Obamacare 2022 Rates for Pawnee County

Obamacare > Rates > Nebraska > Pawnee 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 Pawnee County, NE.

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, 85 Plans and 2022 Rates for Pawnee County, Nebraska

Below, you’ll find a summary of the 85 plans for Pawnee County, Nebraska 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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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-833-7352

Toc - Plan #1 Medica
Silver

(EPO) Medica Insure Silver Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$593.71
$673.85
$758.75
$1,060.35
$1,611.31
$1,047.89
$1,128.03
$1,212.93
$1,514.53
$1,502.07
$1,582.21
$1,667.11
$1,968.71
$1,956.25
$2,036.39
$2,121.29
$2,422.89
$454.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,187.42
$1,347.70
$1,517.50
$2,120.70
$3,222.62
$1,641.60
$1,801.88
$1,971.68
$2,574.88
$2,095.78
$2,256.06
$2,425.86
$3,029.06
$2,549.96
$2,710.24
$2,880.04
$3,483.24
$454.18
Toc - Plan #2 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$427.08
$484.73
$545.80
$762.75
$1,159.07
$753.79
$811.44
$872.51
$1,089.46
$1,080.50
$1,138.15
$1,199.22
$1,416.17
$1,407.21
$1,464.86
$1,525.93
$1,742.88
$326.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$854.16
$969.46
$1,091.60
$1,525.50
$2,318.14
$1,180.87
$1,296.17
$1,418.31
$1,852.21
$1,507.58
$1,622.88
$1,745.02
$2,178.92
$1,834.29
$1,949.59
$2,071.73
$2,505.63
$326.71
Toc - Plan #3 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Copay + Dental Reimbursement ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$453.56
$514.78
$579.64
$810.04
$1,230.94
$800.53
$861.75
$926.61
$1,157.01
$1,147.50
$1,208.72
$1,273.58
$1,503.98
$1,494.47
$1,555.69
$1,620.55
$1,850.95
$346.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$907.12
$1,029.56
$1,159.28
$1,620.08
$2,461.88
$1,254.09
$1,376.53
$1,506.25
$1,967.05
$1,601.06
$1,723.50
$1,853.22
$2,314.02
$1,948.03
$2,070.47
$2,200.19
$2,660.99
$346.97
Toc - Plan #4 Medica
Expanded Bronze

(EPO) Medica Insure Bronze HSA ($0 Virtual Care after deductible + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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
$478.24
$542.79
$611.18
$854.12
$1,297.92
$844.09
$908.64
$977.03
$1,219.97
$1,209.94
$1,274.49
$1,342.88
$1,585.82
$1,575.79
$1,640.34
$1,708.73
$1,951.67
$365.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$956.48
$1,085.58
$1,222.36
$1,708.24
$2,595.84
$1,322.33
$1,451.43
$1,588.21
$2,074.09
$1,688.18
$1,817.28
$1,954.06
$2,439.94
$2,054.03
$2,183.13
$2,319.91
$2,805.79
$365.85
Toc - Plan #5 Medica
Catastrophic

(EPO) Medica Insure Catastrophic ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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
$305.87
$347.15
$390.89
$546.27
$830.11
$539.85
$581.13
$624.87
$780.25
$773.83
$815.11
$858.85
$1,014.23
$1,007.81
$1,049.09
$1,092.83
$1,248.21
$233.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$611.74
$694.30
$781.78
$1,092.54
$1,660.22
$845.72
$928.28
$1,015.76
$1,326.52
$1,079.70
$1,162.26
$1,249.74
$1,560.50
$1,313.68
$1,396.24
$1,483.72
$1,794.48
$233.98
Toc - Plan #6 Medica
Gold

(EPO) Medica Insure Gold Share ($0 Virtual Care + $5 Generic Drugs + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$850 $2,550 Annual Deductible
$8,450 $16,900 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
$595.06
$675.38
$760.47
$1,062.76
$1,614.96
$1,050.27
$1,130.59
$1,215.68
$1,517.97
$1,505.48
$1,585.80
$1,670.89
$1,973.18
$1,960.69
$2,041.01
$2,126.10
$2,428.39
$455.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,190.12
$1,350.76
$1,520.94
$2,125.52
$3,229.92
$1,645.33
$1,805.97
$1,976.15
$2,580.73
$2,100.54
$2,261.18
$2,431.36
$3,035.94
$2,555.75
$2,716.39
$2,886.57
$3,491.15
$455.21
Toc - Plan #7 Medica
Silver

(EPO) Medica Insure Silver Share ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,000 $6,000 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
$590.47
$670.17
$754.61
$1,054.56
$1,602.51
$1,042.17
$1,121.87
$1,206.31
$1,506.26
$1,493.87
$1,573.57
$1,658.01
$1,957.96
$1,945.57
$2,025.27
$2,109.71
$2,409.66
$451.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,180.94
$1,340.34
$1,509.22
$2,109.12
$3,205.02
$1,632.64
$1,792.04
$1,960.92
$2,560.82
$2,084.34
$2,243.74
$2,412.62
$3,012.52
$2,536.04
$2,695.44
$2,864.32
$3,464.22
$451.70
Toc - Plan #8 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Share Plus ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $7,500 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
$432.83
$491.26
$553.15
$773.02
$1,174.69
$763.94
$822.37
$884.26
$1,104.13
$1,095.05
$1,153.48
$1,215.37
$1,435.24
$1,426.16
$1,484.59
$1,546.48
$1,766.35
$331.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$865.66
$982.52
$1,106.30
$1,546.04
$2,349.38
$1,196.77
$1,313.63
$1,437.41
$1,877.15
$1,527.88
$1,644.74
$1,768.52
$2,208.26
$1,858.99
$1,975.85
$2,099.63
$2,539.37
$331.11
Toc - Plan #9 Medica
Bronze

(EPO) Medica Insure Bronze Value ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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
$417.60
$473.96
$533.68
$745.81
$1,133.33
$737.05
$793.41
$853.13
$1,065.26
$1,056.50
$1,112.86
$1,172.58
$1,384.71
$1,375.95
$1,432.31
$1,492.03
$1,704.16
$319.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835.20
$947.92
$1,067.36
$1,491.62
$2,266.66
$1,154.65
$1,267.37
$1,386.81
$1,811.07
$1,474.10
$1,586.82
$1,706.26
$2,130.52
$1,793.55
$1,906.27
$2,025.71
$2,449.97
$319.45
Toc - Plan #10 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Copay $0 PC Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$432.96
$491.39
$553.31
$773.24
$1,175.02
$764.16
$822.59
$884.51
$1,104.44
$1,095.36
$1,153.79
$1,215.71
$1,435.64
$1,426.56
$1,484.99
$1,546.91
$1,766.84
$331.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$865.92
$982.78
$1,106.62
$1,546.48
$2,350.04
$1,197.12
$1,313.98
$1,437.82
$1,877.68
$1,528.32
$1,645.18
$1,769.02
$2,208.88
$1,859.52
$1,976.38
$2,100.22
$2,540.08
$331.20
Toc - Plan #11 Medica
Gold

