Obamacare 2023 Rates for Lane County

Obamacare > Rates > Oregon > Lane County

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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 Noti, OR.

The health insurance rates listed below are for calendar year 2023.

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, 48 Plans and 2023 Rates for Lane County, Oregon

Below, you’ll find a summary of the 48 plans for Lane County, Oregon 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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Lane County Resources

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PacificSource Health Plans

Local: 1-541-684-5582 | Toll Free: 1-888-977-9299 | TTY: 1-800-735-2900
Toc - Plan #1 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze HSA 7050

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$363.00
$412.00
$464.00
$649.00
$986.00 		$594.00
$643.00
$695.00
$880.00 		$825.00
$874.00
$926.00
$1,111.00 		$1,056.00
$1,105.00
$1,157.00
$1,342.00 		$231.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$726.00
$824.00
$928.00
$1,298.00
$1,972.00 		$957.00
$1,055.00
$1,159.00
$1,529.00 		$1,188.00
$1,286.00
$1,390.00
$1,760.00 		$1,419.00
$1,517.00
$1,621.00
$1,991.00 		$231.00
Toc - Plan #2 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 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 		$364.00
$413.00
$465.00
$650.00
$988.00 		$595.00
$644.00
$696.00
$881.00 		$826.00
$875.00
$927.00
$1,112.00 		$1,057.00
$1,106.00
$1,158.00
$1,343.00 		$231.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728.00
$826.00
$930.00
$1,300.00
$1,976.00 		$959.00
$1,057.00
$1,161.00
$1,531.00 		$1,190.00
$1,288.00
$1,392.00
$1,762.00 		$1,421.00
$1,519.00
$1,623.00
$1,993.00 		$231.00
Toc - Plan #3 PacificSource Health Plans
Silver

(PPO) Navigator Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,100 $18,200 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 		$477.00
$542.00
$610.00
$852.00
$1,295.00 		$780.00
$845.00
$913.00
$1,155.00 		$1,083.00
$1,148.00
$1,216.00
$1,458.00 		$1,386.00
$1,451.00
$1,519.00
$1,761.00 		$303.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$954.00
$1,084.00
$1,220.00
$1,704.00
$2,590.00 		$1,257.00
$1,387.00
$1,523.00
$2,007.00 		$1,560.00
$1,690.00
$1,826.00
$2,310.00 		$1,863.00
$1,993.00
$2,129.00
$2,613.00 		$303.00
Toc - Plan #4 PacificSource Health Plans
Silver

(PPO) Navigator Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,100 $18,200 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 		$491.00
$558.00
$628.00
$878.00
$1,334.00 		$803.00
$870.00
$940.00
$1,190.00 		$1,115.00
$1,182.00
$1,252.00
$1,502.00 		$1,427.00
$1,494.00
$1,564.00
$1,814.00 		$312.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$982.00
$1,116.00
$1,256.00
$1,756.00
$2,668.00 		$1,294.00
$1,428.00
$1,568.00
$2,068.00 		$1,606.00
$1,740.00
$1,880.00
$2,380.00 		$1,918.00
$2,052.00
$2,192.00
$2,692.00 		$312.00
Toc - Plan #5 PacificSource Health Plans
Catastrophic

(PPO) Navigator Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 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 		$245.00
$278.00
$313.00
$437.00
$664.00 		$400.00
$433.00
$468.00
$592.00 		$555.00
$588.00
$623.00
$747.00 		$710.00
$743.00
$778.00
$902.00 		$155.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$490.00
$556.00
$626.00
$874.00
$1,328.00 		$645.00
$711.00
$781.00
$1,029.00 		$800.00
$866.00
$936.00
$1,184.00 		$955.00
$1,021.00
$1,091.00
$1,339.00 		$155.00
Toc - Plan #6 PacificSource Health Plans
Expanded Bronze

(PPO) PacificSource Oregon Standard Bronze Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$371.00
$421.00
$474.00
$663.00
$1,007.00 		$607.00
$657.00
$710.00
$899.00 		$843.00
$893.00
$946.00
$1,135.00 		$1,079.00
$1,129.00
$1,182.00
$1,371.00 		$236.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$742.00
$842.00
$948.00
$1,326.00
$2,014.00 		$978.00
$1,078.00
$1,184.00
$1,562.00 		$1,214.00
$1,314.00
$1,420.00
$1,798.00 		$1,450.00
$1,550.00
$1,656.00
$2,034.00 		$236.00
Toc - Plan #7 PacificSource Health Plans
Silver

