Obamacare 2022 Rates for Lincoln County

Obamacare > Rates > North Carolina > Lincoln 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 Lincoln County, NC.

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, 55 Plans and 2022 Rates for Lincoln County, North Carolina

Below, you’ll find a summary of the 55 plans for Lincoln County, North Carolina 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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Blue Cross and Blue Shield of NC

Local: 1-800-324-4973 | Toll Free: 1-800-324-4973

Toc - Plan #1 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Value Gold 2500 + 3 Free PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$470.39
$533.89
$601.16
$840.12
$1,276.64 		$830.24
$893.74
$961.01
$1,199.97 		$1,190.09
$1,253.59
$1,320.86
$1,559.82 		$1,549.94
$1,613.44
$1,680.71
$1,919.67 		$359.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$940.78
$1,067.78
$1,202.32
$1,680.24
$2,553.28 		$1,300.63
$1,427.63
$1,562.17
$2,040.09 		$1,660.48
$1,787.48
$1,922.02
$2,399.94 		$2,020.33
$2,147.33
$2,281.87
$2,759.79 		$359.85
Toc - Plan #2 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver 3800 + 3 Free PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 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 		$484.32
$549.70
$618.96
$865.00
$1,314.44 		$854.82
$920.20
$989.46
$1,235.50 		$1,225.32
$1,290.70
$1,359.96
$1,606.00 		$1,595.82
$1,661.20
$1,730.46
$1,976.50 		$370.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$968.64
$1,099.40
$1,237.92
$1,730.00
$2,628.88 		$1,339.14
$1,469.90
$1,608.42
$2,100.50 		$1,709.64
$1,840.40
$1,978.92
$2,471.00 		$2,080.14
$2,210.90
$2,349.42
$2,841.50 		$370.50
Toc - Plan #3 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver 6000 + 3 Free PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$464.41
$527.11
$593.52
$829.44
$1,260.41 		$819.68
$882.38
$948.79
$1,184.71 		$1,174.95
$1,237.65
$1,304.06
$1,539.98 		$1,530.22
$1,592.92
$1,659.33
$1,895.25 		$355.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$928.82
$1,054.22
$1,187.04
$1,658.88
$2,520.82 		$1,284.09
$1,409.49
$1,542.31
$2,014.15 		$1,639.36
$1,764.76
$1,897.58
$2,369.42 		$1,994.63
$2,120.03
$2,252.85
$2,724.69 		$355.27
Toc - Plan #4 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 7000 Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$348.86
$395.96
$445.84
$623.06
$946.81 		$615.74
$662.84
$712.72
$889.94 		$882.62
$929.72
$979.60
$1,156.82 		$1,149.50
$1,196.60
$1,246.48
$1,423.70 		$266.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$697.72
$791.92
$891.68
$1,246.12
$1,893.62 		$964.60
$1,058.80
$1,158.56
$1,513.00 		$1,231.48
$1,325.68
$1,425.44
$1,779.88 		$1,498.36
$1,592.56
$1,692.32
$2,046.76 		$266.88
Toc - Plan #5 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 7000 HSA Eligible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$339.20
$384.99
$433.50
$605.81
$920.59 		$598.69
$644.48
$692.99
$865.30 		$858.18
$903.97
$952.48
$1,124.79 		$1,117.67
$1,163.46
$1,211.97
$1,384.28 		$259.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$678.40
$769.98
$867.00
$1,211.62
$1,841.18 		$937.89
$1,029.47
$1,126.49
$1,471.11 		$1,197.38
$1,288.96
$1,385.98
$1,730.60 		$1,456.87
$1,548.45
$1,645.47
$1,990.09 		$259.49
Toc - Plan #6 Blue Cross and Blue Shield of NC
Bronze

(POS) Blue Value Bronze 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$323.87
$367.59
$413.91
$578.43
$878.98 		$571.63
$615.35
$661.67
$826.19 		$819.39
$863.11
$909.43
$1,073.95 		$1,067.15
$1,110.87
$1,157.19
$1,321.71 		$247.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$647.74
$735.18
$827.82
$1,156.86
$1,757.96 		$895.50
$982.94
$1,075.58
$1,404.62 		$1,143.26
$1,230.70
$1,323.34
$1,652.38 		$1,391.02
$1,478.46
$1,571.10
$1,900.14 		$247.76
Toc - Plan #7 Blue Cross and Blue Shield of NC
Catastrophic

