $1,135.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$684.94 $777.38 $875.34 $1,223.28 $1,858.88 |
$946.92 $1,039.36 $1,137.32 $1,485.26 |
$1,208.90 $1,301.34 $1,399.30 $1,747.24 |
Toc - Plan #40 AultCare Insurance Company | ||||||||||||||||||||
Silver
(PPO) AultCare Standard Silver Premier Select No Pediatric Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-344-8858
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.95 $366.54 $412.72 $576.77 $876.46 |
$570.00 $613.59 $659.77 $823.82 |
$817.05 $860.64 $906.82 $1,070.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$645.90 $733.08 $825.44 $1,153.54 $1,752.92 |
$892.95 $980.13 $1,072.49 $1,400.59 |
$1,140.00 $1,227.18 $1,319.54 $1,647.64 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1808 | Toll Free: 1-855-748-1808 |
Toc - Plan #41 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.61 $371.84 $418.69 $585.11 $889.13 |
$578.23 $622.46 $669.31 $835.73 |
$828.85 $873.08 $919.93 $1,086.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.22 $743.68 $837.38 $1,170.22 $1,778.26 |
$905.84 $994.30 $1,088.00 $1,420.84 |
$1,156.46 $1,244.92 $1,338.62 $1,671.46 |
Toc - Plan #42 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X HMO 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.43 $351.20 $395.45 $552.64 $839.79 |
$546.14 $587.91 $632.16 $789.35 |
$782.85 $824.62 $868.87 $1,026.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$618.86 $702.40 $790.90 $1,105.28 $1,679.58 |
$855.57 $939.11 $1,027.61 $1,341.99 |
$1,092.28 $1,175.82 $1,264.32 $1,578.70 |
Toc - Plan #43 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$412.76 $468.48 $527.51 $737.19 $1,120.23 |
$728.52 $784.24 $843.27 $1,052.95 |
$1,044.28 $1,100.00 $1,159.03 $1,368.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$825.52 $936.96 $1,055.02 $1,474.38 $2,240.46 |
$1,141.28 $1,252.72 $1,370.78 $1,790.14 |
$1,457.04 $1,568.48 $1,686.54 $2,105.90 |
Toc - Plan #44 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 7450/0% for HSA (+ Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$332.36 $377.23 $424.76 $593.59 $902.03 |
$586.62 $631.49 $679.02 $847.85 |
$840.88 $885.75 $933.28 $1,102.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$664.72 $754.46 $849.52 $1,187.18 $1,804.06 |
$918.98 $1,008.72 $1,103.78 $1,441.44 |
$1,173.24 $1,262.98 $1,358.04 $1,695.70 |
Toc - Plan #45 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 3200/10% for HSA (+ Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$415.35 $471.42 $530.82 $741.82 $1,127.26 |
$733.09 $789.16 $848.56 $1,059.56 |
$1,050.83 $1,106.90 $1,166.30 $1,377.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$830.70 $942.84 $1,061.64 $1,483.64 $2,254.52 |
$1,148.44 $1,260.58 $1,379.38 $1,801.38 |
$1,466.18 $1,578.32 $1,697.12 $2,119.12 |
Toc - Plan #46 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 6000/20% for HSA (+ Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336.71 $382.17 $430.32 $601.36 $913.83 |
$594.29 $639.75 $687.90 $858.94 |
$851.87 $897.33 $945.48 $1,116.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$673.42 $764.34 $860.64 $1,202.72 $1,827.66 |
$931.00 $1,021.92 $1,118.22 $1,460.30 |
$1,188.58 $1,279.50 $1,375.80 $1,717.88 |
Toc - Plan #47 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 5400/0% for HSA ( + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.59 $479.64 $540.07 $754.75 $1,146.91 |
$745.87 $802.92 $863.35 $1,078.03 |
$1,069.15 $1,126.20 $1,186.63 $1,401.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.18 $959.28 $1,080.14 $1,509.50 $2,293.82 |
$1,168.46 $1,282.56 $1,403.42 $1,832.78 |
$1,491.74 $1,605.84 $1,726.70 $2,156.06 |
Toc - Plan #48 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 3000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.81 $479.89 $540.35 $755.14 $1,147.51 |
$746.26 $803.34 $863.80 $1,078.59 |
$1,069.71 $1,126.79 $1,187.25 $1,402.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.62 $959.78 $1,080.70 $1,510.28 $2,295.02 |
