Obamacare 2022 Rates for Tattnall County

Obamacare > Rates > Georgia > Tattnall County

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 Tattnall County, GA.

The health insurance rates listed below are for calendar year 2022.

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

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

Obamacare Providers, 77 Plans and 2022 Rates for Tattnall County, Georgia

Below, you’ll find a summary of the 77 plans for Tattnall County, Georgia and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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UnitedHealthcare

Local: 1-800-609-9754 | Toll Free: 1-800-609-9754 | TTY: 1-800-609-9754
Toc - Plan #1 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ ($2 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$7,500 $15,000 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 		$404.26
$458.83
$516.64
$722.00
$1,097.15 		$713.52
$768.09
$825.90
$1,031.26 		$1,022.78
$1,077.35
$1,135.16
$1,340.52 		$1,332.04
$1,386.61
$1,444.42
$1,649.78 		$309.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$808.52
$917.66
$1,033.28
$1,444.00
$2,194.30 		$1,117.78
$1,226.92
$1,342.54
$1,753.26 		$1,427.04
$1,536.18
$1,651.80
$2,062.52 		$1,736.30
$1,845.44
$1,961.06
$2,371.78 		$309.26
Toc - Plan #2 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ Extra ($2 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$7,500 $15,000 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 		$421.27
$478.14
$538.38
$752.38
$1,143.31 		$743.54
$800.41
$860.65
$1,074.65 		$1,065.81
$1,122.68
$1,182.92
$1,396.92 		$1,388.08
$1,444.95
$1,505.19
$1,719.19 		$322.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$842.54
$956.28
$1,076.76
$1,504.76
$2,286.62 		$1,164.81
$1,278.55
$1,399.03
$1,827.03 		$1,487.08
$1,600.82
$1,721.30
$2,149.30 		$1,809.35
$1,923.09
$2,043.57
$2,471.57 		$322.27
Toc - Plan #3 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ ($2 Rx + 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,250 $4,500 Annual Deductible
$7,500 $15,000 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 		$401.52
$455.73
$513.15
$717.12
$1,089.73 		$708.69
$762.90
$820.32
$1,024.29 		$1,015.86
$1,070.07
$1,127.49
$1,331.46 		$1,323.03
$1,377.24
$1,434.66
$1,638.63 		$307.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$803.04
$911.46
$1,026.30
$1,434.24
$2,179.46 		$1,110.21
$1,218.63
$1,333.47
$1,741.41 		$1,417.38
$1,525.80
$1,640.64
$2,048.58 		$1,724.55
$1,832.97
$1,947.81
$2,355.75 		$307.17
Toc - Plan #4 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ Extra ($2 Rx + Dental + Vision + 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,500 $15,000 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 		$420.05
$476.76
$536.82
$750.21
$1,140.02 		$741.39
$798.10
$858.16
$1,071.55 		$1,062.73
$1,119.44
$1,179.50
$1,392.89 		$1,384.07
$1,440.78
$1,500.84
$1,714.23 		$321.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$840.10
$953.52
$1,073.64
$1,500.42
$2,280.04 		$1,161.44
$1,274.86
$1,394.98
$1,821.76 		$1,482.78
$1,596.20
$1,716.32
$2,143.10 		$1,804.12
$1,917.54
$2,037.66
$2,464.44 		$321.34
Toc - Plan #5 UnitedHealthcare
Gold

(HMO) UHC Gold Value+ ($2 Rx + 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$394.84
$448.15
$504.61
$705.19
$1,071.60 		$696.89
$750.20
$806.66
$1,007.24 		$998.94
$1,052.25
$1,108.71
$1,309.29 		$1,300.99
$1,354.30
$1,410.76
$1,611.34 		$302.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789.68
$896.30
$1,009.22
$1,410.38
$2,143.20 		$1,091.73
$1,198.35
$1,311.27
$1,712.43 		$1,393.78
$1,500.40
$1,613.32
$2,014.48 		$1,695.83
$1,802.45
$1,915.37
$2,316.53 		$302.05
Toc - Plan #6 UnitedHealthcare
Gold

(HMO) UHC Gold Value+ Saver ($2 Rx + 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$7,500 $15,000 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 		$400.31
$454.35
$511.59
$714.95
$1,086.44 		$706.55
$760.59
$817.83
$1,021.19 		$1,012.79
$1,066.83
$1,124.07
$1,327.43 		$1,319.03
$1,373.07
$1,430.31
$1,633.67 		$306.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$800.62
$908.70
$1,023.18
$1,429.90
$2,172.88 		$1,106.86
$1,214.94
$1,329.42
$1,736.14 		$1,413.10
$1,521.18
$1,635.66
$2,042.38 		$1,719.34
$1,827.42
$1,941.90
$2,348.62 		$306.24
Toc - Plan #7 UnitedHealthcare
Gold

(HMO) UHC Gold Value+

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$1,400 $2,800 Annual Deductible
$7,050 $14,100 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 		$402.74
$457.11
$514.70
$719.29
$1,093.03 		$710.83
$765.20
$822.79
$1,027.38 		$1,018.92
$1,073.29
$1,130.88
$1,335.47 		$1,327.01
$1,381.38
$1,438.97
$1,643.56 		$308.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805.48
$914.22
$1,029.40
$1,438.58
$2,186.06 		$1,113.57
$1,222.31
$1,337.49
$1,746.67 		$1,421.66
$1,530.40
$1,645.58
$2,054.76 		$1,729.75
$1,838.49
$1,953.67
$2,362.85 		$308.09
Toc - Plan #8 UnitedHealthcare
Silver