(POS) Blue Value Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$231.30
$262.53
$295.60
$413.10
$627.75 		$408.24
$439.47
$472.54
$590.04 		$585.18
$616.41
$649.48
$766.98 		$762.12
$793.35
$826.42
$943.92 		$176.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$462.60
$525.06
$591.20
$826.20
$1,255.50 		$639.54
$702.00
$768.14
$1,003.14 		$816.48
$878.94
$945.08
$1,180.08 		$993.42
$1,055.88
$1,122.02
$1,357.02 		$176.94
Toc - Plan #8 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$483.20
$548.43
$617.53
$863.00
$1,311.40 		$852.85
$918.08
$987.18
$1,232.65 		$1,222.50
$1,287.73
$1,356.83
$1,602.30 		$1,592.15
$1,657.38
$1,726.48
$1,971.95 		$369.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$966.40
$1,096.86
$1,235.06
$1,726.00
$2,622.80 		$1,336.05
$1,466.51
$1,604.71
$2,095.65 		$1,705.70
$1,836.16
$1,974.36
$2,465.30 		$2,075.35
$2,205.81
$2,344.01
$2,834.95 		$369.65
Toc - Plan #9 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver 5300 + 3 Free PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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 		$447.50
$507.91
$571.91
$799.24
$1,214.52 		$789.84
$850.25
$914.25
$1,141.58 		$1,132.18
$1,192.59
$1,256.59
$1,483.92 		$1,474.52
$1,534.93
$1,598.93
$1,826.26 		$342.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$895.00
$1,015.82
$1,143.82
$1,598.48
$2,429.04 		$1,237.34
$1,358.16
$1,486.16
$1,940.82 		$1,579.68
$1,700.50
$1,828.50
$2,283.16 		$1,922.02
$2,042.84
$2,170.84
$2,625.50 		$342.34
Toc - Plan #10 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver 2800 + $15 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 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 		$467.11
$530.17
$596.97
$834.26
$1,267.74 		$824.45
$887.51
$954.31
$1,191.60 		$1,181.79
$1,244.85
$1,311.65
$1,548.94 		$1,539.13
$1,602.19
$1,668.99
$1,906.28 		$357.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$934.22
$1,060.34
$1,193.94
$1,668.52
$2,535.48 		$1,291.56
$1,417.68
$1,551.28
$2,025.86 		$1,648.90
$1,775.02
$1,908.62
$2,383.20 		$2,006.24
$2,132.36
$2,265.96
$2,740.54 		$357.34
Toc - Plan #11 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 7000 + 3 Free PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$327.40
$371.60
$418.42
$584.74
$888.56 		$577.86
$622.06
$668.88
$835.20 		$828.32
$872.52
$919.34
$1,085.66 		$1,078.78
$1,122.98
$1,169.80
$1,336.12 		$250.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$654.80
$743.20
$836.84
$1,169.48
$1,777.12 		$905.26
$993.66
$1,087.30
$1,419.94 		$1,155.72
$1,244.12
$1,337.76
$1,670.40 		$1,406.18
$1,494.58
$1,588.22
$1,920.86 		$250.46
Toc - Plan #12 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Local Gold 2500 + 3 Free PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$507.03
$575.48
$647.98
$905.56
$1,376.08 		$894.91
$963.36
$1,035.86
$1,293.44 		$1,282.79
$1,351.24
$1,423.74
$1,681.32 		$1,670.67
$1,739.12
$1,811.62
$2,069.20 		$387.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,014.06
$1,150.96
$1,295.96
$1,811.12
$2,752.16 		$1,401.94
$1,538.84
$1,683.84
$2,199.00 		$1,789.82
$1,926.72
$2,071.72
$2,586.88 		$2,177.70
$2,314.60
$2,459.60
$2,974.76 		$387.88
Toc - Plan #13 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 3800 + 3 Free PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 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 		$521.49
$591.89
$666.46
$931.38
$1,415.32 		$920.43
$990.83
$1,065.40
$1,330.32 		$1,319.37
$1,389.77
$1,464.34
$1,729.26 		$1,718.31
$1,788.71
$1,863.28
$2,128.20 		$398.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,042.98
$1,183.78
$1,332.92
$1,862.76
$2,830.64 		$1,441.92
$1,582.72
$1,731.86
$2,261.70 		$1,840.86
$1,981.66
$2,130.80
$2,660.64 		$2,239.80
$2,380.60
$2,529.74
$3,059.58 		$398.94
Toc - Plan #14 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 6000 + 3 Free PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$499.94
$567.43
$638.92
$892.89
$1,356.84 		$882.39
$949.88
$1,021.37
$1,275.34 		$1,264.84
$1,332.33
$1,403.82
$1,657.79 		$1,647.29
$1,714.78
$1,786.27
$2,040.24 		$382.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$999.88
$1,134.86
$1,277.84
$1,785.78
$2,713.68 		$1,382.33
$1,517.31
$1,660.29
$2,168.23 		$1,764.78
$1,899.76
$2,042.74
$2,550.68 		$2,147.23
$2,282.21
$2,425.19
$2,933.13 		$382.45
Toc - Plan #15 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Local Bronze 7000 HSA Eligible with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$364.34
$413.53
$465.63
$650.71
$988.82 		$643.06
$692.25
$744.35
$929.43 		$921.78
$970.97
$1,023.07
$1,208.15 		$1,200.50
$1,249.69
$1,301.79
$1,486.87 		$278.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728.68
$827.06
$931.26
$1,301.42
$1,977.64 		$1,007.40
$1,105.78
$1,209.98
$1,580.14 		$1,286.12
$1,384.50
$1,488.70
$1,858.86 		$1,564.84
$1,663.22
$1,767.42
$2,137.58 		$278.72
Toc - Plan #16 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Local Bronze 7000 Copay with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$374.71
$425.30
$478.88
$669.23
$1,016.96 		$661.36
$711.95
$765.53
$955.88 		$948.01
$998.60
$1,052.18
$1,242.53 		$1,234.66
$1,285.25
$1,338.83
$1,529.18 		$286.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$749.42
$850.60
$957.76
$1,338.46
$2,033.92 		$1,036.07
$1,137.25
$1,244.41
$1,625.11 		$1,322.72
$1,423.90
$1,531.06
$1,911.76 		$1,609.37
$1,710.55
$1,817.71
$2,198.41 		$286.65
Toc - Plan #17 Blue Cross and Blue Shield of NC
Bronze

