Obamacare 2022 Rates for Owen County

Obamacare > Rates > Indiana > Owen 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 Owen County, IN.

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, 44 Plans and 2022 Rates for Owen County, Indiana

Below, you’ll find a summary of the 44 plans for Owen County, Indiana 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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Anthem Blue Cross and Blue Shield

Local: 1-855-886-6152 | Toll Free: 1-855-886-6152

Toc - Plan #1 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway Essentials 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

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
$328.46
$372.80
$419.77
$586.63
$891.44
$579.73
$624.07
$671.04
$837.90
$831.00
$875.34
$922.31
$1,089.17
$1,082.27
$1,126.61
$1,173.58
$1,340.44
$251.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$656.92
$745.60
$839.54
$1,173.26
$1,782.88
$908.19
$996.87
$1,090.81
$1,424.53
$1,159.46
$1,248.14
$1,342.08
$1,675.80
$1,410.73
$1,499.41
$1,593.35
$1,927.07
$251.27
Toc - Plan #2 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway Essentials 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

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
$270.69
$307.23
$345.94
$483.45
$734.65
$477.77
$514.31
$553.02
$690.53
$684.85
$721.39
$760.10
$897.61
$891.93
$928.47
$967.18
$1,104.69
$207.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541.38
$614.46
$691.88
$966.90
$1,469.30
$748.46
$821.54
$898.96
$1,173.98
$955.54
$1,028.62
$1,106.04
$1,381.06
$1,162.62
$1,235.70
$1,313.12
$1,588.14
$207.08
Toc - Plan #3 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway Essentials 6550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

Annual Out of Pocket Expenses:

Individual Family
$6,550 $13,100 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
$261.58
$296.89
$334.30
$467.18
$709.93
$461.69
$497.00
$534.41
$667.29
$661.80
$697.11
$734.52
$867.40
$861.91
$897.22
$934.63
$1,067.51
$200.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$523.16
$593.78
$668.60
$934.36
$1,419.86
$723.27
$793.89
$868.71
$1,134.47
$923.38
$994.00
$1,068.82
$1,334.58
$1,123.49
$1,194.11
$1,268.93
$1,534.69
$200.11
Toc - Plan #4 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway Essentials 6550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

Annual Out of Pocket Expenses:

Individual Family
$6,550 $13,100 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
$315.12
$357.66
$402.72
$562.80
$855.24
$556.19
$598.73
$643.79
$803.87
$797.26
$839.80
$884.86
$1,044.94
$1,038.33
$1,080.87
$1,125.93
$1,286.01
$241.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$630.24
$715.32
$805.44
$1,125.60
$1,710.48
$871.31
$956.39
$1,046.51
$1,366.67
$1,112.38
$1,197.46
$1,287.58
$1,607.74
$1,353.45
$1,438.53
$1,528.65
$1,848.81
$241.07
Toc - Plan #5 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway Essentials 2700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

Annual Out of Pocket Expenses:

Individual Family
$2,700 $5,400 Annual Deductible
$5,350 $10,700 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
$478.95
$543.61
$612.10
$855.40
$1,299.87
$845.35
$910.01
$978.50
$1,221.80
$1,211.75
$1,276.41
$1,344.90
$1,588.20
$1,578.15
$1,642.81
$1,711.30
$1,954.60
$366.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$957.90
$1,087.22
$1,224.20
$1,710.80
$2,599.74
$1,324.30
$1,453.62
$1,590.60
$2,077.20
$1,690.70
$1,820.02
$1,957.00
$2,443.60
$2,057.10
$2,186.42
$2,323.40
$2,810.00
$366.40
Toc - Plan #6 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway Essentials 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-886-6152