(HMO) UHC Silver Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$337.13
$382.65
$430.86
$602.12
$914.98 		$595.04
$640.56
$688.77
$860.03 		$852.95
$898.47
$946.68
$1,117.94 		$1,110.86
$1,156.38
$1,204.59
$1,375.85 		$257.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674.26
$765.30
$861.72
$1,204.24
$1,829.96 		$932.17
$1,023.21
$1,119.63
$1,462.15 		$1,190.08
$1,281.12
$1,377.54
$1,720.06 		$1,447.99
$1,539.03
$1,635.45
$1,977.97 		$257.91
Toc - Plan #9 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,000 $16,000 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 		$352.62
$400.23
$450.65
$629.79
$957.02 		$622.38
$669.99
$720.41
$899.55 		$892.14
$939.75
$990.17
$1,169.31 		$1,161.90
$1,209.51
$1,259.93
$1,439.07 		$269.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705.24
$800.46
$901.30
$1,259.58
$1,914.04 		$975.00
$1,070.22
$1,171.06
$1,529.34 		$1,244.76
$1,339.98
$1,440.82
$1,799.10 		$1,514.52
$1,609.74
$1,710.58
$2,068.86 		$269.76
Toc - Plan #10 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ Extra ($3 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$8,000 $16,000 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 		$369.94
$419.88
$472.78
$660.71
$1,004.01 		$652.94
$702.88
$755.78
$943.71 		$935.94
$985.88
$1,038.78
$1,226.71 		$1,218.94
$1,268.88
$1,321.78
$1,509.71 		$283.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$739.88
$839.76
$945.56
$1,321.42
$2,008.02 		$1,022.88
$1,122.76
$1,228.56
$1,604.42 		$1,305.88
$1,405.76
$1,511.56
$1,887.42 		$1,588.88
$1,688.76
$1,794.56
$2,170.42 		$283.00
Toc - Plan #11 UnitedHealthcare
Silver

(HMO) UHC Silver Value+ ($3 Rx + 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$5,650 $11,300 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 		$353.54
$401.26
$451.82
$631.41
$959.49 		$623.99
$671.71
$722.27
$901.86 		$894.44
$942.16
$992.72
$1,172.31 		$1,164.89
$1,212.61
$1,263.17
$1,442.76 		$270.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$707.08
$802.52
$903.64
$1,262.82
$1,918.98 		$977.53
$1,072.97
$1,174.09
$1,533.27 		$1,247.98
$1,343.42
$1,444.54
$1,803.72 		$1,518.43
$1,613.87
$1,714.99
$2,074.17 		$270.45
Toc - Plan #12 UnitedHealthcare
Silver

(HMO) UHC Silver Value+ Saver ($1 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$356.57
$404.71
$455.70
$636.84
$967.74 		$629.35
$677.49
$728.48
$909.62 		$902.13
$950.27
$1,001.26
$1,182.40 		$1,174.91
$1,223.05
$1,274.04
$1,455.18 		$272.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$713.14
$809.42
$911.40
$1,273.68
$1,935.48 		$985.92
$1,082.20
$1,184.18
$1,546.46 		$1,258.70
$1,354.98
$1,456.96
$1,819.24 		$1,531.48
$1,627.76
$1,729.74
$2,092.02 		$272.78
Toc - Plan #13 UnitedHealthcare
Silver

(HMO) UHC Silver Value+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$355.05
$402.99
$453.76
$634.13
$963.62 		$626.67
$674.61
$725.38
$905.75 		$898.29
$946.23
$997.00
$1,177.37 		$1,169.91
$1,217.85
$1,268.62
$1,448.99 		$271.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$710.10
$805.98
$907.52
$1,268.26
$1,927.24 		$981.72
$1,077.60
$1,179.14
$1,539.88 		$1,253.34
$1,349.22
$1,450.76
$1,811.50 		$1,524.96
$1,620.84
$1,722.38
$2,083.12 		$271.62
Toc - Plan #14 UnitedHealthcare
Expanded Bronze

(HMO) UHC Value+ Bronze ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$7,650 $15,300 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 		$326.20
$370.24
$416.88
$582.59
$885.31 		$575.74
$619.78
$666.42
$832.13 		$825.28
$869.32
$915.96
$1,081.67 		$1,074.82
$1,118.86
$1,165.50
$1,331.21 		$249.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$652.40
$740.48
$833.76
$1,165.18
$1,770.62 		$901.94
$990.02
$1,083.30
$1,414.72 		$1,151.48
$1,239.56
$1,332.84
$1,664.26 		$1,401.02
$1,489.10
$1,582.38
$1,913.80 		$249.54
Toc - Plan #15 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential+ (Low Premium)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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 		$303.72
$344.73
$388.16
$542.45
$824.31 		$536.07
$577.08
$620.51
$774.80 		$768.42
$809.43
$852.86
$1,007.15 		$1,000.77
$1,041.78
$1,085.21
$1,239.50 		$232.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$607.44
$689.46
$776.32
$1,084.90
$1,648.62 		$839.79
$921.81
$1,008.67
$1,317.25 		$1,072.14
$1,154.16
$1,241.02
$1,549.60 		$1,304.49
$1,386.51
$1,473.37
$1,781.95 		$232.35
Toc - Plan #16 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 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 		$307.67
$349.21
$393.21
$549.50
$835.02 		$543.04
$584.58
$628.58
$784.87 		$778.41
$819.95
$863.95
$1,020.24 		$1,013.78
$1,055.32
$1,099.32
$1,255.61 		$235.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$615.34
$698.42
$786.42
$1,099.00
$1,670.04 		$850.71
$933.79
$1,021.79
$1,334.37 		$1,086.08
$1,169.16
$1,257.16
$1,569.74 		$1,321.45
$1,404.53
$1,492.53
$1,805.11 		$235.37