(PPO) PacificSource Oregon Standard Silver Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$480.00
$545.00
$614.00
$858.00
$1,303.00 		$785.00
$850.00
$919.00
$1,163.00 		$1,090.00
$1,155.00
$1,224.00
$1,468.00 		$1,395.00
$1,460.00
$1,529.00
$1,773.00 		$305.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$960.00
$1,090.00
$1,228.00
$1,716.00
$2,606.00 		$1,265.00
$1,395.00
$1,533.00
$2,021.00 		$1,570.00
$1,700.00
$1,838.00
$2,326.00 		$1,875.00
$2,005.00
$2,143.00
$2,631.00 		$305.00
Toc - Plan #8 PacificSource Health Plans
Gold

(PPO) PacificSource Oregon Standard Gold Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$522.00
$593.00
$667.00
$933.00
$1,417.00 		$854.00
$925.00
$999.00
$1,265.00 		$1,186.00
$1,257.00
$1,331.00
$1,597.00 		$1,518.00
$1,589.00
$1,663.00
$1,929.00 		$332.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,044.00
$1,186.00
$1,334.00
$1,866.00
$2,834.00 		$1,376.00
$1,518.00
$1,666.00
$2,198.00 		$1,708.00
$1,850.00
$1,998.00
$2,530.00 		$2,040.00
$2,182.00
$2,330.00
$2,862.00 		$332.00
Toc - Plan #9 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 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 		$333.00
$378.00
$426.00
$595.00
$905.00 		$545.00
$590.00
$638.00
$807.00 		$757.00
$802.00
$850.00
$1,019.00 		$969.00
$1,014.00
$1,062.00
$1,231.00 		$212.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$666.00
$756.00
$852.00
$1,190.00
$1,810.00 		$878.00
$968.00
$1,064.00
$1,402.00 		$1,090.00
$1,180.00
$1,276.00
$1,614.00 		$1,302.00
$1,392.00
$1,488.00
$1,826.00 		$212.00
Toc - Plan #10 PacificSource Health Plans
Gold

(PPO) Navigator Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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 		$529.00
$600.00
$676.00
$944.00
$1,435.00 		$865.00
$936.00
$1,012.00
$1,280.00 		$1,201.00
$1,272.00
$1,348.00
$1,616.00 		$1,537.00
$1,608.00
$1,684.00
$1,952.00 		$336.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,058.00
$1,200.00
$1,352.00
$1,888.00
$2,870.00 		$1,394.00
$1,536.00
$1,688.00
$2,224.00 		$1,730.00
$1,872.00
$2,024.00
$2,560.00 		$2,066.00
$2,208.00
$2,360.00
$2,896.00 		$336.00

ADVERTISEMENT

Moda Health Plan, Inc.