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$321.10
$364.45
$410.37
$573.48
$871.47
$566.74
$610.09
$656.01
$819.12
$812.38
$855.73
$901.65
$1,064.76
$1,058.02
$1,101.37
$1,147.29
$1,310.40
$245.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$642.20
$728.90
$820.74
$1,146.96
$1,742.94
$887.84
$974.54
$1,066.38
$1,392.60
$1,133.48
$1,220.18
$1,312.02
$1,638.24
$1,379.12
$1,465.82
$1,557.66
$1,883.88
$245.64

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CareSource

Local: 1-800-479-9502 | Toll Free: 1-877-806-9284

Toc - Plan #7 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$309.70
$351.51
$395.79
$553.12
$840.52
$546.62
$588.43
$632.71
$790.04
$783.54
$825.35
$869.63
$1,026.96
$1,020.46
$1,062.27
$1,106.55
$1,263.88
$236.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619.40
$703.02
$791.58
$1,106.24
$1,681.04
$856.32
$939.94
$1,028.50
$1,343.16
$1,093.24
$1,176.86
$1,265.42
$1,580.08
$1,330.16
$1,413.78
$1,502.34
$1,817.00
$236.92
Toc - Plan #8 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$320.60
$363.88
$409.73
$572.59
$870.11
$565.86
$609.14
$654.99
$817.85
$811.12
$854.40
$900.25
$1,063.11
$1,056.38
$1,099.66
$1,145.51
$1,308.37
$245.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$641.20
$727.76
$819.46
$1,145.18
$1,740.22
$886.46
$973.02
$1,064.72
$1,390.44
$1,131.72
$1,218.28
$1,309.98
$1,635.70
$1,376.98
$1,463.54
$1,555.24
$1,880.96
$245.26
Toc - Plan #9 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$500.43
$567.98
$639.54
$893.75
$1,358.15
$883.25
$950.80
$1,022.36
$1,276.57
$1,266.07
$1,333.62
$1,405.18
$1,659.39
$1,648.89
$1,716.44
$1,788.00
$2,042.21
$382.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,000.86
$1,135.96
$1,279.08
$1,787.50
$2,716.30
$1,383.68
$1,518.78
$1,661.90
$2,170.32
$1,766.50
$1,901.60
$2,044.72
$2,553.14
$2,149.32
$2,284.42
$2,427.54
$2,935.96
$382.82
Toc - Plan #10 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$339.43
$385.25
$433.79
$606.22
$921.20
$599.09
$644.91
$693.45
$865.88
$858.75
$904.57
$953.11
$1,125.54
$1,118.41
$1,164.23
$1,212.77
$1,385.20
$259.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.86
$770.50
$867.58
$1,212.44
$1,842.40
$938.52
$1,030.16
$1,127.24
$1,472.10
$1,198.18
$1,289.82
$1,386.90
$1,731.76
$1,457.84
$1,549.48
$1,646.56
$1,991.42
$259.66
Toc - Plan #11 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$265.98
$301.88
$339.92
$475.03
$721.86
$469.45
$505.35
$543.39
$678.50
$672.92
$708.82
$746.86
$881.97
$876.39
$912.29
$950.33
$1,085.44
$203.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$531.96
$603.76
$679.84
$950.06
$1,443.72
$735.43
$807.23
$883.31
$1,153.53
$938.90
$1,010.70
$1,086.78
$1,357.00
$1,142.37
$1,214.17
$1,290.25
$1,560.47
$203.47
Toc - Plan #12 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$350.99
$398.37
$448.56
$626.86
$952.57
$619.49
$666.87
$717.06
$895.36
$887.99
$935.37
$985.56
$1,163.86
$1,156.49
$1,203.87
$1,254.06
$1,432.36
$268.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701.98
$796.74
$897.12
$1,253.72
$1,905.14
$970.48
$1,065.24
$1,165.62
$1,522.22
$1,238.98
$1,333.74
$1,434.12
$1,790.72
$1,507.48
$1,602.24
$1,702.62
$2,059.22
$268.50
Toc - Plan #13 CareSource
Bronze