(EPO) Medica with CHI Health Gold Copay ($0 Virtual Care + $5 Generic Drugs + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,250 $3,750 Annual Deductible
$8,450 $16,900 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
$457.08
$518.78
$584.14
$816.33
$1,240.49
$806.74
$868.44
$933.80
$1,165.99
$1,156.40
$1,218.10
$1,283.46
$1,515.65
$1,506.06
$1,567.76
$1,633.12
$1,865.31
$349.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$914.16
$1,037.56
$1,168.28
$1,632.66
$2,480.98
$1,263.82
$1,387.22
$1,517.94
$1,982.32
$1,613.48
$1,736.88
$1,867.60
$2,331.98
$1,963.14
$2,086.54
$2,217.26
$2,681.64
$349.66
Toc - Plan #12 Medica
Silver

(EPO) Medica with CHI Health Silver Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$455.06
$516.49
$581.56
$812.73
$1,235.02
$803.18
$864.61
$929.68
$1,160.85
$1,151.30
$1,212.73
$1,277.80
$1,508.97
$1,499.42
$1,560.85
$1,625.92
$1,857.09
$348.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$910.12
$1,032.98
$1,163.12
$1,625.46
$2,470.04
$1,258.24
$1,381.10
$1,511.24
$1,973.58
$1,606.36
$1,729.22
$1,859.36
$2,321.70
$1,954.48
$2,077.34
$2,207.48
$2,669.82
$348.12
Toc - Plan #13 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$327.35
$371.53
$418.34
$584.62
$888.39
$577.76
$621.94
$668.75
$835.03
$828.17
$872.35
$919.16
$1,085.44
$1,078.58
$1,122.76
$1,169.57
$1,335.85
$250.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654.70
$743.06
$836.68
$1,169.24
$1,776.78
$905.11
$993.47
$1,087.09
$1,419.65
$1,155.52
$1,243.88
$1,337.50
$1,670.06
$1,405.93
$1,494.29
$1,587.91
$1,920.47
$250.41
Toc - Plan #14 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay + Dental Reimbursement ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$347.64
$394.56
$444.27
$620.87
$943.47
$613.58
$660.50
$710.21
$886.81
$879.52
$926.44
$976.15
$1,152.75
$1,145.46
$1,192.38
$1,242.09
$1,418.69
$265.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$695.28
$789.12
$888.54
$1,241.74
$1,886.94
$961.22
$1,055.06
$1,154.48
$1,507.68
$1,227.16
$1,321.00
$1,420.42
$1,773.62
$1,493.10
$1,586.94
$1,686.36
$2,039.56
$265.94
Toc - Plan #15 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze HSA ($0 Virtual Care after deductible + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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
$366.56
$416.03
$468.45
$654.66
$994.81
$646.97
$696.44
$748.86
$935.07
$927.38
$976.85
$1,029.27
$1,215.48
$1,207.79
$1,257.26
$1,309.68
$1,495.89
$280.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$733.12
$832.06
$936.90
$1,309.32
$1,989.62
$1,013.53
$1,112.47
$1,217.31
$1,589.73
$1,293.94
$1,392.88
$1,497.72
$1,870.14
$1,574.35
$1,673.29
$1,778.13
$2,150.55
$280.41
Toc - Plan #16 Medica
Catastrophic

(EPO) Medica with CHI Health Catastrophic ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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
$234.44
$266.08
$299.61
$418.70
$636.25
$413.78
$445.42
$478.95
$598.04
$593.12
$624.76
$658.29
$777.38
$772.46
$804.10
$837.63
$956.72
$179.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$468.88
$532.16
$599.22
$837.40
$1,272.50
$648.22
$711.50
$778.56
$1,016.74
$827.56
$890.84
$957.90
$1,196.08
$1,006.90
$1,070.18
$1,137.24
$1,375.42
$179.34
Toc - Plan #17 Medica
Silver

(EPO) Medica with CHI Health Silver Share ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,000 $6,000 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
$452.58
$513.67
$578.38
$808.29
$1,228.27
$798.80
$859.89
$924.60
$1,154.51
$1,145.02
$1,206.11
$1,270.82
$1,500.73
$1,491.24
$1,552.33
$1,617.04
$1,846.95
$346.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$905.16
$1,027.34
$1,156.76
$1,616.58
$2,456.54
$1,251.38
$1,373.56
$1,502.98
$1,962.80
$1,597.60
$1,719.78
$1,849.20
$2,309.02
$1,943.82
$2,066.00
$2,195.42
$2,655.24
$346.22
Toc - Plan #18 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Share Plus ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $7,500 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
$331.76
$376.53
$423.97
$592.50
$900.36
$585.55
$630.32
$677.76
$846.29
$839.34
$884.11
$931.55
$1,100.08
$1,093.13
$1,137.90
$1,185.34
$1,353.87
$253.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$663.52
$753.06
$847.94
$1,185.00
$1,800.72
$917.31
$1,006.85
$1,101.73
$1,438.79
$1,171.10
$1,260.64
$1,355.52
$1,692.58
$1,424.89
$1,514.43
$1,609.31
$1,946.37
$253.79
Toc - Plan #19 Medica
Bronze

(EPO) Medica with CHI Health Bronze Value ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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
$320.08
$363.28
$409.05
$571.64
$868.66
$564.93
$608.13
$653.90
$816.49
$809.78
$852.98
$898.75
$1,061.34
$1,054.63
$1,097.83
$1,143.60
$1,306.19
$244.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$640.16
$726.56
$818.10
$1,143.28
$1,737.32
$885.01
$971.41
$1,062.95
$1,388.13
$1,129.86
$1,216.26
$1,307.80
$1,632.98
$1,374.71
$1,461.11
$1,552.65
$1,877.83
$244.85
Toc - Plan #20 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay $0 PC Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$331.85
$376.64
$424.09
$592.67
$900.61
$585.71
$630.50
$677.95
$846.53
$839.57
$884.36
$931.81
$1,100.39
$1,093.43
$1,138.22
$1,185.67
$1,354.25
$253.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$663.70
$753.28
$848.18
$1,185.34
$1,801.22
$917.56
$1,007.14
$1,102.04
$1,439.20
$1,171.42
$1,261.00
$1,355.90
$1,693.06
$1,425.28
$1,514.86
$1,609.76
$1,946.92
$253.86

