Obamacare 2023 Rates for Orleans Parish

Obamacare > Rates > Louisiana > Orleans Parish

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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 Orleans Parish, LA.

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, 68 Plans and 2023 Rates for Orleans Parish, Louisiana

Below, you’ll find a summary of the 68 plans for Orleans Parish, Louisiana 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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Orleans Parish Resources

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HMO Louisiana

Local: 1-800-392-4087 | Toll Free: 1-800-392-4087 | TTY: 1-800-392-4087
Toc - Plan #1 HMO Louisiana
Gold

(POS) Blue POS Copay 80/60 $1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$1,000 $3,000 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 		$526.60
$597.69
$672.99
$940.51
$1,429.19 		$929.45
$1,000.54
$1,075.84
$1,343.36 		$1,332.30
$1,403.39
$1,478.69
$1,746.21 		$1,735.15
$1,806.24
$1,881.54
$2,149.06 		$402.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,053.20
$1,195.38
$1,345.98
$1,881.02
$2,858.38 		$1,456.05
$1,598.23
$1,748.83
$2,283.87 		$1,858.90
$2,001.08
$2,151.68
$2,686.72 		$2,261.75
$2,403.93
$2,554.53
$3,089.57 		$402.85
Toc - Plan #2 HMO Louisiana
Silver

(POS) Blue POS Copay 60/40 $4300

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$4,300 $12,900 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 		$492.47
$558.95
$629.38
$879.55
$1,336.56 		$869.21
$935.69
$1,006.12
$1,256.29 		$1,245.95
$1,312.43
$1,382.86
$1,633.03 		$1,622.69
$1,689.17
$1,759.60
$2,009.77 		$376.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$984.94
$1,117.90
$1,258.76
$1,759.10
$2,673.12 		$1,361.68
$1,494.64
$1,635.50
$2,135.84 		$1,738.42
$1,871.38
$2,012.24
$2,512.58 		$2,115.16
$2,248.12
$2,388.98
$2,889.32 		$376.74
Toc - Plan #3 HMO Louisiana
Silver

(POS) Blue POS 90/70 $3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,500 $10,500 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 		$462.32
$524.73
$590.84
$825.70
$1,254.74 		$815.99
$878.40
$944.51
$1,179.37 		$1,169.66
$1,232.07
$1,298.18
$1,533.04 		$1,523.33
$1,585.74
$1,651.85
$1,886.71 		$353.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$924.64
$1,049.46
$1,181.68
$1,651.40
$2,509.48 		$1,278.31
$1,403.13
$1,535.35
$2,005.07 		$1,631.98
$1,756.80
$1,889.02
$2,358.74 		$1,985.65
$2,110.47
$2,242.69
$2,712.41 		$353.67
Toc - Plan #4 HMO Louisiana
Bronze

(POS) Blue POS 60/40 $6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$6,500 $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 		$338.25
$383.91
$432.28
$604.11
$918.01 		$597.01
$642.67
$691.04
$862.87 		$855.77
$901.43
$949.80
$1,121.63 		$1,114.53
$1,160.19
$1,208.56
$1,380.39 		$258.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676.50
$767.82
$864.56
$1,208.22
$1,836.02 		$935.26
$1,026.58
$1,123.32
$1,466.98 		$1,194.02
$1,285.34
$1,382.08
$1,725.74 		$1,452.78
$1,544.10
$1,640.84
$1,984.50 		$258.76
Toc - Plan #5 HMO Louisiana
Expanded Bronze

(POS) Blue POS 70/50 $4550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$4,550 $13,650 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 		$374.33
$424.86
$478.39
$668.55
$1,015.93 		$660.69
$711.22
$764.75
$954.91 		$947.05
$997.58
$1,051.11
$1,241.27 		$1,233.41
$1,283.94
$1,337.47
$1,527.63 		$286.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$748.66
$849.72
$956.78
$1,337.10
$2,031.86 		$1,035.02
$1,136.08
$1,243.14
$1,623.46 		$1,321.38
$1,422.44
$1,529.50
$1,909.82 		$1,607.74
$1,708.80
$1,815.86
$2,196.18 		$286.36
Toc - Plan #6 HMO Louisiana
Silver

