Obamacare 2023 Rates for Johnson County

Obamacare > Rates > Georgia > Johnson County

ADVERTISEMENT

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 Johnson County, GA.

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, 49 Plans and 2023 Rates for Johnson County, Georgia

Below, you’ll find a summary of the 49 plans for Johnson County, Georgia 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

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |

ADVERTISEMENT

ADVERTISEMENT

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Toc - Plan #1 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$201.71
$228.94
$257.79
$360.25
$547.44
$356.02
$383.25
$412.10
$514.56
$510.33
$537.56
$566.41
$668.87
$664.64
$691.87
$720.72
$823.18
$154.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$403.42
$457.88
$515.58
$720.50
$1,094.88
$557.73
$612.19
$669.89
$874.81
$712.04
$766.50
$824.20
$1,029.12
$866.35
$920.81
$978.51
$1,183.43
$154.31
Toc - Plan #2 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$293.21
$332.79
$374.72
$523.67
$795.77
$517.52
$557.10
$599.03
$747.98
$741.83
$781.41
$823.34
$972.29
$966.14
$1,005.72
$1,047.65
$1,196.60
$224.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$586.42
$665.58
$749.44
$1,047.34
$1,591.54
$810.73
$889.89
$973.75
$1,271.65
$1,035.04
$1,114.20
$1,198.06
$1,495.96
$1,259.35
$1,338.51
$1,422.37
$1,720.27
$224.31
Toc - Plan #3 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,600 $11,200 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
$283.99
$322.33
$362.94
$507.21
$770.75
$501.24
$539.58
$580.19
$724.46
$718.49
$756.83
$797.44
$941.71
$935.74
$974.08
$1,014.69
$1,158.96
$217.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$567.98
$644.66
$725.88
$1,014.42
$1,541.50
$785.23
$861.91
$943.13
$1,231.67
$1,002.48
$1,079.16
$1,160.38
$1,448.92
$1,219.73
$1,296.41
$1,377.63
$1,666.17
$217.25
Toc - Plan #4 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$279.14
$316.82
$356.74
$498.54
$757.59
$492.68
$530.36
$570.28
$712.08
$706.22
$743.90
$783.82
$925.62
$919.76
$957.44
$997.36
$1,139.16
$213.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$558.28
$633.64
$713.48
$997.08
$1,515.18
$771.82
$847.18
$927.02
$1,210.62
$985.36
$1,060.72
$1,140.56
$1,424.16
$1,198.90
$1,274.26
$1,354.10
$1,637.70
$213.54
Toc - Plan #5 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 3000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$350.37
$397.67
$447.77
$625.76
$950.90
$618.40
$665.70
$715.80
$893.79
$886.43
$933.73
$983.83
$1,161.82
$1,154.46
$1,201.76
$1,251.86
$1,429.85
$268.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$700.74
$795.34
$895.54
$1,251.52
$1,901.80
$968.77
$1,063.37
$1,163.57
$1,519.55
$1,236.80
$1,331.40
$1,431.60
$1,787.58
$1,504.83
$1,599.43
$1,699.63
$2,055.61
$268.03
Toc - Plan #6 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$353.02
$400.68
$451.16
$630.49
$958.10
$623.08
$670.74
$721.22
$900.55
$893.14
$940.80
$991.28
$1,170.61
$1,163.20
$1,210.86
$1,261.34
$1,440.67
$270.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$706.04
$801.36
$902.32
$1,260.98
$1,916.20
$976.10
$1,071.42
$1,172.38
$1,531.04
$1,246.16
$1,341.48
$1,442.44
$1,801.10
$1,516.22
$1,611.54
$1,712.50
$2,071.16
$270.06
Toc - Plan #7 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 8000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$268.09
$304.28
$342.62
$478.81
$727.60
$473.18
$509.37
$547.71
$683.90
$678.27
$714.46
$752.80
$888.99
$883.36
$919.55
$957.89
$1,094.08
$205.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$536.18
$608.56
$685.24
$957.62
$1,455.20
$741.27
$813.65
$890.33
$1,162.71
$946.36
$1,018.74
$1,095.42
$1,367.80
$1,151.45
$1,223.83
$1,300.51
$1,572.89
$205.09
Toc - Plan #8 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 4950($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 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
$355.22
$403.17
$453.97
$634.42
$964.07
$626.96
$674.91
$725.71
$906.16
$898.70
$946.65
$997.45
$1,177.90
$1,170.44
$1,218.39
$1,269.19
$1,449.64