(POS) Blue Local Bronze 8700 with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$347.84
$394.80
$444.54
$621.24
$944.04 		$613.94
$660.90
$710.64
$887.34 		$880.04
$927.00
$976.74
$1,153.44 		$1,146.14
$1,193.10
$1,242.84
$1,419.54 		$266.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.68
$789.60
$889.08
$1,242.48
$1,888.08 		$961.78
$1,055.70
$1,155.18
$1,508.58 		$1,227.88
$1,321.80
$1,421.28
$1,774.68 		$1,493.98
$1,587.90
$1,687.38
$2,040.78 		$266.10
Toc - Plan #18 Blue Cross and Blue Shield of NC
Catastrophic

(POS) Blue Local Catastrophic with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$249.11
$282.74
$318.36
$444.91
$676.08 		$439.68
$473.31
$508.93
$635.48 		$630.25
$663.88
$699.50
$826.05 		$820.82
$854.45
$890.07
$1,016.62 		$190.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$498.22
$565.48
$636.72
$889.82
$1,352.16 		$688.79
$756.05
$827.29
$1,080.39 		$879.36
$946.62
$1,017.86
$1,270.96 		$1,069.93
$1,137.19
$1,208.43
$1,461.53 		$190.57
Toc - Plan #19 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver $0 Deductible with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$520.27
$590.51
$664.91
$929.20
$1,412.01 		$918.28
$988.52
$1,062.92
$1,327.21 		$1,316.29
$1,386.53
$1,460.93
$1,725.22 		$1,714.30
$1,784.54
$1,858.94
$2,123.23 		$398.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,040.54
$1,181.02
$1,329.82
$1,858.40
$2,824.02 		$1,438.55
$1,579.03
$1,727.83
$2,256.41 		$1,836.56
$1,977.04
$2,125.84
$2,654.42 		$2,234.57
$2,375.05
$2,523.85
$3,052.43 		$398.01
Toc - Plan #20 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 5300 + 3 Free PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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 		$481.77
$546.81
$615.70
$860.44
$1,307.52 		$850.32
$915.36
$984.25
$1,228.99 		$1,218.87
$1,283.91
$1,352.80
$1,597.54 		$1,587.42
$1,652.46
$1,721.35
$1,966.09 		$368.55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$963.54
$1,093.62
$1,231.40
$1,720.88
$2,615.04 		$1,332.09
$1,462.17
$1,599.95
$2,089.43 		$1,700.64
$1,830.72
$1,968.50
$2,457.98 		$2,069.19
$2,199.27
$2,337.05
$2,826.53 		$368.55
Toc - Plan #21 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 2800 + $15 PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 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 		$502.93
$570.83
$642.74
$898.23
$1,364.95 		$887.67
$955.57
$1,027.48
$1,282.97 		$1,272.41
$1,340.31
$1,412.22
$1,667.71 		$1,657.15
$1,725.05
$1,796.96
$2,052.45 		$384.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,005.86
$1,141.66
$1,285.48
$1,796.46
$2,729.90 		$1,390.60
$1,526.40
$1,670.22
$2,181.20 		$1,775.34
$1,911.14
$2,054.96
$2,565.94 		$2,160.08
$2,295.88
$2,439.70
$2,950.68 		$384.74
Toc - Plan #22 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Local Bronze 7000 + 3 Free PCP with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$351.61
$399.08
$449.36
$627.98
$954.27 		$620.59
$668.06
$718.34
$896.96 		$889.57
$937.04
$987.32
$1,165.94 		$1,158.55
$1,206.02
$1,256.30
$1,434.92 		$268.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$703.22
$798.16
$898.72
$1,255.96
$1,908.54 		$972.20
$1,067.14
$1,167.70
$1,524.94 		$1,241.18
$1,336.12
$1,436.68
$1,793.92 		$1,510.16
$1,605.10
$1,705.66
$2,062.90 		$268.98