(HMO) CareSource Marketplace Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$252.85
$286.98
$323.13
$451.58
$686.22
$446.27
$480.40
$516.55
$645.00
$639.69
$673.82
$709.97
$838.42
$833.11
$867.24
$903.39
$1,031.84
$193.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$505.70
$573.96
$646.26
$903.16
$1,372.44
$699.12
$767.38
$839.68
$1,096.58
$892.54
$960.80
$1,033.10
$1,290.00
$1,085.96
$1,154.22
$1,226.52
$1,483.42
$193.42
Toc - Plan #14 CareSource
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$328.80
$373.19
$420.20
$587.23
$892.36
$580.33
$624.72
$671.73
$838.76
$831.86
$876.25
$923.26
$1,090.29
$1,083.39
$1,127.78
$1,174.79
$1,341.82
$251.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$657.60
$746.38
$840.40
$1,174.46
$1,784.72
$909.13
$997.91
$1,091.93
$1,425.99
$1,160.66
$1,249.44
$1,343.46
$1,677.52
$1,412.19
$1,500.97
$1,594.99
$1,929.05
$251.53
Toc - Plan #15 CareSource
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$510.26
$579.14
$652.10
$911.31
$1,384.83
$900.60
$969.48
$1,042.44
$1,301.65
$1,290.94
$1,359.82
$1,432.78
$1,691.99
$1,681.28
$1,750.16
$1,823.12
$2,082.33
$390.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,020.52
$1,158.28
$1,304.20
$1,822.62
$2,769.66
$1,410.86
$1,548.62
$1,694.54
$2,212.96
$1,801.20
$1,938.96
$2,084.88
$2,603.30
$2,191.54
$2,329.30
$2,475.22
$2,993.64
$390.34
Toc - Plan #16 CareSource
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$347.63
$394.55
$444.26
$620.85
$943.45
$613.56
$660.48
$710.19
$886.78
$879.49
$926.41
$976.12
$1,152.71
$1,145.42
$1,192.34
$1,242.05
$1,418.64
$265.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$695.26
$789.10
$888.52
$1,241.70
$1,886.90
$961.19
$1,055.03
$1,154.45
$1,507.63
$1,227.12
$1,320.96
$1,420.38
$1,773.56
$1,493.05
$1,586.89
$1,686.31
$2,039.49
$265.93
Toc - Plan #17 CareSource
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$273.12
$309.99
$349.05
$487.79
$741.25
$482.06
$518.93
$557.99
$696.73
$691.00
$727.87
$766.93
$905.67
$899.94
$936.81
$975.87
$1,114.61
$208.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$546.24
$619.98
$698.10
$975.58
$1,482.50
$755.18
$828.92
$907.04
$1,184.52
$964.12
$1,037.86
$1,115.98
$1,393.46
$1,173.06
$1,246.80
$1,324.92
$1,602.40
$208.94
Toc - Plan #18 CareSource
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$359.19
$407.67
$459.03
$641.50
$974.82
$633.96
$682.44
$733.80
$916.27
$908.73
$957.21
$1,008.57
$1,191.04
$1,183.50
$1,231.98
$1,283.34
$1,465.81
$274.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$718.38
$815.34
$918.06
$1,283.00
$1,949.64
$993.15
$1,090.11
$1,192.83
$1,557.77
$1,267.92
$1,364.88
$1,467.60
$1,832.54
$1,542.69
$1,639.65
$1,742.37
$2,107.31
$274.77
Toc - Plan #19 CareSource
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-806-9284

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
$259.63
$294.68
$331.81
$463.70
$704.63
$458.25
$493.30
$530.43
$662.32
$656.87
$691.92
$729.05
$860.94
$855.49
$890.54
$927.67
$1,059.56
$198.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$519.26
$589.36
$663.62
$927.40
$1,409.26
$717.88
$787.98
$862.24
$1,126.02
$916.50
$986.60
$1,060.86
$1,324.64
$1,115.12
$1,185.22
$1,259.48
$1,523.26
$198.62

