Obamacare 2022 Rates for Sheridan County

Obamacare > Rates > Montana > Sheridan 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 Sheridan County, MT.

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, 26 Plans and 2022 Rates for Sheridan County, Montana

Below, you’ll find a summary of the 26 plans for Sheridan County, Montana 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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PacificSource Health Plans

Local: 1-406-442-6589 | Toll Free: 1-877-590-1596 | TTY: 1-800-253-4091
Toc - Plan #1 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze HSA 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$297.00
$337.00
$380.00
$530.00
$806.00 		$524.00
$564.00
$607.00
$757.00 		$751.00
$791.00
$834.00
$984.00 		$978.00
$1,018.00
$1,061.00
$1,211.00 		$227.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$594.00
$674.00
$760.00
$1,060.00
$1,612.00 		$821.00
$901.00
$987.00
$1,287.00 		$1,048.00
$1,128.00
$1,214.00
$1,514.00 		$1,275.00
$1,355.00
$1,441.00
$1,741.00 		$227.00
Toc - Plan #2 PacificSource Health Plans
Silver

(PPO) Navigator Silver HSA 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$6,750 $13,500 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 		$410.00
$465.00
$524.00
$732.00
$1,112.00 		$724.00
$779.00
$838.00
$1,046.00 		$1,038.00
$1,093.00
$1,152.00
$1,360.00 		$1,352.00
$1,407.00
$1,466.00
$1,674.00 		$314.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$820.00
$930.00
$1,048.00
$1,464.00
$2,224.00 		$1,134.00
$1,244.00
$1,362.00
$1,778.00 		$1,448.00
$1,558.00
$1,676.00
$2,092.00 		$1,762.00
$1,872.00
$1,990.00
$2,406.00 		$314.00
Toc - Plan #3 PacificSource Health Plans
Gold

(PPO) Navigator Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,000 $10,000 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 		$442.00
$502.00
$565.00
$790.00
$1,201.00 		$780.00
$840.00
$903.00
$1,128.00 		$1,118.00
$1,178.00
$1,241.00
$1,466.00 		$1,456.00
$1,516.00
$1,579.00
$1,804.00 		$338.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$884.00
$1,004.00
$1,130.00
$1,580.00
$2,402.00 		$1,222.00
$1,342.00
$1,468.00
$1,918.00 		$1,560.00
$1,680.00
$1,806.00
$2,256.00 		$1,898.00
$2,018.00
$2,144.00
$2,594.00 		$338.00
Toc - Plan #4 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 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 		$306.00
$347.00
$391.00
$547.00
$831.00 		$540.00
$581.00
$625.00
$781.00 		$774.00
$815.00
$859.00
$1,015.00 		$1,008.00
$1,049.00
$1,093.00
$1,249.00 		$234.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$612.00
$694.00
$782.00
$1,094.00
$1,662.00 		$846.00
$928.00
$1,016.00
$1,328.00 		$1,080.00
$1,162.00
$1,250.00
$1,562.00 		$1,314.00
$1,396.00
$1,484.00
$1,796.00 		$234.00
Toc - Plan #5 PacificSource Health Plans
Silver

(PPO) Navigator Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,150 $16,300 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 		$397.00
$450.00
$507.00
$708.00
$1,076.00 		$700.00
$753.00
$810.00
$1,011.00 		$1,003.00
$1,056.00
$1,113.00
$1,314.00 		$1,306.00
$1,359.00
$1,416.00
$1,617.00 		$303.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$794.00
$900.00
$1,014.00
$1,416.00
$2,152.00 		$1,097.00
$1,203.00
$1,317.00
$1,719.00 		$1,400.00
$1,506.00
$1,620.00
$2,022.00 		$1,703.00
$1,809.00
$1,923.00
$2,325.00 		$303.00
Toc - Plan #6 PacificSource Health Plans
Bronze

(PPO) Navigator Bronze 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

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 		$277.00
$315.00
$354.00
$495.00
$752.00 		$489.00
$527.00
$566.00
$707.00 		$701.00
$739.00
$778.00
$919.00 		$913.00
$951.00
$990.00
$1,131.00 		$212.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$554.00
$630.00
$708.00
$990.00
$1,504.00 		$766.00
$842.00
$920.00
$1,202.00 		$978.00
$1,054.00
$1,132.00
$1,414.00 		$1,190.00
$1,266.00
$1,344.00
$1,626.00 		$212.00

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Blue Cross and Blue Shield of Montana

Local: 1-855-258-8471 | Toll Free: 1-855-258-8471 | TTY: 1-406-444-4212
Toc - Plan #7 Blue Cross and Blue Shield of Montana
Gold