$271.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$710.44
$806.34
$907.94
$1,268.84
$1,928.14
$982.18
$1,078.08
$1,179.68
$1,540.58
$1,253.92
$1,349.82
$1,451.42
$1,812.32
$1,525.66
$1,621.56
$1,723.16
$2,084.06
$271.74
Toc - Plan #9 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 6500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$348.87
$395.97
$445.86
$623.08
$946.83
$615.76
$662.86
$712.75
$889.97
$882.65
$929.75
$979.64
$1,156.86
$1,149.54
$1,196.64
$1,246.53
$1,423.75
$266.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697.74
$791.94
$891.72
$1,246.16
$1,893.66
$964.63
$1,058.83
$1,158.61
$1,513.05
$1,231.52
$1,325.72
$1,425.50
$1,779.94
$1,498.41
$1,592.61
$1,692.39
$2,046.83
$266.89
Toc - Plan #10 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 1600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 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
$389.86
$442.49
$498.24
$696.29
$1,058.08
$688.10
$740.73
$796.48
$994.53
$986.34
$1,038.97
$1,094.72
$1,292.77
$1,284.58
$1,337.21
$1,392.96
$1,591.01
$298.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$779.72
$884.98
$996.48
$1,392.58
$2,116.16
$1,077.96
$1,183.22
$1,294.72
$1,690.82
$1,376.20
$1,481.46
$1,592.96
$1,989.06
$1,674.44
$1,779.70
$1,891.20
$2,287.30
$298.24
Toc - Plan #11 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$296.02
$335.98
$378.31
$528.69
$803.40
$522.48
$562.44
$604.77
$755.15
$748.94
$788.90
$831.23
$981.61
$975.40
$1,015.36
$1,057.69
$1,208.07
$226.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$592.04
$671.96
$756.62
$1,057.38
$1,606.80
$818.50
$898.42
$983.08
$1,283.84
$1,044.96
$1,124.88
$1,209.54
$1,510.30
$1,271.42
$1,351.34
$1,436.00
$1,736.76
$226.46
Toc - Plan #12 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 2600($0 PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 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
$372.15
$422.39
$475.61
$664.66
$1,010.02
$656.84
$707.08
$760.30
$949.35
$941.53
$991.77
$1,044.99
$1,234.04
$1,226.22
$1,276.46
$1,329.68
$1,518.73
$284.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744.30
$844.78
$951.22
$1,329.32
$2,020.04
$1,028.99
$1,129.47
$1,235.91
$1,614.01
$1,313.68
$1,414.16
$1,520.60
$1,898.70
$1,598.37
$1,698.85
$1,805.29
$2,183.39
$284.69
Toc - Plan #13 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$276.11
$313.38
$352.87
$493.13
$749.36
$487.33
$524.60
$564.09
$704.35
$698.55
$735.82
$775.31
$915.57
$909.77
$947.04
$986.53
$1,126.79
$211.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$552.22
$626.76
$705.74
$986.26
$1,498.72
$763.44
$837.98
$916.96
$1,197.48
$974.66
$1,049.20
$1,128.18
$1,408.70
$1,185.88
$1,260.42
$1,339.40
$1,619.92
$211.22
Toc - Plan #14 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 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
$302.03
$342.80
$385.99
$539.43
$819.71
$533.08
$573.85
$617.04
$770.48
$764.13
$804.90
$848.09
$1,001.53
$995.18
$1,035.95
$1,079.14
$1,232.58
$231.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$604.06
$685.60
$771.98
$1,078.86
$1,639.42
$835.11
$916.65
$1,003.03
$1,309.91
$1,066.16
$1,147.70
$1,234.08
$1,540.96
$1,297.21
$1,378.75
$1,465.13
$1,772.01
$231.05
Toc - Plan #15 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$354.30
$402.13
$452.80
$632.78
$961.57
$625.34
$673.17
$723.84
$903.82
$896.38
$944.21
$994.88
$1,174.86
$1,167.42
$1,215.25
$1,265.92
$1,445.90
$271.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$708.60
$804.26
$905.60
$1,265.56
$1,923.14
$979.64
$1,075.30
$1,176.64
$1,536.60
$1,250.68
$1,346.34
$1,447.68
$1,807.64
$1,521.72
$1,617.38
$1,718.72
$2,078.68
$271.04
Toc - Plan #16 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$400.63
$454.72
$512.01
$715.53
$1,087.31
$707.11
$761.20
$818.49
$1,022.01
$1,013.59
$1,067.68
$1,124.97
$1,328.49
$1,320.07
$1,374.16
$1,431.45
$1,634.97
$306.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$801.26
$909.44
$1,024.02
$1,431.06
$2,174.62
$1,107.74
$1,215.92
$1,330.50
$1,737.54
$1,414.22
$1,522.40
$1,636.98
$2,044.02
$1,720.70
$1,828.88
$1,943.46
$2,350.50
$306.48