Local: 1-888-393-2940 | Toll Free: 1-888-393-2940 | TTY: 1-888-393-2940
Toc - Plan #11 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Oregon Standard Gold (Affinity)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$477.00
$541.00
$609.00
$851.00
$1,294.00 		$780.00
$844.00
$912.00
$1,154.00 		$1,083.00
$1,147.00
$1,215.00
$1,457.00 		$1,386.00
$1,450.00
$1,518.00
$1,760.00 		$303.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$954.00
$1,082.00
$1,218.00
$1,702.00
$2,588.00 		$1,257.00
$1,385.00
$1,521.00
$2,005.00 		$1,560.00
$1,688.00
$1,824.00
$2,308.00 		$1,863.00
$1,991.00
$2,127.00
$2,611.00 		$303.00
Toc - Plan #12 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Oregon Standard Silver (Affinity)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$408.00
$464.00
$522.00
$729.00
$1,108.00 		$667.00
$723.00
$781.00
$988.00 		$926.00
$982.00
$1,040.00
$1,247.00 		$1,185.00
$1,241.00
$1,299.00
$1,506.00 		$259.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$816.00
$928.00
$1,044.00
$1,458.00
$2,216.00 		$1,075.00
$1,187.00
$1,303.00
$1,717.00 		$1,334.00
$1,446.00
$1,562.00
$1,976.00 		$1,593.00
$1,705.00
$1,821.00
$2,235.00 		$259.00
Toc - Plan #13 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Oregon Standard Bronze Plan (Affinity)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$328.00
$372.00
$419.00
$586.00
$890.00 		$536.00
$580.00
$627.00
$794.00 		$744.00
$788.00
$835.00
$1,002.00 		$952.00
$996.00
$1,043.00
$1,210.00 		$208.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656.00
$744.00
$838.00
$1,172.00
$1,780.00 		$864.00
$952.00
$1,046.00
$1,380.00 		$1,072.00
$1,160.00
$1,254.00
$1,588.00 		$1,280.00
$1,368.00
$1,462.00
$1,796.00 		$208.00
Toc - Plan #14 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Affinity Gold 250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$250 $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 		$492.00
$558.00
$628.00
$878.00
$1,334.00 		$804.00
$870.00
$940.00
$1,190.00 		$1,116.00
$1,182.00
$1,252.00
$1,502.00 		$1,428.00
$1,494.00
$1,564.00
$1,814.00 		$312.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$984.00
$1,116.00
$1,256.00
$1,756.00
$2,668.00 		$1,296.00
$1,428.00
$1,568.00
$2,068.00 		$1,608.00
$1,740.00
$1,880.00
$2,380.00 		$1,920.00
$2,052.00
$2,192.00
$2,692.00 		$312.00
Toc - Plan #15 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Affinity Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

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 		$487.00
$553.00
$623.00
$870.00
$1,322.00 		$796.00
$862.00
$932.00
$1,179.00 		$1,105.00
$1,171.00
$1,241.00
$1,488.00 		$1,414.00
$1,480.00
$1,550.00
$1,797.00 		$309.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$974.00
$1,106.00
$1,246.00
$1,740.00
$2,644.00 		$1,283.00
$1,415.00
$1,555.00
$2,049.00 		$1,592.00
$1,724.00
$1,864.00
$2,358.00 		$1,901.00
$2,033.00
$2,173.00
$2,667.00 		$309.00
Toc - Plan #16 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Affinity Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

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 		$419.00
$476.00
$536.00
$749.00
$1,139.00 		$685.00
$742.00
$802.00
$1,015.00 		$951.00
$1,008.00
$1,068.00
$1,281.00 		$1,217.00
$1,274.00
$1,334.00
$1,547.00 		$266.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$838.00
$952.00
$1,072.00
$1,498.00
$2,278.00 		$1,104.00
$1,218.00
$1,338.00
$1,764.00 		$1,370.00
$1,484.00
$1,604.00
$2,030.00 		$1,636.00
$1,750.00
$1,870.00
$2,296.00 		$266.00
Toc - Plan #17 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Affinity Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

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 		$326.00
$370.00
$417.00
$583.00
$886.00 		$533.00
$577.00
$624.00
$790.00 		$740.00
$784.00
$831.00
$997.00 		$947.00
$991.00
$1,038.00
$1,204.00 		$207.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$652.00
$740.00
$834.00
$1,166.00
$1,772.00 		$859.00
$947.00
$1,041.00
$1,373.00 		$1,066.00
$1,154.00
$1,248.00
$1,580.00 		$1,273.00
$1,361.00
$1,455.00
$1,787.00 		$207.00
Toc - Plan #18 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Affinity Bronze HSA 6900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