$1,169.07 $1,283.23 $1,404.15 $1,833.73 |
$1,492.52 $1,606.68 $1,727.60 $2,157.18 |
Toc - Plan #49 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.16 $462.13 $520.35 $727.19 $1,105.03 |
$718.64 $773.61 $831.83 $1,038.67 |
$1,030.12 $1,085.09 $1,143.31 $1,350.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$814.32 $924.26 $1,040.70 $1,454.38 $2,210.06 |
$1,125.80 $1,235.74 $1,352.18 $1,765.86 |
$1,437.28 $1,547.22 $1,663.66 $2,077.34 |
Toc - Plan #50 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Catastrophic
(HMO) Anthem Catastrophic Pathway X HMO 9100 ( + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$244.87 $277.93 $312.94 $437.34 $664.58 |
$432.20 $465.26 $500.27 $624.67 |
$619.53 $652.59 $687.60 $812.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$489.74 $555.86 $625.88 $874.68 $1,329.16 |
$677.07 $743.19 $813.21 $1,062.01 |
$864.40 $930.52 $1,000.54 $1,249.34 |
Toc - Plan #51 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 6000/25% ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$409.79 $465.11 $523.71 $731.88 $1,112.17 |
$723.28 $778.60 $837.20 $1,045.37 |
$1,036.77 $1,092.09 $1,150.69 $1,358.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$819.58 $930.22 $1,047.42 $1,463.76 $2,224.34 |
$1,133.07 $1,243.71 $1,360.91 $1,777.25 |
$1,446.56 $1,557.20 $1,674.40 $2,090.74 |
Toc - Plan #52 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$332.03 $376.85 $424.33 $593.01 $901.13 |
$586.03 $630.85 $678.33 $847.01 |
$840.03 $884.85 $932.33 $1,101.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$664.06 $753.70 $848.66 $1,186.02 $1,802.26 |
$918.06 $1,007.70 $1,102.66 $1,440.02 |
$1,172.06 $1,261.70 $1,356.66 $1,694.02 |
Toc - Plan #53 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$315.50 $358.09 $403.21 $563.48 $856.27 |
$556.86 $599.45 $644.57 $804.84 |
$798.22 $840.81 $885.93 $1,046.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$631.00 $716.18 $806.42 $1,126.96 $1,712.54 |
$872.36 $957.54 $1,047.78 $1,368.32 |
$1,113.72 $1,198.90 $1,289.14 $1,609.68 |
Toc - Plan #54 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X HMO 9100/0% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.12 $351.99 $396.33 $553.87 $841.67 |
$547.36 $589.23 $633.57 $791.11 |
$784.60 $826.47 $870.81 $1,028.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.24 $703.98 $792.66 $1,107.74 $1,683.34 |
$857.48 $941.22 $1,029.90 $1,344.98 |
$1,094.72 $1,178.46 $1,267.14 $1,582.22 |
Toc - Plan #55 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X HMO 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.53 $385.37 $433.92 $606.40 $921.48 |
$599.27 $645.11 $693.66 $866.14 |
$859.01 $904.85 $953.40 $1,125.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$679.06 $770.74 $867.84 $1,212.80 $1,842.96 |
$938.80 $1,030.48 $1,127.58 $1,472.54 |
$1,198.54 $1,290.22 $1,387.32 $1,732.28 |
Toc - Plan #56 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X HMO 5800/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$404.89 $459.55 $517.45 $723.13 $1,098.87 |
$714.63 $769.29 $827.19 $1,032.87 |
$1,024.37 $1,079.03 $1,136.93 $1,342.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$809.78 $919.10 $1,034.90 $1,446.26 $2,197.74 |
$1,119.52 $1,228.84 $1,344.64 $1,756.00 |
$1,429.26 $1,538.58 $1,654.38 $2,065.74 |
Toc - Plan #57 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway X HMO 2000/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1808
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$587.73 $667.07 $751.12 $1,049.69 $1,595.10 |
$1,037.34 $1,116.68 $1,200.73 $1,499.30 |
$1,486.95 $1,566.29 $1,650.34 $1,948.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,175.46 $1,334.14 $1,502.24 $2,099.38 $3,190.20 |
$1,625.07 $1,783.75 $1,951.85 $2,548.99 |
$2,074.68 $2,233.36 $2,401.46 $2,998.60 |
ADVERTISEMENT
Ambetter from Buckeye Health PlanLocal: 1-877-687-1189 | Toll Free: 1-877-687-1189 | TTY: 1-877-941-9236 |
