Obamacare 2020 Rates and Health Insurance Providers for Brevard County , Florida


Obamacare > Rates > Florida > Brevard County

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Brevard County, FL.

The health insurance rates listed below are for calendar year 2020.

Obamacare Providers, Plans and 2020 Rates for Brevard County, Florida

Below, you’ll find a summary of the 109 plans for Brevard County, Florida and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

For detailed information on available subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at
  • Contact the provider directly

The table below shows premiums for the following profiles at various ages:

  • Individuals
  • Couples
  • Couples with 1, 2, or 3 children
  • Individuals with 1, 2, or 3 children
  • A child alone

Each plan links to the insurance provider's website. You can find the following:

  • Summary of plan benefits and costs
  • Plan brochure
  • Provider Directory where you can find out which doctors and hospitals in the Melbourne, FL area accept this insurance coverage as within the plan's network.
Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |

2020 Obamacare Rates, Providers, and Plans for Brevard County

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Blue Cross and Blue Shield of Florida

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771
 

Silver

(EPO) BlueOptions Silver 1423

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,950 $11,900
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$588.76
$668.24
$752.44
$1,051.53
$1,597.89 		$1,177.52
$1,336.48
$1,504.88
$2,103.06
$3,195.78 		$1,627.92
$1,786.88
$1,955.28
$2,553.46 		$2,078.32
$2,237.28
$2,405.68
$3,003.86 		$2,528.72
$2,687.68
$2,856.08
$3,454.26 		$1,039.16
$1,118.64
$1,202.84
$1,501.93 		$1,489.56
$1,569.04
$1,653.24
$1,952.33 		$1,939.96
$2,019.44
$2,103.64
$2,402.73 		$450.40
 

Bronze

(EPO) BlueOptions Bronze 1419

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$369.47
$419.35
$472.18
$659.87
$1,002.74 		$738.94
$838.70
$944.36
$1,319.74
$2,005.48 		$1,021.58
$1,121.34
$1,227.00
$1,602.38 		$1,304.22
$1,403.98
$1,509.64
$1,885.02 		$1,586.86
$1,686.62
$1,792.28
$2,167.66 		$652.11
$701.99
$754.82
$942.51 		$934.75
$984.63
$1,037.46
$1,225.15 		$1,217.39
$1,267.27
$1,320.10
$1,507.79 		$282.64
 

Silver

(EPO) BlueOptions Silver 1431

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,700 $11,400
Maximum Out of Pocket Per Year $7,700 $15,400
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$601.39
$682.58
$768.58
$1,074.08
$1,632.17 		$1,202.78
$1,365.16
$1,537.16
$2,148.16
$3,264.34 		$1,662.84
$1,825.22
$1,997.22
$2,608.22 		$2,122.90
$2,285.28
$2,457.28
$3,068.28 		$2,582.96
$2,745.34
$2,917.34
$3,528.34 		$1,061.45
$1,142.64
$1,228.64
$1,534.14 		$1,521.51
$1,602.70
$1,688.70
$1,994.20 		$1,981.57
$2,062.76
$2,148.76
$2,454.26 		$460.06
 

Platinum

(EPO) BlueOptions Platinum 1418

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,000 $2,000
Maximum Out of Pocket Per Year $3,500 $7,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$724.66
$822.49
$926.12
$1,294.24
$1,966.73 		$1,449.32
$1,644.98
$1,852.24
$2,588.48
$3,933.46 		$2,003.68
$2,199.34
$2,406.60
$3,142.84 		$2,558.04
$2,753.70
$2,960.96
$3,697.20 		$3,112.40
$3,308.06
$3,515.32
$4,251.56 		$1,279.02
$1,376.85
$1,480.48
$1,848.60 		$1,833.38
$1,931.21
$2,034.84
$2,402.96 		$2,387.74
$2,485.57
$2,589.20
$2,957.32 		$554.36
 

Expanded Bronze

(EPO) BlueOptions Bronze 1416

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,700 $15,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$395.13
$448.47
$504.98
$705.70
$1,072.38 		$790.26
$896.94
$1,009.96
$1,411.40
$2,144.76 		$1,092.53
$1,199.21
$1,312.23
$1,713.67 		$1,394.80
$1,501.48
$1,614.50
$2,015.94 		$1,697.07
$1,803.75
$1,916.77
$2,318.21 		$697.40
$750.74
$807.25
$1,007.97 		$999.67
$1,053.01
$1,109.52
$1,310.24 		$1,301.94
$1,355.28
$1,411.79
$1,612.51 		$302.27
 

Platinum

(EPO) BlueOptions Platinum 1424

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$759.95
$862.54
$971.22
$1,357.27
$2,062.50 		$1,519.90
$1,725.08
$1,942.44
$2,714.54
$4,125.00 		$2,101.26
$2,306.44
$2,523.80
$3,295.90 		$2,682.62
$2,887.80
$3,105.16
$3,877.26 		$3,263.98
$3,469.16
$3,686.52
$4,458.62 		$1,341.31
$1,443.90
$1,552.58
$1,938.63 		$1,922.67
$2,025.26
$2,133.94
$2,519.99 		$2,504.03
$2,606.62
$2,715.30
$3,101.35 		$581.36
 

Silver

(EPO) BlueOptions Silver 1410

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,000 $14,000
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$545.81
$619.49
$697.55
$974.82
$1,481.33 		$1,091.62
$1,238.98
$1,395.10
$1,949.64
$2,962.66 		$1,509.16
$1,656.52
$1,812.64
$2,367.18 		$1,926.70
$2,074.06
$2,230.18
$2,784.72 		$2,344.24
$2,491.60
$2,647.72
$3,202.26 		$963.35
$1,037.03
$1,115.09
$1,392.36 		$1,380.89
$1,454.57
$1,532.63
$1,809.90 		$1,798.43
$1,872.11
$1,950.17
$2,227.44 		$417.54
 

Gold

(EPO) BlueOptions Gold 1505

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $5,000 $10,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$588.00
$667.38
$751.46
$1,050.17
$1,595.83 		$1,176.00
$1,334.76
$1,502.92
$2,100.34
$3,191.66 		$1,625.82
$1,784.58
$1,952.74
$2,550.16 		$2,075.64
$2,234.40
$2,402.56
$2,999.98 		$2,525.46
$2,684.22
$2,852.38
$3,449.80 		$1,037.82
$1,117.20
$1,201.28
$1,499.99 		$1,487.64
$1,567.02
$1,651.10
$1,949.81 		$1,937.46
$2,016.84
$2,100.92
$2,399.63 		$449.82
 

Expanded Bronze

(EPO) BlueOptions Bronze (HSA) 1705

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $6,000 $12,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$391.27
$444.09
$500.04
$698.81
$1,061.91 		$782.54
$888.18
$1,000.08
$1,397.62
$2,123.82 		$1,081.86
$1,187.50
$1,299.40
$1,696.94 		$1,381.18
$1,486.82
$1,598.72
$1,996.26 		$1,680.50
$1,786.14
$1,898.04
$2,295.58 		$690.59
$743.41
$799.36
$998.13 		$989.91
$1,042.73
$1,098.68
$1,297.45 		$1,289.23
$1,342.05
$1,398.00
$1,596.77 		$299.32
 

Silver

(EPO) BlueOptions Silver 1706S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,600 $7,200
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$594.80
$675.10
$760.15
$1,062.31
$1,614.29 		$1,189.60
$1,350.20
$1,520.30
$2,124.62
$3,228.58 		$1,644.62
$1,805.22
$1,975.32
$2,579.64 		$2,099.64
$2,260.24
$2,430.34
$3,034.66 		$2,554.66
$2,715.26
$2,885.36
$3,489.68 		$1,049.82
$1,130.12
$1,215.17
$1,517.33 		$1,504.84
$1,585.14
$1,670.19
$1,972.35 		$1,959.86
$2,040.16
$2,125.21
$2,427.37 		$455.02
 

Expanded Bronze

(EPO) BlueOptions Bronze 1707S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,650 $13,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$391.86
$444.76
$500.80
$699.86
$1,063.51 		$783.72
$889.52
$1,001.60
$1,399.72
$2,127.02 		$1,083.49
$1,189.29
$1,301.37
$1,699.49 		$1,383.26
$1,489.06
$1,601.14
$1,999.26 		$1,683.03
$1,788.83
$1,900.91
$2,299.03 		$691.63
$744.53
$800.57
$999.63 		$991.40
$1,044.30
$1,100.34
$1,299.40 		$1,291.17
$1,344.07
$1,400.11
$1,599.17 		$299.77
 

Gold

(EPO) BlueOptions Gold 1805

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$567.55
$644.17
$725.33
$1,013.64
$1,540.33 		$1,135.10
$1,288.34
$1,450.66
$2,027.28
$3,080.66 		$1,569.28
$1,722.52
$1,884.84
$2,461.46 		$2,003.46
$2,156.70
$2,319.02
$2,895.64 		$2,437.64
$2,590.88
$2,753.20
$3,329.82 		$1,001.73
$1,078.35
$1,159.51
$1,447.82 		$1,435.91
$1,512.53
$1,593.69
$1,882.00 		$1,870.09
$1,946.71
$2,027.87
$2,316.18 		$434.18
 