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 		$338.00
$384.00
$433.00
$604.00
$919.00 		$553.00
$599.00
$648.00
$819.00 		$768.00
$814.00
$863.00
$1,034.00 		$983.00
$1,029.00
$1,078.00
$1,249.00 		$215.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676.00
$768.00
$866.00
$1,208.00
$1,838.00 		$891.00
$983.00
$1,081.00
$1,423.00 		$1,106.00
$1,198.00
$1,296.00
$1,638.00 		$1,321.00
$1,413.00
$1,511.00
$1,853.00 		$215.00
Toc - Plan #19 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Affinity Silver 4500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$8,050 $16,100 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 		$412.00
$468.00
$527.00
$736.00
$1,118.00 		$674.00
$730.00
$789.00
$998.00 		$936.00
$992.00
$1,051.00
$1,260.00 		$1,198.00
$1,254.00
$1,313.00
$1,522.00 		$262.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$824.00
$936.00
$1,054.00
$1,472.00
$2,236.00 		$1,086.00
$1,198.00
$1,316.00
$1,734.00 		$1,348.00
$1,460.00
$1,578.00
$1,996.00 		$1,610.00
$1,722.00
$1,840.00
$2,258.00 		$262.00
Toc - Plan #20 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Affinity Bronze 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

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 		$326.00
$370.00
$417.00
$582.00
$885.00 		$533.00
$577.00
$624.00
$789.00 		$740.00
$784.00
$831.00
$996.00 		$947.00
$991.00
$1,038.00
$1,203.00 		$207.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$652.00
$740.00
$834.00
$1,164.00
$1,770.00 		$859.00
$947.00
$1,041.00
$1,371.00 		$1,066.00
$1,154.00
$1,248.00
$1,578.00 		$1,273.00
$1,361.00
$1,455.00
$1,785.00 		$207.00
Toc - Plan #21 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Affinity Silver 6400

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$6,400 $12,800 Annual Deductible
$7,400 $14,800 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 		$412.00
$467.00
$526.00
$735.00
$1,117.00 		$673.00
$728.00
$787.00
$996.00 		$934.00
$989.00
$1,048.00
$1,257.00 		$1,195.00
$1,250.00
$1,309.00
$1,518.00 		$261.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$824.00
$934.00
$1,052.00
$1,470.00
$2,234.00 		$1,085.00
$1,195.00
$1,313.00
$1,731.00 		$1,346.00
$1,456.00
$1,574.00
$1,992.00 		$1,607.00
$1,717.00
$1,835.00
$2,253.00 		$261.00

ADVERTISEMENT

Providence Health Plan

Local: 1-503-574-5000 | Toll Free: 1-800-878-4445 | TTY: 1-888-244-6642
Toc - Plan #22 Providence Health Plan
Gold

(EPO) Providence Oregon Standard Gold Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$460.00
$522.00
$588.00
$822.00
$1,248.00 		$752.00
$814.00
$880.00
$1,114.00 		$1,044.00
$1,106.00
$1,172.00
$1,406.00 		$1,336.00
$1,398.00
$1,464.00
$1,698.00 		$292.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$920.00
$1,044.00
$1,176.00
$1,644.00
$2,496.00 		$1,212.00
$1,336.00
$1,468.00
$1,936.00 		$1,504.00
$1,628.00
$1,760.00
$2,228.00 		$1,796.00
$1,920.00
$2,052.00
$2,520.00 		$292.00
Toc - Plan #23 Providence Health Plan
Silver

(EPO) Providence Oregon Standard Silver Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$412.00
$467.00
$526.00
$735.00
$1,118.00 		$673.00
$728.00
$787.00
$996.00 		$934.00
$989.00
$1,048.00
$1,257.00 		$1,195.00
$1,250.00
$1,309.00
$1,518.00 		$261.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$824.00
$934.00
$1,052.00
$1,470.00
$2,236.00 		$1,085.00
$1,195.00
$1,313.00
$1,731.00 		$1,346.00
$1,456.00
$1,574.00
$1,992.00 		$1,607.00
$1,717.00
$1,835.00
$2,253.00 		$261.00
Toc - Plan #24 Providence Health Plan
Expanded Bronze

(EPO) Providence Oregon Standard Bronze Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$315.00
$357.00
$402.00
$562.00
$854.00 		$515.00
$557.00
$602.00
$762.00 		$715.00
$757.00
$802.00
$962.00 		$915.00
$957.00
$1,002.00
$1,162.00 		$200.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$630.00
$714.00
$804.00
$1,124.00
$1,708.00 		$830.00
$914.00
$1,004.00
$1,324.00 		$1,030.00
$1,114.00
$1,204.00
$1,524.00 		$1,230.00
$1,314.00
$1,404.00
$1,724.00 		$200.00
Toc - Plan #25 Providence Health Plan
Expanded Bronze