Toc - Plan #58 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Complete Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.76 $408.32 $459.76 $642.51 $976.36 |
$634.97 $683.53 $734.97 $917.72 |
$910.18 $958.74 $1,010.18 $1,192.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.52 $816.64 $919.52 $1,285.02 $1,952.72 |
$994.73 $1,091.85 $1,194.73 $1,560.23 |
$1,269.94 $1,367.06 $1,469.94 $1,835.44 |
Toc - Plan #59 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Everyday Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.49 $404.60 $455.58 $636.67 $967.48 |
$629.19 $677.30 $728.28 $909.37 |
$901.89 $950.00 $1,000.98 $1,182.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$712.98 $809.20 $911.16 $1,273.34 $1,934.96 |
$985.68 $1,081.90 $1,183.86 $1,546.04 |
$1,258.38 $1,354.60 $1,456.56 $1,818.74 |
Toc - Plan #60 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Complete Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.94 $436.90 $491.94 $687.49 $1,044.71 |
$679.41 $731.37 $786.41 $981.96 |
$973.88 $1,025.84 $1,080.88 $1,276.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.88 $873.80 $983.88 $1,374.98 $2,089.42 |
$1,064.35 $1,168.27 $1,278.35 $1,669.45 |
$1,358.82 $1,462.74 $1,572.82 $1,963.92 |
Toc - Plan #61 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Bronze
(HMO) Clear Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289.25 $328.29 $369.65 $516.58 $784.99 |
$510.52 $549.56 $590.92 $737.85 |
$731.79 $770.83 $812.19 $959.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$578.50 $656.58 $739.30 $1,033.16 $1,569.98 |
$799.77 $877.85 $960.57 $1,254.43 |
$1,021.04 $1,099.12 $1,181.84 $1,475.70 |
Toc - Plan #62 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Choice Bronze HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.66 $359.40 $404.68 $565.54 $859.39 |
$558.90 $601.64 $646.92 $807.78 |
$801.14 $843.88 $889.16 $1,050.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.32 $718.80 $809.36 $1,131.08 $1,718.78 |
$875.56 $961.04 $1,051.60 $1,373.32 |
$1,117.80 $1,203.28 $1,293.84 $1,615.56 |
Toc - Plan #63 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Everyday Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.28 $349.89 $393.97 $550.57 $836.64 |
$544.11 $585.72 $629.80 $786.40 |
$779.94 $821.55 $865.63 $1,022.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$616.56 $699.78 $787.94 $1,101.14 $1,673.28 |
$852.39 $935.61 $1,023.77 $1,336.97 |
$1,088.22 $1,171.44 $1,259.60 $1,572.80 |
Toc - Plan #64 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Elite Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.12 $391.70 $441.05 $616.36 $936.62 |
$609.13 $655.71 $705.06 $880.37 |
$873.14 $919.72 $969.07 $1,144.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$690.24 $783.40 $882.10 $1,232.72 $1,873.24 |
$954.25 $1,047.41 $1,146.11 $1,496.73 |
$1,218.26 $1,311.42 $1,410.12 $1,760.74 |
Toc - Plan #65 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Clear Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352.74 $400.35 $450.79 $629.98 $957.32 |
$622.58 $670.19 $720.63 $899.82 |
$892.42 $940.03 $990.47 $1,169.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$705.48 $800.70 $901.58 $1,259.96 $1,914.64 |
$975.32 $1,070.54 $1,171.42 $1,529.80 |
$1,245.16 $1,340.38 $1,441.26 $1,799.64 |
Toc - Plan #66 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Focused Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$355.30 $403.25 $454.06 $634.55 $964.25 |
$627.10 $675.05 $725.86 $906.35 |
$898.90 $946.85 $997.66 $1,178.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$710.60 $806.50 $908.12 $1,269.10 $1,928.50 |
$982.40 $1,078.30 $1,179.92 $1,540.90 |
$1,254.20 $1,350.10 $1,451.72 $1,812.70 |
Toc - Plan #67 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Everyday Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.54 $419.42 $472.27 $659.99 $1,002.92 |
$652.23 $702.11 $754.96 $942.68 |
$934.92 $984.80 $1,037.65 $1,225.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.08 $838.84 $944.54 $1,319.98 $2,005.84 |
$1,021.77 $1,121.53 $1,227.23 $1,602.67 |