(POS) Blue POS 80/60 $3400

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,400 $10,200 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 		$457.75
$519.55
$585.00
$817.54
$1,242.33 		$807.93
$869.73
$935.18
$1,167.72 		$1,158.11
$1,219.91
$1,285.36
$1,517.90 		$1,508.29
$1,570.09
$1,635.54
$1,868.08 		$350.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$915.50
$1,039.10
$1,170.00
$1,635.08
$2,484.66 		$1,265.68
$1,389.28
$1,520.18
$1,985.26 		$1,615.86
$1,739.46
$1,870.36
$2,335.44 		$1,966.04
$2,089.64
$2,220.54
$2,685.62 		$350.18
Toc - Plan #7 HMO Louisiana
Bronze

(POS) Blue POS 100/100 $9100 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$331.00
$375.69
$423.02
$591.17
$898.33 		$584.22
$628.91
$676.24
$844.39 		$837.44
$882.13
$929.46
$1,097.61 		$1,090.66
$1,135.35
$1,182.68
$1,350.83 		$253.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$662.00
$751.38
$846.04
$1,182.34
$1,796.66 		$915.22
$1,004.60
$1,099.26
$1,435.56 		$1,168.44
$1,257.82
$1,352.48
$1,688.78 		$1,421.66
$1,511.04
$1,605.70
$1,942.00 		$253.22
Toc - Plan #8 HMO Louisiana
Expanded Bronze

(POS) Blue POS Copay 50/50 $7900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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 		$403.10
$457.52
$515.16
$719.94
$1,094.01 		$711.47
$765.89
$823.53
$1,028.31 		$1,019.84
$1,074.26
$1,131.90
$1,336.68 		$1,328.21
$1,382.63
$1,440.27
$1,645.05 		$308.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806.20
$915.04
$1,030.32
$1,439.88
$2,188.02 		$1,114.57
$1,223.41
$1,338.69
$1,748.25 		$1,422.94
$1,531.78
$1,647.06
$2,056.62 		$1,731.31
$1,840.15
$1,955.43
$2,364.99 		$308.37
Toc - Plan #9 HMO Louisiana
Silver

(POS) Blue POS Copay 60/40 $5800 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$491.80
$558.19
$628.52
$878.35
$1,334.75 		$868.03
$934.42
$1,004.75
$1,254.58 		$1,244.26
$1,310.65
$1,380.98
$1,630.81 		$1,620.49
$1,686.88
$1,757.21
$2,007.04 		$376.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$983.60
$1,116.38
$1,257.04
$1,756.70
$2,669.50 		$1,359.83
$1,492.61
$1,633.27
$2,132.93 		$1,736.06
$1,868.84
$2,009.50
$2,509.16 		$2,112.29
$2,245.07
$2,385.73
$2,885.39 		$376.23
Toc - Plan #10 HMO Louisiana
Gold

(POS) Blue POS Copay 75/55 $2000 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$539.11
$611.89
$688.98
$962.85
$1,463.14 		$951.53
$1,024.31
$1,101.40
$1,375.27 		$1,363.95
$1,436.73
$1,513.82
$1,787.69 		$1,776.37
$1,849.15
$1,926.24
$2,200.11 		$412.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,078.22
$1,223.78
$1,377.96
$1,925.70
$2,926.28 		$1,490.64
$1,636.20
$1,790.38
$2,338.12 		$1,903.06
$2,048.62
$2,202.80
$2,750.54 		$2,315.48
$2,461.04
$2,615.22
$3,162.96 		$412.42
Toc - Plan #11 HMO Louisiana
Gold

(POS) Blue Connect Copay 80/60 $1000 (N)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$1,000 $3,000 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 		$478.16
$542.71
$611.09
$853.99
$1,297.73 		$843.95
$908.50
$976.88
$1,219.78 		$1,209.74
$1,274.29
$1,342.67
$1,585.57 		$1,575.53
$1,640.08
$1,708.46
$1,951.36 		$365.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$956.32
$1,085.42
$1,222.18
$1,707.98
$2,595.46 		$1,322.11
$1,451.21
$1,587.97
$2,073.77 		$1,687.90
$1,817.00
$1,953.76
$2,439.56 		$2,053.69
$2,182.79
$2,319.55
$2,805.35 		$365.79
Toc - Plan #12 HMO Louisiana
Silver