ADVERTISEMENT

WellCare of North Carolina

Local: 1-312-332-5401 | Toll Free: 1-800-779-7989

Toc - Plan #23 WellCare of North Carolina
Expanded Bronze

(PPO) WellCare Secure Health Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-779-7989

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$608.92
$691.12
$778.19
$1,087.52
$1,652.59 		$1,074.74
$1,156.94
$1,244.01
$1,553.34 		$1,540.56
$1,622.76
$1,709.83
$2,019.16 		$2,006.38
$2,088.58
$2,175.65
$2,484.98 		$465.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,217.84
$1,382.24
$1,556.38
$2,175.04
$3,305.18 		$1,683.66
$1,848.06
$2,022.20
$2,640.86 		$2,149.48
$2,313.88
$2,488.02
$3,106.68 		$2,615.30
$2,779.70
$2,953.84
$3,572.50 		$465.82
Toc - Plan #24 WellCare of North Carolina
Silver

(PPO) WellCare Secure Health Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-779-7989

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$869.60
$986.99
$1,111.34
$1,553.09
$2,360.07 		$1,534.84
$1,652.23
$1,776.58
$2,218.33 		$2,200.08
$2,317.47
$2,441.82
$2,883.57 		$2,865.32
$2,982.71
$3,107.06
$3,548.81 		$665.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,739.20
$1,973.98
$2,222.68
$3,106.18
$4,720.14 		$2,404.44
$2,639.22
$2,887.92
$3,771.42 		$3,069.68
$3,304.46
$3,553.16
$4,436.66 		$3,734.92
$3,969.70
$4,218.40
$5,101.90 		$665.24
Toc - Plan #25 WellCare of North Carolina
Gold

(PPO) WellCare Secure Health Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-779-7989

Annual Out of Pocket Expenses:

Individual Family
$1,350 $2,700 Annual Deductible
$5,850 $11,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$862.16
$978.54
$1,101.83
$1,539.80
$2,339.88 		$1,521.71
$1,638.09
$1,761.38
$2,199.35 		$2,181.26
$2,297.64
$2,420.93
$2,858.90 		$2,840.81
$2,957.19
$3,080.48
$3,518.45 		$659.55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,724.32
$1,957.08
$2,203.66
$3,079.60
$4,679.76 		$2,383.87
$2,616.63
$2,863.21
$3,739.15 		$3,043.42
$3,276.18
$3,522.76
$4,398.70 		$3,702.97
$3,935.73
$4,182.31
$5,058.25 		$659.55

ADVERTISEMENT

Aetna CVS Health

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

Toc - Plan #26 Aetna CVS Health
Expanded Bronze

(HMO) Aetna CVS Bronze: Low-Cost MinuteClinic Visits, Telehealth, Store Discounts

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$362.20
$411.09
$462.89
$646.89
$983.01 		$639.28
$688.17
$739.97
$923.97 		$916.36
$965.25
$1,017.05
$1,201.05 		$1,193.44
$1,242.33
$1,294.13
$1,478.13 		$277.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$724.40
$822.18
$925.78
$1,293.78
$1,966.02 		$1,001.48
$1,099.26
$1,202.86
$1,570.86 		$1,278.56
$1,376.34
$1,479.94
$1,847.94 		$1,555.64
$1,653.42
$1,757.02
$2,125.02 		$277.08
Toc - Plan #27 Aetna CVS Health
Bronze

(HMO) Aetna CVS Bronze: $0 MinuteClinic Visits, Telehealth, Store Discounts

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

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$313.67
$356.02
$400.88
$560.22
$851.31 		$553.63
$595.98
$640.84
$800.18 		$793.59
$835.94
$880.80
$1,040.14 		$1,033.55
$1,075.90
$1,120.76
$1,280.10 		$239.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$627.34
$712.04
$801.76
$1,120.44
$1,702.62 		$867.30
$952.00
$1,041.72
$1,360.40 		$1,107.26
$1,191.96
$1,281.68
$1,600.36 		$1,347.22
$1,431.92
$1,521.64
$1,840.32 		$239.96
Toc - Plan #28 Aetna CVS Health
Gold