(PPO) Blue Preferred Gold PPO? 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 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 		$447.39
$507.79
$571.77
$799.04
$1,214.22 		$789.64
$850.04
$914.02
$1,141.29 		$1,131.89
$1,192.29
$1,256.27
$1,483.54 		$1,474.14
$1,534.54
$1,598.52
$1,825.79 		$342.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$894.78
$1,015.58
$1,143.54
$1,598.08
$2,428.44 		$1,237.03
$1,357.83
$1,485.79
$1,940.33 		$1,579.28
$1,700.08
$1,828.04
$2,282.58 		$1,921.53
$2,042.33
$2,170.29
$2,624.83 		$342.25
Toc - Plan #8 Blue Cross and Blue Shield of Montana
Silver

(PPO) Blue Preferred Silver PPO? 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$800 $1,600 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 		$425.01
$482.39
$543.16
$759.07
$1,153.48 		$750.14
$807.52
$868.29
$1,084.20 		$1,075.27
$1,132.65
$1,193.42
$1,409.33 		$1,400.40
$1,457.78
$1,518.55
$1,734.46 		$325.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$850.02
$964.78
$1,086.32
$1,518.14
$2,306.96 		$1,175.15
$1,289.91
$1,411.45
$1,843.27 		$1,500.28
$1,615.04
$1,736.58
$2,168.40 		$1,825.41
$1,940.17
$2,061.71
$2,493.53 		$325.13
Toc - Plan #9 Blue Cross and Blue Shield of Montana
Expanded Bronze

(PPO) Blue Preferred Bronze PPO? 201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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 		$321.24
$364.60
$410.54
$573.73
$871.84 		$566.99
$610.35
$656.29
$819.48 		$812.74
$856.10
$902.04
$1,065.23 		$1,058.49
$1,101.85
$1,147.79
$1,310.98 		$245.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$642.48
$729.20
$821.08
$1,147.46
$1,743.68 		$888.23
$974.95
$1,066.83
$1,393.21 		$1,133.98
$1,220.70
$1,312.58
$1,638.96 		$1,379.73
$1,466.45
$1,558.33
$1,884.71 		$245.75
Toc - Plan #10 Blue Cross and Blue Shield of Montana
Expanded Bronze

(PPO) Blue Preferred Bronze PPO? 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$337.09
$382.59
$430.80
$602.04
$914.85 		$594.96
$640.46
$688.67
$859.91 		$852.83
$898.33
$946.54
$1,117.78 		$1,110.70
$1,156.20
$1,204.41
$1,375.65 		$257.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674.18
$765.18
$861.60
$1,204.08
$1,829.70 		$932.05
$1,023.05
$1,119.47
$1,461.95 		$1,189.92
$1,280.92
$1,377.34
$1,719.82 		$1,447.79
$1,538.79
$1,635.21
$1,977.69 		$257.87
Toc - Plan #11 Blue Cross and Blue Shield of Montana
Catastrophic

(PPO) Blue Preferred Security PPO? 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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 		$281.17
$319.13
$359.34
$502.18
$763.10 		$496.27
$534.23
$574.44
$717.28 		$711.37
$749.33
$789.54
$932.38 		$926.47
$964.43
$1,004.64
$1,147.48 		$215.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$562.34
$638.26
$718.68
$1,004.36
$1,526.20 		$777.44
$853.36
$933.78
$1,219.46 		$992.54
$1,068.46
$1,148.88
$1,434.56 		$1,207.64
$1,283.56
$1,363.98
$1,649.66 		$215.10
Toc - Plan #12 Blue Cross and Blue Shield of Montana
Silver

(PPO) Blue Preferred Silver PPO? 308

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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 		$395.96
$449.41
$506.04
$707.19
$1,074.64 		$698.87
$752.32
$808.95
$1,010.10 		$1,001.78
$1,055.23
$1,111.86
$1,313.01 		$1,304.69
$1,358.14
$1,414.77
$1,615.92 		$302.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791.92
$898.82
$1,012.08
$1,414.38
$2,149.28 		$1,094.83
$1,201.73
$1,314.99
$1,717.29 		$1,397.74
$1,504.64
$1,617.90
$2,020.20 		$1,700.65
$1,807.55
$1,920.81
$2,323.11 		$302.91
Toc - Plan #13 Blue Cross and Blue Shield of Montana
Bronze

(PPO) Blue Preferred Bronze PPO? 301

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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 		$306.33
$347.69
$391.49
$547.11
$831.38 		$540.67
$582.03
$625.83
$781.45 		$775.01
$816.37
$860.17
$1,015.79 		$1,009.35
$1,050.71
$1,094.51
$1,250.13 		$234.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$612.66
$695.38
$782.98
$1,094.22
$1,662.76 		$847.00
$929.72
$1,017.32
$1,328.56 		$1,081.34
$1,164.06
$1,251.66
$1,562.90 		$1,315.68
$1,398.40
$1,486.00
$1,797.24 		$234.34

ADVERTISEMENT

Mountain Health CO-OP

Local: 1-406-447-9510 | Toll Free: 1-855-447-2900 | TTY: 1-855-447-2900
Toc - Plan #14 Mountain Health CO-OP
Gold

(PPO) PLUS IND GOLD MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 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 		$409.18
$464.42
$522.93
$730.79
$1,110.51 		$722.20
$777.44
$835.95
$1,043.81 		$1,035.22
$1,090.46
$1,148.97
$1,356.83 		$1,348.24
$1,403.48
$1,461.99
$1,669.85 		$313.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$818.36
$928.84
$1,045.86
$1,461.58
$2,221.02 		$1,131.38
$1,241.86
$1,358.88
$1,774.60 		$1,444.40
$1,554.88
$1,671.90
$2,087.62 		$1,757.42
$1,867.90
$1,984.92
$2,400.64 		$313.02
Toc - Plan #15 Mountain Health CO-OP
Silver

(PPO) PLUS IND SILVER MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 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 		$372.83
$423.16
$476.48
$665.87
$1,011.86 		$658.04
$708.37
$761.69
$951.08 		$943.25
$993.58
$1,046.90
$1,236.29 		$1,228.46
$1,278.79
$1,332.11
$1,521.50 		$285.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$745.66
$846.32
$952.96
$1,331.74
$2,023.72 		$1,030.87
$1,131.53
$1,238.17
$1,616.95 		$1,316.08
$1,416.74
$1,523.38
$1,902.16 		$1,601.29
$1,701.95
$1,808.59
$2,187.37 		$285.21
Toc - Plan #16 Mountain Health CO-OP
Expanded Bronze

(PPO) PLUS IND BRONZE MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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 		$278.81
$316.45
$356.32
$497.95
$756.68 		$492.10
$529.74
$569.61
$711.24 		$705.39
$743.03
$782.90
$924.53 		$918.68
$956.32
$996.19
$1,137.82 		$213.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557.62
$632.90
$712.64
$995.90
$1,513.36 		$770.91
$846.19
$925.93
$1,209.19 		$984.20
$1,059.48
$1,139.22
$1,422.48 		$1,197.49
$1,272.77
$1,352.51
$1,635.77 		$213.29
Toc - Plan #17 Mountain Health CO-OP
Expanded Bronze

(PPO) PLUS IND BRONZE MT HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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 		$289.09
$328.12
$369.46
$516.32
$784.59 		$510.24
$549.27
$590.61
$737.47 		$731.39
$770.42
$811.76
$958.62 		$952.54
$991.57
$1,032.91
$1,179.77 		$221.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$578.18
$656.24
$738.92
$1,032.64
$1,569.18 		$799.33
$877.39
$960.07
$1,253.79 		$1,020.48
$1,098.54
$1,181.22
$1,474.94 		$1,241.63
$1,319.69
$1,402.37
$1,696.09 		$221.15
Toc - Plan #18 Mountain Health CO-OP
Gold

(PPO) CONNECT IND GOLD MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,000 $12,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$429.82
$487.84
$549.30
$767.65
$1,166.52 		$758.63
$816.65
$878.11
$1,096.46 		$1,087.44
$1,145.46
$1,206.92
$1,425.27 		$1,416.25
$1,474.27
$1,535.73
$1,754.08 		$328.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$859.64
$975.68
$1,098.60
$1,535.30
$2,333.04 		$1,188.45
$1,304.49
$1,427.41
$1,864.11 		$1,517.26
$1,633.30
$1,756.22
$2,192.92 		$1,846.07
$1,962.11
$2,085.03
$2,521.73 		$328.81
Toc - Plan #19 Mountain Health CO-OP
Silver

(PPO) CONNECT IND SILVER MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 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 		$397.26
$450.89
$507.70
$709.51
$1,078.17 		$701.16
$754.79
$811.60
$1,013.41 		$1,005.06
$1,058.69
$1,115.50
$1,317.31 		$1,308.96
$1,362.59
$1,419.40
$1,621.21 		$303.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$794.52
$901.78
$1,015.40
$1,419.02
$2,156.34 		$1,098.42
$1,205.68
$1,319.30
$1,722.92 		$1,402.32
$1,509.58
$1,623.20
$2,026.82 		$1,706.22
$1,813.48
$1,927.10
$2,330.72 		$303.90
Toc - Plan #20 Mountain Health CO-OP
Expanded Bronze

(PPO) CONNECT IND BRONZE MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,500 $16,300 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 		$287.85
$326.71
$367.87
$514.10
$781.22 		$508.05
$546.91
$588.07
$734.30 		$728.25
$767.11
$808.27
$954.50 		$948.45
$987.31
$1,028.47
$1,174.70 		$220.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$575.70
$653.42
$735.74
$1,028.20
$1,562.44 		$795.90
$873.62
$955.94
$1,248.40 		$1,016.10
$1,093.82
$1,176.14
$1,468.60 		$1,236.30
$1,314.02
$1,396.34
$1,688.80 		$220.20
Toc - Plan #21 Mountain Health CO-OP
Expanded Bronze

(PPO) CONNECT IND BRONZE MT HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$301.19
$341.86
$384.93
$537.93
$817.44 		$531.60
$572.27
$615.34
$768.34 		$762.01
$802.68
$845.75
$998.75 		$992.42
$1,033.09
$1,076.16
$1,229.16 		$230.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$602.38
$683.72
$769.86
$1,075.86
$1,634.88 		$832.79
$914.13
$1,000.27
$1,306.27 		$1,063.20
$1,144.54
$1,230.68
$1,536.68 		$1,293.61
$1,374.95
$1,461.09
$1,767.09 		$230.41
Toc - Plan #22 Mountain Health CO-OP
Silver

(PPO) CONNECT IND SILVER MT OPTION 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$8,150 $16,300 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 		$389.62
$442.22
$497.93
$695.86
$1,057.42 		$687.68
$740.28
$795.99
$993.92 		$985.74
$1,038.34
$1,094.05
$1,291.98 		$1,283.80
$1,336.40
$1,392.11
$1,590.04 		$298.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$779.24
$884.44
$995.86
$1,391.72
$2,114.84 		$1,077.30
$1,182.50
$1,293.92
$1,689.78 		$1,375.36
$1,480.56
$1,591.98
$1,987.84 		$1,673.42
$1,778.62
$1,890.04
$2,285.90 		$298.06
Toc - Plan #23 Mountain Health CO-OP
Catastrophic

(PPO) CONNECT IND CATASTROPHIC MT

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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 		$227.02
$257.67
$290.13
$405.46
$616.14 		$400.69
$431.34
$463.80
$579.13 		$574.36
$605.01
$637.47
$752.80 		$748.03
$778.68
$811.14
$926.47 		$173.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$454.04
$515.34
$580.26
$810.92
$1,232.28 		$627.71
$689.01
$753.93
$984.59 		$801.38
$862.68
$927.60
$1,158.26 		$975.05
$1,036.35
$1,101.27
$1,331.93 		$173.67
Toc - Plan #24 Mountain Health CO-OP
Expanded Bronze

(PPO) CONNECT IND BRONZE MT EXPANDED

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$8,400 $16,800 Annual Deductible
$8,550 $17,100 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 		$297.26
$337.39
$379.89
$530.90
$806.75 		$524.66
$564.79
$607.29
$758.30 		$752.06
$792.19
$834.69
$985.70 		$979.46
$1,019.59
$1,062.09
$1,213.10 		$227.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$594.52
$674.78
$759.78
$1,061.80
$1,613.50 		$821.92
$902.18
$987.18
$1,289.20 		$1,049.32
$1,129.58
$1,214.58
$1,516.60 		$1,276.72
$1,356.98
$1,441.98
$1,744.00 		$227.40
Toc - Plan #25 Mountain Health CO-OP
Gold

(PPO) CONNECT IND GOLD MT BASE

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$3,100 $6,200 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 		$405.78
$460.56
$518.58
$724.72
$1,101.28 		$716.20
$770.98
$829.00
$1,035.14 		$1,026.62
$1,081.40
$1,139.42
$1,345.56 		$1,337.04
$1,391.82
$1,449.84
$1,655.98 		$310.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$811.56
$921.12
$1,037.16
$1,449.44
$2,202.56 		$1,121.98
$1,231.54
$1,347.58
$1,759.86 		$1,432.40
$1,541.96
$1,658.00
$2,070.28 		$1,742.82
$1,852.38
$1,968.42
$2,380.70 		$310.42
Toc - Plan #26 Mountain Health CO-OP
Silver

(PPO) CONNECT IND SILVER BASE

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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 		$381.12
$432.57
$487.07
$680.67
$1,034.35 		$672.67
$724.12
$778.62
$972.22 		$964.22
$1,015.67
$1,070.17
$1,263.77 		$1,255.77
$1,307.22
$1,361.72
$1,555.32 		$291.55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$762.24
$865.14
$974.14
$1,361.34
$2,068.70 		$1,053.79
$1,156.69
$1,265.69
$1,652.89 		$1,345.34
$1,448.24
$1,557.24
$1,944.44 		$1,636.89
$1,739.79
$1,848.79
$2,235.99 		$291.55

‡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 Sheridan County here.

Sheridan County is in “Rating Area 4” of Montana.

Currently, there are 26 plans offered in Rating Area 4.

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2022 Obamacare Plans for Sheridan County, MT

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