ADVERTISEMENT

Ambetter from MHS

Local: 1-877-687-1182 | Toll Free: 1-877-687-1182 | TTY: 1-877-941-9232

Toc - Plan #20 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$339.16
$384.93
$433.43
$605.72
$920.45
$598.61
$644.38
$692.88
$865.17
$858.06
$903.83
$952.33
$1,124.62
$1,117.51
$1,163.28
$1,211.78
$1,384.07
$259.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.32
$769.86
$866.86
$1,211.44
$1,840.90
$937.77
$1,029.31
$1,126.31
$1,470.89
$1,197.22
$1,288.76
$1,385.76
$1,730.34
$1,456.67
$1,548.21
$1,645.21
$1,989.79
$259.45
Toc - Plan #21 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$335.46
$380.74
$428.71
$599.12
$910.41
$592.08
$637.36
$685.33
$855.74
$848.70
$893.98
$941.95
$1,112.36
$1,105.32
$1,150.60
$1,198.57
$1,368.98
$256.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$670.92
$761.48
$857.42
$1,198.24
$1,820.82
$927.54
$1,018.10
$1,114.04
$1,454.86
$1,184.16
$1,274.72
$1,370.66
$1,711.48
$1,440.78
$1,531.34
$1,627.28
$1,968.10
$256.62
Toc - Plan #22 Ambetter from MHS
Gold

(EPO) Ambetter Secure Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$435.24
$493.98
$556.22
$777.32
$1,181.21
$768.19
$826.93
$889.17
$1,110.27
$1,101.14
$1,159.88
$1,222.12
$1,443.22
$1,434.09
$1,492.83
$1,555.07
$1,776.17
$332.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$870.48
$987.96
$1,112.44
$1,554.64
$2,362.42
$1,203.43
$1,320.91
$1,445.39
$1,887.59
$1,536.38
$1,653.86
$1,778.34
$2,220.54
$1,869.33
$1,986.81
$2,111.29
$2,553.49
$332.95
Toc - Plan #23 Ambetter from MHS
Bronze

(EPO) Ambetter Essential Care 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$291.71
$331.08
$372.79
$520.98
$791.68
$514.86
$554.23
$595.94
$744.13
$738.01
$777.38
$819.09
$967.28
$961.16
$1,000.53
$1,042.24
$1,190.43
$223.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$583.42
$662.16
$745.58
$1,041.96
$1,583.36
$806.57
$885.31
$968.73
$1,265.11
$1,029.72
$1,108.46
$1,191.88
$1,488.26
$1,252.87
$1,331.61
$1,415.03
$1,711.41
$223.15
Toc - Plan #24 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 24

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 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
$345.91
$392.59
$442.06
$617.77
$938.76
$610.52
$657.20
$706.67
$882.38
$875.13
$921.81
$971.28
$1,146.99
$1,139.74
$1,186.42
$1,235.89
$1,411.60
$264.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$691.82
$785.18
$884.12
$1,235.54
$1,877.52
$956.43
$1,049.79
$1,148.73
$1,500.15
$1,221.04
$1,314.40
$1,413.34
$1,764.76
$1,485.65
$1,579.01
$1,677.95
$2,029.37
$264.61
Toc - Plan #25 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 28