ADVERTISEMENT

Ambetter from Peach State Health Plan

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180 | TTY: 1-877-941-9231

Toc - Plan #17 Ambetter from Peach State Health Plan
Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$245.30
$278.40
$313.48
$438.09
$665.72
$432.95
$466.05
$501.13
$625.74
$620.60
$653.70
$688.78
$813.39
$808.25
$841.35
$876.43
$1,001.04
$187.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$490.60
$556.80
$626.96
$876.18
$1,331.44
$678.25
$744.45
$814.61
$1,063.83
$865.90
$932.10
$1,002.26
$1,251.48
$1,053.55
$1,119.75
$1,189.91
$1,439.13
$187.65
Toc - Plan #18 Ambetter from Peach State Health Plan
Silver

(HMO) Premier Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 Annual Deductible
$7,550 $15,100 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
$294.58
$334.34
$376.46
$526.11
$799.47
$519.93
$559.69
$601.81
$751.46
$745.28
$785.04
$827.16
$976.81
$970.63
$1,010.39
$1,052.51
$1,202.16
$225.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$589.16
$668.68
$752.92
$1,052.22
$1,598.94
$814.51
$894.03
$978.27
$1,277.57
$1,039.86
$1,119.38
$1,203.62
$1,502.92
$1,265.21
$1,344.73
$1,428.97
$1,728.27
$225.35
Toc - Plan #19 Ambetter from Peach State Health Plan
Silver

(HMO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$291.31
$330.63
$372.28
$520.27
$790.59
$514.16
$553.48
$595.13
$743.12
$737.01
$776.33
$817.98
$965.97
$959.86
$999.18
$1,040.83
$1,188.82
$222.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$582.62
$661.26
$744.56
$1,040.54
$1,581.18
$805.47
$884.11
$967.41
$1,263.39
$1,028.32
$1,106.96
$1,190.26
$1,486.24
$1,251.17
$1,329.81
$1,413.11
$1,709.09
$222.85
Toc - Plan #20 Ambetter from Peach State Health Plan
Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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
$308.22
$349.82
$393.89
$550.46
$836.48
$544.00
$585.60
$629.67
$786.24
$779.78
$821.38
$865.45
$1,022.02
$1,015.56
$1,057.16
$1,101.23
$1,257.80
$235.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$616.44
$699.64
$787.78
$1,100.92
$1,672.96
$852.22
$935.42
$1,023.56
$1,336.70
$1,088.00
$1,171.20
$1,259.34
$1,572.48
$1,323.78
$1,406.98
$1,495.12
$1,808.26
$235.78
Toc - Plan #21 Ambetter from Peach State Health Plan
Silver