ADVERTISEMENT

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Toc - Plan #17 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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 		$199.83
$226.81
$255.38
$356.90
$542.34 		$352.70
$379.68
$408.25
$509.77 		$505.57
$532.55
$561.12
$662.64 		$658.44
$685.42
$713.99
$815.51 		$152.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$399.66
$453.62
$510.76
$713.80
$1,084.68 		$552.53
$606.49
$663.63
$866.67 		$705.40
$759.36
$816.50
$1,019.54 		$858.27
$912.23
$969.37
$1,172.41 		$152.87
Toc - Plan #18 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 0 for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 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 		$278.56
$316.17
$356.00
$497.51
$756.01 		$491.66
$529.27
$569.10
$710.61 		$704.76
$742.37
$782.20
$923.71 		$917.86
$955.47
$995.30
$1,136.81 		$213.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557.12
$632.34
$712.00
$995.02
$1,512.02 		$770.22
$845.44
$925.10
$1,208.12 		$983.32
$1,058.54
$1,138.20
$1,421.22 		$1,196.42
$1,271.64
$1,351.30
$1,634.32 		$213.10
Toc - Plan #19 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,600 $11,200 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 		$275.19
$312.34
$351.69
$491.49
$746.87 		$485.71
$522.86
$562.21
$702.01 		$696.23
$733.38
$772.73
$912.53 		$906.75
$943.90
$983.25
$1,123.05 		$210.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$550.38
$624.68
$703.38
$982.98
$1,493.74 		$760.90
$835.20
$913.90
$1,193.50 		$971.42
$1,045.72
$1,124.42
$1,404.02 		$1,181.94
$1,256.24
$1,334.94
$1,614.54 		$210.52
Toc - Plan #20 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$272.51
$309.30
$348.27
$486.70
$739.59 		$480.98
$517.77
$556.74
$695.17 		$689.45
$726.24
$765.21
$903.64 		$897.92
$934.71
$973.68
$1,112.11 		$208.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$545.02
$618.60
$696.54
$973.40
$1,479.18 		$753.49
$827.07
$905.01
$1,181.87 		$961.96
$1,035.54
$1,113.48
$1,390.34 		$1,170.43
$1,244.01
$1,321.95
$1,598.81 		$208.47
Toc - Plan #21 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,700 $15,400 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 		$342.56
$388.81
$437.79
$611.81
$929.71 		$604.62
$650.87
$699.85
$873.87 		$866.68
$912.93
$961.91
$1,135.93 		$1,128.74
$1,174.99
$1,223.97
$1,397.99 		$262.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$685.12
$777.62
$875.58
$1,223.62
$1,859.42 		$947.18
$1,039.68
$1,137.64
$1,485.68 		$1,209.24
$1,301.74
$1,399.70
$1,747.74 		$1,471.30
$1,563.80
$1,661.76
$2,009.80 		$262.06
Toc - Plan #22 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$327.49
$371.70
$418.53
$584.90
$888.81 		$578.02
$622.23
$669.06
$835.43 		$828.55
$872.76
$919.59
$1,085.96 		$1,079.08
$1,123.29
$1,170.12
$1,336.49 		$250.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$654.98
$743.40
$837.06
$1,169.80
$1,777.62 		$905.51
$993.93
$1,087.59
$1,420.33 		$1,156.04
$1,244.46
$1,338.12
$1,670.86 		$1,406.57
$1,494.99
$1,588.65
$1,921.39 		$250.53
Toc - Plan #23 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 8000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$262.66
$298.12
$335.68
$469.11
$712.86 		$463.59
$499.05
$536.61
$670.04 		$664.52
$699.98
$737.54
$870.97 		$865.45
$900.91
$938.47
$1,071.90 		$200.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$525.32
$596.24
$671.36
$938.22
$1,425.72 		$726.25
$797.17
$872.29
$1,139.15 		$927.18
$998.10
$1,073.22
$1,340.08 		$1,128.11
$1,199.03
$1,274.15
$1,541.01 		$200.93
Toc - Plan #24 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 4950

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 Annual Deductible
$7,500 $15,000 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 		$339.26
$385.06
$433.57
$605.92
$920.75 		$598.79
$644.59
$693.10
$865.45 		$858.32
$904.12
$952.63
$1,124.98 		$1,117.85
$1,163.65
$1,212.16
$1,384.51 		$259.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$678.52
$770.12
$867.14
$1,211.84
$1,841.50 		$938.05
$1,029.65
$1,126.67
$1,471.37 		$1,197.58
$1,289.18
$1,386.20
$1,730.90 		$1,457.11
$1,548.71
$1,645.73
$1,990.43 		$259.53
Toc - Plan #25 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$326.42
$370.49
$417.16
$582.99
$885.90 		$576.13
$620.20
$666.87
$832.70 		$825.84
$869.91
$916.58
$1,082.41 		$1,075.55
$1,119.62
$1,166.29
$1,332.12 		$249.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$652.84
$740.98
$834.32
$1,165.98
$1,771.80 		$902.55
$990.69
$1,084.03
$1,415.69 		$1,152.26
$1,240.40
$1,333.74
$1,665.40 		$1,401.97
$1,490.11
$1,583.45
$1,915.11 		$249.71
Toc - Plan #26 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 1900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$1,900 $3,800 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 		$387.82
$440.18
$495.63
$692.65
$1,052.54 		$684.50
$736.86
$792.31
$989.33 		$981.18
$1,033.54
$1,088.99
$1,286.01 		$1,277.86
$1,330.22
$1,385.67
$1,582.69 		$296.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$775.64
$880.36
$991.26
$1,385.30
$2,105.08 		$1,072.32
$1,177.04
$1,287.94
$1,681.98 		$1,369.00
$1,473.72
$1,584.62
$1,978.66 		$1,665.68
$1,770.40
$1,881.30
$2,275.34 		$296.68
Toc - Plan #27 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$286.23
$324.87
$365.80
$511.21
$776.83 		$505.20
$543.84
$584.77
$730.18 		$724.17
$762.81
$803.74
$949.15 		$943.14
$981.78
$1,022.71
$1,168.12 		$218.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$572.46
$649.74
$731.60
$1,022.42
$1,553.66 		$791.43
$868.71
$950.57
$1,241.39 		$1,010.40
$1,087.68
$1,169.54
$1,460.36 		$1,229.37
$1,306.65
$1,388.51
$1,679.33 		$218.97
Toc - Plan #28 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 2600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 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 		$368.98
$418.79
$471.56
$659.00
$1,001.41 		$651.25
$701.06
$753.83
$941.27 		$933.52
$983.33
$1,036.10
$1,223.54 		$1,215.79
$1,265.60
$1,318.37
$1,505.81 		$282.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$737.96
$837.58
$943.12
$1,318.00
$2,002.82 		$1,020.23
$1,119.85
$1,225.39
$1,600.27 		$1,302.50
$1,402.12
$1,507.66
$1,882.54 		$1,584.77
$1,684.39
$1,789.93
$2,164.81 		$282.27