ADVERTISEMENT

Ambetter from Nebraska Total Care

Local: 1-833-890-0329 | Toll Free: 1-833-890-0329

Toc - Plan #21 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$334.15
$379.25
$427.03
$596.77
$906.85
$589.77
$634.87
$682.65
$852.39
$845.39
$890.49
$938.27
$1,108.01
$1,101.01
$1,146.11
$1,193.89
$1,363.63
$255.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$668.30
$758.50
$854.06
$1,193.54
$1,813.70
$923.92
$1,014.12
$1,109.68
$1,449.16
$1,179.54
$1,269.74
$1,365.30
$1,704.78
$1,435.16
$1,525.36
$1,620.92
$1,960.40
$255.62
Toc - Plan #22 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Ambetter Essential Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$330.68
$375.31
$422.60
$590.58
$897.44
$583.64
$628.27
$675.56
$843.54
$836.60
$881.23
$928.52
$1,096.50
$1,089.56
$1,134.19
$1,181.48
$1,349.46
$252.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$661.36
$750.62
$845.20
$1,181.16
$1,794.88
$914.32
$1,003.58
$1,098.16
$1,434.12
$1,167.28
$1,256.54
$1,351.12
$1,687.08
$1,420.24
$1,509.50
$1,604.08
$1,940.04
$252.96
Toc - Plan #23 Ambetter from Nebraska Total Care
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$357.91
$406.22
$457.40
$639.22
$971.35
$631.71
$680.02
$731.20
$913.02
$905.51
$953.82
$1,005.00
$1,186.82
$1,179.31
$1,227.62
$1,278.80
$1,460.62
$273.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$715.82
$812.44
$914.80
$1,278.44
$1,942.70
$989.62
$1,086.24
$1,188.60
$1,552.24
$1,263.42
$1,360.04
$1,462.40
$1,826.04
$1,537.22
$1,633.84
$1,736.20
$2,099.84
$273.80
Toc - Plan #24 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Ambetter Essential Care: $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$375.70
$426.41
$480.13
$670.98
$1,019.62
$663.10
$713.81
$767.53
$958.38
$950.50
$1,001.21
$1,054.93
$1,245.78
$1,237.90
$1,288.61
$1,342.33
$1,533.18
$287.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$751.40
$852.82
$960.26
$1,341.96
$2,039.24
$1,038.80
$1,140.22
$1,247.66
$1,629.36
$1,326.20
$1,427.62
$1,535.06
$1,916.76
$1,613.60
$1,715.02
$1,822.46
$2,204.16
$287.40
Toc - Plan #25 Ambetter from Nebraska Total Care
Silver

(HMO) Ambetter Balanced Care 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$412.63
$468.32
$527.32
$736.93
$1,119.84
$728.28
$783.97
$842.97
$1,052.58
$1,043.93
$1,099.62
$1,158.62
$1,368.23
$1,359.58
$1,415.27
$1,474.27
$1,683.88
$315.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.26
$936.64
$1,054.64
$1,473.86
$2,239.68
$1,140.91
$1,252.29
$1,370.29
$1,789.51
$1,456.56
$1,567.94
$1,685.94
$2,105.16
$1,772.21
$1,883.59
$2,001.59
$2,420.81
$315.65
Toc - Plan #26 Ambetter from Nebraska Total Care
Silver

(HMO) Ambetter Balanced Care 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$407.68
$462.70
$521.00
$728.09
$1,106.40
$719.54
$774.56
$832.86
$1,039.95
$1,031.40
$1,086.42
$1,144.72
$1,351.81
$1,343.26
$1,398.28
$1,456.58
$1,663.67
$311.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$815.36
$925.40
$1,042.00
$1,456.18
$2,212.80
$1,127.22
$1,237.26
$1,353.86
$1,768.04
$1,439.08
$1,549.12
$1,665.72
$2,079.90
$1,750.94
$1,860.98
$1,977.58
$2,391.76
$311.86
Toc - Plan #27 Ambetter from Nebraska Total Care
Gold

(HMO) Ambetter Secure Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$463.50
$526.06
$592.34
$827.80
$1,257.92
$818.07
$880.63
$946.91
$1,182.37
$1,172.64
$1,235.20
$1,301.48
$1,536.94
$1,527.21
$1,589.77
$1,656.05
$1,891.51
$354.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$927.00
$1,052.12
$1,184.68
$1,655.60
$2,515.84
$1,281.57
$1,406.69
$1,539.25
$2,010.17
$1,636.14
$1,761.26
$1,893.82
$2,364.74
$1,990.71
$2,115.83
$2,248.39
$2,719.31
$354.57
Toc - Plan #28 Ambetter from Nebraska Total Care
Bronze

(HMO) Ambetter Essential Care 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$305.88
$347.17
$390.91
$546.29
$830.14
$539.87
$581.16
$624.90
$780.28
$773.86
$815.15
$858.89
$1,014.27
$1,007.85
$1,049.14
$1,092.88
$1,248.26
$233.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$611.76
$694.34
$781.82
$1,092.58
$1,660.28
$845.75
$928.33
$1,015.81
$1,326.57
$1,079.74
$1,162.32
$1,249.80
$1,560.56
$1,313.73
$1,396.31
$1,483.79
$1,794.55
$233.99
Toc - Plan #29 Ambetter from Nebraska Total Care
Silver

(HMO) Ambetter Balanced Care 30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$386.51
$438.68
$493.94
$690.29
$1,048.96
$682.18
$734.35
$789.61
$985.96
$977.85
$1,030.02
$1,085.28
$1,281.63
$1,273.52
$1,325.69
$1,380.95
$1,577.30
$295.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773.02
$877.36
$987.88
$1,380.58
$2,097.92
$1,068.69
$1,173.03
$1,283.55
$1,676.25
$1,364.36
$1,468.70
$1,579.22
$1,971.92
$1,660.03
$1,764.37
$1,874.89
$2,267.59
$295.67
Toc - Plan #30 Ambetter from Nebraska Total Care
Silver

(HMO) Ambetter Balanced Care 31

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$386.51
$438.68
$493.94
$690.29
$1,048.96
$682.18
$734.35
$789.61
$985.96
$977.85
$1,030.02
$1,085.28
$1,281.63
$1,273.52
$1,325.69
$1,380.95
$1,577.30
$295.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773.02
$877.36
$987.88
$1,380.58
$2,097.92
$1,068.69
$1,173.03
$1,283.55
$1,676.25
$1,364.36
$1,468.70
$1,579.22
$1,971.92
$1,660.03
$1,764.37
$1,874.89
$2,267.59
$295.67
Toc - Plan #31 Ambetter from Nebraska Total Care
Silver

(HMO) Ambetter Balanced Care 32

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$395.67
$449.07
$505.65
$706.65
$1,073.82
$698.35
$751.75
$808.33
$1,009.33
$1,001.03
$1,054.43
$1,111.01
$1,312.01
$1,303.71
$1,357.11
$1,413.69
$1,614.69
$302.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.34
$898.14
$1,011.30
$1,413.30
$2,147.64
$1,094.02
$1,200.82
$1,313.98
$1,715.98
$1,396.70
$1,503.50
$1,616.66
$2,018.66
$1,699.38
$1,806.18
$1,919.34
$2,321.34
$302.68
Toc - Plan #32 Ambetter from Nebraska Total Care
Gold