(HMO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$288.28
$327.18
$368.41
$514.85
$782.36
$508.81
$547.71
$588.94
$735.38
$729.34
$768.24
$809.47
$955.91
$949.87
$988.77
$1,030.00
$1,176.44
$220.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$576.56
$654.36
$736.82
$1,029.70
$1,564.72
$797.09
$874.89
$957.35
$1,250.23
$1,017.62
$1,095.42
$1,177.88
$1,470.76
$1,238.15
$1,315.95
$1,398.41
$1,691.29
$220.53
Toc - Plan #22 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$269.54
$305.92
$344.46
$481.39
$731.51
$475.73
$512.11
$550.65
$687.58
$681.92
$718.30
$756.84
$893.77
$888.11
$924.49
$963.03
$1,099.96
$206.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$539.08
$611.84
$688.92
$962.78
$1,463.02
$745.27
$818.03
$895.11
$1,168.97
$951.46
$1,024.22
$1,101.30
$1,375.16
$1,157.65
$1,230.41
$1,307.49
$1,581.35
$206.19
Toc - Plan #23 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$263.92
$299.53
$337.27
$471.34
$716.24
$465.81
$501.42
$539.16
$673.23
$667.70
$703.31
$741.05
$875.12
$869.59
$905.20
$942.94
$1,077.01
$201.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$527.84
$599.06
$674.54
$942.68
$1,432.48
$729.73
$800.95
$876.43
$1,144.57
$931.62
$1,002.84
$1,078.32
$1,346.46
$1,133.51
$1,204.73
$1,280.21
$1,548.35
$201.89
Toc - Plan #24 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$298.62
$338.92
$381.62
$533.31
$810.42
$527.05
$567.35
$610.05
$761.74
$755.48
$795.78
$838.48
$990.17
$983.91
$1,024.21
$1,066.91
$1,218.60
$228.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$597.24
$677.84
$763.24
$1,066.62
$1,620.84
$825.67
$906.27
$991.67
$1,295.05
$1,054.10
$1,134.70
$1,220.10
$1,523.48
$1,282.53
$1,363.13
$1,448.53
$1,751.91
$228.43
Toc - Plan #25 Ambetter from Peach State Health Plan
Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$283.98
$322.30
$362.91
$507.17
$770.69
$501.22
$539.54
$580.15
$724.41
$718.46
$756.78
$797.39
$941.65
$935.70
$974.02
$1,014.63
$1,158.89
$217.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$567.96
$644.60
$725.82
$1,014.34
$1,541.38
$785.20
$861.84
$943.06
$1,231.58
$1,002.44
$1,079.08
$1,160.30
$1,448.82
$1,219.68
$1,296.32
$1,377.54
$1,666.06
$217.24
Toc - Plan #26 Ambetter from Peach State Health Plan
Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$287.19
$325.95
$367.01
$512.90
$779.40
$506.88
$545.64
$586.70
$732.59
$726.57
$765.33
$806.39
$952.28
$946.26
$985.02
$1,026.08
$1,171.97
$219.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$574.38
$651.90
$734.02
$1,025.80
$1,558.80
$794.07
$871.59
$953.71
$1,245.49
$1,013.76
$1,091.28
$1,173.40
$1,465.18
$1,233.45
$1,310.97
$1,393.09
$1,684.87
$219.69
Toc - Plan #27 Ambetter from Peach State Health Plan
Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$294.61
$334.37
$376.50
$526.16
$799.55
$519.98
$559.74
$601.87
$751.53
$745.35
$785.11
$827.24
$976.90
$970.72
$1,010.48
$1,052.61
$1,202.27
$225.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$589.22
$668.74
$753.00
$1,052.32
$1,599.10
$814.59
$894.11
$978.37
$1,277.69
$1,039.96
$1,119.48
$1,203.74
$1,503.06
$1,265.33
$1,344.85
$1,429.11
$1,728.43
$225.37
Toc - Plan #28 Ambetter from Peach State Health Plan
Gold