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$356.22
$404.30
$455.23
$636.19
$966.75
$628.72
$676.80
$727.73
$908.69
$901.22
$949.30
$1,000.23
$1,181.19
$1,173.72
$1,221.80
$1,272.73
$1,453.69
$272.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$712.44
$808.60
$910.46
$1,272.38
$1,933.50
$984.94
$1,081.10
$1,182.96
$1,544.88
$1,257.44
$1,353.60
$1,455.46
$1,817.38
$1,529.94
$1,626.10
$1,727.96
$2,089.88
$272.50
Toc - Plan #26 Ambetter from MHS
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$319.28
$362.38
$408.03
$570.22
$866.51
$563.52
$606.62
$652.27
$814.46
$807.76
$850.86
$896.51
$1,058.70
$1,052.00
$1,095.10
$1,140.75
$1,302.94
$244.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$638.56
$724.76
$816.06
$1,140.44
$1,733.02
$882.80
$969.00
$1,060.30
$1,384.68
$1,127.04
$1,213.24
$1,304.54
$1,628.92
$1,371.28
$1,457.48
$1,548.78
$1,873.16
$244.24
Toc - Plan #27 Ambetter from MHS
Expanded Bronze

(EPO) Ambetter Essential Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$312.50
$354.68
$399.36
$558.11
$848.10
$551.56
$593.74
$638.42
$797.17
$790.62
$832.80
$877.48
$1,036.23
$1,029.68
$1,071.86
$1,116.54
$1,275.29
$239.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$625.00
$709.36
$798.72
$1,116.22
$1,696.20
$864.06
$948.42
$1,037.78
$1,355.28
$1,103.12
$1,187.48
$1,276.84
$1,594.34
$1,342.18
$1,426.54
$1,515.90
$1,833.40
$239.06
Toc - Plan #28 Ambetter from MHS
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$338.89
$384.63
$433.08
$605.23
$919.71
$598.13
$643.87
$692.32
$864.47
$857.37
$903.11
$951.56
$1,123.71
$1,116.61
$1,162.35
$1,210.80
$1,382.95
$259.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$677.78
$769.26
$866.16
$1,210.46
$1,839.42
$937.02
$1,028.50
$1,125.40
$1,469.70
$1,196.26
$1,287.74
$1,384.64
$1,728.94
$1,455.50
$1,546.98
$1,643.88
$1,988.18
$259.24
Toc - Plan #29 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$321.08
$364.42
$410.33
$573.43
$871.39
$566.70
$610.04
$655.95
$819.05
$812.32
$855.66
$901.57
$1,064.67
$1,057.94
$1,101.28
$1,147.19
$1,310.29
$245.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$642.16
$728.84
$820.66
$1,146.86
$1,742.78
$887.78
$974.46
$1,066.28
$1,392.48
$1,133.40
$1,220.08
$1,311.90
$1,638.10
$1,379.02
$1,465.70
$1,557.52
$1,883.72
$245.62
Toc - Plan #30 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 31

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$320.88
$364.19
$410.07
$573.07
$870.84
$566.34
$609.65
$655.53
$818.53
$811.80
$855.11
$900.99
$1,063.99
$1,057.26
$1,100.57
$1,146.45
$1,309.45
$245.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$641.76
$728.38
$820.14
$1,146.14
$1,741.68
$887.22
$973.84
$1,065.60
$1,391.60
$1,132.68
$1,219.30
$1,311.06
$1,637.06
$1,378.14
$1,464.76
$1,556.52
$1,882.52
$245.46
Toc - Plan #31 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 32

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$326.24
$370.27
$416.92
$582.64
$885.38
$575.80
$619.83
$666.48
$832.20
$825.36
$869.39
$916.04
$1,081.76
$1,074.92
$1,118.95
$1,165.60
$1,331.32
$249.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$652.48
$740.54
$833.84
$1,165.28
$1,770.76
$902.04
$990.10
$1,083.40
$1,414.84
$1,151.60
$1,239.66
$1,332.96
$1,664.40
$1,401.16
$1,489.22
$1,582.52
$1,913.96
$249.56
Toc - Plan #32 Ambetter from MHS
Gold