(HMO) Ambetter Secure Care 20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$434.70
$493.38
$555.54
$776.36
$1,179.75
$767.24
$825.92
$888.08
$1,108.90
$1,099.78
$1,158.46
$1,220.62
$1,441.44
$1,432.32
$1,491.00
$1,553.16
$1,773.98
$332.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.40
$986.76
$1,111.08
$1,552.72
$2,359.50
$1,201.94
$1,319.30
$1,443.62
$1,885.26
$1,534.48
$1,651.84
$1,776.16
$2,217.80
$1,867.02
$1,984.38
$2,108.70
$2,550.34
$332.54
Toc - Plan #33 Ambetter from Nebraska Total Care
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$346.20
$392.93
$442.43
$618.29
$939.56
$611.04
$657.77
$707.27
$883.13
$875.88
$922.61
$972.11
$1,147.97
$1,140.72
$1,187.45
$1,236.95
$1,412.81
$264.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692.40
$785.86
$884.86
$1,236.58
$1,879.12
$957.24
$1,050.70
$1,149.70
$1,501.42
$1,222.08
$1,315.54
$1,414.54
$1,766.26
$1,486.92
$1,580.38
$1,679.38
$2,031.10
$264.84
Toc - Plan #34 Ambetter from Nebraska Total Care
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$342.61
$388.85
$437.84
$611.88
$929.81
$604.70
$650.94
$699.93
$873.97
$866.79
$913.03
$962.02
$1,136.06
$1,128.88
$1,175.12
$1,224.11
$1,398.15
$262.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685.22
$777.70
$875.68
$1,223.76
$1,859.62
$947.31
$1,039.79
$1,137.77
$1,485.85
$1,209.40
$1,301.88
$1,399.86
$1,747.94
$1,471.49
$1,563.97
$1,661.95
$2,010.03
$262.09
Toc - Plan #35 Ambetter from Nebraska Total Care
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$370.82
$420.87
$473.90
$662.27
$1,006.39
$654.49
$704.54
$757.57
$945.94
$938.16
$988.21
$1,041.24
$1,229.61
$1,221.83
$1,271.88
$1,324.91
$1,513.28
$283.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$741.64
$841.74
$947.80
$1,324.54
$2,012.78
$1,025.31
$1,125.41
$1,231.47
$1,608.21
$1,308.98
$1,409.08
$1,515.14
$1,891.88
$1,592.65
$1,692.75
$1,798.81
$2,175.55
$283.67
Toc - Plan #36 Ambetter from Nebraska Total Care
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$389.25
$441.79
$497.45
$695.18
$1,056.39
$687.02
$739.56
$795.22
$992.95
$984.79
$1,037.33
$1,092.99
$1,290.72
$1,282.56
$1,335.10
$1,390.76
$1,588.49
$297.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778.50
$883.58
$994.90
$1,390.36
$2,112.78
$1,076.27
$1,181.35
$1,292.67
$1,688.13
$1,374.04
$1,479.12
$1,590.44
$1,985.90
$1,671.81
$1,776.89
$1,888.21
$2,283.67
$297.77
Toc - Plan #37 Ambetter from Nebraska Total Care
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$427.51
$485.21
$546.35
$763.52
$1,160.24
$754.55
$812.25
$873.39
$1,090.56
$1,081.59
$1,139.29
$1,200.43
$1,417.60
$1,408.63
$1,466.33
$1,527.47
$1,744.64
$327.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$855.02
$970.42
$1,092.70
$1,527.04
$2,320.48
$1,182.06
$1,297.46
$1,419.74
$1,854.08
$1,509.10
$1,624.50
$1,746.78
$2,181.12
$1,836.14
$1,951.54
$2,073.82
$2,508.16
$327.04
Toc - Plan #38 Ambetter from Nebraska Total Care
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$480.22
$545.04
$613.71
$857.66
$1,303.29
$847.58
$912.40
$981.07
$1,225.02
$1,214.94
$1,279.76
$1,348.43
$1,592.38
$1,582.30
$1,647.12
$1,715.79
$1,959.74
$367.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$960.44
$1,090.08
$1,227.42
$1,715.32
$2,606.58
$1,327.80
$1,457.44
$1,594.78
$2,082.68
$1,695.16
$1,824.80
$1,962.14
$2,450.04
$2,062.52
$2,192.16
$2,329.50
$2,817.40
$367.36
Toc - Plan #39 Ambetter from Nebraska Total Care
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$316.92
$359.69
$405.01
$565.99
$860.08
$559.35
$602.12
$647.44
$808.42
$801.78
$844.55
$889.87
$1,050.85
$1,044.21
$1,086.98
$1,132.30
$1,293.28
$242.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$633.84
$719.38
$810.02
$1,131.98
$1,720.16
$876.27
$961.81
$1,052.45
$1,374.41
$1,118.70
$1,204.24
$1,294.88
$1,616.84
$1,361.13
$1,446.67
$1,537.31
$1,859.27
$242.43
Toc - Plan #40 Ambetter from Nebraska Total Care
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$400.45
$454.50
$511.76
$715.18
$1,086.79
$706.79
$760.84
$818.10
$1,021.52
$1,013.13
$1,067.18
$1,124.44
$1,327.86
$1,319.47
$1,373.52
$1,430.78
$1,634.20
$306.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$800.90
$909.00
$1,023.52
$1,430.36
$2,173.58
$1,107.24
$1,215.34
$1,329.86
$1,736.70
$1,413.58
$1,521.68
$1,636.20
$2,043.04
$1,719.92
$1,828.02
$1,942.54
$2,349.38
$306.34
Toc - Plan #41 Ambetter from Nebraska Total Care
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$409.94
$465.27
$523.89
$732.14
$1,112.55
$723.54
$778.87
$837.49
$1,045.74
$1,037.14
$1,092.47
$1,151.09
$1,359.34
$1,350.74
$1,406.07
$1,464.69
$1,672.94
$313.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$819.88
$930.54
$1,047.78
$1,464.28
$2,225.10
$1,133.48
$1,244.14
$1,361.38
$1,777.88
$1,447.08
$1,557.74
$1,674.98
$2,091.48
$1,760.68
$1,871.34
$1,988.58
$2,405.08
$313.60
Toc - Plan #42 Ambetter from Nebraska Total Care
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$450.38
$511.17
$575.57
$804.36
$1,222.31
$794.91
$855.70
$920.10
$1,148.89
$1,139.44
$1,200.23
$1,264.63
$1,493.42
$1,483.97
$1,544.76
$1,609.16
$1,837.95
$344.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$900.76
$1,022.34
$1,151.14
$1,608.72
$2,444.62
$1,245.29
$1,366.87
$1,495.67
$1,953.25
$1,589.82
$1,711.40
$1,840.20
$2,297.78
$1,934.35
$2,055.93
$2,184.73
$2,642.31
$344.53

ADVERTISEMENT

Oscar Insurance Company

Local:  | Toll Free: 