ADVERTISEMENT

CareSource

Local: 1-833-230-2030 | Toll Free: 1-833-230-2030 | TTY: 1-800-255-0056
Toc - Plan #29 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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 		$251.79
$285.77
$321.78
$449.68
$683.34 		$444.40
$478.38
$514.39
$642.29 		$637.01
$670.99
$707.00
$834.90 		$829.62
$863.60
$899.61
$1,027.51 		$192.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$503.58
$571.54
$643.56
$899.36
$1,366.68 		$696.19
$764.15
$836.17
$1,091.97 		$888.80
$956.76
$1,028.78
$1,284.58 		$1,081.41
$1,149.37
$1,221.39
$1,477.19 		$192.61
Toc - Plan #30 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 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 		$351.87
$399.37
$449.68
$628.43
$954.96 		$621.05
$668.55
$718.86
$897.61 		$890.23
$937.73
$988.04
$1,166.79 		$1,159.41
$1,206.91
$1,257.22
$1,435.97 		$269.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$703.74
$798.74
$899.36
$1,256.86
$1,909.92 		$972.92
$1,067.92
$1,168.54
$1,526.04 		$1,242.10
$1,337.10
$1,437.72
$1,795.22 		$1,511.28
$1,606.28
$1,706.90
$2,064.40 		$269.18
Toc - Plan #31 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$353.64
$401.38
$451.95
$631.60
$959.78 		$624.18
$671.92
$722.49
$902.14 		$894.72
$942.46
$993.03
$1,172.68 		$1,165.26
$1,213.00
$1,263.57
$1,443.22 		$270.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$707.28
$802.76
$903.90
$1,263.20
$1,919.56 		$977.82
$1,073.30
$1,174.44
$1,533.74 		$1,248.36
$1,343.84
$1,444.98
$1,804.28 		$1,518.90
$1,614.38
$1,715.52
$2,074.82 		$270.54
Toc - Plan #32 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 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 		$373.28
$423.67
$477.05
$666.67
$1,013.07 		$658.84
$709.23
$762.61
$952.23 		$944.40
$994.79
$1,048.17
$1,237.79 		$1,229.96
$1,280.35
$1,333.73
$1,523.35 		$285.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$746.56
$847.34
$954.10
$1,333.34
$2,026.14 		$1,032.12
$1,132.90
$1,239.66
$1,618.90 		$1,317.68
$1,418.46
$1,525.22
$1,904.46 		$1,603.24
$1,704.02
$1,810.78
$2,190.02 		$285.56
Toc - Plan #33 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 Annual Deductible
$7,500 $15,000 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 		$385.65
$437.71
$492.86
$688.77
$1,046.65 		$680.67
$732.73
$787.88
$983.79 		$975.69
$1,027.75
$1,082.90
$1,278.81 		$1,270.71
$1,322.77
$1,377.92
$1,573.83 		$295.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$771.30
$875.42
$985.72
$1,377.54
$2,093.30 		$1,066.32
$1,170.44
$1,280.74
$1,672.56 		$1,361.34
$1,465.46
$1,575.76
$1,967.58 		$1,656.36
$1,760.48
$1,870.78
$2,262.60 		$295.02
Toc - Plan #34 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$7,000 $14,000 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 		$281.35
$319.33
$359.56
$502.48
$763.57 		$496.58
$534.56
$574.79
$717.71 		$711.81
$749.79
$790.02
$932.94 		$927.04
$965.02
$1,005.25
$1,148.17 		$215.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$562.70
$638.66
$719.12
$1,004.96
$1,527.14 		$777.93
$853.89
$934.35
$1,220.19 		$993.16
$1,069.12
$1,149.58
$1,435.42 		$1,208.39
$1,284.35
$1,364.81
$1,650.65 		$215.23
Toc - Plan #35 CareSource
Bronze

(HMO) CareSource Marketplace Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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 		$241.21
$273.77
$308.26
$430.80
$654.64 		$425.73
$458.29
$492.78
$615.32 		$610.25
$642.81
$677.30
$799.84 		$794.77
$827.33
$861.82
$984.36 		$184.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$482.42
$547.54
$616.52
$861.60
$1,309.28 		$666.94
$732.06
$801.04
$1,046.12 		$851.46
$916.58
$985.56
$1,230.64 		$1,035.98
$1,101.10
$1,170.08
$1,415.16 		$184.52
Toc - Plan #36 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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 		$258.36
$293.24
$330.18
$461.43
$701.18 		$456.00
$490.88
$527.82
$659.07 		$653.64
$688.52
$725.46
$856.71 		$851.28
$886.16
$923.10
$1,054.35 		$197.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$516.72
$586.48
$660.36
$922.86
$1,402.36 		$714.36
$784.12
$858.00
$1,120.50 		$912.00
$981.76
$1,055.64
$1,318.14 		$1,109.64
$1,179.40
$1,253.28
$1,515.78 		$197.64
Toc - Plan #37 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 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 		$358.68
$407.10
$458.39
$640.60
$973.46 		$633.07
$681.49
$732.78
$914.99 		$907.46
$955.88
$1,007.17
$1,189.38 		$1,181.85
$1,230.27
$1,281.56
$1,463.77 		$274.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$717.36
$814.20
$916.78
$1,281.20
$1,946.92 		$991.75
$1,088.59
$1,191.17
$1,555.59 		$1,266.14
$1,362.98
$1,465.56
$1,829.98 		$1,540.53
$1,637.37
$1,739.95
$2,104.37 		$274.39
Toc - Plan #38 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$360.46
$409.12
$460.67
$643.78
$978.29 		$636.21
$684.87
$736.42
$919.53 		$911.96
$960.62
$1,012.17
$1,195.28 		$1,187.71
$1,236.37
$1,287.92
$1,471.03 		$275.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$720.92
$818.24
$921.34
$1,287.56
$1,956.58 		$996.67
$1,093.99
$1,197.09
$1,563.31 		$1,272.42
$1,369.74
$1,472.84
$1,839.06 		$1,548.17
$1,645.49
$1,748.59
$2,114.81 		$275.75
Toc - Plan #39 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 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 		$380.09
$431.39
$485.75
$678.83
$1,031.55 		$670.85
$722.15
$776.51
$969.59 		$961.61
$1,012.91
$1,067.27
$1,260.35 		$1,252.37
$1,303.67
$1,358.03
$1,551.11 		$290.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$760.18
$862.78
$971.50
$1,357.66
$2,063.10 		$1,050.94
$1,153.54
$1,262.26
$1,648.42 		$1,341.70
$1,444.30
$1,553.02
$1,939.18 		$1,632.46
$1,735.06
$1,843.78
$2,229.94 		$290.76
Toc - Plan #40 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 Annual Deductible
$7,500 $15,000 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 		$392.47
$445.45
$501.57
$700.94
$1,065.15 		$692.71
$745.69
$801.81
$1,001.18 		$992.95
$1,045.93
$1,102.05
$1,301.42 		$1,293.19
$1,346.17
$1,402.29
$1,601.66 		$300.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$784.94
$890.90
$1,003.14
$1,401.88
$2,130.30 		$1,085.18
$1,191.14
$1,303.38
$1,702.12 		$1,385.42
$1,491.38
$1,603.62
$2,002.36 		$1,685.66
$1,791.62
$1,903.86
$2,302.60 		$300.24
Toc - Plan #41 CareSource
Bronze