(EPO) HSA Qualified 7050 Bronze - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$320.00
$363.00
$409.00
$571.00
$868.00 		$523.00
$566.00
$612.00
$774.00 		$726.00
$769.00
$815.00
$977.00 		$929.00
$972.00
$1,018.00
$1,180.00 		$203.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640.00
$726.00
$818.00
$1,142.00
$1,736.00 		$843.00
$929.00
$1,021.00
$1,345.00 		$1,046.00
$1,132.00
$1,224.00
$1,548.00 		$1,249.00
$1,335.00
$1,427.00
$1,751.00 		$203.00

ADVERTISEMENT

BridgeSpan Health Company

Local: 1-855-857-9944 | Toll Free: 1-855-857-9944 | TTY: 1-800-735-2900
Toc - Plan #26 BridgeSpan Health Company
Gold

(EPO) BridgeSpan Standard Gold Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$484.51
$549.93
$619.21
$865.34
$1,314.97 		$792.18
$857.60
$926.88
$1,173.01 		$1,099.85
$1,165.27
$1,234.55
$1,480.68 		$1,407.52
$1,472.94
$1,542.22
$1,788.35 		$307.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$969.02
$1,099.86
$1,238.42
$1,730.68
$2,629.94 		$1,276.69
$1,407.53
$1,546.09
$2,038.35 		$1,584.36
$1,715.20
$1,853.76
$2,346.02 		$1,892.03
$2,022.87
$2,161.43
$2,653.69 		$307.67
Toc - Plan #27 BridgeSpan Health Company
Expanded Bronze

(EPO) BridgeSpan Standard Bronze Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$315.96
$358.62
$403.80
$564.31
$857.52 		$516.59
$559.25
$604.43
$764.94 		$717.22
$759.88
$805.06
$965.57 		$917.85
$960.51
$1,005.69
$1,166.20 		$200.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$631.92
$717.24
$807.60
$1,128.62
$1,715.04 		$832.55
$917.87
$1,008.23
$1,329.25 		$1,033.18
$1,118.50
$1,208.86
$1,529.88 		$1,233.81
$1,319.13
$1,409.49
$1,730.51 		$200.63
Toc - Plan #28 BridgeSpan Health Company
Silver

(EPO) BridgeSpan Standard Silver Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$412.20
$467.85
$526.78
$736.18
$1,118.70 		$673.95
$729.60
$788.53
$997.93 		$935.70
$991.35
$1,050.28
$1,259.68 		$1,197.45
$1,253.10
$1,312.03
$1,521.43 		$261.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$824.40
$935.70
$1,053.56
$1,472.36
$2,237.40 		$1,086.15
$1,197.45
$1,315.31
$1,734.11 		$1,347.90
$1,459.20
$1,577.06
$1,995.86 		$1,609.65
$1,720.95
$1,838.81
$2,257.61 		$261.75

ADVERTISEMENT

Kaiser Permanente

Local: 1-800-801-1270 | Toll Free: 1-800-801-1270 | TTY: 1-800-735-2900
Toc - Plan #29 Kaiser Permanente
Gold

(EPO) KP OR Gold 0/20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

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 		$405.00
$460.00
$518.00
$723.00
$1,099.00 		$662.00
$717.00
$775.00
$980.00 		$919.00
$974.00
$1,032.00
$1,237.00 		$1,176.00
$1,231.00
$1,289.00
$1,494.00 		$257.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$810.00
$920.00
$1,036.00
$1,446.00
$2,198.00 		$1,067.00
$1,177.00
$1,293.00
$1,703.00 		$1,324.00
$1,434.00
$1,550.00
$1,960.00 		$1,581.00
$1,691.00
$1,807.00
$2,217.00 		$257.00
Toc - Plan #30 Kaiser Permanente
Gold

(EPO) KP Oregon Standard Gold Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$395.00
$448.00
$505.00
$706.00
$1,072.00 		$646.00
$699.00
$756.00
$957.00 		$897.00
$950.00
$1,007.00
$1,208.00 		$1,148.00
$1,201.00
$1,258.00
$1,459.00 		$251.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$790.00
$896.00
$1,010.00
$1,412.00
$2,144.00 		$1,041.00
$1,147.00
$1,261.00
$1,663.00 		$1,292.00
$1,398.00
$1,512.00
$1,914.00 		$1,543.00
$1,649.00
$1,763.00
$2,165.00 		$251.00
Toc - Plan #31 Kaiser Permanente
Silver