Toc - Plan #43 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic- PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$378.92
$430.06
$484.25
$676.73
$1,028.36
$668.79
$719.93
$774.12
$966.60
$958.66
$1,009.80
$1,063.99
$1,256.47
$1,248.53
$1,299.67
$1,353.86
$1,546.34
$289.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757.84
$860.12
$968.50
$1,353.46
$2,056.72
$1,047.71
$1,149.99
$1,258.37
$1,643.33
$1,337.58
$1,439.86
$1,548.24
$1,933.20
$1,627.45
$1,729.73
$1,838.11
$2,223.07
$289.87
Toc - Plan #44 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$371.82
$422.01
$475.18
$664.06
$1,009.10
$656.26
$706.45
$759.62
$948.50
$940.70
$990.89
$1,044.06
$1,232.94
$1,225.14
$1,275.33
$1,328.50
$1,517.38
$284.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.64
$844.02
$950.36
$1,328.12
$2,018.20
$1,028.08
$1,128.46
$1,234.80
$1,612.56
$1,312.52
$1,412.90
$1,519.24
$1,897.00
$1,596.96
$1,697.34
$1,803.68
$2,181.44
$284.44
Toc - Plan #45 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite- $0 Ded+PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$434.64
$493.31
$555.46
$776.25
$1,179.59
$767.13
$825.80
$887.95
$1,108.74
$1,099.62
$1,158.29
$1,220.44
$1,441.23
$1,432.11
$1,490.78
$1,552.93
$1,773.72
$332.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.28
$986.62
$1,110.92
$1,552.50
$2,359.18
$1,201.77
$1,319.11
$1,443.41
$1,884.99
$1,534.26
$1,651.60
$1,775.90
$2,217.48
$1,866.75
$1,984.09
$2,108.39
$2,549.97
$332.49
Toc - Plan #46 Oscar Insurance Company
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 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
$486.59
$552.27
$621.85
$869.03
$1,320.58
$858.82
$924.50
$994.08
$1,241.26
$1,231.05
$1,296.73
$1,366.31
$1,613.49
$1,603.28
$1,668.96
$1,738.54
$1,985.72
$372.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$973.18
$1,104.54
$1,243.70
$1,738.06
$2,641.16
$1,345.41
$1,476.77
$1,615.93
$2,110.29
$1,717.64
$1,849.00
$1,988.16
$2,482.52
$2,089.87
$2,221.23
$2,360.39
$2,854.75
$372.23
Toc - Plan #47 Oscar Insurance Company
Silver

(EPO) Silver Simple

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$4,200 $8,400 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
$478.35
$542.92
$611.32
$854.32
$1,298.22
$844.28
$908.85
$977.25
$1,220.25
$1,210.21
$1,274.78
$1,343.18
$1,586.18
$1,576.14
$1,640.71
$1,709.11
$1,952.11
$365.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$956.70
$1,085.84
$1,222.64
$1,708.64
$2,596.44
$1,322.63
$1,451.77
$1,588.57
$2,074.57
$1,688.56
$1,817.70
$1,954.50
$2,440.50
$2,054.49
$2,183.63
$2,320.43
$2,806.43
$365.93
Toc - Plan #48 Oscar Insurance Company
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$320.73
$364.02
$409.88
$572.81
$870.44
$566.08
$609.37
$655.23
$818.16
$811.43
$854.72
$900.58
$1,063.51
$1,056.78
$1,100.07
$1,145.93
$1,308.86
$245.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$641.46
$728.04
$819.76
$1,145.62
$1,740.88
$886.81
$973.39
$1,065.11
$1,390.97
$1,132.16
$1,218.74
$1,310.46
$1,636.32
$1,377.51
$1,464.09
$1,555.81
$1,881.67
$245.35
Toc - Plan #49 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite- $0 Ded+Specialist Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$434.73
$493.41
$555.58
$776.42
$1,179.84
$767.29
$825.97
$888.14
$1,108.98
$1,099.85
$1,158.53
$1,220.70
$1,441.54
$1,432.41
$1,491.09
$1,553.26
$1,774.10
$332.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.46
$986.82
$1,111.16
$1,552.84
$2,359.68
$1,202.02
$1,319.38
$1,443.72
$1,885.40
$1,534.58
$1,651.94
$1,776.28
$2,217.96
$1,867.14
$1,984.50
$2,108.84
$2,550.52
$332.56
Toc - Plan #50 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Simple- HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 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
$402.56
$456.89
$514.46
$718.95
$1,092.51
$710.51
$764.84
$822.41
$1,026.90
$1,018.46
$1,072.79
$1,130.36
$1,334.85
$1,326.41
$1,380.74
$1,438.31
$1,642.80
$307.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$805.12
$913.78
$1,028.92
$1,437.90
$2,185.02
$1,113.07
$1,221.73
$1,336.87
$1,745.85
$1,421.02
$1,529.68
$1,644.82
$2,053.80
$1,728.97
$1,837.63
$1,952.77
$2,361.75
$307.95
Toc - Plan #51 Oscar Insurance Company
Silver

(EPO) Silver Simple- Specialist Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,450 $12,900 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
$478.49
$543.08
$611.50
$854.57
$1,298.60
$844.53
$909.12
$977.54
$1,220.61
$1,210.57
$1,275.16
$1,343.58
$1,586.65
$1,576.61
$1,641.20
$1,709.62
$1,952.69
$366.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$956.98
$1,086.16
$1,223.00
$1,709.14
$2,597.20
$1,323.02
$1,452.20
$1,589.04
$2,075.18
$1,689.06
$1,818.24
$1,955.08
$2,441.22
$2,055.10
$2,184.28
$2,321.12
$2,807.26
$366.04
Toc - Plan #52 Oscar Insurance Company
Silver

(EPO) Silver Classic- $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$503.52
$571.49
$643.49
$899.27
$1,366.53
$888.71
$956.68
$1,028.68
$1,284.46
$1,273.90
$1,341.87
$1,413.87
$1,669.65
$1,659.09
$1,727.06
$1,799.06
$2,054.84
$385.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,007.04
$1,142.98
$1,286.98
$1,798.54
$2,733.06
$1,392.23
$1,528.17
$1,672.17
$2,183.73
$1,777.42
$1,913.36
$2,057.36
$2,568.92
$2,162.61
$2,298.55
$2,442.55
$2,954.11
$385.19
Toc - Plan #53 Oscar Insurance Company
Gold