(HMO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$900 $1,800 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
$291.19
$330.49
$372.13
$520.06
$790.27
$513.95
$553.25
$594.89
$742.82
$736.71
$776.01
$817.65
$965.58
$959.47
$998.77
$1,040.41
$1,188.34
$222.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$582.38
$660.98
$744.26
$1,040.12
$1,580.54
$805.14
$883.74
$967.02
$1,262.88
$1,027.90
$1,106.50
$1,189.78
$1,485.64
$1,250.66
$1,329.26
$1,412.54
$1,708.40
$222.76
Toc - Plan #29 Ambetter from Peach State Health Plan
Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.03
$385.93
$434.55
$607.28
$922.83
$600.15
$646.05
$694.67
$867.40
$860.27
$906.17
$954.79
$1,127.52
$1,120.39
$1,166.29
$1,214.91
$1,387.64
$260.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680.06
$771.86
$869.10
$1,214.56
$1,845.66
$940.18
$1,031.98
$1,129.22
$1,474.68
$1,200.30
$1,292.10
$1,389.34
$1,734.80
$1,460.42
$1,552.22
$1,649.46
$1,994.92
$260.12
Toc - Plan #30 Ambetter from Peach State Health Plan
Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$233.52
$265.03
$298.42
$417.04
$633.74
$412.15
$443.66
$477.05
$595.67
$590.78
$622.29
$655.68
$774.30
$769.41
$800.92
$834.31
$952.93
$178.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$467.04
$530.06
$596.84
$834.08
$1,267.48
$645.67
$708.69
$775.47
$1,012.71
$824.30
$887.32
$954.10
$1,191.34
$1,002.93
$1,065.95
$1,132.73
$1,369.97
$178.63
Toc - Plan #31 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 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
$258.38
$293.25
$330.20
$461.45
$701.21
$456.03
$490.90
$527.85
$659.10
$653.68
$688.55
$725.50
$856.75
$851.33
$886.20
$923.15
$1,054.40
$197.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$516.76
$586.50
$660.40
$922.90
$1,402.42
$714.41
$784.15
$858.05
$1,120.55
$912.06
$981.80
$1,055.70
$1,318.20
$1,109.71
$1,179.45
$1,253.35
$1,515.85
$197.65
Toc - Plan #32 Ambetter from Peach State Health Plan
Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$284.60
$323.01
$363.70
$508.27
$772.37
$502.31
$540.72
$581.41
$725.98
$720.02
$758.43
$799.12
$943.69
$937.73
$976.14
$1,016.83
$1,161.40
$217.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$569.20
$646.02
$727.40
$1,016.54
$1,544.74
$786.91
$863.73
$945.11
$1,234.25
$1,004.62
$1,081.44
$1,162.82
$1,451.96
$1,222.33
$1,299.15
$1,380.53
$1,669.67
$217.71
Toc - Plan #33 Ambetter from Peach State Health Plan
Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$291.84
$331.23
$372.96
$521.21
$792.03
$515.09
$554.48
$596.21
$744.46
$738.34
$777.73
$819.46
$967.71
$961.59
$1,000.98
$1,042.71
$1,190.96
$223.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$583.68
$662.46
$745.92
$1,042.42
$1,584.06
$806.93
$885.71
$969.17
$1,265.67
$1,030.18
$1,108.96
$1,192.42
$1,488.92
$1,253.43
$1,332.21
$1,415.67
$1,712.17
$223.25
Toc - Plan #34 Ambetter from Peach State Health Plan
Silver

(HMO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$299.70
$340.14
$383.00
$535.24
$813.35
$528.96
$569.40
$612.26
$764.50
$758.22
$798.66
$841.52
$993.76
$987.48
$1,027.92
$1,070.78
$1,223.02
$229.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$599.40
$680.28
$766.00
$1,070.48
$1,626.70
$828.66
$909.54
$995.26
$1,299.74
$1,057.92
$1,138.80
$1,224.52
$1,529.00
$1,287.18
$1,368.06
$1,453.78
$1,758.26
$229.26
Toc - Plan #35 Ambetter from Peach State Health Plan
Silver

(HMO) Premier Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 Annual Deductible
$7,550 $15,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$306.25
$347.58
$391.37
$546.94
$831.13
$540.52
$581.85
$625.64
$781.21
$774.79
$816.12
$859.91
$1,015.48
$1,009.06
$1,050.39
$1,094.18
$1,249.75
$234.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$612.50
$695.16
$782.74
$1,093.88
$1,662.26
$846.77
$929.43
$1,017.01
$1,328.15
$1,081.04
$1,163.70
$1,251.28
$1,562.42
$1,315.31
$1,397.97
$1,485.55
$1,796.69
$234.27
Toc - Plan #36 Ambetter from Peach State Health Plan
Silver