(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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 		$247.51
$280.92
$316.32
$442.05
$671.74 		$436.86
$470.27
$505.67
$631.40 		$626.21
$659.62
$695.02
$820.75 		$815.56
$848.97
$884.37
$1,010.10 		$189.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$495.02
$561.84
$632.64
$884.10
$1,343.48 		$684.37
$751.19
$821.99
$1,073.45 		$873.72
$940.54
$1,011.34
$1,262.80 		$1,063.07
$1,129.89
$1,200.69
$1,452.15 		$189.35

ADVERTISEMENT

Ambetter from Peach State Health Plan

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180 | TTY: 1-877-941-9231
Toc - Plan #42 Ambetter from Peach State Health Plan
Bronze

(HMO) Ambetter Essential Care 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 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 		$292.61
$332.10
$373.94
$522.58
$794.12 		$516.45
$555.94
$597.78
$746.42 		$740.29
$779.78
$821.62
$970.26 		$964.13
$1,003.62
$1,045.46
$1,194.10 		$223.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$585.22
$664.20
$747.88
$1,045.16
$1,588.24 		$809.06
$888.04
$971.72
$1,269.00 		$1,032.90
$1,111.88
$1,195.56
$1,492.84 		$1,256.74
$1,335.72
$1,419.40
$1,716.68 		$223.84
Toc - Plan #43 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 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 		$382.94
$434.63
$489.39
$683.92
$1,039.28 		$675.88
$727.57
$782.33
$976.86 		$968.82
$1,020.51
$1,075.27
$1,269.80 		$1,261.76
$1,313.45
$1,368.21
$1,562.74 		$292.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$765.88
$869.26
$978.78
$1,367.84
$2,078.56 		$1,058.82
$1,162.20
$1,271.72
$1,660.78 		$1,351.76
$1,455.14
$1,564.66
$1,953.72 		$1,644.70
$1,748.08
$1,857.60
$2,246.66 		$292.94
Toc - Plan #44 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 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 		$370.46
$420.46
$473.44
$661.62
$1,005.40 		$653.85
$703.85
$756.83
$945.01 		$937.24
$987.24
$1,040.22
$1,228.40 		$1,220.63
$1,270.63
$1,323.61
$1,511.79 		$283.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$740.92
$840.92
$946.88
$1,323.24
$2,010.80 		$1,024.31
$1,124.31
$1,230.27
$1,606.63 		$1,307.70
$1,407.70
$1,513.66
$1,890.02 		$1,591.09
$1,691.09
$1,797.05
$2,173.41 		$283.39
Toc - Plan #45 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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 		$391.18
$443.97
$499.91
$698.62
$1,061.63 		$690.42
$743.21
$799.15
$997.86 		$989.66
$1,042.45
$1,098.39
$1,297.10 		$1,288.90
$1,341.69
$1,397.63
$1,596.34 		$299.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$782.36
$887.94
$999.82
$1,397.24
$2,123.26 		$1,081.60
$1,187.18
$1,299.06
$1,696.48 		$1,380.84
$1,486.42
$1,598.30
$1,995.72 		$1,680.08
$1,785.66
$1,897.54
$2,294.96 		$299.24
Toc - Plan #46 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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 		$365.86
$415.25
$467.56
$653.42
$992.93 		$645.74
$695.13
$747.44
$933.30 		$925.62
$975.01
$1,027.32
$1,213.18 		$1,205.50
$1,254.89
$1,307.20
$1,493.06 		$279.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$731.72
$830.50
$935.12
$1,306.84
$1,985.86 		$1,011.60
$1,110.38
$1,215.00
$1,586.72 		$1,291.48
$1,390.26
$1,494.88
$1,866.60 		$1,571.36
$1,670.14
$1,774.76
$2,146.48 		$279.88
Toc - Plan #47 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 29

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,650 $17,300 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 		$361.27
$410.03
$461.69
$645.21
$980.46 		$637.63
$686.39
$738.05
$921.57 		$913.99
$962.75
$1,014.41
$1,197.93 		$1,190.35
$1,239.11
$1,290.77
$1,474.29 		$276.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722.54
$820.06
$923.38
$1,290.42
$1,960.92 		$998.90
$1,096.42
$1,199.74
$1,566.78 		$1,275.26
$1,372.78
$1,476.10
$1,843.14 		$1,551.62
$1,649.14
$1,752.46
$2,119.50 		$276.36
Toc - Plan #48 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 28