$1,304.46 $1,404.22 $1,509.92 $1,885.36 |
Toc - Plan #68 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Enhanced Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.47 $402.31 $453.00 $633.07 $962.01 |
$625.63 $673.47 $724.16 $904.23 |
$896.79 $944.63 $995.32 $1,175.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.94 $804.62 $906.00 $1,266.14 $1,924.02 |
$980.10 $1,075.78 $1,177.16 $1,537.30 |
$1,251.26 $1,346.94 $1,448.32 $1,808.46 |
Toc - Plan #69 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Clear Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.76 $413.99 $466.15 $651.44 $989.93 |
$643.79 $693.02 $745.18 $930.47 |
$922.82 $972.05 $1,024.21 $1,209.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.52 $827.98 $932.30 $1,302.88 $1,979.86 |
$1,008.55 $1,107.01 $1,211.33 $1,581.91 |
$1,287.58 $1,386.04 $1,490.36 $1,860.94 |
Toc - Plan #70 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) CMS Standard Expanded Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.34 $343.15 $386.38 $539.97 $820.53 |
$533.63 $574.44 $617.67 $771.26 |
$764.92 $805.73 $848.96 $1,002.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.68 $686.30 $772.76 $1,079.94 $1,641.06 |
$835.97 $917.59 $1,004.05 $1,311.23 |
$1,067.26 $1,148.88 $1,235.34 $1,542.52 |
Toc - Plan #71 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) CMS Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352.24 $399.78 $450.15 $629.08 $955.96 |
$621.70 $669.24 $719.61 $898.54 |
$891.16 $938.70 $989.07 $1,168.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$704.48 $799.56 $900.30 $1,258.16 $1,911.92 |
$973.94 $1,069.02 $1,169.76 $1,527.62 |
$1,243.40 $1,338.48 $1,439.22 $1,797.08 |
Toc - Plan #72 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) CMS Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.99 $416.52 $469.00 $655.43 $995.99 |
$647.73 $697.26 $749.74 $936.17 |
$928.47 $978.00 $1,030.48 $1,216.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$733.98 $833.04 $938.00 $1,310.86 $1,991.98 |
$1,014.72 $1,113.78 $1,218.74 $1,591.60 |
$1,295.46 $1,394.52 $1,499.48 $1,872.34 |
Toc - Plan #73 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Everyday Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.30 $418.01 $470.68 $657.77 $999.55 |
$650.04 $699.75 $752.42 $939.51 |
$931.78 $981.49 $1,034.16 $1,221.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.60 $836.02 $941.36 $1,315.54 $1,999.10 |
$1,018.34 $1,117.76 $1,223.10 $1,597.28 |
$1,300.08 $1,399.50 $1,504.84 $1,879.02 |
Toc - Plan #74 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Complete Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.69 $421.85 $475.00 $663.81 $1,008.73 |
$656.02 $706.18 $759.33 $948.14 |
$940.35 $990.51 $1,043.66 $1,232.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.38 $843.70 $950.00 $1,327.62 $2,017.46 |
$1,027.71 $1,128.03 $1,234.33 $1,611.95 |
$1,312.04 $1,412.36 $1,518.66 $1,896.28 |
Toc - Plan #75 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Complete Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.70 $451.38 $508.25 $710.28 $1,079.34 |
$701.93 $755.61 $812.48 $1,014.51 |
$1,006.16 $1,059.84 $1,116.71 $1,318.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.40 $902.76 $1,016.50 $1,420.56 $2,158.68 |
$1,099.63 $1,206.99 $1,320.73 $1,724.79 |
$1,403.86 $1,511.22 $1,624.96 $2,029.02 |
Toc - Plan #76 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Bronze
(HMO) Clear Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.84 $339.17 $381.90 $533.70 $811.02 |
$527.44 $567.77 $610.50 $762.30 |
$756.04 $796.37 $839.10 $990.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.68 $678.34 $763.80 $1,067.40 $1,622.04 |
$826.28 $906.94 $992.40 $1,296.00 |
$1,054.88 $1,135.54 $1,221.00 $1,524.60 |
Toc - Plan #77 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Choice Bronze HSA + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.16 $371.31 $418.10 $584.29 $887.88 |
$577.43 $621.58 $668.37 $834.56 |