(EPO) Ambetter Secure Care 20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$408.92
$464.11
$522.59
$730.31
$1,109.78
$721.74
$776.93
$835.41
$1,043.13
$1,034.56
$1,089.75
$1,148.23
$1,355.95
$1,347.38
$1,402.57
$1,461.05
$1,668.77
$312.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$817.84
$928.22
$1,045.18
$1,460.62
$2,219.56
$1,130.66
$1,241.04
$1,358.00
$1,773.44
$1,443.48
$1,553.86
$1,670.82
$2,086.26
$1,756.30
$1,866.68
$1,983.64
$2,399.08
$312.82
Toc - Plan #33 Ambetter from MHS
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$350.33
$397.61
$447.71
$625.67
$950.76
$618.32
$665.60
$715.70
$893.66
$886.31
$933.59
$983.69
$1,161.65
$1,154.30
$1,201.58
$1,251.68
$1,429.64
$267.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$700.66
$795.22
$895.42
$1,251.34
$1,901.52
$968.65
$1,063.21
$1,163.41
$1,519.33
$1,236.64
$1,331.20
$1,431.40
$1,787.32
$1,504.63
$1,599.19
$1,699.39
$2,055.31
$267.99
Toc - Plan #34 Ambetter from MHS
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$354.19
$401.99
$452.64
$632.56
$961.24
$625.14
$672.94
$723.59
$903.51
$896.09
$943.89
$994.54
$1,174.46
$1,167.04
$1,214.84
$1,265.49
$1,445.41
$270.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$708.38
$803.98
$905.28
$1,265.12
$1,922.48
$979.33
$1,074.93
$1,176.23
$1,536.07
$1,250.28
$1,345.88
$1,447.18
$1,807.02
$1,521.23
$1,616.83
$1,718.13
$2,077.97
$270.95
Toc - Plan #35 Ambetter from MHS
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$454.53
$515.88
$580.87
$811.77
$1,233.56
$802.23
$863.58
$928.57
$1,159.47
$1,149.93
$1,211.28
$1,276.27
$1,507.17
$1,497.63
$1,558.98
$1,623.97
$1,854.87
$347.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$909.06
$1,031.76
$1,161.74
$1,623.54
$2,467.12
$1,256.76
$1,379.46
$1,509.44
$1,971.24
$1,604.46
$1,727.16
$1,857.14
$2,318.94
$1,952.16
$2,074.86
$2,204.84
$2,666.64
$347.70
Toc - Plan #36 Ambetter from MHS
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$304.64
$345.75
$389.31
$544.07
$826.76
$537.68
$578.79
$622.35
$777.11
$770.72
$811.83
$855.39
$1,010.15
$1,003.76
$1,044.87
$1,088.43
$1,243.19
$233.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$609.28
$691.50
$778.62
$1,088.14
$1,653.52
$842.32
$924.54
$1,011.66
$1,321.18
$1,075.36
$1,157.58
$1,244.70
$1,554.22
$1,308.40
$1,390.62
$1,477.74
$1,787.26
$233.04
Toc - Plan #37 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 24 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 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
$361.24
$409.99
$461.65
$645.15
$980.37
$637.58
$686.33
$737.99
$921.49
$913.92
$962.67
$1,014.33
$1,197.83
$1,190.26
$1,239.01
$1,290.67
$1,474.17
$276.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$722.48
$819.98
$923.30
$1,290.30
$1,960.74
$998.82
$1,096.32
$1,199.64
$1,566.64
$1,275.16
$1,372.66
$1,475.98
$1,842.98
$1,551.50
$1,649.00
$1,752.32
$2,119.32
$276.34
Toc - Plan #38 Ambetter from MHS
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$372.00
$422.21
$475.41
$664.38
$1,009.59
$656.57
$706.78
$759.98
$948.95
$941.14
$991.35
$1,044.55
$1,233.52
$1,225.71
$1,275.92
$1,329.12
$1,518.09
$284.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744.00
$844.42
$950.82
$1,328.76
$2,019.18
$1,028.57
$1,128.99
$1,235.39
$1,613.33
$1,313.14
$1,413.56
$1,519.96
$1,897.90
$1,597.71
$1,698.13
$1,804.53
$2,182.47
$284.57
Toc - Plan #39 Ambetter from MHS
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$333.43
$378.43
$426.11
$595.49
$904.91
$588.50
$633.50
$681.18
$850.56
$843.57
$888.57
$936.25
$1,105.63
$1,098.64
$1,143.64
$1,191.32
$1,360.70
$255.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$666.86
$756.86
$852.22
$1,190.98
$1,809.82
$921.93
$1,011.93
$1,107.29
$1,446.05
$1,177.00
$1,267.00
$1,362.36
$1,701.12
$1,432.07
$1,522.07
$1,617.43
$1,956.19
$255.07
Toc - Plan #40 Ambetter from MHS
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$326.35
$370.40
$417.06
$582.84
$885.68
$576.00
$620.05
$666.71
$832.49
$825.65
$869.70
$916.36
$1,082.14
$1,075.30
$1,119.35
$1,166.01
$1,331.79
$249.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$652.70
$740.80
$834.12
$1,165.68
$1,771.36
$902.35
$990.45
$1,083.77
$1,415.33
$1,152.00
$1,240.10
$1,333.42
$1,664.98
$1,401.65
$1,489.75
$1,583.07
$1,914.63
$249.65
Toc - Plan #41 Ambetter from MHS
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$353.90
$401.67
$452.28
$632.06
$960.47
$624.63
$672.40
$723.01
$902.79
$895.36
$943.13
$993.74
$1,173.52
$1,166.09
$1,213.86
$1,264.47
$1,444.25
$270.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$707.80
$803.34
$904.56
$1,264.12
$1,920.94
$978.53
$1,074.07
$1,175.29
$1,534.85
$1,249.26
$1,344.80
$1,446.02
$1,805.58
$1,519.99
$1,615.53
$1,716.75
$2,076.31
$270.73
Toc - Plan #42 Ambetter from MHS
Silver