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$392.90
$445.93
$502.11
$701.70
$1,066.30 		$693.46
$746.49
$802.67
$1,002.26 		$994.02
$1,047.05
$1,103.23
$1,302.82 		$1,294.58
$1,347.61
$1,403.79
$1,603.38 		$300.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785.80
$891.86
$1,004.22
$1,403.40
$2,132.60 		$1,086.36
$1,192.42
$1,304.78
$1,703.96 		$1,386.92
$1,492.98
$1,605.34
$2,004.52 		$1,687.48
$1,793.54
$1,905.90
$2,305.08 		$300.56
Toc - Plan #49 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 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 		$320.30
$363.52
$409.33
$572.03
$869.26 		$565.32
$608.54
$654.35
$817.05 		$810.34
$853.56
$899.37
$1,062.07 		$1,055.36
$1,098.58
$1,144.39
$1,307.09 		$245.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640.60
$727.04
$818.66
$1,144.06
$1,738.52 		$885.62
$972.06
$1,063.68
$1,389.08 		$1,130.64
$1,217.08
$1,308.70
$1,634.10 		$1,375.66
$1,462.10
$1,553.72
$1,879.12 		$245.02
Toc - Plan #50 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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 		$317.04
$359.83
$405.17
$566.22
$860.42 		$559.57
$602.36
$647.70
$808.75 		$802.10
$844.89
$890.23
$1,051.28 		$1,044.63
$1,087.42
$1,132.76
$1,293.81 		$242.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$634.08
$719.66
$810.34
$1,132.44
$1,720.84 		$876.61
$962.19
$1,052.87
$1,374.97 		$1,119.14
$1,204.72
$1,295.40
$1,617.50 		$1,361.67
$1,447.25
$1,537.93
$1,860.03 		$242.53
Toc - Plan #51 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 22

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$337.07
$382.56
$430.76
$601.99
$914.78 		$594.92
$640.41
$688.61
$859.84 		$852.77
$898.26
$946.46
$1,117.69 		$1,110.62
$1,156.11
$1,204.31
$1,375.54 		$257.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674.14
$765.12
$861.52
$1,203.98
$1,829.56 		$931.99
$1,022.97
$1,119.37
$1,461.83 		$1,189.84
$1,280.82
$1,377.22
$1,719.68 		$1,447.69
$1,538.67
$1,635.07
$1,977.53 		$257.85
Toc - Plan #52 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care: $1,500 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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 		$344.88
$391.43
$440.74
$615.94
$935.98 		$608.71
$655.26
$704.57
$879.77 		$872.54
$919.09
$968.40
$1,143.60 		$1,136.37
$1,182.92
$1,232.23
$1,407.43 		$263.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$689.76
$782.86
$881.48
$1,231.88
$1,871.96 		$953.59
$1,046.69
$1,145.31
$1,495.71 		$1,217.42
$1,310.52
$1,409.14
$1,759.54 		$1,481.25
$1,574.35
$1,672.97
$2,023.37 		$263.83
Toc - Plan #53 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care: $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$362.65
$411.59
$463.45
$647.67
$984.20 		$640.07
$689.01
$740.87
$925.09 		$917.49
$966.43
$1,018.29
$1,202.51 		$1,194.91
$1,243.85
$1,295.71
$1,479.93 		$277.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$725.30
$823.18
$926.90
$1,295.34
$1,968.40 		$1,002.72
$1,100.60
$1,204.32
$1,572.76 		$1,280.14
$1,378.02
$1,481.74
$1,850.18 		$1,557.56
$1,655.44
$1,759.16
$2,127.60 		$277.42
Toc - Plan #54 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$6,100 $12,200 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 		$346.49
$393.25
$442.80
$618.81
$940.34 		$611.55
$658.31
$707.86
$883.87 		$876.61
$923.37
$972.92
$1,148.93 		$1,141.67
$1,188.43
$1,237.98
$1,413.99 		$265.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.98
$786.50
$885.60
$1,237.62
$1,880.68 		$958.04
$1,051.56
$1,150.66
$1,502.68 		$1,223.10
$1,316.62
$1,415.72
$1,767.74 		$1,488.16
$1,581.68
$1,680.78
$2,032.80 		$265.06
Toc - Plan #55 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 31

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$6,450 $12,900 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 		$346.60
$393.38
$442.95
$619.02
$940.65 		$611.74
$658.52
$708.09
$884.16 		$876.88
$923.66
$973.23
$1,149.30 		$1,142.02
$1,188.80
$1,238.37
$1,414.44 		$265.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$693.20
$786.76
$885.90
$1,238.04
$1,881.30 		$958.34
$1,051.90
$1,151.04
$1,503.18 		$1,223.48
$1,317.04
$1,416.18
$1,768.32 		$1,488.62
$1,582.18
$1,681.32
$2,033.46 		$265.14
Toc - Plan #56 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 32

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 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 		$354.76
$402.64
$453.37
$633.58
$962.79 		$626.14
$674.02
$724.75
$904.96 		$897.52
$945.40
$996.13
$1,176.34 		$1,168.90
$1,216.78
$1,267.51
$1,447.72 		$271.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$709.52
$805.28
$906.74
$1,267.16
$1,925.58 		$980.90
$1,076.66
$1,178.12
$1,538.54 		$1,252.28
$1,348.04
$1,449.50
$1,809.92 		$1,523.66
$1,619.42
$1,720.88
$2,081.30 		$271.38
Toc - Plan #57 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 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 		$366.44
$415.90
$468.30
$654.44
$994.49 		$646.76
$696.22
$748.62
$934.76 		$927.08
$976.54
$1,028.94
$1,215.08 		$1,207.40
$1,256.86
$1,309.26
$1,495.40 		$280.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$732.88
$831.80
$936.60
$1,308.88
$1,988.98 		$1,013.20
$1,112.12
$1,216.92
$1,589.20 		$1,293.52
$1,392.44
$1,497.24
$1,869.52 		$1,573.84
$1,672.76
$1,777.56
$2,149.84 		$280.32
Toc - Plan #58 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 12 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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 		$381.26
$432.72
$487.24
$680.91
$1,034.72 		$672.92
$724.38
$778.90
$972.57 		$964.58
$1,016.04
$1,070.56
$1,264.23 		$1,256.24
$1,307.70
$1,362.22
$1,555.89 		$291.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$762.52
$865.44
$974.48
$1,361.82
$2,069.44 		$1,054.18
$1,157.10
$1,266.14
$1,653.48 		$1,345.84
$1,448.76
$1,557.80
$1,945.14 		$1,637.50
$1,740.42
$1,849.46
$2,236.80 		$291.66
Toc - Plan #59 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 4 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 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 		$399.06
$452.92
$509.98
$712.70
$1,083.02 		$704.33
$758.19
$815.25
$1,017.97 		$1,009.60
$1,063.46
$1,120.52
$1,323.24 		$1,314.87
$1,368.73
$1,425.79
$1,628.51 		$305.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$798.12
$905.84
$1,019.96
$1,425.40
$2,166.04 		$1,103.39
$1,211.11
$1,325.23
$1,730.67 		$1,408.66
$1,516.38
$1,630.50
$2,035.94 		$1,713.93
$1,821.65
$1,935.77
$2,341.21 		$305.27
Toc - Plan #60 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 11 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 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 		$386.05
$438.16
$493.36
$689.47
$1,047.71 		$681.37
$733.48
$788.68
$984.79 		$976.69
$1,028.80
$1,084.00
$1,280.11 		$1,272.01
$1,324.12
$1,379.32
$1,575.43 		$295.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$772.10
$876.32
$986.72
$1,378.94
$2,095.42 		$1,067.42
$1,171.64
$1,282.04
$1,674.26 		$1,362.74
$1,466.96
$1,577.36
$1,969.58 		$1,658.06
$1,762.28
$1,872.68
$2,264.90 		$295.32
Toc - Plan #61 Ambetter from Peach State Health Plan
Bronze

(HMO) Ambetter Essential Care 1 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 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 		$304.92
$346.08
$389.68
$544.57
$827.53 		$538.18
$579.34
$622.94
$777.83 		$771.44
$812.60
$856.20
$1,011.09 		$1,004.70
$1,045.86
$1,089.46
$1,244.35 		$233.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$609.84
$692.16
$779.36
$1,089.14
$1,655.06 		$843.10
$925.42
$1,012.62
$1,322.40 		$1,076.36
$1,158.68
$1,245.88
$1,555.66 		$1,309.62
$1,391.94
$1,479.14
$1,788.92 		$233.26
Toc - Plan #62 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 5 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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 		$407.64
$462.66
$520.95
$728.02
$1,106.30 		$719.48
$774.50
$832.79
$1,039.86 		$1,031.32
$1,086.34
$1,144.63
$1,351.70 		$1,343.16
$1,398.18
$1,456.47
$1,663.54 		$311.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815.28
$925.32
$1,041.90
$1,456.04
$2,212.60 		$1,127.12
$1,237.16
$1,353.74
$1,767.88 		$1,438.96
$1,549.00
$1,665.58
$2,079.72 		$1,750.80
$1,860.84
$1,977.42
$2,391.56 		$311.84
Toc - Plan #63 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 28 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$409.43
$464.70
$523.24
$731.23
$1,111.18 		$722.64
$777.91
$836.45
$1,044.44 		$1,035.85
$1,091.12
$1,149.66
$1,357.65 		$1,349.06
$1,404.33
$1,462.87
$1,670.86 		$313.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$818.86
$929.40
$1,046.48
$1,462.46
$2,222.36 		$1,132.07
$1,242.61
$1,359.69
$1,775.67 		$1,445.28
$1,555.82
$1,672.90
$2,088.88 		$1,758.49
$1,869.03
$1,986.11
$2,402.09 		$313.21
Toc - Plan #64 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 29 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,650 $17,300 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 		$376.47
$427.29
$481.12
$672.36
$1,021.72 		$664.46
$715.28
$769.11
$960.35 		$952.45
$1,003.27
$1,057.10
$1,248.34 		$1,240.44
$1,291.26
$1,345.09
$1,536.33 		$287.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$752.94
$854.58
$962.24
$1,344.72
$2,043.44 		$1,040.93
$1,142.57
$1,250.23
$1,632.71 		$1,328.92
$1,430.56
$1,538.22
$1,920.70 		$1,616.91
$1,718.55
$1,826.21
$2,208.69 		$287.99
Toc - Plan #65 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 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 		$333.77
$378.82
$426.55
$596.10
$905.84 		$589.10
$634.15
$681.88
$851.43 		$844.43
$889.48
$937.21
$1,106.76 		$1,099.76
$1,144.81
$1,192.54
$1,362.09 		$255.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$667.54
$757.64
$853.10
$1,192.20
$1,811.68 		$922.87
$1,012.97
$1,108.43
$1,447.53 		$1,178.20
$1,268.30
$1,363.76
$1,702.86 		$1,433.53
$1,523.63
$1,619.09
$1,958.19 		$255.33
Toc - Plan #66 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 5 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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 		$330.38
$374.97
$422.22
$590.05
$896.63 		$583.11
$627.70
$674.95
$842.78 		$835.84
$880.43
$927.68
$1,095.51 		$1,088.57
$1,133.16
$1,180.41
$1,348.24 		$252.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$660.76
$749.94
$844.44
$1,180.10
$1,793.26 		$913.49
$1,002.67
$1,097.17
$1,432.83 		$1,166.22
$1,255.40
$1,349.90
$1,685.56 		$1,418.95
$1,508.13
$1,602.63
$1,938.29 		$252.73
Toc - Plan #67 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 22 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$351.25
$398.66
$448.89
$627.32
$953.27 		$619.95
$667.36
$717.59
$896.02 		$888.65
$936.06
$986.29
$1,164.72 		$1,157.35
$1,204.76
$1,254.99
$1,433.42 		$268.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$702.50
$797.32
$897.78
$1,254.64
$1,906.54 		$971.20
$1,066.02
$1,166.48
$1,523.34 		$1,239.90
$1,334.72
$1,435.18
$1,792.04 		$1,508.60
$1,603.42
$1,703.88
$2,060.74 		$268.70
Toc - Plan #68 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care: $1,500 Medical Deductible + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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 		$359.39
$407.90
$459.29
$641.86
$975.37 		$634.32
$682.83
$734.22
$916.79 		$909.25
$957.76
$1,009.15
$1,191.72 		$1,184.18
$1,232.69
$1,284.08
$1,466.65 		$274.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718.78
$815.80
$918.58
$1,283.72
$1,950.74 		$993.71
$1,090.73
$1,193.51
$1,558.65 		$1,268.64
$1,365.66
$1,468.44
$1,833.58 		$1,543.57
$1,640.59
$1,743.37
$2,108.51 		$274.93
Toc - Plan #69 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care: $0 Medical Deductible + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$377.91
$428.92
$482.96
$674.93
$1,025.62 		$667.00
$718.01
$772.05
$964.02 		$956.09
$1,007.10
$1,061.14
$1,253.11 		$1,245.18
$1,296.19
$1,350.23
$1,542.20 		$289.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$755.82
$857.84
$965.92
$1,349.86
$2,051.24 		$1,044.91
$1,146.93
$1,255.01
$1,638.95 		$1,334.00
$1,436.02
$1,544.10
$1,928.04 		$1,623.09
$1,725.11
$1,833.19
$2,217.13 		$289.09
Toc - Plan #70 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 31 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$6,450 $12,900 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 		$361.19
$409.94
$461.59
$645.07
$980.24 		$637.49
$686.24
$737.89
$921.37 		$913.79
$962.54
$1,014.19
$1,197.67 		$1,190.09
$1,238.84
$1,290.49
$1,473.97 		$276.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722.38
$819.88
$923.18
$1,290.14
$1,960.48 		$998.68
$1,096.18
$1,199.48
$1,566.44 		$1,274.98
$1,372.48
$1,475.78
$1,842.74 		$1,551.28
$1,648.78
$1,752.08
$2,119.04 		$276.30
Toc - Plan #71 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 32 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 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 		$369.69
$419.59
$472.45
$660.25
$1,003.31 		$652.49
$702.39
$755.25
$943.05 		$935.29
$985.19
$1,038.05
$1,225.85 		$1,218.09
$1,267.99
$1,320.85
$1,508.65 		$282.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$739.38
$839.18
$944.90
$1,320.50
$2,006.62 		$1,022.18
$1,121.98
$1,227.70
$1,603.30 		$1,304.98
$1,404.78
$1,510.50
$1,886.10 		$1,587.78
$1,687.58
$1,793.30
$2,168.90 		$282.80
Toc - Plan #72 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 20 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 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 		$381.86
$433.40
$488.00
$681.98
$1,036.34 		$673.98
$725.52
$780.12
$974.10 		$966.10
$1,017.64
$1,072.24
$1,266.22 		$1,258.22
$1,309.76
$1,364.36
$1,558.34 		$292.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$763.72
$866.80
$976.00
$1,363.96
$2,072.68 		$1,055.84
$1,158.92
$1,268.12
$1,656.08 		$1,347.96
$1,451.04
$1,560.24
$1,948.20 		$1,640.08
$1,743.16
$1,852.36
$2,240.32 		$292.12