(EPO) KP Oregon Standard Silver Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$378.00
$429.00
$483.00
$675.00
$1,026.00 		$618.00
$669.00
$723.00
$915.00 		$858.00
$909.00
$963.00
$1,155.00 		$1,098.00
$1,149.00
$1,203.00
$1,395.00 		$240.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$756.00
$858.00
$966.00
$1,350.00
$2,052.00 		$996.00
$1,098.00
$1,206.00
$1,590.00 		$1,236.00
$1,338.00
$1,446.00
$1,830.00 		$1,476.00
$1,578.00
$1,686.00
$2,070.00 		$240.00
Toc - Plan #32 Kaiser Permanente
Expanded Bronze

(EPO) KP Oregon Standard Bronze Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$273.00
$310.00
$349.00
$488.00
$742.00 		$447.00
$484.00
$523.00
$662.00 		$621.00
$658.00
$697.00
$836.00 		$795.00
$832.00
$871.00
$1,010.00 		$174.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$546.00
$620.00
$698.00
$976.00
$1,484.00 		$720.00
$794.00
$872.00
$1,150.00 		$894.00
$968.00
$1,046.00
$1,324.00 		$1,068.00
$1,142.00
$1,220.00
$1,498.00 		$174.00
Toc - Plan #33 Kaiser Permanente
Gold

(EPO) KP OR Gold 2000/20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$373.00
$424.00
$477.00
$667.00
$1,013.00 		$610.00
$661.00
$714.00
$904.00 		$847.00
$898.00
$951.00
$1,141.00 		$1,084.00
$1,135.00
$1,188.00
$1,378.00 		$237.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$746.00
$848.00
$954.00
$1,334.00
$2,026.00 		$983.00
$1,085.00
$1,191.00
$1,571.00 		$1,220.00
$1,322.00
$1,428.00
$1,808.00 		$1,457.00
$1,559.00
$1,665.00
$2,045.00 		$237.00
Toc - Plan #34 Kaiser Permanente
Silver

(EPO) KP OR Silver 3500/40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,850 $17,700 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 		$383.00
$435.00
$490.00
$685.00
$1,041.00 		$626.00
$678.00
$733.00
$928.00 		$869.00
$921.00
$976.00
$1,171.00 		$1,112.00
$1,164.00
$1,219.00
$1,414.00 		$243.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$766.00
$870.00
$980.00
$1,370.00
$2,082.00 		$1,009.00
$1,113.00
$1,223.00
$1,613.00 		$1,252.00
$1,356.00
$1,466.00
$1,856.00 		$1,495.00
$1,599.00
$1,709.00
$2,099.00 		$243.00
Toc - Plan #35 Kaiser Permanente
Silver

(EPO) KP OR Silver 4000/40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,850 $17,700 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 		$356.00
$405.00
$455.00
$637.00
$967.00 		$582.00
$631.00
$681.00
$863.00 		$808.00
$857.00
$907.00
$1,089.00 		$1,034.00
$1,083.00
$1,133.00
$1,315.00 		$226.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$712.00
$810.00
$910.00
$1,274.00
$1,934.00 		$938.00
$1,036.00
$1,136.00
$1,500.00 		$1,164.00
$1,262.00
$1,362.00
$1,726.00 		$1,390.00
$1,488.00
$1,588.00
$1,952.00 		$226.00
Toc - Plan #36 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 5500/50

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,900 $17,800 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 		$280.00
$317.00
$357.00
$499.00
$759.00 		$458.00
$495.00
$535.00
$677.00 		$636.00
$673.00
$713.00
$855.00 		$814.00
$851.00
$891.00
$1,033.00 		$178.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$560.00
$634.00
$714.00
$998.00
$1,518.00 		$738.00
$812.00
$892.00
$1,176.00 		$916.00
$990.00
$1,070.00
$1,354.00 		$1,094.00
$1,168.00
$1,248.00
$1,532.00 		$178.00
Toc - Plan #37 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 6900/0% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