(EPO) Gold Classic- Low Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$1,250 $2,500 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
$479.38
$544.09
$612.64
$856.16
$1,301.01
$846.10
$910.81
$979.36
$1,222.88
$1,212.82
$1,277.53
$1,346.08
$1,589.60
$1,579.54
$1,644.25
$1,712.80
$1,956.32
$366.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$958.76
$1,088.18
$1,225.28
$1,712.32
$2,602.02
$1,325.48
$1,454.90
$1,592.00
$2,079.04
$1,692.20
$1,821.62
$1,958.72
$2,445.76
$2,058.92
$2,188.34
$2,325.44
$2,812.48
$366.72
Toc - Plan #54 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic- $0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$392.08
$445.00
$501.07
$700.24
$1,064.08
$692.01
$744.93
$801.00
$1,000.17
$991.94
$1,044.86
$1,100.93
$1,300.10
$1,291.87
$1,344.79
$1,400.86
$1,600.03
$299.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$784.16
$890.00
$1,002.14
$1,400.48
$2,128.16
$1,084.09
$1,189.93
$1,302.07
$1,700.41
$1,384.02
$1,489.86
$1,602.00
$2,000.34
$1,683.95
$1,789.79
$1,901.93
$2,300.27
$299.93
Toc - Plan #55 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic- Specialist Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$417.38
$473.71
$533.40
$745.42
$1,132.73
$736.67
$793.00
$852.69
$1,064.71
$1,055.96
$1,112.29
$1,171.98
$1,384.00
$1,375.25
$1,431.58
$1,491.27
$1,703.29
$319.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$834.76
$947.42
$1,066.80
$1,490.84
$2,265.46
$1,154.05
$1,266.71
$1,386.09
$1,810.13
$1,473.34
$1,586.00
$1,705.38
$2,129.42
$1,792.63
$1,905.29
$2,024.67
$2,448.71
$319.29
Toc - Plan #56 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic- $3000 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$419.56
$476.19
$536.19
$749.32
$1,138.67
$740.52
$797.15
$857.15
$1,070.28
$1,061.48
$1,118.11
$1,178.11
$1,391.24
$1,382.44
$1,439.07
$1,499.07
$1,712.20
$320.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$839.12
$952.38
$1,072.38
$1,498.64
$2,277.34
$1,160.08
$1,273.34
$1,393.34
$1,819.60
$1,481.04
$1,594.30
$1,714.30
$2,140.56
$1,802.00
$1,915.26
$2,035.26
$2,461.52
$320.96
Toc - Plan #57 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic- $4700 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 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
$394.00
$447.17
$503.51
$703.66
$1,069.28
$695.40
$748.57
$804.91
$1,005.06
$996.80
$1,049.97
$1,106.31
$1,306.46
$1,298.20
$1,351.37
$1,407.71
$1,607.86
$301.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$788.00
$894.34
$1,007.02
$1,407.32
$2,138.56
$1,089.40
$1,195.74
$1,308.42
$1,708.72
$1,390.80
$1,497.14
$1,609.82
$2,010.12
$1,692.20
$1,798.54
$1,911.22
$2,311.52
$301.40
Toc - Plan #58 Oscar Insurance Company
Silver

(EPO) Silver Simple- PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,375 $16,750 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
$473.49
$537.40
$605.11
$845.63
$1,285.02
$835.70
$899.61
$967.32
$1,207.84
$1,197.91
$1,261.82
$1,329.53
$1,570.05
$1,560.12
$1,624.03
$1,691.74
$1,932.26
$362.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$946.98
$1,074.80
$1,210.22
$1,691.26
$2,570.04
$1,309.19
$1,437.01
$1,572.43
$2,053.47
$1,671.40
$1,799.22
$1,934.64
$2,415.68
$2,033.61
$2,161.43
$2,296.85
$2,777.89
$362.21
Toc - Plan #59 Oscar Insurance Company
Silver

(EPO) Silver Elite- Specialist Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$499.63
$567.07
$638.51
$892.32
$1,355.97
$881.84
$949.28
$1,020.72
$1,274.53
$1,264.05
$1,331.49
$1,402.93
$1,656.74
$1,646.26
$1,713.70
$1,785.14
$2,038.95
$382.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$999.26
$1,134.14
$1,277.02
$1,784.64
$2,711.94
$1,381.47
$1,516.35
$1,659.23
$2,166.85
$1,763.68
$1,898.56
$2,041.44
$2,549.06
$2,145.89
$2,280.77
$2,423.65
$2,931.27
$382.21
Toc - Plan #60 Oscar Insurance Company
Silver

(EPO) Silver Classic- Low Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$486.01
$551.62
$621.11
$868.00
$1,319.02
$857.80
$923.41
$992.90
$1,239.79
$1,229.59
$1,295.20
$1,364.69
$1,611.58
$1,601.38
$1,666.99
$1,736.48
$1,983.37
$371.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$972.02
$1,103.24
$1,242.22
$1,736.00
$2,638.04
$1,343.81
$1,475.03
$1,614.01
$2,107.79
$1,715.60
$1,846.82
$1,985.80
$2,479.58
$2,087.39
$2,218.61
$2,357.59
$2,851.37
$371.79
Toc - Plan #61 Oscar Insurance Company
Silver

(EPO) Silver Elite- $0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$500.63
$568.20
$639.79
$894.10
$1,358.67
$883.60
$951.17
$1,022.76
$1,277.07
$1,266.57
$1,334.14
$1,405.73
$1,660.04
$1,649.54
$1,717.11
$1,788.70
$2,043.01
$382.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,001.26
$1,136.40
$1,279.58
$1,788.20
$2,717.34
$1,384.23
$1,519.37
$1,662.55
$2,171.17
$1,767.20
$1,902.34
$2,045.52
$2,554.14
$2,150.17
$2,285.31
$2,428.49
$2,937.11
$382.97
Toc - Plan #62 Oscar Insurance Company
Silver

(EPO) Silver Simple- HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$4,500 $9,000 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
$496.28
$563.27
$634.24
$886.35
$1,346.89
$875.93
$942.92
$1,013.89
$1,266.00
$1,255.58
$1,322.57
$1,393.54
$1,645.65
$1,635.23
$1,702.22
$1,773.19
$2,025.30
$379.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$992.56
$1,126.54
$1,268.48
$1,772.70
$2,693.78
$1,372.21
$1,506.19
$1,648.13
$2,152.35
$1,751.86
$1,885.84
$2,027.78
$2,532.00
$2,131.51
$2,265.49
$2,407.43
$2,911.65
$379.65
Toc - Plan #63 Oscar Insurance Company
Silver

(EPO) Silver Elite- $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$492.16
$558.59
$628.97
$878.98
$1,335.69
$868.65
$935.08
$1,005.46
$1,255.47
$1,245.14
$1,311.57
$1,381.95
$1,631.96
$1,621.63
$1,688.06
$1,758.44
$2,008.45
$376.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$984.32
$1,117.18
$1,257.94
$1,757.96
$2,671.38
$1,360.81
$1,493.67
$1,634.43
$2,134.45
$1,737.30
$1,870.16
$2,010.92
$2,510.94
$2,113.79
$2,246.65
$2,387.41
$2,887.43
$376.49
Toc - Plan #64 Oscar Insurance Company
Gold

(EPO) Gold Simple

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,550 $13,100 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
$459.00
$520.95
$586.59
$819.75
$1,245.69
$810.13
$872.08
$937.72
$1,170.88
$1,161.26
$1,223.21
$1,288.85
$1,522.01
$1,512.39
$1,574.34
$1,639.98
$1,873.14
$351.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.00
$1,041.90
$1,173.18
$1,639.50
$2,491.38
$1,269.13
$1,393.03
$1,524.31
$1,990.63
$1,620.26
$1,744.16
$1,875.44
$2,341.76
$1,971.39
$2,095.29
$2,226.57
$2,692.89
$351.13
Toc - Plan #65 Oscar Insurance Company
Gold