(HMO) Aetna CVS Gold: $0 MinuteClinic Visits, Telehealth, Store Discounts

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

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$523.20
$593.83
$668.65
$934.43
$1,419.96 		$923.45
$994.08
$1,068.90
$1,334.68 		$1,323.70
$1,394.33
$1,469.15
$1,734.93 		$1,723.95
$1,794.58
$1,869.40
$2,135.18 		$400.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,046.40
$1,187.66
$1,337.30
$1,868.86
$2,839.92 		$1,446.65
$1,587.91
$1,737.55
$2,269.11 		$1,846.90
$1,988.16
$2,137.80
$2,669.36 		$2,247.15
$2,388.41
$2,538.05
$3,069.61 		$400.25
Toc - Plan #29 Aetna CVS Health
Silver

(HMO) Aetna CVS Silver 1: $0 MinuteClinic Visits, Telehealth, Store Discounts

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

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$501.01
$568.64
$640.29
$894.80
$1,359.73 		$884.28
$951.91
$1,023.56
$1,278.07 		$1,267.55
$1,335.18
$1,406.83
$1,661.34 		$1,650.82
$1,718.45
$1,790.10
$2,044.61 		$383.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,002.02
$1,137.28
$1,280.58
$1,789.60
$2,719.46 		$1,385.29
$1,520.55
$1,663.85
$2,172.87 		$1,768.56
$1,903.82
$2,047.12
$2,556.14 		$2,151.83
$2,287.09
$2,430.39
$2,939.41 		$383.27
Toc - Plan #30 Aetna CVS Health
Silver

(HMO) Aetna CVS Silver 2: $0 MinuteClinic Visits, Telehealth, Store Discounts

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

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$436.23
$495.12
$557.50
$779.10
$1,183.91 		$769.94
$828.83
$891.21
$1,112.81 		$1,103.65
$1,162.54
$1,224.92
$1,446.52 		$1,437.36
$1,496.25
$1,558.63
$1,780.23 		$333.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$872.46
$990.24
$1,115.00
$1,558.20
$2,367.82 		$1,206.17
$1,323.95
$1,448.71
$1,891.91 		$1,539.88
$1,657.66
$1,782.42
$2,225.62 		$1,873.59
$1,991.37
$2,116.13
$2,559.33 		$333.71

ADVERTISEMENT

Ambetter of North Carolina

Local: 1-833-863-1310 | Toll Free: 1-833-863-1310

Toc - Plan #31 Ambetter of North Carolina
Bronze

(HMO) Ambetter Essential Care 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$347.77
$394.70
$444.43
$621.09
$943.81 		$613.80
$660.73
$710.46
$887.12 		$879.83
$926.76
$976.49
$1,153.15 		$1,145.86
$1,192.79
$1,242.52
$1,419.18 		$266.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.54
$789.40
$888.86
$1,242.18
$1,887.62 		$961.57
$1,055.43
$1,154.89
$1,508.21 		$1,227.60
$1,321.46
$1,420.92
$1,774.24 		$1,493.63
$1,587.49
$1,686.95
$2,040.27 		$266.03
Toc - Plan #32 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$381.47
$432.96
$487.51
$681.30
$1,035.29 		$673.29
$724.78
$779.33
$973.12 		$965.11
$1,016.60
$1,071.15
$1,264.94 		$1,256.93
$1,308.42
$1,362.97
$1,556.76 		$291.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$762.94
$865.92
$975.02
$1,362.60
$2,070.58 		$1,054.76
$1,157.74
$1,266.84
$1,654.42 		$1,346.58
$1,449.56
$1,558.66
$1,946.24 		$1,638.40
$1,741.38
$1,850.48
$2,238.06 		$291.82
Toc - Plan #33 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$487.82
$553.66
$623.42
$871.22
$1,323.91 		$860.99
$926.83
$996.59
$1,244.39 		$1,234.16
$1,300.00
$1,369.76
$1,617.56 		$1,607.33
$1,673.17
$1,742.93
$1,990.73 		$373.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$975.64
$1,107.32
$1,246.84
$1,742.44
$2,647.82 		$1,348.81
$1,480.49
$1,620.01
$2,115.61 		$1,721.98
$1,853.66
$1,993.18
$2,488.78 		$2,095.15
$2,226.83
$2,366.35
$2,861.95 		$373.17
Toc - Plan #34 Ambetter of North Carolina
Gold