Silver

(EPO) BlueSelect Silver 1456

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,950 $11,900
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$367.43
$417.03
$469.58
$656.23
$997.21 		$734.86
$834.06
$939.16
$1,312.46
$1,994.42 		$1,015.94
$1,115.14
$1,220.24
$1,593.54 		$1,297.02
$1,396.22
$1,501.32
$1,874.62 		$1,578.10
$1,677.30
$1,782.40
$2,155.70 		$648.51
$698.11
$750.66
$937.31 		$929.59
$979.19
$1,031.74
$1,218.39 		$1,210.67
$1,260.27
$1,312.82
$1,499.47 		$281.08
 

Bronze

(EPO) BlueSelect Bronze 1452

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$267.74
$303.88
$342.17
$478.18
$726.65 		$535.48
$607.76
$684.34
$956.36
$1,453.30 		$740.30
$812.58
$889.16
$1,161.18 		$945.12
$1,017.40
$1,093.98
$1,366.00 		$1,149.94
$1,222.22
$1,298.80
$1,570.82 		$472.56
$508.70
$546.99
$683.00 		$677.38
$713.52
$751.81
$887.82 		$882.20
$918.34
$956.63
$1,092.64 		$204.82
 

Silver

(EPO) BlueSelect Silver 1464

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,700 $11,400
Maximum Out of Pocket Per Year $7,700 $15,400
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$381.02
$432.46
$486.94
$680.50
$1,034.09 		$762.04
$864.92
$973.88
$1,361.00
$2,068.18 		$1,053.52
$1,156.40
$1,265.36
$1,652.48 		$1,345.00
$1,447.88
$1,556.84
$1,943.96 		$1,636.48
$1,739.36
$1,848.32
$2,235.44 		$672.50
$723.94
$778.42
$971.98 		$963.98
$1,015.42
$1,069.90
$1,263.46 		$1,255.46
$1,306.90
$1,361.38
$1,554.94 		$291.48
 

Platinum

(EPO) BlueSelect Platinum 1451

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,000 $2,000
Maximum Out of Pocket Per Year $3,500 $7,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$465.94
$528.84
$595.47
$832.17
$1,264.56 		$931.88
$1,057.68
$1,190.94
$1,664.34
$2,529.12 		$1,288.32
$1,414.12
$1,547.38
$2,020.78 		$1,644.76
$1,770.56
$1,903.82
$2,377.22 		$2,001.20
$2,127.00
$2,260.26
$2,733.66 		$822.38
$885.28
$951.91
$1,188.61 		$1,178.82
$1,241.72
$1,308.35
$1,545.05 		$1,535.26
$1,598.16
$1,664.79
$1,901.49 		$356.44
 

Expanded Bronze

(EPO) BlueSelect Bronze 1449

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,700 $15,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$286.26
$324.91
$365.84
$511.26
$776.91 		$572.52
$649.82
$731.68
$1,022.52
$1,553.82 		$791.51
$868.81
$950.67
$1,241.51 		$1,010.50
$1,087.80
$1,169.66
$1,460.50 		$1,229.49
$1,306.79
$1,388.65
$1,679.49 		$505.25
$543.90
$584.83
$730.25 		$724.24
$762.89
$803.82
$949.24 		$943.23
$981.88
$1,022.81
$1,168.23 		$218.99
 

Platinum

(EPO) BlueSelect Platinum 1457

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$492.65
$559.16
$629.61
$879.87
$1,337.05 		$985.30
$1,118.32
$1,259.22
$1,759.74
$2,674.10 		$1,362.18
$1,495.20
$1,636.10
$2,136.62 		$1,739.06
$1,872.08
$2,012.98
$2,513.50 		$2,115.94
$2,248.96
$2,389.86
$2,890.38 		$869.53
$936.04
$1,006.49
$1,256.75 		$1,246.41
$1,312.92
$1,383.37
$1,633.63 		$1,623.29
$1,689.80
$1,760.25
$2,010.51 		$376.88
 

Silver

(EPO) BlueSelect Silver 1443

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,000 $14,000
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$343.22
$389.55
$438.64
$612.99
$931.50 		$686.44
$779.10
$877.28
$1,225.98
$1,863.00 		$949.00
$1,041.66
$1,139.84
$1,488.54 		$1,211.56
$1,304.22
$1,402.40
$1,751.10 		$1,474.12
$1,566.78
$1,664.96
$2,013.66 		$605.78
$652.11
$701.20
$875.55 		$868.34
$914.67
$963.76
$1,138.11 		$1,130.90
$1,177.23
$1,226.32
$1,400.67 		$262.56
 

Gold

(EPO) BlueSelect Gold 1535

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $5,000 $10,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$400.57
$454.65
$511.93
$715.42
$1,087.15 		$801.14
$909.30
$1,023.86
$1,430.84
$2,174.30 		$1,107.58
$1,215.74
$1,330.30
$1,737.28 		$1,414.02
$1,522.18
$1,636.74
$2,043.72 		$1,720.46
$1,828.62
$1,943.18
$2,350.16 		$707.01
$761.09
$818.37
$1,021.86 		$1,013.45
$1,067.53
$1,124.81
$1,328.30 		$1,319.89
$1,373.97
$1,431.25
$1,634.74 		$306.44
 

Expanded Bronze

(EPO) BlueSelect Bronze (HSA) 1735

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $6,000 $12,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$283.18
$321.41
$361.90
$505.76
$768.55 		$566.36
$642.82
$723.80
$1,011.52
$1,537.10 		$782.99
$859.45
$940.43
$1,228.15 		$999.62
$1,076.08
$1,157.06
$1,444.78 		$1,216.25
$1,292.71
$1,373.69
$1,661.41 		$499.81
$538.04
$578.53
$722.39 		$716.44
$754.67
$795.16
$939.02 		$933.07
$971.30
$1,011.79
$1,155.65 		$216.63
 

Silver

(EPO) BlueSelect Silver 1736S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,600 $7,200
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$373.83
$424.30
$477.75
$667.66
$1,014.57 		$747.66
$848.60
$955.50
$1,335.32
$2,029.14 		$1,033.64
$1,134.58
$1,241.48
$1,621.30 		$1,319.62
$1,420.56
$1,527.46
$1,907.28 		$1,605.60
$1,706.54
$1,813.44
$2,193.26 		$659.81
$710.28
$763.73
$953.64 		$945.79
$996.26
$1,049.71
$1,239.62 		$1,231.77
$1,282.24
$1,335.69
$1,525.60 		$285.98
 

Expanded Bronze

(EPO) BlueSelect Bronze 1737S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,650 $13,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$283.54
$321.82
$362.36
$506.40
$769.53 		$567.08
$643.64
$724.72
$1,012.80
$1,539.06 		$783.99
$860.55
$941.63
$1,229.71 		$1,000.90
$1,077.46
$1,158.54
$1,446.62 		$1,217.81
$1,294.37
$1,375.45
$1,663.53 		$500.45
$538.73
$579.27
$723.31 		$717.36
$755.64
$796.18
$940.22 		$934.27
$972.55
$1,013.09
$1,157.13 		$216.91
 

Gold

(EPO) BlueSelect Gold 1835

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$381.80
$433.34
$487.94
$681.89
$1,036.21 		$763.60
$866.68
$975.88
$1,363.78
$2,072.42 		$1,055.68
$1,158.76
$1,267.96
$1,655.86 		$1,347.76
$1,450.84
$1,560.04
$1,947.94 		$1,639.84
$1,742.92
$1,852.12
$2,240.02 		$673.88
$725.42
$780.02
$973.97 		$965.96
$1,017.50
$1,072.10
$1,266.05 		$1,258.04
$1,309.58
$1,364.18
$1,558.13 		$292.08
ADVERTISEMENT

Celtic Insurance Company

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770
 

Gold

(EPO) Ambetter Secure Care 5 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,250 $2,500
Maximum Out of Pocket Per Year $5,900 $11,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$362.00
$410.86
$462.62
$646.51
$982.44 		$724.00
$821.72
$925.24
$1,293.02
$1,964.88 		$1,000.92
$1,098.64
$1,202.16
$1,569.94 		$1,277.84
$1,375.56
$1,479.08
$1,846.86 		$1,554.76
$1,652.48
$1,756.00
$2,123.78 		$638.92
$687.78
$739.54
$923.43 		$915.84
$964.70
$1,016.46
$1,200.35 		$1,192.76
$1,241.62
$1,293.38
$1,477.27 		$276.92
 

Bronze

(EPO) Ambetter Essential Care 1 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$248.55
$282.09
$317.63
$443.89
$674.54 		$497.10
$564.18
$635.26
$887.78
$1,349.08 		$687.23
$754.31
$825.39
$1,077.91 		$877.36
$944.44
$1,015.52
$1,268.04 		$1,067.49
$1,134.57
$1,205.65
$1,458.17 		$438.68
$472.22
$507.76
$634.02 		$628.81
$662.35
$697.89
$824.15 		$818.94
$852.48
$888.02
$1,014.28 		$190.13
 

Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,750 $13,500
Maximum Out of Pocket Per Year $6,750 $13,500
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$254.27
$288.59
$324.95
$454.11
$690.07 		$508.54
$577.18
$649.90
$908.22
$1,380.14 		$703.05
$771.69
$844.41
$1,102.73 		$897.56
$966.20
$1,038.92
$1,297.24 		$1,092.07
$1,160.71
$1,233.43
$1,491.75 		$448.78
$483.10
$519.46
$648.62 		$643.29
$677.61
$713.97
$843.13 		$837.80
$872.12
$908.48
$1,037.64 		$194.51
 

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$254.73
$289.11
$325.54
$454.94
$691.32 		$509.46
$578.22
$651.08
$909.88
$1,382.64 		$704.32
$773.08
$845.94
$1,104.74 		$899.18
$967.94
$1,040.80
$1,299.60 		$1,094.04
$1,162.80
$1,235.66
$1,494.46 		$449.59
$483.97
$520.40
$649.80 		$644.45
$678.83
$715.26
$844.66 		$839.31
$873.69
$910.12
$1,039.52 		$194.86
 

Silver

(EPO) Ambetter Balanced Care 1 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,650 $11,300
Maximum Out of Pocket Per Year $6,950 $13,900
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$366.90
$416.42
$468.89
$655.27
$995.75 		$733.80
$832.84
$937.78
$1,310.54
$1,991.50 		$1,014.47
$1,113.51
$1,218.45
$1,591.21 		$1,295.14
$1,394.18
$1,499.12
$1,871.88 		$1,575.81
$1,674.85
$1,779.79
$2,152.55 		$647.57
$697.09
$749.56
$935.94 		$928.24
$977.76
$1,030.23
$1,216.61 		$1,208.91
$1,258.43
$1,310.90
$1,497.28 		$280.67
 

Silver

(EPO) Ambetter Balanced Care 4 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,050 $14,100
Maximum Out of Pocket Per Year $7,050 $14,100
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$355.42
$403.39
$454.22
$634.77
$964.59 		$710.84
$806.78
$908.44
$1,269.54
$1,929.18 		$982.73
$1,078.67
$1,180.33
$1,541.43 		$1,254.62
$1,350.56
$1,452.22
$1,813.32 		$1,526.51
$1,622.45
$1,724.11
$2,085.21 		$627.31
$675.28
$726.11
$906.66 		$899.20
$947.17
$998.00
$1,178.55 		$1,171.09
$1,219.06
$1,269.89
$1,450.44 		$271.89
 

Silver

(EPO) Ambetter Balanced Care 5 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,350 $14,700
Maximum Out of Pocket Per Year $7,350 $14,700
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$342.02
$388.19
$437.09
$610.84
$928.23 		$684.04
$776.38
$874.18
$1,221.68
$1,856.46 		$945.68
$1,038.02
$1,135.82
$1,483.32 		$1,207.32
$1,299.66
$1,397.46
$1,744.96 		$1,468.96
$1,561.30
$1,659.10
$2,006.60 		$603.66
$649.83
$698.73
$872.48 		$865.30
$911.47
$960.37
$1,134.12 		$1,126.94
$1,173.11
$1,222.01
$1,395.76 		$261.64
 

Silver

(EPO) Ambetter Balanced Care 11 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,100 $16,200
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$338.83
$384.56
$433.01
$605.12
$919.55 		$677.66
$769.12
$866.02
$1,210.24
$1,839.10 		$936.85
$1,028.31
$1,125.21
$1,469.43 		$1,196.04
$1,287.50
$1,384.40
$1,728.62 		$1,455.23
$1,546.69
$1,643.59
$1,987.81 		$598.02
$643.75
$692.20
$864.31 		$857.21
$902.94
$951.39
$1,123.50 		$1,116.40
$1,162.13
$1,210.58
$1,382.69 		$259.19
 

Silver

(EPO) Ambetter Balanced Care 12 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$334.13
$379.23
$427.01
$596.75
$906.81 		$668.26
$758.46
$854.02
$1,193.50
$1,813.62 		$923.86
$1,014.06
$1,109.62
$1,449.10 		$1,179.46
$1,269.66
$1,365.22
$1,704.70 		$1,435.06
$1,525.26
$1,620.82
$1,960.30 		$589.73
$634.83
$682.61
$852.35 		$845.33
$890.43
$938.21
$1,107.95 		$1,100.93
$1,146.03
$1,193.81
$1,363.55 		$255.60
 

Silver

(EPO) Ambetter Balanced Care 15 (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,950 $5,900
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$378.42
$429.49
$483.61
$675.84
$1,027.00 		$756.84
$858.98
$967.22
$1,351.68
$2,054.00 		$1,046.32
$1,148.46
$1,256.70
$1,641.16 		$1,335.80
$1,437.94
$1,546.18
$1,930.64 		$1,625.28
$1,727.42
$1,835.66
$2,220.12 		$667.90
$718.97
$773.09
$965.32 		$957.38
$1,008.45
$1,062.57
$1,254.80 		$1,246.86
$1,297.93
$1,352.05
$1,544.28 		$289.48
 

Gold

(EPO) Ambetter Secure Care 5 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,250 $2,500
Maximum Out of Pocket Per Year $5,900 $11,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$376.25
$427.04
$480.84
$671.97
$1,021.12 		$752.50
$854.08
$961.68
$1,343.94
$2,042.24 		$1,040.33
$1,141.91
$1,249.51
$1,631.77 		$1,328.16
$1,429.74
$1,537.34
$1,919.60 		$1,615.99
$1,717.57
$1,825.17
$2,207.43 		$664.08
$714.87
$768.67
$959.80 		$951.91
$1,002.70
$1,056.50
$1,247.63 		$1,239.74
$1,290.53
$1,344.33
$1,535.46 		$287.83
 

Bronze

(EPO) Ambetter Essential Care 1 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$258.34
$293.20
$330.14
$461.37
$701.10 		$516.68
$586.40
$660.28
$922.74
$1,402.20 		$714.30
$784.02
$857.90
$1,120.36 		$911.92
$981.64
$1,055.52
$1,317.98 		$1,109.54
$1,179.26
$1,253.14
$1,515.60 		$455.96
$490.82
$527.76
$658.99 		$653.58
$688.44
$725.38
$856.61 		$851.20
$886.06
$923.00
$1,054.23 		$197.62
 

Expanded Bronze

(EPO) Ambetter Essential Care 10 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$264.76
$300.50
$338.36
$472.85
$718.55 		$529.52
$601.00
$676.72
$945.70
$1,437.10 		$732.06
$803.54
$879.26
$1,148.24 		$934.60
$1,006.08
$1,081.80
$1,350.78 		$1,137.14
$1,208.62
$1,284.34
$1,553.32 		$467.30
$503.04
$540.90
$675.39 		$669.84
$705.58
$743.44
$877.93 		$872.38
$908.12
$945.98
$1,080.47 		$202.54
 

Silver

(EPO) Ambetter Balanced Care 1 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,650 $11,300
Maximum Out of Pocket Per Year $6,950 $13,900
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$381.35
$432.82
$487.35
$681.07
$1,034.96 		$762.70
$865.64
$974.70
$1,362.14
$2,069.92 		$1,054.43
$1,157.37
$1,266.43
$1,653.87 		$1,346.16
$1,449.10
$1,558.16
$1,945.60 		$1,637.89
$1,740.83
$1,849.89
$2,237.33 		$673.08
$724.55
$779.08
$972.80 		$964.81
$1,016.28
$1,070.81
$1,264.53 		$1,256.54
$1,308.01
$1,362.54
$1,556.26 		$291.73
 

Silver

(EPO) Ambetter Balanced Care 4 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,050 $14,100
Maximum Out of Pocket Per Year $7,050 $14,100
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$369.42
$419.28
$472.10
$659.76
$1,002.57 		$738.84
$838.56
$944.20
$1,319.52
$2,005.14 		$1,021.44
$1,121.16
$1,226.80
$1,602.12 		$1,304.04
$1,403.76
$1,509.40
$1,884.72 		$1,586.64
$1,686.36
$1,792.00
$2,167.32 		$652.02
$701.88
$754.70
$942.36 		$934.62
$984.48
$1,037.30
$1,224.96 		$1,217.22
$1,267.08
$1,319.90
$1,507.56 		$282.60
 

Silver

(EPO) Ambetter Balanced Care 5 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,350 $14,700
Maximum Out of Pocket Per Year $7,350 $14,700
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$355.49
$403.47
$454.31
$634.89
$964.78 		$710.98
$806.94
$908.62
$1,269.78
$1,929.56 		$982.92
$1,078.88
$1,180.56
$1,541.72 		$1,254.86
$1,350.82
$1,452.50
$1,813.66 		$1,526.80
$1,622.76
$1,724.44
$2,085.60 		$627.43
$675.41
$726.25
$906.83 		$899.37
$947.35
$998.19
$1,178.77 		$1,171.31
$1,219.29
$1,270.13
$1,450.71 		$271.94
 

Silver

(EPO) Ambetter Balanced Care 11 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,100 $16,200
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352.17
$399.70
$450.06
$628.95
$955.75 		$704.34
$799.40
$900.12
$1,257.90
$1,911.50 		$973.74
$1,068.80
$1,169.52
$1,527.30 		$1,243.14
$1,338.20
$1,438.92
$1,796.70 		$1,512.54
$1,607.60
$1,708.32
$2,066.10 		$621.57
$669.10
$719.46
$898.35 		$890.97
$938.50
$988.86
$1,167.75 		$1,160.37
$1,207.90
$1,258.26
$1,437.15 		$269.40
 

Silver

(EPO) Ambetter Balanced Care 15 + Vision + Adult Dental (2020)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,950 $5,900
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393.32
$446.41
$502.65
$702.45
$1,067.44 		$786.64
$892.82
$1,005.30
$1,404.90
$2,134.88 		$1,087.52
$1,193.70
$1,306.18
$1,705.78 		$1,388.40
$1,494.58
$1,607.06
$2,006.66 		$1,689.28
$1,795.46
$1,907.94
$2,307.54 		$694.20
$747.29
$803.53
$1,003.33 		$995.08
$1,048.17
$1,104.41
$1,304.21 		$1,295.96
$1,349.05
$1,405.29
$1,605.09 		$300.88
ADVERTISEMENT

Health Options, Inc.