(EPO) Gold Elite- $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$515.48
$585.06
$658.77
$920.62
$1,398.98
$909.81
$979.39
$1,053.10
$1,314.95
$1,304.14
$1,373.72
$1,447.43
$1,709.28
$1,698.47
$1,768.05
$1,841.76
$2,103.61
$394.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,030.96
$1,170.12
$1,317.54
$1,841.24
$2,797.96
$1,425.29
$1,564.45
$1,711.87
$2,235.57
$1,819.62
$1,958.78
$2,106.20
$2,629.90
$2,213.95
$2,353.11
$2,500.53
$3,024.23
$394.33
Toc - Plan #66 Oscar Insurance Company
Gold

(EPO) Gold Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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
$491.91
$558.30
$628.64
$878.53
$1,335.01
$868.21
$934.60
$1,004.94
$1,254.83
$1,244.51
$1,310.90
$1,381.24
$1,631.13
$1,620.81
$1,687.20
$1,757.54
$2,007.43
$376.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$983.82
$1,116.60
$1,257.28
$1,757.06
$2,670.02
$1,360.12
$1,492.90
$1,633.58
$2,133.36
$1,736.42
$1,869.20
$2,009.88
$2,509.66
$2,112.72
$2,245.50
$2,386.18
$2,885.96
$376.30
Toc - Plan #67 Oscar Insurance Company
Gold

(EPO) Gold Classic- HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,850 $5,700 Annual Deductible
$5,500 $11,000 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
$464.25
$526.91
$593.29
$829.12
$1,259.94
$819.39
$882.05
$948.43
$1,184.26
$1,174.53
$1,237.19
$1,303.57
$1,539.40
$1,529.67
$1,592.33
$1,658.71
$1,894.54
$355.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$928.50
$1,053.82
$1,186.58
$1,658.24
$2,519.88
$1,283.64
$1,408.96
$1,541.72
$2,013.38
$1,638.78
$1,764.10
$1,896.86
$2,368.52
$1,993.92
$2,119.24
$2,252.00
$2,723.66
$355.14
Toc - Plan #68 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$428.39
$486.21
$547.46
$765.08
$1,162.61
$756.10
$813.92
$875.17
$1,092.79
$1,083.81
$1,141.63
$1,202.88
$1,420.50
$1,411.52
$1,469.34
$1,530.59
$1,748.21
$327.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856.78
$972.42
$1,094.92
$1,530.16
$2,325.22
$1,184.49
$1,300.13
$1,422.63
$1,857.87
$1,512.20
$1,627.84
$1,750.34
$2,185.58
$1,839.91
$1,955.55
$2,078.05
$2,513.29
$327.71
Toc - Plan #69 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite- $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$430.48
$488.59
$550.14
$768.82
$1,168.30
$759.79
$817.90
$879.45
$1,098.13
$1,089.10
$1,147.21
$1,208.76
$1,427.44
$1,418.41
$1,476.52
$1,538.07
$1,756.75
$329.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$860.96
$977.18
$1,100.28
$1,537.64
$2,336.60
$1,190.27
$1,306.49
$1,429.59
$1,866.95
$1,519.58
$1,635.80
$1,758.90
$2,196.26
$1,848.89
$1,965.11
$2,088.21
$2,525.57
$329.31
Toc - Plan #70 Oscar Insurance Company
Silver

(EPO) Silver Simple- For Diabetes

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,450 $12,900 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
$481.35
$546.32
$615.15
$859.68
$1,306.36
$849.58
$914.55
$983.38
$1,227.91
$1,217.81
$1,282.78
$1,351.61
$1,596.14
$1,586.04
$1,651.01
$1,719.84
$1,964.37
$368.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$962.70
$1,092.64
$1,230.30
$1,719.36
$2,612.72
$1,330.93
$1,460.87
$1,598.53
$2,087.59
$1,699.16
$1,829.10
$1,966.76
$2,455.82
$2,067.39
$2,197.33
$2,334.99
$2,824.05
$368.23

ADVERTISEMENT

Bright HealthCare

Local: 1-855-827-4448 | Toll Free: 1-855-827-4448

Toc - Plan #71 Bright HealthCare
Gold

(EPO) Statewide Gold 1000 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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
$544.88
$618.44
$696.36
$973.16
$1,478.81
$961.72
$1,035.28
$1,113.20
$1,390.00
$1,378.56
$1,452.12
$1,530.04
$1,806.84
$1,795.40
$1,868.96
$1,946.88
$2,223.68
$416.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,089.76
$1,236.88
$1,392.72
$1,946.32
$2,957.62
$1,506.60
$1,653.72
$1,809.56
$2,363.16
$1,923.44
$2,070.56
$2,226.40
$2,780.00
$2,340.28
$2,487.40
$2,643.24
$3,196.84
$416.84
Toc - Plan #72 Bright HealthCare
Silver

(EPO) Statewide Silver 5000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$504.77
$572.91
$645.10
$901.52
$1,369.94
$890.92
$959.06
$1,031.25
$1,287.67
$1,277.07
$1,345.21
$1,417.40
$1,673.82
$1,663.22
$1,731.36
$1,803.55
$2,059.97
$386.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,009.54
$1,145.82
$1,290.20
$1,803.04
$2,739.88
$1,395.69
$1,531.97
$1,676.35
$2,189.19
$1,781.84
$1,918.12
$2,062.50
$2,575.34
$2,167.99
$2,304.27
$2,448.65
$2,961.49
$386.15
Toc - Plan #73 Bright HealthCare
Silver

(EPO) Statewide Silver $0 Deductible ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$514.21
$583.63
$657.16
$918.38
$1,395.56
$907.58
$977.00
$1,050.53
$1,311.75
$1,300.95
$1,370.37
$1,443.90
$1,705.12
$1,694.32
$1,763.74
$1,837.27
$2,098.49
$393.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,028.42
$1,167.26
$1,314.32
$1,836.76
$2,791.12
$1,421.79
$1,560.63
$1,707.69
$2,230.13
$1,815.16
$1,954.00
$2,101.06
$2,623.50
$2,208.53
$2,347.37
$2,494.43
$3,016.87
$393.37
Toc - Plan #74 Bright HealthCare
Silver

(EPO) Statewide Silver 3000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$508.14
$576.74
$649.40
$907.54
$1,379.09
$896.87
$965.47
$1,038.13
$1,296.27
$1,285.60
$1,354.20
$1,426.86
$1,685.00
$1,674.33
$1,742.93
$1,815.59
$2,073.73
$388.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,016.28
$1,153.48
$1,298.80
$1,815.08
$2,758.18
$1,405.01
$1,542.21
$1,687.53
$2,203.81
$1,793.74
$1,930.94
$2,076.26
$2,592.54
$2,182.47
$2,319.67
$2,464.99
$2,981.27
$388.73
Toc - Plan #75 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze 8700 + $0 Mental Health ($0 Telehealth + $0 Primary Care + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$353.51
$401.24
$451.79
$631.38
$959.44
$623.95
$671.68
$722.23
$901.82
$894.39
$942.12
$992.67
$1,172.26
$1,164.83
$1,212.56
$1,263.11
$1,442.70
$270.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$707.02
$802.48
$903.58
$1,262.76
$1,918.88
$977.46
$1,072.92
$1,174.02
$1,533.20
$1,247.90
$1,343.36
$1,444.46
$1,803.64
$1,518.34
$1,613.80
$1,714.90
$2,074.08
$270.44
Toc - Plan #76 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze 5300 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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
$380.81
$432.22
$486.68
$680.13
$1,033.53
$672.13
$723.54
$778.00
$971.45
$963.45
$1,014.86
$1,069.32
$1,262.77
$1,254.77
$1,306.18
$1,360.64
$1,554.09
$291.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$761.62
$864.44
$973.36
$1,360.26
$2,067.06
$1,052.94
$1,155.76
$1,264.68
$1,651.58
$1,344.26
$1,447.08
$1,556.00
$1,942.90
$1,635.58
$1,738.40
$1,847.32
$2,234.22
$291.32
Toc - Plan #77 Bright HealthCare
Catastrophic