(HMO) Ambetter Secure Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$527.67
$598.89
$674.35
$942.40
$1,432.07 		$931.33
$1,002.55
$1,078.01
$1,346.06 		$1,334.99
$1,406.21
$1,481.67
$1,749.72 		$1,738.65
$1,809.87
$1,885.33
$2,153.38 		$403.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,055.34
$1,197.78
$1,348.70
$1,884.80
$2,864.14 		$1,459.00
$1,601.44
$1,752.36
$2,288.46 		$1,862.66
$2,005.10
$2,156.02
$2,692.12 		$2,266.32
$2,408.76
$2,559.68
$3,095.78 		$403.66
Toc - Plan #35 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$482.11
$547.18
$616.12
$861.03
$1,308.42 		$850.92
$915.99
$984.93
$1,229.84 		$1,219.73
$1,284.80
$1,353.74
$1,598.65 		$1,588.54
$1,653.61
$1,722.55
$1,967.46 		$368.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$964.22
$1,094.36
$1,232.24
$1,722.06
$2,616.84 		$1,333.03
$1,463.17
$1,601.05
$2,090.87 		$1,701.84
$1,831.98
$1,969.86
$2,459.68 		$2,070.65
$2,200.79
$2,338.67
$2,828.49 		$368.81
Toc - Plan #36 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$374.50
$425.04
$478.60
$668.84
$1,016.36 		$660.98
$711.52
$765.08
$955.32 		$947.46
$998.00
$1,051.56
$1,241.80 		$1,233.94
$1,284.48
$1,338.04
$1,528.28 		$286.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$749.00
$850.08
$957.20
$1,337.68
$2,032.72 		$1,035.48
$1,136.56
$1,243.68
$1,624.16 		$1,321.96
$1,423.04
$1,530.16
$1,910.64 		$1,608.44
$1,709.52
$1,816.64
$2,197.12 		$286.48
Toc - Plan #37 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 22

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$397.67
$451.34
$508.21
$710.22
$1,079.25 		$701.88
$755.55
$812.42
$1,014.43 		$1,006.09
$1,059.76
$1,116.63
$1,318.64 		$1,310.30
$1,363.97
$1,420.84
$1,622.85 		$304.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795.34
$902.68
$1,016.42
$1,420.44
$2,158.50 		$1,099.55
$1,206.89
$1,320.63
$1,724.65 		$1,403.76
$1,511.10
$1,624.84
$2,028.86 		$1,707.97
$1,815.31
$1,929.05
$2,333.07 		$304.21
Toc - Plan #38 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$406.69
$461.59
$519.74
$726.34
$1,103.74 		$717.80
$772.70
$830.85
$1,037.45 		$1,028.91
$1,083.81
$1,141.96
$1,348.56 		$1,340.02
$1,394.92
$1,453.07
$1,659.67 		$311.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$813.38
$923.18
$1,039.48
$1,452.68
$2,207.48 		$1,124.49
$1,234.29
$1,350.59
$1,763.79 		$1,435.60
$1,545.40
$1,661.70
$2,074.90 		$1,746.71
$1,856.51
$1,972.81
$2,386.01 		$311.11
Toc - Plan #39 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care: $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$427.13
$484.78
$545.86
$762.84
$1,159.21 		$753.88
$811.53
$872.61
$1,089.59 		$1,080.63
$1,138.28
$1,199.36
$1,416.34 		$1,407.38
$1,465.03
$1,526.11
$1,743.09 		$326.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$854.26
$969.56
$1,091.72
$1,525.68
$2,318.42 		$1,181.01
$1,296.31
$1,418.47
$1,852.43 		$1,507.76
$1,623.06
$1,745.22
$2,179.18 		$1,834.51
$1,949.81
$2,071.97
$2,505.93 		$326.75
Toc - Plan #40 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$462.01
$524.37
$590.44
$825.13
$1,253.87 		$815.44
$877.80
$943.87
$1,178.56 		$1,168.87
$1,231.23
$1,297.30
$1,531.99 		$1,522.30
$1,584.66
$1,650.73
$1,885.42 		$353.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$924.02
$1,048.74
$1,180.88
$1,650.26
$2,507.74 		$1,277.45
$1,402.17
$1,534.31
$2,003.69 		$1,630.88
$1,755.60
$1,887.74
$2,357.12 		$1,984.31
$2,109.03
$2,241.17
$2,710.55 		$353.43
Toc - Plan #41 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 31

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$462.06
$524.43
$590.50
$825.22
$1,254.00 		$815.53
$877.90
$943.97
$1,178.69 		$1,169.00
$1,231.37
$1,297.44
$1,532.16 		$1,522.47
$1,584.84
$1,650.91
$1,885.63 		$353.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$924.12
$1,048.86
$1,181.00
$1,650.44
$2,508.00 		$1,277.59
$1,402.33
$1,534.47
$2,003.91 		$1,631.06
$1,755.80
$1,887.94
$2,357.38 		$1,984.53
$2,109.27
$2,241.41
$2,710.85 		$353.47
Toc - Plan #42 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 32