ADVERTISEMENT

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #73 Aetna CVS Health
Expanded Bronze

(HMO) Aetna CVS Bronze: Low-Cost Walk-in Clinic Visits, Telehealth, Savannah

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$7,000 $14,000 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 		$293.80
$333.47
$375.48
$524.73
$797.38 		$518.56
$558.23
$600.24
$749.49 		$743.32
$782.99
$825.00
$974.25 		$968.08
$1,007.75
$1,049.76
$1,199.01 		$224.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587.60
$666.94
$750.96
$1,049.46
$1,594.76 		$812.36
$891.70
$975.72
$1,274.22 		$1,037.12
$1,116.46
$1,200.48
$1,498.98 		$1,261.88
$1,341.22
$1,425.24
$1,723.74 		$224.76
Toc - Plan #74 Aetna CVS Health
Bronze

(HMO) Aetna CVS Bronze: $0 Walk-In Clinic Visits, Telehealth, Savannah

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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 		$285.74
$324.32
$365.18
$510.33
$775.50 		$504.33
$542.91
$583.77
$728.92 		$722.92
$761.50
$802.36
$947.51 		$941.51
$980.09
$1,020.95
$1,166.10 		$218.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$571.48
$648.64
$730.36
$1,020.66
$1,551.00 		$790.07
$867.23
$948.95
$1,239.25 		$1,008.66
$1,085.82
$1,167.54
$1,457.84 		$1,227.25
$1,304.41
$1,386.13
$1,676.43 		$218.59
Toc - Plan #75 Aetna CVS Health
Gold

(HMO) Aetna CVS Gold: $0 Walk-In Clinic Visits, Telehealth, Savannah

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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 		$389.09
$441.62
$497.26
$694.92
$1,056.00 		$686.75
$739.28
$794.92
$992.58 		$984.41
$1,036.94
$1,092.58
$1,290.24 		$1,282.07
$1,334.60
$1,390.24
$1,587.90 		$297.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$778.18
$883.24
$994.52
$1,389.84
$2,112.00 		$1,075.84
$1,180.90
$1,292.18
$1,687.50 		$1,373.50
$1,478.56
$1,589.84
$1,985.16 		$1,671.16
$1,776.22
$1,887.50
$2,282.82 		$297.66
Toc - Plan #76 Aetna CVS Health
Silver

(HMO) Aetna CVS Silver 2: $0 Walk-In Clinic Visits, Telehealth, Savannah

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$353.22
$400.90
$451.41
$630.85
$958.63 		$623.43
$671.11
$721.62
$901.06 		$893.64
$941.32
$991.83
$1,171.27 		$1,163.85
$1,211.53
$1,262.04
$1,441.48 		$270.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$706.44
$801.80
$902.82
$1,261.70
$1,917.26 		$976.65
$1,072.01
$1,173.03
$1,531.91 		$1,246.86
$1,342.22
$1,443.24
$1,802.12 		$1,517.07
$1,612.43
$1,713.45
$2,072.33 		$270.21
Toc - Plan #77 Aetna CVS Health
Silver

(HMO) Aetna CVS Silver 1: $0 Walk-In Clinic Visits, Telehealth, Savannah

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$409.57
$464.86
$523.42
$731.48
$1,111.56 		$722.89
$778.18
$836.74
$1,044.80 		$1,036.21
$1,091.50
$1,150.06
$1,358.12 		$1,349.53
$1,404.82
$1,463.38
$1,671.44 		$313.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$819.14
$929.72
$1,046.84
$1,462.96
$2,223.12 		$1,132.46
$1,243.04
$1,360.16
$1,776.28 		$1,445.78
$1,556.36
$1,673.48
$2,089.60 		$1,759.10
$1,869.68
$1,986.80
$2,402.92 		$313.32

‡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 Tattnall County here.

Tattnall County is in “Rating Area 14” of Georgia.

Currently, there are 77 plans offered in Rating Area 14.

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2022 Obamacare Plans for Tattnall County, GA

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