(EPO) Ambetter Balanced Care 30 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$335.31
$380.57
$428.51
$598.85
$910.00
$591.81
$637.07
$685.01
$855.35
$848.31
$893.57
$941.51
$1,111.85
$1,104.81
$1,150.07
$1,198.01
$1,368.35
$256.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$670.62
$761.14
$857.02
$1,197.70
$1,820.00
$927.12
$1,017.64
$1,113.52
$1,454.20
$1,183.62
$1,274.14
$1,370.02
$1,710.70
$1,440.12
$1,530.64
$1,626.52
$1,967.20
$256.50
Toc - Plan #43 Ambetter from MHS
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$340.69
$386.68
$435.39
$608.46
$924.61
$601.31
$647.30
$696.01
$869.08
$861.93
$907.92
$956.63
$1,129.70
$1,122.55
$1,168.54
$1,217.25
$1,390.32
$260.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681.38
$773.36
$870.78
$1,216.92
$1,849.22
$942.00
$1,033.98
$1,131.40
$1,477.54
$1,202.62
$1,294.60
$1,392.02
$1,738.16
$1,463.24
$1,555.22
$1,652.64
$1,998.78
$260.62
Toc - Plan #44 Ambetter from MHS
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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
$427.04
$484.68
$545.75
$762.68
$1,158.96
$753.72
$811.36
$872.43
$1,089.36
$1,080.40
$1,138.04
$1,199.11
$1,416.04
$1,407.08
$1,464.72
$1,525.79
$1,742.72
$326.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$854.08
$969.36
$1,091.50
$1,525.36
$2,317.92
$1,180.76
$1,296.04
$1,418.18
$1,852.04
$1,507.44
$1,622.72
$1,744.86
$2,178.72
$1,834.12
$1,949.40
$2,071.54
$2,505.40
$326.68

‡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 Owen County here.

Owen County is in “Rating Area 15” of Indiana.

Currently, there are 44 plans offered in Rating Area 15.

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2022 Obamacare Plans for Owen County, IN

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