(HMO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$302.85
$343.72
$387.03
$540.87
$821.91
$534.52
$575.39
$618.70
$772.54
$766.19
$807.06
$850.37
$1,004.21
$997.86
$1,038.73
$1,082.04
$1,235.88
$231.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$605.70
$687.44
$774.06
$1,081.74
$1,643.82
$837.37
$919.11
$1,005.73
$1,313.41
$1,069.04
$1,150.78
$1,237.40
$1,545.08
$1,300.71
$1,382.45
$1,469.07
$1,776.75
$231.67
Toc - Plan #37 Ambetter from Peach State Health Plan
Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$255.02
$289.43
$325.90
$455.44
$692.09
$450.10
$484.51
$520.98
$650.52
$645.18
$679.59
$716.06
$845.60
$840.26
$874.67
$911.14
$1,040.68
$195.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$510.04
$578.86
$651.80
$910.88
$1,384.18
$705.12
$773.94
$846.88
$1,105.96
$900.20
$969.02
$1,041.96
$1,301.04
$1,095.28
$1,164.10
$1,237.04
$1,496.12
$195.08
Toc - Plan #38 Ambetter from Peach State Health Plan
Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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
$320.43
$363.68
$409.49
$572.27
$869.62
$565.55
$608.80
$654.61
$817.39
$810.67
$853.92
$899.73
$1,062.51
$1,055.79
$1,099.04
$1,144.85
$1,307.63
$245.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$640.86
$727.36
$818.98
$1,144.54
$1,739.24
$885.98
$972.48
$1,064.10
$1,389.66
$1,131.10
$1,217.60
$1,309.22
$1,634.78
$1,376.22
$1,462.72
$1,554.34
$1,879.90
$245.12
Toc - Plan #39 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$280.22
$318.04
$358.11
$500.45
$760.49
$494.58
$532.40
$572.47
$714.81
$708.94
$746.76
$786.83
$929.17
$923.30
$961.12
$1,001.19
$1,143.53
$214.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$560.44
$636.08
$716.22
$1,000.90
$1,520.98
$774.80
$850.44
$930.58
$1,215.26
$989.16
$1,064.80
$1,144.94
$1,429.62
$1,203.52
$1,279.16
$1,359.30
$1,643.98
$214.36
Toc - Plan #40 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$274.37
$311.40
$350.63
$490.01
$744.61
$484.26
$521.29
$560.52
$699.90
$694.15
$731.18
$770.41
$909.79
$904.04
$941.07
$980.30
$1,119.68
$209.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$548.74
$622.80
$701.26
$980.02
$1,489.22
$758.63
$832.69
$911.15
$1,189.91
$968.52
$1,042.58
$1,121.04
$1,399.80
$1,178.41
$1,252.47
$1,330.93
$1,609.69
$209.89
Toc - Plan #41 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$310.45
$352.34
$396.74
$554.44
$842.52
$547.93
$589.82
$634.22
$791.92
$785.41
$827.30
$871.70
$1,029.40
$1,022.89
$1,064.78
$1,109.18
$1,266.88
$237.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$620.90
$704.68
$793.48
$1,108.88
$1,685.04
$858.38
$942.16
$1,030.96
$1,346.36
$1,095.86
$1,179.64
$1,268.44
$1,583.84
$1,333.34
$1,417.12
$1,505.92
$1,821.32
$237.48
Toc - Plan #42 Ambetter from Peach State Health Plan
Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$298.56
$338.86
$381.55
$533.22
$810.27
$526.95
$567.25
$609.94
$761.61
$755.34
$795.64
$838.33
$990.00
$983.73
$1,024.03
$1,066.72
$1,218.39
$228.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$597.12
$677.72
$763.10
$1,066.44
$1,620.54
$825.51
$906.11
$991.49
$1,294.83
$1,053.90
$1,134.50
$1,219.88
$1,523.22
$1,282.29
$1,362.89
$1,448.27
$1,751.61
$228.39
Toc - Plan #43 Ambetter from Peach State Health Plan
Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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
$306.28
$347.62
$391.41
$547.00
$831.22
$540.58
$581.92
$625.71
$781.30
$774.88
$816.22
$860.01
$1,015.60
$1,009.18
$1,050.52
$1,094.31
$1,249.90
$234.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$612.56
$695.24
$782.82
$1,094.00
$1,662.44
$846.86
$929.54
$1,017.12
$1,328.30
$1,081.16
$1,163.84
$1,251.42
$1,562.60
$1,315.46
$1,398.14
$1,485.72
$1,796.90
$234.30
Toc - Plan #44 Ambetter from Peach State Health Plan
Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$295.23
$335.07
$377.28
$527.25
$801.21
$521.07
$560.91
$603.12
$753.09
$746.91
$786.75
$828.96
$978.93
$972.75
$1,012.59
$1,054.80
$1,204.77
$225.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$590.46
$670.14
$754.56
$1,054.50
$1,602.42
$816.30
$895.98
$980.40
$1,280.34
$1,042.14
$1,121.82
$1,206.24
$1,506.18
$1,267.98
$1,347.66
$1,432.08
$1,732.02
$225.84
Toc - Plan #45 Ambetter from Peach State Health Plan
Gold