$827.70 $871.85 $918.64 $1,084.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.32 $742.62 $836.20 $1,168.58 $1,775.76 |
$904.59 $992.89 $1,086.47 $1,418.85 |
$1,154.86 $1,243.16 $1,336.74 $1,669.12 |
Toc - Plan #78 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Everyday Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.50 $361.48 $407.03 $568.82 $864.38 |
$562.14 $605.12 $650.67 $812.46 |
$805.78 $848.76 $894.31 $1,056.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.00 $722.96 $814.06 $1,137.64 $1,728.76 |
$880.64 $966.60 $1,057.70 $1,381.28 |
$1,124.28 $1,210.24 $1,301.34 $1,624.92 |
Toc - Plan #79 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Elite Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.56 $404.68 $455.67 $636.79 $967.67 |
$629.32 $677.44 $728.43 $909.55 |
$902.08 $950.20 $1,001.19 $1,182.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.12 $809.36 $911.34 $1,273.58 $1,935.34 |
$985.88 $1,082.12 $1,184.10 $1,546.34 |
$1,258.64 $1,354.88 $1,456.86 $1,819.10 |
Toc - Plan #80 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Clear Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.44 $413.63 $465.74 $650.87 $989.06 |
$643.23 $692.42 $744.53 $929.66 |
$922.02 $971.21 $1,023.32 $1,208.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.88 $827.26 $931.48 $1,301.74 $1,978.12 |
$1,007.67 $1,106.05 $1,210.27 $1,580.53 |
$1,286.46 $1,384.84 $1,489.06 $1,859.32 |
Toc - Plan #81 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Focused Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$367.08 $416.62 $469.11 $655.58 $996.22 |
$647.89 $697.43 $749.92 $936.39 |
$928.70 $978.24 $1,030.73 $1,217.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$734.16 $833.24 $938.22 $1,311.16 $1,992.44 |
$1,014.97 $1,114.05 $1,219.03 $1,591.97 |
$1,295.78 $1,394.86 $1,499.84 $1,872.78 |
Toc - Plan #82 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Everyday Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381.79 $433.33 $487.92 $681.87 $1,036.16 |
$673.86 $725.40 $779.99 $973.94 |
$965.93 $1,017.47 $1,072.06 $1,266.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$763.58 $866.66 $975.84 $1,363.74 $2,072.32 |
$1,055.65 $1,158.73 $1,267.91 $1,655.81 |
$1,347.72 $1,450.80 $1,559.98 $1,947.88 |
Toc - Plan #83 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Enhanced Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.22 $415.65 $468.02 $654.05 $993.90 |
$646.37 $695.80 $748.17 $934.20 |
$926.52 $975.95 $1,028.32 $1,214.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.44 $831.30 $936.04 $1,308.10 $1,987.80 |
$1,012.59 $1,111.45 $1,216.19 $1,588.25 |
$1,292.74 $1,391.60 $1,496.34 $1,868.40 |
Toc - Plan #84 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Clear Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.85 $427.72 $481.60 $673.04 $1,022.75 |
$665.13 $716.00 $769.88 $961.32 |
$953.41 $1,004.28 $1,058.16 $1,249.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.70 $855.44 $963.20 $1,346.08 $2,045.50 |
$1,041.98 $1,143.72 $1,251.48 $1,634.36 |
$1,330.26 $1,432.00 $1,539.76 $1,922.64 |
Toc - Plan #85 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.91 $342.66 $385.83 $539.20 $819.36 |
$532.87 $573.62 $616.79 $770.16 |
$763.83 $804.58 $847.75 $1,001.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.82 $685.32 $771.66 $1,078.40 $1,638.72 |
$834.78 $916.28 $1,002.62 $1,309.36 |
$1,065.74 $1,147.24 $1,233.58 $1,540.32 |
Toc - Plan #86 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Silver
(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348.61 $395.66 $445.51 $622.60 $946.09 |
$615.29 $662.34 $712.19 $889.28 |
$881.97 $929.02 $978.87 $1,155.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697.22 $791.32 $891.02 $1,245.20 $1,892.18 |
$963.90 $1,058.00 $1,157.70 $1,511.88 |
$1,230.58 $1,324.68 $1,424.38 $1,778.56 |
Toc - Plan #87 Ambetter from Buckeye Health Plan | ||||||||||||||||||||
Gold
(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1189
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.01 $419.95 $472.86 $660.82 $1,004.19 |
$653.06 $703.00 $755.91 $943.87 |
$936.11 $986.05 $1,038.96 $1,226.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.02 $839.90 $945.72 $1,321.64 $2,008.38 |
$1,023.07 $1,122.95 $1,228.77 $1,604.69 |
$1,306.12 $1,406.00 $1,511.82 $1,887.74 |
ADVERTISEMENT
CareSourceLocal: 1-833-230-2099 | Toll Free: 1-833-230-2099 | TTY: 1-800-750-0750 |
Toc - Plan #88 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Low Premium Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.22 $423.61 $476.98 $666.57 $1,012.92 |
$658.73 $709.12 $762.49 $952.08 |
$944.24 $994.63 $1,048.00 $1,237.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.44 $847.22 $953.96 $1,333.14 $2,025.84 |
$1,031.95 $1,132.73 $1,239.47 $1,618.65 |
$1,317.46 $1,418.24 $1,524.98 $1,904.16 |
Toc - Plan #89 CareSource | ||||||||||||||||||||
Gold
(HMO) CareSource Marketplace Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$527.96 $599.23 $674.72 $942.92 $1,432.87 |
$931.84 $1,003.11 $1,078.60 $1,346.80 |
$1,335.72 $1,406.99 $1,482.48 $1,750.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,055.92 $1,198.46 $1,349.44 $1,885.84 $2,865.74 |
$1,459.80 $1,602.34 $1,753.32 $2,289.72 |
$1,863.68 $2,006.22 $2,157.20 $2,693.60 |
Toc - Plan #90 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381.19 $432.64 $487.15 $680.80 $1,034.53 |
$672.80 $724.25 $778.76 $972.41 |
$964.41 $1,015.86 $1,070.37 $1,264.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$762.38 $865.28 $974.30 $1,361.60 $2,069.06 |
$1,053.99 $1,156.89 $1,265.91 $1,653.21 |
$1,345.60 $1,448.50 $1,557.52 $1,944.82 |
Toc - Plan #91 CareSource | ||||||||||||||||||||
Expanded Bronze
(HMO) CareSource Marketplace Bronze First |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.82 $314.18 $353.77 $494.39 $751.27 |
$488.58 $525.94 $565.53 $706.15 |
$700.34 $737.70 $777.29 $917.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$553.64 $628.36 $707.54 $988.78 $1,502.54 |
$765.40 $840.12 $919.30 $1,200.54 |
$977.16 $1,051.88 $1,131.06 $1,412.30 |
Toc - Plan #92 CareSource | ||||||||||||||||||||
Bronze
(HMO) CareSource Marketplace Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270.78 $307.33 $346.05 $483.60 $734.88 |
$477.92 $514.47 $553.19 $690.74 |
$685.06 $721.61 $760.33 $897.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$541.56 $614.66 $692.10 $967.20 $1,469.76 |
$748.70 $821.80 $899.24 $1,174.34 |
$955.84 $1,028.94 $1,106.38 $1,381.48 |
Toc - Plan #93 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Essential Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.74 $484.34 $545.37 $762.15 $1,158.16 |
$753.19 $810.79 $871.82 $1,088.60 |
$1,079.64 $1,137.24 $1,198.27 $1,415.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$853.48 $968.68 $1,090.74 $1,524.30 $2,316.32 |
$1,179.93 $1,295.13 $1,417.19 $1,850.75 |
$1,506.38 $1,621.58 $1,743.64 $2,177.20 |
Toc - Plan #94 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.23 $430.42 $484.65 $677.29 $1,029.21 |
$669.34 $720.53 $774.76 $967.40 |
$959.45 $1,010.64 $1,064.87 $1,257.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$758.46 $860.84 $969.30 $1,354.58 $2,058.42 |
$1,048.57 $1,150.95 $1,259.41 $1,644.69 |
$1,338.68 $1,441.06 $1,549.52 $1,934.80 |
Toc - Plan #95 CareSource | ||||||||||||||||||||
Gold
(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$535.23 $607.48 $684.01 $955.91 $1,452.59 |
$944.68 $1,016.93 $1,093.46 $1,365.36 |
$1,354.13 $1,426.38 $1,502.91 $1,774.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,070.46 $1,214.96 $1,368.02 $1,911.82 $2,905.18 |
$1,479.91 $1,624.41 $1,777.47 $2,321.27 |
$1,889.36 $2,033.86 $2,186.92 $2,730.72 |
Toc - Plan #96 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.18 $439.45 $494.81 $691.50 $1,050.80 |
$683.37 $735.64 $791.00 $987.69 |
$979.56 $1,031.83 $1,087.19 $1,283.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.36 $878.90 $989.62 $1,383.00 $2,101.60 |
$1,070.55 $1,175.09 $1,285.81 $1,679.19 |
$1,366.74 $1,471.28 $1,582.00 $1,975.38 |
Toc - Plan #97 CareSource | ||||||||||||||||||||
Expanded Bronze
(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$282.19 $320.28 $360.64 $503.99 $765.86 |
$498.06 $536.15 $576.51 $719.86 |
$713.93 $752.02 $792.38 $935.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$564.38 $640.56 $721.28 $1,007.98 $1,531.72 |
$780.25 $856.43 $937.15 $1,223.85 |
$996.12 $1,072.30 $1,153.02 $1,439.72 |
Toc - Plan #98 CareSource | ||||||||||||||||||||
Bronze
(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$275.84 $313.08 $352.52 $492.65 $748.62 |
$486.86 $524.10 $563.54 $703.67 |
$697.88 $735.12 $774.56 $914.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$551.68 $626.16 $705.04 $985.30 $1,497.24 |
$762.70 $837.18 $916.06 $1,196.32 |
$973.72 $1,048.20 $1,127.08 $1,407.34 |
Toc - Plan #99 CareSource | ||||||||||||||||||||
Silver
(HMO) CareSource Marketplace Essential Silver Dental, Vision, & Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-230-2099
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$432.53 $490.92 $552.77 $772.50 $1,173.89 |
$763.42 $821.81 $883.66 $1,103.39 |
$1,094.31 $1,152.70 $1,214.55 $1,434.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$865.06 $981.84 $1,105.54 $1,545.00 $2,347.78 |
$1,195.95 $1,312.73 $1,436.43 $1,875.89 |
$1,526.84 $1,643.62 $1,767.32 $2,206.78 |
ADVERTISEMENT
MedMutualLocal: 1-888-308-0357 | Toll Free: 1-888-308-0357 |
Toc - Plan #100 MedMutual | ||||||||||||||||||||
Silver
(HMO) Market HMO 3500 - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417.02 $473.32 $532.95 $744.80 $1,131.79 |
$736.04 $792.34 $851.97 $1,063.82 |
$1,055.06 $1,111.36 $1,170.99 $1,382.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$834.04 $946.64 $1,065.90 $1,489.60 $2,263.58 |
$1,153.06 $1,265.66 $1,384.92 $1,808.62 |
$1,472.08 $1,584.68 $1,703.94 $2,127.64 |
Toc - Plan #101 MedMutual | ||||||||||||||||||||
Silver
(HMO) Market HMO 4000 HSA - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417.02 $473.32 $532.95 $744.80 $1,131.79 |
$736.04 $792.34 $851.97 $1,063.82 |
$1,055.06 $1,111.36 $1,170.99 $1,382.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$834.04 $946.64 $1,065.90 $1,489.60 $2,263.58 |
$1,153.06 $1,265.66 $1,384.92 $1,808.62 |
$1,472.08 $1,584.68 $1,703.94 $2,127.64 |
Toc - Plan #102 MedMutual | ||||||||||||||||||||
Expanded Bronze
(HMO) Market HMO 7000 HSA - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.38 $360.23 $405.62 $566.85 $861.38 |
$560.18 $603.03 $648.42 $809.65 |
$802.98 $845.83 $891.22 $1,052.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$634.76 $720.46 $811.24 $1,133.70 $1,722.76 |
$877.56 $963.26 $1,054.04 $1,376.50 |
$1,120.36 $1,206.06 $1,296.84 $1,619.30 |
Toc - Plan #103 MedMutual | ||||||||||||||||||||
Bronze
(HMO) Market HMO 9100 - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.23 $340.76 $383.69 $536.21 $814.82 |
$529.90 $570.43 $613.36 $765.88 |
$759.57 $800.10 $843.03 $995.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$600.46 $681.52 $767.38 $1,072.42 $1,629.64 |
$830.13 $911.19 $997.05 $1,302.09 |
$1,059.80 $1,140.86 $1,226.72 $1,531.76 |
Toc - Plan #104 MedMutual | ||||||||||||||||||||
Catastrophic
(HMO) Market HMO Young Adult Essentials - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$198.28 $225.05 $253.40 $354.13 $538.14 |
$349.97 $376.74 $405.09 $505.82 |
$501.66 $528.43 $556.78 $657.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$396.56 $450.10 $506.80 $708.26 $1,076.28 |
$548.25 $601.79 $658.49 $859.95 |
$699.94 $753.48 $810.18 $1,011.64 |
Toc - Plan #105 MedMutual | ||||||||||||||||||||
Silver
(HMO) Market HMO 6500 - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$415.70 $471.82 $531.26 $742.44 $1,128.21 |
$733.71 $789.83 $849.27 $1,060.45 |
$1,051.72 $1,107.84 $1,167.28 $1,378.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$831.40 $943.64 $1,062.52 $1,484.88 $2,256.42 |
$1,149.41 $1,261.65 $1,380.53 $1,802.89 |
$1,467.42 $1,579.66 $1,698.54 $2,120.90 |
Toc - Plan #106 MedMutual | ||||||||||||||||||||
Expanded Bronze
(HMO) Market HMO Select Bronze - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.29 $406.66 $457.90 $639.91 $972.41 |
$632.38 $680.75 $731.99 $914.00 |
$906.47 $954.84 $1,006.08 $1,188.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.58 $813.32 $915.80 $1,279.82 $1,944.82 |
$990.67 $1,087.41 $1,189.89 $1,553.91 |
$1,264.76 $1,361.50 $1,463.98 $1,828.00 |
Toc - Plan #107 MedMutual | ||||||||||||||||||||
Silver
(HMO) Market HMO Select Silver - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$448.36 $508.89 $573.01 $800.77 $1,216.85 |
$791.36 $851.89 $916.01 $1,143.77 |
$1,134.36 $1,194.89 $1,259.01 $1,486.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$896.72 $1,017.78 $1,146.02 $1,601.54 $2,433.70 |
$1,239.72 $1,360.78 $1,489.02 $1,944.54 |
$1,582.72 $1,703.78 $1,832.02 $2,287.54 |
Toc - Plan #108 MedMutual | ||||||||||||||||||||
Expanded Bronze
(HMO) Market HMO 8000 - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304.19 $345.25 $388.75 $543.28 $825.56 |
$536.89 $577.95 $621.45 $775.98 |
$769.59 $810.65 $854.15 $1,008.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$608.38 $690.50 $777.50 $1,086.56 $1,651.12 |
$841.08 $923.20 $1,010.20 $1,319.26 |
$1,073.78 $1,155.90 $1,242.90 $1,551.96 |
Toc - Plan #109 MedMutual | ||||||||||||||||||||
Gold
(HMO) Market HMO 2500 - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$555.26 $630.21 $709.62 $991.69 $1,506.96 |
$980.03 $1,054.98 $1,134.39 $1,416.46 |
$1,404.80 $1,479.75 $1,559.16 $1,841.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,110.52 $1,260.42 $1,419.24 $1,983.38 $3,013.92 |
$1,535.29 $1,685.19 $1,844.01 $2,408.15 |
$1,960.06 $2,109.96 $2,268.78 $2,832.92 |
Toc - Plan #110 MedMutual | ||||||||||||||||||||
Gold
(HMO) Market HMO Standard Gold - Northern Ohio |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$534.14 $606.25 $682.63 $953.97 $1,449.66 |
$942.76 $1,014.87 $1,091.25 $1,362.59 |
$1,351.38 $1,423.49 $1,499.87 $1,771.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,068.28 $1,212.50 $1,365.26 $1,907.94 $2,899.32 |
$1,476.90 $1,621.12 $1,773.88 $2,316.56 |
$1,885.52 $2,029.74 $2,182.50 $2,725.18 |
Toc - Plan #111 MedMutual | ||||||||||||||||||||
Silver
(HMO) Market HMO Standard Silver - Northern Ohio |
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Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$413.72 $469.57 $528.73 $738.90 $1,122.83 |
$730.22 $786.07 $845.23 $1,055.40 |
$1,046.72 $1,102.57 $1,161.73 $1,371.90 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827.44 $939.14 $1,057.46 $1,477.80 $2,245.66 |
$1,143.94 $1,255.64 $1,373.96 $1,794.30 |
$1,460.44 $1,572.14 $1,690.46 $2,110.80 |
Toc - Plan #112 MedMutual | ||||||||||||||||||||
Expanded Bronze
(HMO) Market HMO Standard Expanded Bronze - Northern Ohio |
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Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$324.97 $368.84 $415.31 $580.40 $881.97 |
$573.57 $617.44 $663.91 $829.00 |
$822.17 $866.04 $912.51 $1,077.60 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$649.94 $737.68 $830.62 $1,160.80 $1,763.94 |
$898.54 $986.28 $1,079.22 $1,409.40 |
$1,147.14 $1,234.88 $1,327.82 $1,658.00 |
Toc - Plan #113 MedMutual | ||||||||||||||||||||
Bronze
(HMO) Market HMO Standard Bronze - Northern Ohio |
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Benefits & Coverage
Provider Directory
Customer Service Phone: 1-888-308-0357
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.86 $344.88 $388.33 $542.69 $824.67 |
$536.31 $577.33 $620.78 $775.14 |
$768.76 $809.78 $853.23 $1,007.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$607.72 $689.76 $776.66 $1,085.38 $1,649.34 |
$840.17 $922.21 $1,009.11 $1,317.83 |
$1,072.62 $1,154.66 $1,241.56 $1,550.28 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Carroll County here.
Carroll County is in “Rating Area 15” of Ohio.
Currently, there are 113 plans offered in Rating Area 15.