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 		$280.00
$318.00
$358.00
$500.00
$760.00 		$458.00
$496.00
$536.00
$678.00 		$636.00
$674.00
$714.00
$856.00 		$814.00
$852.00
$892.00
$1,034.00 		$178.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$560.00
$636.00
$716.00
$1,000.00
$1,520.00 		$738.00
$814.00
$894.00
$1,178.00 		$916.00
$992.00
$1,072.00
$1,356.00 		$1,094.00
$1,170.00
$1,250.00
$1,534.00 		$178.00
Toc - Plan #38 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 8900/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$8,900 $17,800 Annual Deductible
$8,900 $17,800 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 		$267.00
$303.00
$341.00
$476.00
$724.00 		$436.00
$472.00
$510.00
$645.00 		$605.00
$641.00
$679.00
$814.00 		$774.00
$810.00
$848.00
$983.00 		$169.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$534.00
$606.00
$682.00
$952.00
$1,448.00 		$703.00
$775.00
$851.00
$1,121.00 		$872.00
$944.00
$1,020.00
$1,290.00 		$1,041.00
$1,113.00
$1,189.00
$1,459.00 		$169.00
Toc - Plan #39 Kaiser Permanente
Silver

(EPO) KP OR Silver 750/30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$8,900 $17,800 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 		$410.00
$465.00
$524.00
$732.00
$1,113.00 		$670.00
$725.00
$784.00
$992.00 		$930.00
$985.00
$1,044.00
$1,252.00 		$1,190.00
$1,245.00
$1,304.00
$1,512.00 		$260.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$820.00
$930.00
$1,048.00
$1,464.00
$2,226.00 		$1,080.00
$1,190.00
$1,308.00
$1,724.00 		$1,340.00
$1,450.00
$1,568.00
$1,984.00 		$1,600.00
$1,710.00
$1,828.00
$2,244.00 		$260.00