(HMO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$900 $1,800 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
$302.73
$343.58
$386.87
$540.65
$821.58
$534.31
$575.16
$618.45
$772.23
$765.89
$806.74
$850.03
$1,003.81
$997.47
$1,038.32
$1,081.61
$1,235.39
$231.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$605.46
$687.16
$773.74
$1,081.30
$1,643.16
$837.04
$918.74
$1,005.32
$1,312.88
$1,068.62
$1,150.32
$1,236.90
$1,544.46
$1,300.20
$1,381.90
$1,468.48
$1,776.04
$231.58
Toc - Plan #46 Ambetter from Peach State Health Plan
Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$353.50
$401.21
$451.76
$631.34
$959.38
$623.92
$671.63
$722.18
$901.76
$894.34
$942.05
$992.60
$1,172.18
$1,164.76
$1,212.47
$1,263.02
$1,442.60
$270.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$707.00
$802.42
$903.52
$1,262.68
$1,918.76
$977.42
$1,072.84
$1,173.94
$1,533.10
$1,247.84
$1,343.26
$1,444.36
$1,803.52
$1,518.26
$1,613.68
$1,714.78
$2,073.94
$270.42
Toc - Plan #47 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$256.82
$291.48
$328.20
$458.66
$696.98
$453.28
$487.94
$524.66
$655.12
$649.74
$684.40
$721.12
$851.58
$846.20
$880.86
$917.58
$1,048.04
$196.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$513.64
$582.96
$656.40
$917.32
$1,393.96
$710.10
$779.42
$852.86
$1,113.78
$906.56
$975.88
$1,049.32
$1,310.24
$1,103.02
$1,172.34
$1,245.78
$1,506.70
$196.46
Toc - Plan #48 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 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
$281.00
$318.93
$359.11
$501.85
$762.61
$495.96
$533.89
$574.07
$716.81
$710.92
$748.85
$789.03
$931.77
$925.88
$963.81
$1,003.99
$1,146.73
$214.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$562.00
$637.86
$718.22
$1,003.70
$1,525.22
$776.96
$852.82
$933.18
$1,218.66
$991.92
$1,067.78
$1,148.14
$1,433.62
$1,206.88
$1,282.74
$1,363.10
$1,648.58
$214.96
Toc - Plan #49 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$950 $1,900 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
$299.41
$339.82
$382.64
$534.73
$812.58
$528.45
$568.86
$611.68
$763.77
$757.49
$797.90
$840.72
$992.81
$986.53
$1,026.94
$1,069.76
$1,221.85
$229.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$598.82
$679.64
$765.28
$1,069.46
$1,625.16
$827.86
$908.68
$994.32
$1,298.50
$1,056.90
$1,137.72
$1,223.36
$1,527.54
$1,285.94
$1,366.76
$1,452.40
$1,756.58
$229.04

‡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 Johnson County here.

Johnson County is in “Rating Area 11” of Georgia.

Currently, there are 49 plans offered in Rating Area 11.

Top

2023 Obamacare Plans for Johnson County, GA

Plan Browser: 49 Plans
scroll down for more
Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork