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Anchorage, Alaska 99501

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Premera Blue Cross Blue Shield of Alaska

Local: 1-800-809-9361 | Toll Free: 1-800-809-9361 | TTY: 1-800-842-5357
Toc - Plan #1 Premera Blue Cross Blue Shield of Alaska
Gold

(PPO) Premera Blue Cross Preferred Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$679.06
$770.73
$867.84
$1,212.80
$1,842.97 		$1,198.54
$1,290.21
$1,387.32
$1,732.28 		$1,718.02
$1,809.69
$1,906.80
$2,251.76 		$2,237.50
$2,329.17
$2,426.28
$2,771.24 		$519.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,358.12
$1,541.46
$1,735.68
$2,425.60
$3,685.94 		$1,877.60
$2,060.94
$2,255.16
$2,945.08 		$2,397.08
$2,580.42
$2,774.64
$3,464.56 		$2,916.56
$3,099.90
$3,294.12
$3,984.04 		$519.48
Toc - Plan #2 Premera Blue Cross Blue Shield of Alaska
Silver

(PPO) Premera Blue Cross Preferred Silver 4500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$782.68
$888.34
$1,000.27
$1,397.87
$2,124.19 		$1,381.43
$1,487.09
$1,599.02
$1,996.62 		$1,980.18
$2,085.84
$2,197.77
$2,595.37 		$2,578.93
$2,684.59
$2,796.52
$3,194.12 		$598.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,565.36
$1,776.68
$2,000.54
$2,795.74
$4,248.38 		$2,164.11
$2,375.43
$2,599.29
$3,394.49 		$2,762.86
$2,974.18
$3,198.04
$3,993.24 		$3,361.61
$3,572.93
$3,796.79
$4,591.99 		$598.75
Toc - Plan #3 Premera Blue Cross Blue Shield of Alaska
Expanded Bronze

(PPO) Premera Blue Cross Preferred Bronze 6350

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$516.42
$586.14
$659.98
$922.33
$1,401.56 		$911.48
$981.20
$1,055.04
$1,317.39 		$1,306.54
$1,376.26
$1,450.10
$1,712.45 		$1,701.60
$1,771.32
$1,845.16
$2,107.51 		$395.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,032.84
$1,172.28
$1,319.96
$1,844.66
$2,803.12 		$1,427.90
$1,567.34
$1,715.02
$2,239.72 		$1,822.96
$1,962.40
$2,110.08
$2,634.78 		$2,218.02
$2,357.46
$2,505.14
$3,029.84 		$395.06
Toc - Plan #4 Premera Blue Cross Blue Shield of Alaska
Expanded Bronze

(PPO) Premera Blue Cross Preferred Bronze 5800 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$518.80
$588.84
$663.03
$926.58
$1,408.02 		$915.68
$985.72
$1,059.91
$1,323.46 		$1,312.56
$1,382.60
$1,456.79
$1,720.34 		$1,709.44
$1,779.48
$1,853.67
$2,117.22 		$396.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,037.60
$1,177.68
$1,326.06
$1,853.16
$2,816.04 		$1,434.48
$1,574.56
$1,722.94
$2,250.04 		$1,831.36
$1,971.44
$2,119.82
$2,646.92 		$2,228.24
$2,368.32
$2,516.70
$3,043.80 		$396.88
Toc - Plan #5 Premera Blue Cross Blue Shield of Alaska
Gold

(PPO) Premera Blue Cross Alaska One Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$678.31
$769.88
$866.88
$1,211.46
$1,840.93 		$1,197.22
$1,288.79
$1,385.79
$1,730.37 		$1,716.13
$1,807.70
$1,904.70
$2,249.28 		$2,235.04
$2,326.61
$2,423.61
$2,768.19 		$518.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,356.62
$1,539.76
$1,733.76
$2,422.92
$3,681.86 		$1,875.53
$2,058.67
$2,252.67
$2,941.83 		$2,394.44
$2,577.58
$2,771.58
$3,460.74 		$2,913.35
$3,096.49
$3,290.49
$3,979.65 		$518.91
Toc - Plan #6 Premera Blue Cross Blue Shield of Alaska
Expanded Bronze

(PPO) Premera Blue Cross Alaska One Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$515.76
$585.39
$659.14
$921.15
$1,399.77 		$910.32
$979.95
$1,053.70
$1,315.71 		$1,304.88
$1,374.51
$1,448.26
$1,710.27 		$1,699.44
$1,769.07
$1,842.82
$2,104.83 		$394.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,031.52
$1,170.78
$1,318.28
$1,842.30
$2,799.54 		$1,426.08
$1,565.34
$1,712.84
$2,236.86 		$1,820.64
$1,959.90
$2,107.40
$2,631.42 		$2,215.20
$2,354.46
$2,501.96
$3,025.98 		$394.56
Toc - Plan #7 Premera Blue Cross Blue Shield of Alaska
Gold

(PPO) Premera Blue Cross Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$674.29
$765.32
$861.74
$1,204.28
$1,830.02 		$1,190.12
$1,281.15
$1,377.57
$1,720.11 		$1,705.95
$1,796.98
$1,893.40
$2,235.94 		$2,221.78
$2,312.81
$2,409.23
$2,751.77 		$515.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,348.58
$1,530.64
$1,723.48
$2,408.56
$3,660.04 		$1,864.41
$2,046.47
$2,239.31
$2,924.39 		$2,380.24
$2,562.30
$2,755.14
$3,440.22 		$2,896.07
$3,078.13
$3,270.97
$3,956.05 		$515.83
Toc - Plan #8 Premera Blue Cross Blue Shield of Alaska
Silver

(PPO) Premera Blue Cross Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$765.95
$869.35
$978.88
$1,367.99
$2,078.79 		$1,351.90
$1,455.30
$1,564.83
$1,953.94 		$1,937.85
$2,041.25
$2,150.78
$2,539.89 		$2,523.80
$2,627.20
$2,736.73
$3,125.84 		$585.95
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,531.90
$1,738.70
$1,957.76
$2,735.98
$4,157.58 		$2,117.85
$2,324.65
$2,543.71
$3,321.93 		$2,703.80
$2,910.60
$3,129.66
$3,907.88 		$3,289.75
$3,496.55
$3,715.61
$4,493.83 		$585.95
Toc - Plan #9 Premera Blue Cross Blue Shield of Alaska
Expanded Bronze

(PPO) Premera Blue Cross Standard Bronze II

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-809-9361

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$500.42
$567.98
$639.54
$893.75
$1,358.14 		$883.24
$950.80
$1,022.36
$1,276.57 		$1,266.06
$1,333.62
$1,405.18
$1,659.39 		$1,648.88
$1,716.44
$1,788.00
$2,042.21 		$382.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,000.84
$1,135.96
$1,279.08
$1,787.50
$2,716.28 		$1,383.66
$1,518.78
$1,661.90
$2,170.32 		$1,766.48
$1,901.60
$2,044.72
$2,553.14 		$2,149.30
$2,284.42
$2,427.54
$2,935.96 		$382.82

ADVERTISEMENT

Moda Health Plan, Inc.

Local: 1-844-274-9117 | Toll Free: 1-844-274-9117 | TTY: 1-844-274-9117
Toc - Plan #10 Moda Health Plan, Inc.
Gold

(PPO) Moda Pioneer Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,000 $12,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$599.00
$680.00
$766.00
$1,071.00
$1,627.00 		$1,058.00
$1,139.00
$1,225.00
$1,530.00 		$1,517.00
$1,598.00
$1,684.00
$1,989.00 		$1,976.00
$2,057.00
$2,143.00
$2,448.00 		$459.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,198.00
$1,360.00
$1,532.00
$2,142.00
$3,254.00 		$1,657.00
$1,819.00
$1,991.00
$2,601.00 		$2,116.00
$2,278.00
$2,450.00
$3,060.00 		$2,575.00
$2,737.00
$2,909.00
$3,519.00 		$459.00
Toc - Plan #11 Moda Health Plan, Inc.
Silver

(PPO) Moda Pioneer Silver 4500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$675.00
$766.00
$863.00
$1,206.00
$1,832.00 		$1,191.00
$1,282.00
$1,379.00
$1,722.00 		$1,707.00
$1,798.00
$1,895.00
$2,238.00 		$2,223.00
$2,314.00
$2,411.00
$2,754.00 		$516.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,350.00
$1,532.00
$1,726.00
$2,412.00
$3,664.00 		$1,866.00
$2,048.00
$2,242.00
$2,928.00 		$2,382.00
$2,564.00
$2,758.00
$3,444.00 		$2,898.00
$3,080.00
$3,274.00
$3,960.00 		$516.00
Toc - Plan #12 Moda Health Plan, Inc.
Expanded Bronze

(PPO) Moda Pioneer Bronze 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$428.00
$486.00
$547.00
$765.00
$1,162.00 		$756.00
$814.00
$875.00
$1,093.00 		$1,084.00
$1,142.00
$1,203.00
$1,421.00 		$1,412.00
$1,470.00
$1,531.00
$1,749.00 		$328.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$856.00
$972.00
$1,094.00
$1,530.00
$2,324.00 		$1,184.00
$1,300.00
$1,422.00
$1,858.00 		$1,512.00
$1,628.00
$1,750.00
$2,186.00 		$1,840.00
$1,956.00
$2,078.00
$2,514.00 		$328.00
Toc - Plan #13 Moda Health Plan, Inc.
Gold

(PPO) Moda Pioneer Alaska Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$600.00
$682.00
$767.00
$1,072.00
$1,630.00 		$1,059.00
$1,141.00
$1,226.00
$1,531.00 		$1,518.00
$1,600.00
$1,685.00
$1,990.00 		$1,977.00
$2,059.00
$2,144.00
$2,449.00 		$459.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,200.00
$1,364.00
$1,534.00
$2,144.00
$3,260.00 		$1,659.00
$1,823.00
$1,993.00
$2,603.00 		$2,118.00
$2,282.00
$2,452.00
$3,062.00 		$2,577.00
$2,741.00
$2,911.00
$3,521.00 		$459.00
Toc - Plan #14 Moda Health Plan, Inc.
Silver

(PPO) Moda Pioneer Alaska Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$657.00
$746.00
$840.00
$1,173.00
$1,783.00 		$1,160.00
$1,249.00
$1,343.00
$1,676.00 		$1,663.00
$1,752.00
$1,846.00
$2,179.00 		$2,166.00
$2,255.00
$2,349.00
$2,682.00 		$503.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,314.00
$1,492.00
$1,680.00
$2,346.00
$3,566.00 		$1,817.00
$1,995.00
$2,183.00
$2,849.00 		$2,320.00
$2,498.00
$2,686.00
$3,352.00 		$2,823.00
$3,001.00
$3,189.00
$3,855.00 		$503.00
Toc - Plan #15 Moda Health Plan, Inc.
Expanded Bronze

(PPO) Moda Pioneer Alaska Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$401.00
$455.00
$512.00
$715.00
$1,087.00 		$707.00
$761.00
$818.00
$1,021.00 		$1,013.00
$1,067.00
$1,124.00
$1,327.00 		$1,319.00
$1,373.00
$1,430.00
$1,633.00 		$306.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$802.00
$910.00
$1,024.00
$1,430.00
$2,174.00 		$1,108.00
$1,216.00
$1,330.00
$1,736.00 		$1,414.00
$1,522.00
$1,636.00
$2,042.00 		$1,720.00
$1,828.00
$1,942.00
$2,348.00 		$306.00
Toc - Plan #16 Moda Health Plan, Inc.
Bronze

(PPO) Moda Pioneer Bronze 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-274-9117

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$427.00
$484.00
$545.00
$762.00
$1,158.00 		$753.00
$810.00
$871.00
$1,088.00 		$1,079.00
$1,136.00
$1,197.00
$1,414.00 		$1,405.00
$1,462.00
$1,523.00
$1,740.00 		$326.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$854.00
$968.00
$1,090.00
$1,524.00
$2,316.00 		$1,180.00
$1,294.00
$1,416.00
$1,850.00 		$1,506.00
$1,620.00
$1,742.00
$2,176.00 		$1,832.00
$1,946.00
$2,068.00
$2,502.00 		$326.00

‡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 Anchorage Borough here.

Anchorage Borough is in “Rating Area 1” of Alaska.

Currently, there are 16 plans offered in Rating Area 1.

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2024 Obamacare Plans for Anchorage Borough, AK

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