(EPO) Statewide Catastrophic 8700 Direct ($0 Primary Care)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$244.94
$278.01
$313.04
$437.47
$664.78
$432.32
$465.39
$500.42
$624.85
$619.70
$652.77
$687.80
$812.23
$807.08
$840.15
$875.18
$999.61
$187.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$489.88
$556.02
$626.08
$874.94
$1,329.56
$677.26
$743.40
$813.46
$1,062.32
$864.64
$930.78
$1,000.84
$1,249.70
$1,052.02
$1,118.16
$1,188.22
$1,437.08
$187.38
Toc - Plan #78 Bright HealthCare
Silver

(EPO) Statewide Silver 6700 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$510.45
$579.36
$652.36
$911.66
$1,385.36
$900.94
$969.85
$1,042.85
$1,302.15
$1,291.43
$1,360.34
$1,433.34
$1,692.64
$1,681.92
$1,750.83
$1,823.83
$2,083.13
$390.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,020.90
$1,158.72
$1,304.72
$1,823.32
$2,770.72
$1,411.39
$1,549.21
$1,695.21
$2,213.81
$1,801.88
$1,939.70
$2,085.70
$2,604.30
$2,192.37
$2,330.19
$2,476.19
$2,994.79
$390.49
Toc - Plan #79 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze 7200 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$364.05
$413.20
$465.26
$650.20
$988.04
$642.55
$691.70
$743.76
$928.70
$921.05
$970.20
$1,022.26
$1,207.20
$1,199.55
$1,248.70
$1,300.76
$1,485.70
$278.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728.10
$826.40
$930.52
$1,300.40
$1,976.08
$1,006.60
$1,104.90
$1,209.02
$1,578.90
$1,285.10
$1,383.40
$1,487.52
$1,857.40
$1,563.60
$1,661.90
$1,766.02
$2,135.90
$278.50
Toc - Plan #80 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze $0 Medical Deductible ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Pr

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$390.32
$443.01
$498.83
$697.11
$1,059.33
$688.92
$741.61
$797.43
$995.71
$987.52
$1,040.21
$1,096.03
$1,294.31
$1,286.12
$1,338.81
$1,394.63
$1,592.91
$298.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.64
$886.02
$997.66
$1,394.22
$2,118.66
$1,079.24
$1,184.62
$1,296.26
$1,692.82
$1,377.84
$1,483.22
$1,594.86
$1,991.42
$1,676.44
$1,781.82
$1,893.46
$2,290.02
$298.60
Toc - Plan #81 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze 7200 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescriptio

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$374.48
$425.03
$478.58
$668.81
$1,016.33
$660.95
$711.50
$765.05
$955.28
$947.42
$997.97
$1,051.52
$1,241.75
$1,233.89
$1,284.44
$1,337.99
$1,528.22
$286.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$748.96
$850.06
$957.16
$1,337.62
$2,032.66
$1,035.43
$1,136.53
$1,243.63
$1,624.09
$1,321.90
$1,423.00
$1,530.10
$1,910.56
$1,608.37
$1,709.47
$1,816.57
$2,197.03
$286.47
Toc - Plan #82 Bright HealthCare
Silver

(EPO) Statewide Silver 6700 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$520.87
$591.19
$665.68
$930.28
$1,413.65
$919.34
$989.66
$1,064.15
$1,328.75
$1,317.81
$1,388.13
$1,462.62
$1,727.22
$1,716.28
$1,786.60
$1,861.09
$2,125.69
$398.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,041.74
$1,182.38
$1,331.36
$1,860.56
$2,827.30
$1,440.21
$1,580.85
$1,729.83
$2,259.03
$1,838.68
$1,979.32
$2,128.30
$2,657.50
$2,237.15
$2,377.79
$2,526.77
$3,055.97
$398.47
Toc - Plan #83 Bright HealthCare
Gold

(EPO) Statewide Gold $0 Deductible + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Pre

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$580.12
$658.43
$741.39
$1,036.09
$1,574.44
$1,023.91
$1,102.22
$1,185.18
$1,479.88
$1,467.70
$1,546.01
$1,628.97
$1,923.67
$1,911.49
$1,989.80
$2,072.76
$2,367.46
$443.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,160.24
$1,316.86
$1,482.78
$2,072.18
$3,148.88
$1,604.03
$1,760.65
$1,926.57
$2,515.97
$2,047.82
$2,204.44
$2,370.36
$2,959.76
$2,491.61
$2,648.23
$2,814.15
$3,403.55
$443.79
Toc - Plan #84 Bright HealthCare
Expanded Bronze

(EPO) Statewide Bronze 8700 ($25 Generic)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$352.77
$400.40
$450.85
$630.05
$957.43
$622.64
$670.27
$720.72
$899.92
$892.51
$940.14
$990.59
$1,169.79
$1,162.38
$1,210.01
$1,260.46
$1,439.66
$269.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705.54
$800.80
$901.70
$1,260.10
$1,914.86
$975.41
$1,070.67
$1,171.57
$1,529.97
$1,245.28
$1,340.54
$1,441.44
$1,799.84
$1,515.15
$1,610.41
$1,711.31
$2,069.71
$269.87
Toc - Plan #85 Bright HealthCare
Silver

(EPO) Statewide Silver 4000 ($35 Primary Care + $15 Generic)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$497.39
$564.54
$635.67
$888.34
$1,349.92
$877.90
$945.05
$1,016.18
$1,268.85
$1,258.41
$1,325.56
$1,396.69
$1,649.36
$1,638.92
$1,706.07
$1,777.20
$2,029.87
$380.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$994.78
$1,129.08
$1,271.34
$1,776.68
$2,699.84
$1,375.29
$1,509.59
$1,651.85
$2,157.19
$1,755.80
$1,890.10
$2,032.36
$2,537.70
$2,136.31
$2,270.61
$2,412.87
$2,918.21
$380.51

‡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 Pawnee County here.

Pawnee County is in “Rating Area 2” of Nebraska.

Currently, there are 85 plans offered in Rating Area 2.

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2022 Obamacare Plans for Pawnee County, NE

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