ADVERTISEMENT

Regence BlueCross BlueShield of Oregon

Local: 1-888-675-6570 | Toll Free: 1-888-675-6570

Toc - Plan #40 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze HSA 6750 Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$6,750 $13,500 Annual Deductible
$7,100 $14,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$321.96
$365.43
$411.47
$575.02
$873.81 		$526.41
$569.88
$615.92
$779.47 		$730.86
$774.33
$820.37
$983.92 		$935.31
$978.78
$1,024.82
$1,188.37 		$204.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$643.92
$730.86
$822.94
$1,150.04
$1,747.62 		$848.37
$935.31
$1,027.39
$1,354.49 		$1,052.82
$1,139.76
$1,231.84
$1,558.94 		$1,257.27
$1,344.21
$1,436.29
$1,763.39 		$204.45
Toc - Plan #41 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Essential 8000 With 4 Copay No Deductible Office Visits Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$304.30
$345.37
$388.89
$543.48
$825.86 		$497.53
$538.60
$582.12
$736.71 		$690.76
$731.83
$775.35
$929.94 		$883.99
$925.06
$968.58
$1,123.17 		$193.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$608.60
$690.74
$777.78
$1,086.96
$1,651.72 		$801.83
$883.97
$971.01
$1,280.19 		$995.06
$1,077.20
$1,164.24
$1,473.42 		$1,188.29
$1,270.43
$1,357.47
$1,666.65 		$193.23
Toc - Plan #42 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Virtual Value 8500 Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$9,100 $18,200 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 		$290.55
$329.77
$371.32
$518.92
$788.54 		$475.05
$514.27
$555.82
$703.42 		$659.55
$698.77
$740.32
$887.92 		$844.05
$883.27
$924.82
$1,072.42 		$184.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$581.10
$659.54
$742.64
$1,037.84
$1,577.08 		$765.60
$844.04
$927.14
$1,222.34 		$950.10
$1,028.54
$1,111.64
$1,406.84 		$1,134.60
$1,213.04
$1,296.14
$1,591.34 		$184.50
Toc - Plan #43 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver 4500 Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$9,100 $18,200 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 		$405.13
$459.82
$517.76
$723.56
$1,099.53 		$662.39
$717.08
$775.02
$980.82 		$919.65
$974.34
$1,032.28
$1,238.08 		$1,176.91
$1,231.60
$1,289.54
$1,495.34 		$257.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$810.26
$919.64
$1,035.52
$1,447.12
$2,199.06 		$1,067.52
$1,176.90
$1,292.78
$1,704.38 		$1,324.78
$1,434.16
$1,550.04
$1,961.64 		$1,582.04
$1,691.42
$1,807.30
$2,218.90 		$257.26
Toc - Plan #44 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver 6500 Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 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 		$385.77
$437.85
$493.01
$688.98
$1,046.98 		$630.73
$682.81
$737.97
$933.94 		$875.69
$927.77
$982.93
$1,178.90 		$1,120.65
$1,172.73
$1,227.89
$1,423.86 		$244.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$771.54
$875.70
$986.02
$1,377.96
$2,093.96 		$1,016.50
$1,120.66
$1,230.98
$1,622.92 		$1,261.46
$1,365.62
$1,475.94
$1,867.88 		$1,506.42
$1,610.58
$1,720.90
$2,112.84 		$244.96
Toc - Plan #45 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Regence Standard Silver Plan Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$9,100 $18,200 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 		$408.08
$463.16
$521.52
$728.83
$1,107.53 		$667.21
$722.29
$780.65
$987.96 		$926.34
$981.42
$1,039.78
$1,247.09 		$1,185.47
$1,240.55
$1,298.91
$1,506.22 		$259.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$816.16
$926.32
$1,043.04
$1,457.66
$2,215.06 		$1,075.29
$1,185.45
$1,302.17
$1,716.79 		$1,334.42
$1,444.58
$1,561.30
$1,975.92 		$1,593.55
$1,703.71
$1,820.43
$2,235.05 		$259.13
Toc - Plan #46 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Regence Standard Bronze Plan Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,800 $17,600 Annual Deductible
$8,800 $17,600 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 		$312.80
$355.03
$399.76
$558.65
$848.93 		$511.43
$553.66
$598.39
$757.28 		$710.06
$752.29
$797.02
$955.91 		$908.69
$950.92
$995.65
$1,154.54 		$198.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$625.60
$710.06
$799.52
$1,117.30
$1,697.86 		$824.23
$908.69
$998.15
$1,315.93 		$1,022.86
$1,107.32
$1,196.78
$1,514.56 		$1,221.49
$1,305.95
$1,395.41
$1,713.19 		$198.63
Toc - Plan #47 Regence BlueCross BlueShield of Oregon
Gold

(EPO) Regence Standard Gold Plan Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$7,300 $14,600 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 		$479.67
$544.43
$613.02
$856.69
$1,301.83 		$784.26
$849.02
$917.61
$1,161.28 		$1,088.85
$1,153.61
$1,222.20
$1,465.87 		$1,393.44
$1,458.20
$1,526.79
$1,770.46 		$304.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$959.34
$1,088.86
$1,226.04
$1,713.38
$2,603.66 		$1,263.93
$1,393.45
$1,530.63
$2,017.97 		$1,568.52
$1,698.04
$1,835.22
$2,322.56 		$1,873.11
$2,002.63
$2,139.81
$2,627.15 		$304.59
Toc - Plan #48 Regence BlueCross BlueShield of Oregon
Gold

(EPO) Gold 2000 With Dental and Vision Exam Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$9,100 $18,200 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 		$449.89
$510.63
$574.96
$803.51
$1,221.00 		$735.58
$796.32
$860.65
$1,089.20 		$1,021.27
$1,082.01
$1,146.34
$1,374.89 		$1,306.96
$1,367.70
$1,432.03
$1,660.58 		$285.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$899.78
$1,021.26
$1,149.92
$1,607.02
$2,442.00 		$1,185.47
$1,306.95
$1,435.61
$1,892.71 		$1,471.16
$1,592.64
$1,721.30
$2,178.40 		$1,756.85
$1,878.33
$2,006.99
$2,464.09 		$285.69

‡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 Lane County here.

Lane County is in “Rating Area 2” of Oregon.

Currently, there are 48 plans offered in Rating Area 2.

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2023 Obamacare Plans for Lane County, OR

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