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771
 

Silver

(HMO) BlueCare Silver 1490

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,950 $11,900
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$553.86
$628.63
$707.83
$989.19
$1,503.18 		$1,107.72
$1,257.26
$1,415.66
$1,978.38
$3,006.36 		$1,531.42
$1,680.96
$1,839.36
$2,402.08 		$1,955.12
$2,104.66
$2,263.06
$2,825.78 		$2,378.82
$2,528.36
$2,686.76
$3,249.48 		$977.56
$1,052.33
$1,131.53
$1,412.89 		$1,401.26
$1,476.03
$1,555.23
$1,836.59 		$1,824.96
$1,899.73
$1,978.93
$2,260.29 		$423.70
 

Bronze

(HMO) BlueCare Bronze 1486

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361.69
$410.52
$462.24
$645.98
$981.63 		$723.38
$821.04
$924.48
$1,291.96
$1,963.26 		$1,000.07
$1,097.73
$1,201.17
$1,568.65 		$1,276.76
$1,374.42
$1,477.86
$1,845.34 		$1,553.45
$1,651.11
$1,754.55
$2,122.03 		$638.38
$687.21
$738.93
$922.67 		$915.07
$963.90
$1,015.62
$1,199.36 		$1,191.76
$1,240.59
$1,292.31
$1,476.05 		$276.69
 

Silver

(HMO) BlueCare Silver 1498

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,700 $11,400
Maximum Out of Pocket Per Year $7,700 $15,400
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$550.12
$624.39
$703.05
$982.51
$1,493.03 		$1,100.24
$1,248.78
$1,406.10
$1,965.02
$2,986.06 		$1,521.08
$1,669.62
$1,826.94
$2,385.86 		$1,941.92
$2,090.46
$2,247.78
$2,806.70 		$2,362.76
$2,511.30
$2,668.62
$3,227.54 		$970.96
$1,045.23
$1,123.89
$1,403.35 		$1,391.80
$1,466.07
$1,544.73
$1,824.19 		$1,812.64
$1,886.91
$1,965.57
$2,245.03 		$420.84
 

Platinum

(HMO) BlueCare Platinum 1485

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,000 $2,000
Maximum Out of Pocket Per Year $3,500 $7,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$623.05
$707.16
$796.26
$1,112.77
$1,690.96 		$1,246.10
$1,414.32
$1,592.52
$2,225.54
$3,381.92 		$1,722.73
$1,890.95
$2,069.15
$2,702.17 		$2,199.36
$2,367.58
$2,545.78
$3,178.80 		$2,675.99
$2,844.21
$3,022.41
$3,655.43 		$1,099.68
$1,183.79
$1,272.89
$1,589.40 		$1,576.31
$1,660.42
$1,749.52
$2,066.03 		$2,052.94
$2,137.05
$2,226.15
$2,542.66 		$476.63
 

Expanded Bronze

(HMO) BlueCare Bronze 1483

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,700 $15,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$396.44
$449.96
$506.65
$708.04
$1,075.94 		$792.88
$899.92
$1,013.30
$1,416.08
$2,151.88 		$1,096.16
$1,203.20
$1,316.58
$1,719.36 		$1,399.44
$1,506.48
$1,619.86
$2,022.64 		$1,702.72
$1,809.76
$1,923.14
$2,325.92 		$699.72
$753.24
$809.93
$1,011.32 		$1,003.00
$1,056.52
$1,113.21
$1,314.60 		$1,306.28
$1,359.80
$1,416.49
$1,617.88 		$303.28
 

Platinum

(HMO) BlueCare Platinum 1491

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$663.24
$752.78
$847.62
$1,184.55
$1,800.03 		$1,326.48
$1,505.56
$1,695.24
$2,369.10
$3,600.06 		$1,833.86
$2,012.94
$2,202.62
$2,876.48 		$2,341.24
$2,520.32
$2,710.00
$3,383.86 		$2,848.62
$3,027.70
$3,217.38
$3,891.24 		$1,170.62
$1,260.16
$1,355.00
$1,691.93 		$1,678.00
$1,767.54
$1,862.38
$2,199.31 		$2,185.38
$2,274.92
$2,369.76
$2,706.69 		$507.38
 

Silver

(HMO) BlueCare Silver 1477

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,000 $14,000
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$484.62
$550.04
$619.34
$865.53
$1,315.26 		$969.24
$1,100.08
$1,238.68
$1,731.06
$2,630.52 		$1,339.97
$1,470.81
$1,609.41
$2,101.79 		$1,710.70
$1,841.54
$1,980.14
$2,472.52 		$2,081.43
$2,212.27
$2,350.87
$2,843.25 		$855.35
$920.77
$990.07
$1,236.26 		$1,226.08
$1,291.50
$1,360.80
$1,606.99 		$1,596.81
$1,662.23
$1,731.53
$1,977.72 		$370.73
 

Gold

(HMO) BlueCare Gold 1565

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $5,000 $10,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$568.58
$645.34
$726.65
$1,015.48
$1,543.13 		$1,137.16
$1,290.68
$1,453.30
$2,030.96
$3,086.26 		$1,572.12
$1,725.64
$1,888.26
$2,465.92 		$2,007.08
$2,160.60
$2,323.22
$2,900.88 		$2,442.04
$2,595.56
$2,758.18
$3,335.84 		$1,003.54
$1,080.30
$1,161.61
$1,450.44 		$1,438.50
$1,515.26
$1,596.57
$1,885.40 		$1,873.46
$1,950.22
$2,031.53
$2,320.36 		$434.96
 

Expanded Bronze

(HMO) BlueCare Bronze (HSA) 1765

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $6,000 $12,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$388.16
$440.56
$496.07
$693.25
$1,053.47 		$776.32
$881.12
$992.14
$1,386.50
$2,106.94 		$1,073.26
$1,178.06
$1,289.08
$1,683.44 		$1,370.20
$1,475.00
$1,586.02
$1,980.38 		$1,667.14
$1,771.94
$1,882.96
$2,277.32 		$685.10
$737.50
$793.01
$990.19 		$982.04
$1,034.44
$1,089.95
$1,287.13 		$1,278.98
$1,331.38
$1,386.89
$1,584.07 		$296.94
 

Silver

(HMO) BlueCare Silver 1766S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,600 $7,200
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$545.90
$619.60
$697.66
$974.98
$1,481.57 		$1,091.80
$1,239.20
$1,395.32
$1,949.96
$2,963.14 		$1,509.41
$1,656.81
$1,812.93
$2,367.57 		$1,927.02
$2,074.42
$2,230.54
$2,785.18 		$2,344.63
$2,492.03
$2,648.15
$3,202.79 		$963.51
$1,037.21
$1,115.27
$1,392.59 		$1,381.12
$1,454.82
$1,532.88
$1,810.20 		$1,798.73
$1,872.43
$1,950.49
$2,227.81 		$417.61
 

Expanded Bronze

(HMO) BlueCare Bronze 1767S

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,650 $13,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$391.42
$444.26
$500.23
$699.08
$1,062.31 		$782.84
$888.52
$1,000.46
$1,398.16
$2,124.62 		$1,082.28
$1,187.96
$1,299.90
$1,697.60 		$1,381.72
$1,487.40
$1,599.34
$1,997.04 		$1,681.16
$1,786.84
$1,898.78
$2,296.48 		$690.86
$743.70
$799.67
$998.52 		$990.30
$1,043.14
$1,099.11
$1,297.96 		$1,289.74
$1,342.58
$1,398.55
$1,597.40 		$299.44
 

Gold

(HMO) BlueCare Gold 1865

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$544.05
$617.50
$695.30
$971.67
$1,476.55 		$1,088.10
$1,235.00
$1,390.60
$1,943.34
$2,953.10 		$1,504.30
$1,651.20
$1,806.80
$2,359.54 		$1,920.50
$2,067.40
$2,223.00
$2,775.74 		$2,336.70
$2,483.60
$2,639.20
$3,191.94 		$960.25
$1,033.70
$1,111.50
$1,387.87 		$1,376.45
$1,449.90
$1,527.70
$1,804.07 		$1,792.65
$1,866.10
$1,943.90
$2,220.27 		$416.20
ADVERTISEMENT

Health First Commercial Plans, Inc.

Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771
 

Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 70 1656

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,100 $16,200
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$292.56
$332.06
$373.89
$522.51
$794.01 		$585.12
$664.12
$747.78
$1,045.02
$1,588.02 		$808.93
$887.93
$971.59
$1,268.83 		$1,032.74
$1,111.74
$1,195.40
$1,492.64 		$1,256.55
$1,335.55
$1,419.21
$1,716.45 		$516.37
$555.87
$597.70
$746.32 		$740.18
$779.68
$821.51
$970.13 		$963.99
$1,003.49
$1,045.32
$1,193.94 		$223.81
 

Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 100 HSA 1658

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$284.16
$322.52
$363.15
$507.51
$771.21 		$568.32
$645.04
$726.30
$1,015.02
$1,542.42 		$785.70
$862.42
$943.68
$1,232.40 		$1,003.08
$1,079.80
$1,161.06
$1,449.78 		$1,220.46
$1,297.18
$1,378.44
$1,667.16 		$501.54
$539.90
$580.53
$724.89 		$718.92
$757.28
$797.91
$942.27 		$936.30
$974.66
$1,015.29
$1,159.65 		$217.38
 

Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 70 HSA 1662

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,500 $11,000
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$282.52
$320.66
$361.06
$504.59
$766.77 		$565.04
$641.32
$722.12
$1,009.18
$1,533.54 		$781.17
$857.45
$938.25
$1,225.31 		$997.30
$1,073.58
$1,154.38
$1,441.44 		$1,213.43
$1,289.71
$1,370.51
$1,657.57 		$498.65
$536.79
$577.19
$720.72 		$714.78
$752.92
$793.32
$936.85 		$930.91
$969.05
$1,009.45
$1,152.98 		$216.13
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 100 1664

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,750 $11,500
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$404.26
$458.84
$516.65
$722.01
$1,097.17 		$808.52
$917.68
$1,033.30
$1,444.02
$2,194.34 		$1,117.78
$1,226.94
$1,342.56
$1,753.28 		$1,427.04
$1,536.20
$1,651.82
$2,062.54 		$1,736.30
$1,845.46
$1,961.08
$2,371.80 		$713.52
$768.10
$825.91
$1,031.27 		$1,022.78
$1,077.36
$1,135.17
$1,340.53 		$1,332.04
$1,386.62
$1,444.43
$1,649.79 		$309.26
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 100 1672

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,650 $9,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.37
$474.85
$534.68
$747.21
$1,135.46 		$836.74
$949.70
$1,069.36
$1,494.42
$2,270.92 		$1,156.79
$1,269.75
$1,389.41
$1,814.47 		$1,476.84
$1,589.80
$1,709.46
$2,134.52 		$1,796.89
$1,909.85
$2,029.51
$2,454.57 		$738.42
$794.90
$854.73
$1,067.26 		$1,058.47
$1,114.95
$1,174.78
$1,387.31 		$1,378.52
$1,435.00
$1,494.83
$1,707.36 		$320.05
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 80 1688

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,950 $9,900
Maximum Out of Pocket Per Year $7,900 $15,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$399.08
$452.95
$510.02
$712.76
$1,083.10 		$798.16
$905.90
$1,020.04
$1,425.52
$2,166.20 		$1,103.46
$1,211.20
$1,325.34
$1,730.82 		$1,408.76
$1,516.50
$1,630.64
$2,036.12 		$1,714.06
$1,821.80
$1,935.94
$2,341.42 		$704.38
$758.25
$815.32
$1,018.06 		$1,009.68
$1,063.55
$1,120.62
$1,323.36 		$1,314.98
$1,368.85
$1,425.92
$1,628.66 		$305.30
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 70 1704

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,850 $7,700
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$409.25
$464.49
$523.02
$730.91
$1,110.69 		$818.50
$928.98
$1,046.04
$1,461.82
$2,221.38 		$1,131.57
$1,242.05
$1,359.11
$1,774.89 		$1,444.64
$1,555.12
$1,672.18
$2,087.96 		$1,757.71
$1,868.19
$1,985.25
$2,401.03 		$722.32
$777.56
$836.09
$1,043.98 		$1,035.39
$1,090.63
$1,149.16
$1,357.05 		$1,348.46
$1,403.70
$1,462.23
$1,670.12 		$313.07
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 70 1720

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
Maximum Out of Pocket Per Year $7,750 $15,500
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$419.84
$476.52
$536.56
$749.83
$1,139.45 		$839.68
$953.04
$1,073.12
$1,499.66
$2,278.90 		$1,160.86
$1,274.22
$1,394.30
$1,820.84 		$1,482.04
$1,595.40
$1,715.48
$2,142.02 		$1,803.22
$1,916.58
$2,036.66
$2,463.20 		$741.02
$797.70
$857.74
$1,071.01 		$1,062.20
$1,118.88
$1,178.92
$1,392.19 		$1,383.38
$1,440.06
$1,500.10
$1,713.37 		$321.18
 

Silver

(HMO) Health First GYM ACCESS Silver HMO 80 HSA 1728

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,500 $5,000
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$424.11
$481.36
$542.01
$757.46
$1,151.03 		$848.22
$962.72
$1,084.02
$1,514.92
$2,302.06 		$1,172.66
$1,287.16
$1,408.46
$1,839.36 		$1,497.10
$1,611.60
$1,732.90
$2,163.80 		$1,821.54
$1,936.04
$2,057.34
$2,488.24 		$748.55
$805.80
$866.45
$1,081.90 		$1,072.99
$1,130.24
$1,190.89
$1,406.34 		$1,397.43
$1,454.68
$1,515.33
$1,730.78 		$324.44
 

Gold

(HMO) Health First GYM ACCESS Gold HMO 100 1736

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,500 $5,000
Maximum Out of Pocket Per Year $5,200 $10,400
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$365.30
$414.62
$466.86
$652.43
$991.43 		$730.60
$829.24
$933.72
$1,304.86
$1,982.86 		$1,010.06
$1,108.70
$1,213.18
$1,584.32 		$1,289.52
$1,388.16
$1,492.64
$1,863.78 		$1,568.98
$1,667.62
$1,772.10
$2,143.24 		$644.76
$694.08
$746.32
$931.89 		$924.22
$973.54
$1,025.78
$1,211.35 		$1,203.68
$1,253.00
$1,305.24
$1,490.81 		$279.46
 

Gold

(HMO) Health First GYM ACCESS Gold HMO 80 1740

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,900 $5,800
Maximum Out of Pocket Per Year $7,900 $15,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352.06
$399.59
$449.94
$628.79
$955.50 		$704.12
$799.18
$899.88
$1,257.58
$1,911.00 		$973.45
$1,068.51
$1,169.21
$1,526.91 		$1,242.78
$1,337.84
$1,438.54
$1,796.24 		$1,512.11
$1,607.17
$1,707.87
$2,065.57 		$621.39
$668.92
$719.27
$898.12 		$890.72
$938.25
$988.60
$1,167.45 		$1,160.05
$1,207.58
$1,257.93
$1,436.78 		$269.33
 

Gold

(HMO) Health First GYM ACCESS Gold HMO 70 1742

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $4,100 $8,200
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372.53
$422.82
$476.09
$665.33
$1,011.04 		$745.06
$845.64
$952.18
$1,330.66
$2,022.08 		$1,030.04
$1,130.62
$1,237.16
$1,615.64 		$1,315.02
$1,415.60
$1,522.14
$1,900.62 		$1,600.00
$1,700.58
$1,807.12
$2,185.60 		$657.51
$707.80
$761.07
$950.31 		$942.49
$992.78
$1,046.05
$1,235.29 		$1,227.47
$1,277.76
$1,331.03
$1,520.27 		$284.98
 

Gold

(HMO) Health First GYM ACCESS Gold HMO 90 HSA 1744

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $3,000 $6,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$376.47
$427.30
$481.13
$672.38
$1,021.75 		$752.94
$854.60
$962.26
$1,344.76
$2,043.50 		$1,040.94
$1,142.60
$1,250.26
$1,632.76 		$1,328.94
$1,430.60
$1,538.26
$1,920.76 		$1,616.94
$1,718.60
$1,826.26
$2,208.76 		$664.47
$715.30
$769.13
$960.38 		$952.47
$1,003.30
$1,057.13
$1,248.38 		$1,240.47
$1,291.30
$1,345.13
$1,536.38 		$288.00
 

Catastrophic

(HMO) Health First GYM ACCESS Catastrophic HMO 1746

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$156.12
$177.20
$199.52
$278.83
$423.71 		$312.24
$354.40
$399.04
$557.66
$847.42 		$431.67
$473.83
$518.47
$677.09 		$551.10
$593.26
$637.90
$796.52 		$670.53
$712.69
$757.33
$915.95 		$275.55
$296.63
$318.95
$398.26 		$394.98
$416.06
$438.38
$517.69 		$514.41
$535.49
$557.81
$637.12 		$119.43
 

Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 50 1796

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $7,700 $15,400
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$279.13
$316.81
$356.72
$498.52
$757.55 		$558.26
$633.62
$713.44
$997.04
$1,515.10 		$771.79
$847.15
$926.97
$1,210.57 		$985.32
$1,060.68
$1,140.50
$1,424.10 		$1,198.85
$1,274.21
$1,354.03
$1,637.63 		$492.66
$530.34
$570.25
$712.05 		$706.19
$743.87
$783.78
$925.58 		$919.72
$957.40
$997.31
$1,139.11 		$213.53
 