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$468.06
$531.24
$598.17
$835.94
$1,270.29 		$826.12
$889.30
$956.23
$1,194.00 		$1,184.18
$1,247.36
$1,314.29
$1,552.06 		$1,542.24
$1,605.42
$1,672.35
$1,910.12 		$358.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$936.12
$1,062.48
$1,196.34
$1,671.88
$2,540.58 		$1,294.18
$1,420.54
$1,554.40
$2,029.94 		$1,652.24
$1,778.60
$1,912.46
$2,388.00 		$2,010.30
$2,136.66
$2,270.52
$2,746.06 		$358.06
Toc - Plan #43 Ambetter of North Carolina
Gold

(HMO) Ambetter Secure Care 20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$494.89
$561.69
$632.46
$883.85
$1,343.10 		$873.47
$940.27
$1,011.04
$1,262.43 		$1,252.05
$1,318.85
$1,389.62
$1,641.01 		$1,630.63
$1,697.43
$1,768.20
$2,019.59 		$378.58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$989.78
$1,123.38
$1,264.92
$1,767.70
$2,686.20 		$1,368.36
$1,501.96
$1,643.50
$2,146.28 		$1,746.94
$1,880.54
$2,022.08
$2,524.86 		$2,125.52
$2,259.12
$2,400.66
$2,903.44 		$378.58
Toc - Plan #44 Ambetter of North Carolina
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$363.23
$412.25
$464.19
$648.71
$985.77 		$641.09
$690.11
$742.05
$926.57 		$918.95
$967.97
$1,019.91
$1,204.43 		$1,196.81
$1,245.83
$1,297.77
$1,482.29 		$277.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$726.46
$824.50
$928.38
$1,297.42
$1,971.54 		$1,004.32
$1,102.36
$1,206.24
$1,575.28 		$1,282.18
$1,380.22
$1,484.10
$1,853.14 		$1,560.04
$1,658.08
$1,761.96
$2,131.00 		$277.86
Toc - Plan #45 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$398.43
$452.21
$509.18
$711.58
$1,081.32 		$703.22
$757.00
$813.97
$1,016.37 		$1,008.01
$1,061.79
$1,118.76
$1,321.16 		$1,312.80
$1,366.58
$1,423.55
$1,625.95 		$304.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$796.86
$904.42
$1,018.36
$1,423.16
$2,162.64 		$1,101.65
$1,209.21
$1,323.15
$1,727.95 		$1,406.44
$1,514.00
$1,627.94
$2,032.74 		$1,711.23
$1,818.79
$1,932.73
$2,337.53 		$304.79
Toc - Plan #46 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$509.50
$578.27
$651.13
$909.95
$1,382.76 		$899.26
$968.03
$1,040.89
$1,299.71 		$1,289.02
$1,357.79
$1,430.65
$1,689.47 		$1,678.78
$1,747.55
$1,820.41
$2,079.23 		$389.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,019.00
$1,156.54
$1,302.26
$1,819.90
$2,765.52 		$1,408.76
$1,546.30
$1,692.02
$2,209.66 		$1,798.52
$1,936.06
$2,081.78
$2,599.42 		$2,188.28
$2,325.82
$2,471.54
$2,989.18 		$389.76
Toc - Plan #47 Ambetter of North Carolina
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$551.13
$625.52
$704.33
$984.30
$1,495.73 		$972.73
$1,047.12
$1,125.93
$1,405.90 		$1,394.33
$1,468.72
$1,547.53
$1,827.50 		$1,815.93
$1,890.32
$1,969.13
$2,249.10 		$421.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,102.26
$1,251.04
$1,408.66
$1,968.60
$2,991.46 		$1,523.86
$1,672.64
$1,830.26
$2,390.20 		$1,945.46
$2,094.24
$2,251.86
$2,811.80 		$2,367.06
$2,515.84
$2,673.46
$3,233.40 		$421.60
Toc - Plan #48 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$503.54
$571.51
$643.51
$899.31
$1,366.58 		$888.74
$956.71
$1,028.71
$1,284.51 		$1,273.94
$1,341.91
$1,413.91
$1,669.71 		$1,659.14
$1,727.11
$1,799.11
$2,054.91 		$385.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,007.08
$1,143.02
$1,287.02
$1,798.62
$2,733.16 		$1,392.28
$1,528.22
$1,672.22
$2,183.82 		$1,777.48
$1,913.42
$2,057.42
$2,569.02 		$2,162.68
$2,298.62
$2,442.62
$2,954.22 		$385.20
Toc - Plan #49 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$391.15
$443.94
$499.87
$698.57
$1,061.55 		$690.37
$743.16
$799.09