Expanded Bronze

(HMO) Health First Bronze HMO 60 1750

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,500 $15,000
Maximum Out of Pocket Per Year $7,900 $15,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$280.79
$318.70
$358.85
$501.50
$762.07 		$561.58
$637.40
$717.70
$1,003.00
$1,524.14 		$776.39
$852.21
$932.51
$1,217.81 		$991.20
$1,067.02
$1,147.32
$1,432.62 		$1,206.01
$1,281.83
$1,362.13
$1,647.43 		$495.60
$533.51
$573.66
$716.31 		$710.41
$748.32
$788.47
$931.12 		$925.22
$963.13
$1,003.28
$1,145.93 		$214.81
 

Silver

(HMO) Health First Silver HMO 80 1754

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,650 $9,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$404.89
$459.55
$517.44
$723.13
$1,098.86 		$809.78
$919.10
$1,034.88
$1,446.26
$2,197.72 		$1,119.52
$1,228.84
$1,344.62
$1,756.00 		$1,429.26
$1,538.58
$1,654.36
$2,065.74 		$1,739.00
$1,848.32
$1,964.10
$2,375.48 		$714.63
$769.29
$827.18
$1,032.87 		$1,024.37
$1,079.03
$1,136.92
$1,342.61 		$1,334.11
$1,388.77
$1,446.66
$1,652.35 		$309.74
 

Gold

(HMO) Health First Gold HMO 80 1770

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,400 $2,800
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$358.82
$407.26
$458.58
$640.86
$973.85 		$717.64
$814.52
$917.16
$1,281.72
$1,947.70 		$992.14
$1,089.02
$1,191.66
$1,556.22 		$1,266.64
$1,363.52
$1,466.16
$1,830.72 		$1,541.14
$1,638.02
$1,740.66
$2,105.22 		$633.32
$681.76
$733.08
$915.36 		$907.82
$956.26
$1,007.58
$1,189.86 		$1,182.32
$1,230.76
$1,282.08
$1,464.36 		$274.50
 

Bronze

(HMO) Health First Bronze HMO 100 1774

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$269.78
$306.20
$344.77
$481.82
$732.17 		$539.56
$612.40
$689.54
$963.64
$1,464.34 		$745.94
$818.78
$895.92
$1,170.02 		$952.32
$1,025.16
$1,102.30
$1,376.40 		$1,158.70
$1,231.54
$1,308.68
$1,582.78 		$476.16
$512.58
$551.15
$688.20 		$682.54
$718.96
$757.53
$894.58 		$888.92
$925.34
$963.91
$1,100.96 		$206.38
 

Silver

(HMO) Health First Silver HMO 80 1778

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,900 $5,800
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$416.03
$472.19
$531.68
$743.02
$1,129.09 		$832.06
$944.38
$1,063.36
$1,486.04
$2,258.18 		$1,150.32
$1,262.64
$1,381.62
$1,804.30 		$1,468.58
$1,580.90
$1,699.88
$2,122.56 		$1,786.84
$1,899.16
$2,018.14
$2,440.82 		$734.29
$790.45
$849.94
$1,061.28 		$1,052.55
$1,108.71
$1,168.20
$1,379.54 		$1,370.81
$1,426.97
$1,486.46
$1,697.80 		$318.26
 

Expanded Bronze

(HMO) Health First Bronze HMO 100 HSA 1794

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$280.82
$318.73
$358.89
$501.54
$762.15 		$561.64
$637.46
$717.78
$1,003.08
$1,524.30 		$776.47
$852.29
$932.61
$1,217.91 		$991.30
$1,067.12
$1,147.44
$1,432.74 		$1,206.13
$1,281.95
$1,362.27
$1,647.57 		$495.65
$533.56
$573.72
$716.37 		$710.48
$748.39
$788.55
$931.20 		$925.31
$963.22
$1,003.38
$1,146.03 		$214.83
 

Silver

(HMO) Health First Silver HMO 65 1806

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,900 $5,800
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$394.61
$447.89
$504.32
$704.78
$1,070.98 		$789.22
$895.78
$1,008.64
$1,409.56
$2,141.96 		$1,091.10
$1,197.66
$1,310.52
$1,711.44 		$1,392.98
$1,499.54
$1,612.40
$2,013.32 		$1,694.86
$1,801.42
$1,914.28
$2,315.20 		$696.49
$749.77
$806.20
$1,006.66 		$998.37
$1,051.65
$1,108.08
$1,308.54 		$1,300.25
$1,353.53
$1,409.96
$1,610.42 		$301.88
ADVERTISEMENT

Florida Health Care Plan, Inc.

Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771
 

Catastrophic

(HMO) Gym Access IND Essential Plus Catastrophic HMO 36

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$220.30
$250.04
$281.55
$393.46
$597.90 		$440.60
$500.08
$563.10
$786.92
$1,195.80 		$609.13
$668.61
$731.63
$955.45 		$777.66
$837.14
$900.16
$1,123.98 		$946.19
$1,005.67
$1,068.69
$1,292.51 		$388.83
$418.57
$450.08
$561.99 		$557.36
$587.10
$618.61
$730.52 		$725.89
$755.63
$787.14
$899.05 		$168.53
 

Catastrophic

(POS) Gym Access IND Essential Plus Catastrophic POS 37

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$242.34
$275.05
$309.71
$432.81
$657.70 		$484.68
$550.10
$619.42
$865.62
$1,315.40 		$670.07
$735.49
$804.81
$1,051.01 		$855.46
$920.88
$990.20
$1,236.40 		$1,040.85
$1,106.27
$1,175.59
$1,421.79 		$427.73
$460.44
$495.10
$618.20 		$613.12
$645.83
$680.49
$803.59 		$798.51
$831.22
$865.88
$988.98 		$185.39
 

Silver

(HMO) Gym Access IND Essential Plus Silver HMO 53

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,900 $5,800
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364.85
$414.11
$466.28
$651.63
$990.21 		$729.70
$828.22
$932.56
$1,303.26
$1,980.42 		$1,008.81
$1,107.33
$1,211.67
$1,582.37 		$1,287.92
$1,386.44
$1,490.78
$1,861.48 		$1,567.03
$1,665.55
$1,769.89
$2,140.59 		$643.96
$693.22
$745.39
$930.74 		$923.07
$972.33
$1,024.50
$1,209.85 		$1,202.18
$1,251.44
$1,303.61
$1,488.96 		$279.11
 

Gold

(HMO) Gym Access IND Essential Plus Gold HMO 63

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,600 $3,200
Maximum Out of Pocket Per Year $5,000 $10,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372.00
$422.22
$475.42
$664.40
$1,009.62 		$744.00
$844.44
$950.84
$1,328.80
$2,019.24 		$1,028.58
$1,129.02
$1,235.42
$1,613.38 		$1,313.16
$1,413.60
$1,520.00
$1,897.96 		$1,597.74
$1,698.18
$1,804.58
$2,182.54 		$656.58
$706.80
$760.00
$948.98 		$941.16
$991.38
$1,044.58
$1,233.56 		$1,225.74
$1,275.96
$1,329.16
$1,518.14 		$284.58
 

Platinum

(HMO) Gym Access IND Essential Plus Platinum HMO 65

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$498.72
$566.05
$637.37
$890.72
$1,353.53 		$997.44
$1,132.10
$1,274.74
$1,781.44
$2,707.06 		$1,378.96
$1,513.62
$1,656.26
$2,162.96 		$1,760.48
$1,895.14
$2,037.78
$2,544.48 		$2,142.00
$2,276.66
$2,419.30
$2,926.00 		$880.24
$947.57
$1,018.89
$1,272.24 		$1,261.76
$1,329.09
$1,400.41
$1,653.76 		$1,643.28
$1,710.61
$1,781.93
$2,035.28 		$381.52
 

Silver

(POS) Gym Access IND Essential Plus Silver POS 54

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,900 $5,800
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$383.89
$435.72
$490.61
$685.63
$1,041.88 		$767.78
$871.44
$981.22
$1,371.26
$2,083.76 		$1,061.46
$1,165.12
$1,274.90
$1,664.94 		$1,355.14
$1,458.80
$1,568.58
$1,958.62 		$1,648.82
$1,752.48
$1,862.26
$2,252.30 		$677.57
$729.40
$784.29
$979.31 		$971.25
$1,023.08
$1,077.97
$1,272.99 		$1,264.93
$1,316.76
$1,371.65
$1,566.67 		$293.68
 

Platinum

(HMO) Gym Access IND Platinum HMO 4000

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $4,000 $8,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$488.08
$553.97
$623.76
$871.70
$1,324.64 		$976.16
$1,107.94
$1,247.52
$1,743.40
$2,649.28 		$1,349.54
$1,481.32
$1,620.90
$2,116.78 		$1,722.92
$1,854.70
$1,994.28
$2,490.16 		$2,096.30
$2,228.08
$2,367.66
$2,863.54 		$861.46
$927.35
$997.14
$1,245.08 		$1,234.84
$1,300.73
$1,370.52
$1,618.46 		$1,608.22
$1,674.11
$1,743.90
$1,991.84 		$373.38
 

Platinum

(POS) Gym Access IND Platinum POS 4000

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $4,000 $8,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$536.88
$609.36
$686.14
$958.88
$1,457.10 		$1,073.76
$1,218.72
$1,372.28
$1,917.76
$2,914.20 		$1,484.48
$1,629.44
$1,783.00
$2,328.48 		$1,895.20
$2,040.16
$2,193.72
$2,739.20 		$2,305.92
$2,450.88
$2,604.44
$3,149.92 		$947.60
$1,020.08
$1,096.86
$1,369.60 		$1,358.32
$1,430.80
$1,507.58
$1,780.32 		$1,769.04
$1,841.52
$1,918.30
$2,191.04 		$410.72
 

Gold

(HMO) Gym Access IND Gold HMO 5500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,500 $5,000
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$371.06
$421.15
$474.21
$662.71
$1,007.05 		$742.12
$842.30
$948.42
$1,325.42
$2,014.10 		$1,025.98
$1,126.16
$1,232.28
$1,609.28 		$1,309.84
$1,410.02
$1,516.14
$1,893.14 		$1,593.70
$1,693.88
$1,800.00
$2,177.00 		$654.92
$705.01
$758.07
$946.57 		$938.78
$988.87
$1,041.93
$1,230.43 		$1,222.64
$1,272.73
$1,325.79
$1,514.29 		$283.86
 

Gold

(POS) Gym Access IND Gold POS 5500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,500 $5,000
Maximum Out of Pocket Per Year $5,500 $11,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$408.16
$463.27
$521.63
$728.98
$1,107.76 		$816.32
$926.54
$1,043.26
$1,457.96
$2,215.52 		$1,128.57
$1,238.79
$1,355.51
$1,770.21 		$1,440.82
$1,551.04
$1,667.76
$2,082.46 		$1,753.07
$1,863.29
$1,980.01
$2,394.71 		$720.41
$775.52
$833.88
$1,041.23 		$1,032.66
$1,087.77
$1,146.13
$1,353.48 		$1,344.91
$1,400.02
$1,458.38
$1,665.73 		$312.25
 

Gold

(HMO) Gym Access IND Gold HMO 4500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,200 $4,400
Maximum Out of Pocket Per Year $4,500 $9,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372.44
$422.71
$475.97
$665.17
$1,010.79 		$744.88
$845.42
$951.94
$1,330.34
$2,021.58 		$1,029.79
$1,130.33
$1,236.85
$1,615.25 		$1,314.70
$1,415.24
$1,521.76
$1,900.16 		$1,599.61
$1,700.15
$1,806.67
$2,185.07 		$657.35
$707.62
$760.88
$950.08 		$942.26
$992.53
$1,045.79
$1,234.99 		$1,227.17
$1,277.44
$1,330.70
$1,519.90 		$284.91
 

Expanded Bronze

(HMO) Gym Access IND Bronze HMO HSA 5000/6550

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $6,550 $13,100
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$261.73
$297.06
$334.49
$467.44
$710.32 		$523.46
$594.12
$668.98
$934.88
$1,420.64 		$723.68
$794.34
$869.20
$1,135.10 		$923.90
$994.56
$1,069.42
$1,335.32 		$1,124.12
$1,194.78
$1,269.64
$1,535.54 		$461.95
$497.28
$534.71
$667.66 		$662.17
$697.50
$734.93
$867.88 		$862.39
$897.72
$935.15
$1,068.10 		$200.22
 

Expanded Bronze

(HMO) Gym Access IND Bronze HMO HSA 6000/6000

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $6,000 $12,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$266.29
$302.24
$340.32
$475.59
$722.71 		$532.58
$604.48
$680.64
$951.18
$1,445.42 		$736.29
$808.19
$884.35
$1,154.89 		$940.00
$1,011.90
$1,088.06
$1,358.60 		$1,143.71
$1,215.61
$1,291.77
$1,562.31 		$470.00
$505.95
$544.03
$679.30 		$673.71
$709.66
$747.74
$883.01 		$877.42
$913.37
$951.45
$1,086.72 		$203.71
 

Expanded Bronze

(HMO) Gym Access IND Bronze HMO BC 3841

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,400 $12,800
Maximum Out of Pocket Per Year $8,000 $16,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$279.29
$316.99
$356.93
$498.80
$757.98 		$558.58
$633.98
$713.86
$997.60
$1,515.96 		$772.23
$847.63
$927.51
$1,211.25 		$985.88
$1,061.28
$1,141.16
$1,424.90 		$1,199.53
$1,274.93
$1,354.81
$1,638.55 		$492.94
$530.64
$570.58
$712.45 		$706.59
$744.29
$784.23
$926.10 		$920.24
$957.94
$997.88
$1,139.75 		$213.65
 

Expanded Bronze

(POS) Gym Access IND Bronze POS BC 3841

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,400 $12,800
Maximum Out of Pocket Per Year $8,000 $16,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$307.21
$348.69
$392.62
$548.68
$833.77 		$614.42
$697.38
$785.24
$1,097.36
$1,667.54 		$849.44
$932.40
$1,020.26
$1,332.38 		$1,084.46
$1,167.42
$1,255.28
$1,567.40 		$1,319.48
$1,402.44
$1,490.30
$1,802.42 		$542.23
$583.71
$627.64
$783.70 		$777.25
$818.73
$862.66
$1,018.72 		$1,012.27
$1,053.75
$1,097.68
$1,253.74 		$235.02
 

Silver

(HMO) Gym Access IND Silver HMO BC 0941

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,600 $11,200
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$351.22
$398.63
$448.85
$627.27
$953.20 		$702.44
$797.26
$897.70
$1,254.54
$1,906.40 		$971.12
$1,065.94
$1,166.38
$1,523.22 		$1,239.80
$1,334.62
$1,435.06
$1,791.90 		$1,508.48
$1,603.30
$1,703.74
$2,060.58 		$619.90
$667.31
$717.53
$895.95 		$888.58
$935.99
$986.21
$1,164.63 		$1,157.26
$1,204.67
$1,254.89
$1,433.31 		$268.68
 

Silver

(POS) Gym Access IND Silver POS BC 0941

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,600 $11,200
Maximum Out of Pocket Per Year $7,150 $14,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$386.34
$438.49
$493.74
$690.00
$1,048.51 		$772.68
$876.98
$987.48
$1,380.00
$2,097.02 		$1,068.23
$1,172.53
$1,283.03
$1,675.55 		$1,363.78
$1,468.08
$1,578.58
$1,971.10 		$1,659.33
$1,763.63
$1,874.13
$2,266.65 		$681.89
$734.04
$789.29
$985.55 		$977.44
$1,029.59
$1,084.84
$1,281.10 		$1,272.99
$1,325.14
$1,380.39
$1,576.65 		$295.55
 

Silver

(HMO) IND Silver HMO BC 7741

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $7,300 $14,600
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$338.77
$384.50
$432.94
$605.04
$919.41 		$677.54
$769.00
$865.88
$1,210.08
$1,838.82 		$936.70
$1,028.16
$1,125.04
$1,469.24 		$1,195.86
$1,287.32
$1,384.20
$1,728.40 		$1,455.02
$1,546.48
$1,643.36
$1,987.56 		$597.93
$643.66
$692.10
$864.20 		$857.09
$902.82
$951.26
$1,123.36 		$1,116.25
$1,161.98
$1,210.42
$1,382.52 		$259.16
 

Silver

(POS) Gym Access IND Silver POS BC 7741

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $7,300 $14,600
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$373.39
$423.79
$477.19
$666.87
$1,013.37 		$746.78
$847.58
$954.38
$1,333.74
$2,026.74 		$1,032.42
$1,133.22
$1,240.02
$1,619.38 		$1,318.06
$1,418.86
$1,525.66
$1,905.02 		$1,603.70
$1,704.50
$1,811.30
$2,190.66 		$659.03
$709.43
$762.83
$952.51 		$944.67
$995.07
$1,048.47
$1,238.15 		$1,230.31
$1,280.71
$1,334.11
$1,523.79 		$285.64
 

Gold

(HMO) Gym Access IND Gold HMO BC 5651

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $5,800 $11,600
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$390.54
$443.26
$499.11
$697.50
$1,059.92 		$781.08
$886.52
$998.22
$1,395.00
$2,119.84 		$1,079.84
$1,185.28
$1,296.98
$1,693.76 		$1,378.60
$1,484.04
$1,595.74
$1,992.52 		$1,677.36
$1,782.80
$1,894.50
$2,291.28 		$689.30
$742.02
$797.87
$996.26 		$988.06
$1,040.78
$1,096.63
$1,295.02 		$1,286.82
$1,339.54
$1,395.39
$1,593.78 		$298.76
 

Gold

(POS) Gym Access IND Gold POS BC 5651

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $5,800 $11,600
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$429.59
$487.58
$549.01
$767.24
$1,165.90 		$859.18
$975.16
$1,098.02
$1,534.48
$2,331.80 		$1,187.81
$1,303.79
$1,426.65
$1,863.11 		$1,516.44
$1,632.42
$1,755.28
$2,191.74 		$1,845.07
$1,961.05
$2,083.91
$2,520.37 		$758.22
$816.21
$877.64
$1,095.87 		$1,086.85
$1,144.84
$1,206.27
$1,424.50 		$1,415.48
$1,473.47
$1,534.90
$1,753.13 		$328.63
 

Platinum

(HMO) Gym Access IND Platinum HMO BC 5841

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $800 $1,600
Maximum Out of Pocket Per Year $2,500 $5,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$478.73
$543.36
$611.81
$855.01
$1,299.27 		$957.46
$1,086.72
$1,223.62
$1,710.02
$2,598.54 		$1,323.69
$1,452.95
$1,589.85
$2,076.25 		$1,689.92
$1,819.18
$1,956.08
$2,442.48 		$2,056.15
$2,185.41
$2,322.31
$2,808.71 		$844.96
$909.59
$978.04
$1,221.24 		$1,211.19
$1,275.82
$1,344.27
$1,587.47 		$1,577.42
$1,642.05
$1,710.50
$1,953.70 		$366.23
 

Platinum

(POS) Gym Access IND Platinum POS BC 5841

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $800 $1,600
Maximum Out of Pocket Per Year $2,500 $5,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$526.60
$597.69
$673.00
$940.51
$1,429.20 		$1,053.20
$1,195.38
$1,346.00
$1,881.02
$2,858.40 		$1,456.05
$1,598.23
$1,748.85
$2,283.87 		$1,858.90
$2,001.08
$2,151.70
$2,686.72 		$2,261.75
$2,403.93
$2,554.55
$3,089.57 		$929.45
$1,000.54
$1,075.85
$1,343.36 		$1,332.30
$1,403.39
$1,478.70
$1,746.21 		$1,735.15
$1,806.24
$1,881.55
$2,149.06 		$402.85
 

Platinum

(HMO) Gym Access IND Platinum HMO BC 1941

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$498.55
$565.85
$637.14
$890.41
$1,353.06 		$997.10
$1,131.70
$1,274.28
$1,780.82
$2,706.12 		$1,378.49
$1,513.09
$1,655.67
$2,162.21 		$1,759.88
$1,894.48
$2,037.06
$2,543.60 		$2,141.27
$2,275.87
$2,418.45
$2,924.99 		$879.94
$947.24
$1,018.53
$1,271.80 		$1,261.33
$1,328.63
$1,399.92
$1,653.19 		$1,642.72
$1,710.02
$1,781.31
$2,034.58 		$381.39
 

Platinum

(POS) Gym Access IND Platinum POS BC 1941

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $2,000 $4,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$548.40
$622.44
$700.86
$979.45
$1,488.37 		$1,096.80
$1,244.88
$1,401.72
$1,958.90
$2,976.74 		$1,516.33
$1,664.41
$1,821.25
$2,378.43 		$1,935.86
$2,083.94
$2,240.78
$2,797.96 		$2,355.39
$2,503.47
$2,660.31
$3,217.49 		$967.93
$1,041.97
$1,120.39
$1,398.98 		$1,387.46
$1,461.50
$1,539.92
$1,818.51 		$1,806.99
$1,881.03
$1,959.45
$2,238.04 		$419.53
 

Platinum

(HMO) Gym Access IND Platinum HMO 91

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $250 $500
Maximum Out of Pocket Per Year $2,500 $5,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$496.67
$563.72
$634.75
$887.05
$1,347.97 		$993.34
$1,127.44
$1,269.50
$1,774.10
$2,695.94 		$1,373.29
$1,507.39
$1,649.45
$2,154.05 		$1,753.24
$1,887.34
$2,029.40
$2,534.00 		$2,133.19
$2,267.29
$2,409.35
$2,913.95 		$876.62
$943.67
$1,014.70
$1,267.00 		$1,256.57
$1,323.62
$1,394.65
$1,646.95 		$1,636.52
$1,703.57
$1,774.60
$2,026.90 		$379.95
 

Platinum

(HMO) Gym Acccess IND Platinum HMO 92

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $500 $1,000
Maximum Out of Pocket Per Year $3,000 $6,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$495.51
$562.41
$633.27
$884.99
$1,344.83 		$991.02
$1,124.82
$1,266.54
$1,769.98
$2,689.66 		$1,370.09
$1,503.89
$1,645.61
$2,149.05 		$1,749.16
$1,882.96
$2,024.68
$2,528.12 		$2,128.23
$2,262.03
$2,403.75
$2,907.19 		$874.58
$941.48
$1,012.34
$1,264.06 		$1,253.65
$1,320.55
$1,391.41
$1,643.13 		$1,632.72
$1,699.62
$1,770.48
$2,022.20 		$379.07
 

Expanded Bronze

(HMO) Gym Access IND Bronze Standardized HMO

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,650 $13,300
Maximum Out of Pocket Per Year $7,600 $15,200
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$265.79
$301.67
$339.68
$474.70
$721.35 		$531.58
$603.34
$679.36
$949.40
$1,442.70 		$734.91
$806.67
$882.69
$1,152.73 		$938.24
$1,010.00
$1,086.02
$1,356.06 		$1,141.57
$1,213.33
$1,289.35
$1,559.39 		$469.12
$505.00
$543.01
$678.03 		$672.45
$708.33
$746.34
$881.36 		$875.78
$911.66
$949.67
$1,084.69 		$203.33
 

Silver

(HMO) Gym Access IND Silver Standardized HMO 1

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,800 $7,600
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$367.75
$417.40
$469.99
$656.80
$998.08 		$735.50
$834.80
$939.98
$1,313.60
$1,996.16 		$1,016.83
$1,116.13
$1,221.31
$1,594.93 		$1,298.16
$1,397.46
$1,502.64
$1,876.26 		$1,579.49
$1,678.79
$1,783.97
$2,157.59 		$649.08
$698.73
$751.32
$938.13 		$930.41
$980.06
$1,032.65
$1,219.46 		$1,211.74
$1,261.39
$1,313.98
$1,500.79 		$281.33
 

Bronze

(HMO) Gym Access IND Bronze HMO 1340

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$242.11
$274.80
$309.42
$432.41
$657.09 		$484.22
$549.60
$618.84
$864.82
$1,314.18 		$669.43
$734.81
$804.05
$1,050.03 		$854.64
$920.02
$989.26
$1,235.24 		$1,039.85
$1,105.23
$1,174.47
$1,420.45 		$427.32
$460.01
$494.63
$617.62 		$612.53
$645.22
$679.84
$802.83 		$797.74
$830.43
$865.05
$988.04 		$185.21
 

Expanded Bronze

(HMO) Gym Access IND Bronze HMO 1041

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,700 $9,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$272.36
$309.13
$348.08
$486.44
$739.19 		$544.72
$618.26
$696.16
$972.88
$1,478.38 		$753.08
$826.62
$904.52
$1,181.24 		$961.44
$1,034.98
$1,112.88
$1,389.60 		$1,169.80
$1,243.34
$1,321.24
$1,597.96 		$480.72
$517.49
$556.44
$694.80 		$689.08
$725.85
$764.80
$903.16 		$897.44
$934.21
$973.16
$1,111.52 		$208.36
 

Expanded Bronze

(POS) Gym Access IND Bronze POS 1042

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$299.59
$340.04
$382.88
$535.08
$813.10 		$599.18
$680.08
$765.76
$1,070.16
$1,626.20 		$828.37
$909.27
$994.95
$1,299.35 		$1,057.56
$1,138.46
$1,224.14
$1,528.54 		$1,286.75
$1,367.65
$1,453.33
$1,757.73 		$528.78
$569.23
$612.07
$764.27 		$757.97
$798.42
$841.26
$993.46 		$987.16
$1,027.61
$1,070.45
$1,222.65 		$229.19
 

Gold

(HMO) Gym Access IND Gold HMO H.S.A 9010

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $4,000 $8,000
Monthly Premiums:
Age Individual
 Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$360.33
$408.98
$460.51
$643.55
$977.94 		$720.66
$817.96
$921.02
$1,287.10
$1,955.88 		$996.31
$1,093.61
$1,196.67
$1,562.75 		$1,271.96
$1,369.26
$1,472.32
$1,838.40 		$1,547.61
$1,644.91
$1,747.97
$2,114.05 		$635.98
$684.63
$736.16
$919.20 		$911.63
$960.28
$1,011.81
$1,194.85 		$1,187.28
$1,235.93
$1,287.46
$1,470.50 		$275.65

‡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 Brevard County here.

Brevard County is in “Rating Area 5” of Florida.

Currently, there are 109 plans offered in Rating Area 5.


Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016| 2017 | 2018 | 2019

You may also be interested in:

Ways to Save Money on Health Insurance in Florida

There are three primary ways to reduce the cost of health plans under the Affordable Care Act in Florida.

  • You may be able to lower the cost of monthly premiums when you sign up for a private health insurance plan. Your subsidies will come in the form of a federal tax credit. This article is updated to cover the tax credits available under the American Rescue Plan Act of 2021 and extended under the Inflation Reduction Act through 2025.
  • You may be able to reduce your out-of-pocket costs -- including copayments, deductibles, and coinsurance -- with cost-sharing subsidies paid for by insurers.
  • You may qualify for free or low-cost coverage through Medicaid in Florida, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).

Each of these forms of assistance depends on your income and family size.

Many people who apply for coverage at the Florida exchange will be eligible for some form of financial assistance. Read on to learn more about each option.

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