$997.79 		$989.59
$1,042.38
$1,098.31
$1,297.01 		$1,288.81
$1,341.60
$1,397.53
$1,596.23 		$299.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$782.30
$887.88
$999.74
$1,397.14
$2,123.10 		$1,081.52
$1,187.10
$1,298.96
$1,696.36 		$1,380.74
$1,486.32
$1,598.18
$1,995.58 		$1,679.96
$1,785.54
$1,897.40
$2,294.80 		$299.22
Toc - Plan #50 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$415.35
$471.41
$530.80
$741.79
$1,127.23 		$733.08
$789.14
$848.53
$1,059.52 		$1,050.81
$1,106.87
$1,166.26
$1,377.25 		$1,368.54
$1,424.60
$1,483.99
$1,694.98 		$317.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$830.70
$942.82
$1,061.60
$1,483.58
$2,254.46 		$1,148.43
$1,260.55
$1,379.33
$1,801.31 		$1,466.16
$1,578.28
$1,697.06
$2,119.04 		$1,783.89
$1,896.01
$2,014.79
$2,436.77 		$317.73
Toc - Plan #51 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$424.77
$482.11
$542.85
$758.63
$1,152.81 		$749.71
$807.05
$867.79
$1,083.57 		$1,074.65
$1,131.99
$1,192.73
$1,408.51 		$1,399.59
$1,456.93
$1,517.67
$1,733.45 		$324.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$849.54
$964.22
$1,085.70
$1,517.26
$2,305.62 		$1,174.48
$1,289.16
$1,410.64
$1,842.20 		$1,499.42
$1,614.10
$1,735.58
$2,167.14 		$1,824.36
$1,939.04
$2,060.52
$2,492.08 		$324.94
Toc - Plan #52 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$446.12
$506.34
$570.13
$796.75
$1,210.75 		$787.40
$847.62
$911.41
$1,138.03 		$1,128.68
$1,188.90
$1,252.69
$1,479.31 		$1,469.96
$1,530.18
$1,593.97
$1,820.59 		$341.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$892.24
$1,012.68
$1,140.26
$1,593.50
$2,421.50 		$1,233.52
$1,353.96
$1,481.54
$1,934.78 		$1,574.80
$1,695.24
$1,822.82
$2,276.06 		$1,916.08
$2,036.52
$2,164.10
$2,617.34 		$341.28
Toc - Plan #53 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$482.60
$547.74
$616.75
$861.91
$1,309.75 		$851.78
$916.92
$985.93
$1,231.09 		$1,220.96
$1,286.10
$1,355.11
$1,600.27 		$1,590.14
$1,655.28
$1,724.29
$1,969.45 		$369.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$965.20
$1,095.48
$1,233.50
$1,723.82
$2,619.50 		$1,334.38
$1,464.66
$1,602.68
$2,093.00 		$1,703.56
$1,833.84
$1,971.86
$2,462.18 		$2,072.74
$2,203.02
$2,341.04
$2,831.36 		$369.18
Toc - Plan #54 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$488.87
$554.85
$624.76
$873.10
$1,326.76 		$862.85
$928.83
$998.74
$1,247.08 		$1,236.83
$1,302.81
$1,372.72
$1,621.06 		$1,610.81
$1,676.79
$1,746.70
$1,995.04 		$373.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$977.74
$1,109.70
$1,249.52
$1,746.20
$2,653.52 		$1,351.72
$1,483.68
$1,623.50
$2,120.18 		$1,725.70
$1,857.66
$1,997.48
$2,494.16 		$2,099.68
$2,231.64
$2,371.46
$2,868.14 		$373.98
Toc - Plan #55 Ambetter of North Carolina
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$516.89
$586.66
$660.57
$923.15
$1,402.81 		$912.30
$982.07
$1,055.98
$1,318.56 		$1,307.71
$1,377.48
$1,451.39
$1,713.97 		$1,703.12
$1,772.89
$1,846.80
$2,109.38 		$395.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,033.78
$1,173.32
$1,321.14
$1,846.30
$2,805.62 		$1,429.19
$1,568.73
$1,716.55
$2,241.71 		$1,824.60
$1,964.14
$2,111.96
$2,637.12 		$2,220.01
$2,359.55
$2,507.37
$3,032.53 		$395.41

‡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 Lincoln County here.

Lincoln County is in “Rating Area 2” of North Carolina.

Currently, there are 55 plans offered in Rating Area 2.

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2022 Obamacare Plans for Lincoln County, NC

Plan Browser: 55 Plans
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