(POS) Blue Connect Copay 70/50 $3000 (N)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,000 $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 		$434.63
$493.31
$555.46
$776.25
$1,179.59 		$767.12
$825.80
$887.95
$1,108.74 		$1,099.61
$1,158.29
$1,220.44
$1,441.23 		$1,432.10
$1,490.78
$1,552.93
$1,773.72 		$332.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$869.26
$986.62
$1,110.92
$1,552.50
$2,359.18 		$1,201.75
$1,319.11
$1,443.41
$1,884.99 		$1,534.24
$1,651.60
$1,775.90
$2,217.48 		$1,866.73
$1,984.09
$2,108.39
$2,549.97 		$332.49
Toc - Plan #13 HMO Louisiana
Silver

(POS) Blue Connect 80/60 $3400 (N)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,400 $10,200 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 		$411.97
$467.59
$526.50
$735.78
$1,118.09 		$727.13
$782.75
$841.66
$1,050.94 		$1,042.29
$1,097.91
$1,156.82
$1,366.10 		$1,357.45
$1,413.07
$1,471.98
$1,681.26 		$315.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$823.94
$935.18
$1,053.00
$1,471.56
$2,236.18 		$1,139.10
$1,250.34
$1,368.16
$1,786.72 		$1,454.26
$1,565.50
$1,683.32
$2,101.88 		$1,769.42
$1,880.66
$1,998.48
$2,417.04 		$315.16
Toc - Plan #14 HMO Louisiana
Gold

(POS) Signature Blue Copay 80/60 $1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$1,000 $3,000 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 		$462.75
$525.22
$591.39
$826.47
$1,255.90 		$816.75
$879.22
$945.39
$1,180.47 		$1,170.75
$1,233.22
$1,299.39
$1,534.47 		$1,524.75
$1,587.22
$1,653.39
$1,888.47 		$354.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$925.50
$1,050.44
$1,182.78
$1,652.94
$2,511.80 		$1,279.50
$1,404.44
$1,536.78
$2,006.94 		$1,633.50
$1,758.44
$1,890.78
$2,360.94 		$1,987.50
$2,112.44
$2,244.78
$2,714.94 		$354.00
Toc - Plan #15 HMO Louisiana
Silver

(POS) Signature Blue Copay 70/50 $3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,000 $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 		$420.63
$477.42
$537.57
$751.25
$1,141.59 		$742.41
$799.20
$859.35
$1,073.03 		$1,064.19
$1,120.98
$1,181.13
$1,394.81 		$1,385.97
$1,442.76
$1,502.91
$1,716.59 		$321.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$841.26
$954.84
$1,075.14
$1,502.50
$2,283.18 		$1,163.04
$1,276.62
$1,396.92
$1,824.28 		$1,484.82
$1,598.40
$1,718.70
$2,146.06 		$1,806.60
$1,920.18
$2,040.48
$2,467.84 		$321.78
Toc - Plan #16 HMO Louisiana
Silver

(POS) Signature Blue 80/60 $3400

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,400 $10,200 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 		$398.70
$452.52
$509.54
$712.08
$1,082.07 		$703.71
$757.53
$814.55
$1,017.09 		$1,008.72
$1,062.54
$1,119.56
$1,322.10 		$1,313.73
$1,367.55
$1,424.57
$1,627.11 		$305.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$797.40
$905.04
$1,019.08
$1,424.16
$2,164.14 		$1,102.41
$1,210.05
$1,324.09
$1,729.17 		$1,407.42
$1,515.06
$1,629.10
$2,034.18 		$1,712.43
$1,820.07
$1,934.11
$2,339.19 		$305.01

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Ambetter from Louisiana Healthcare Connections

Local: 1-833-635-0450 | Toll Free: 1-833-635-0450 | TTY: 1-833-635-0450
Toc - Plan #17 Ambetter from Louisiana Healthcare Connections
Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$320.13
$363.34
$409.12
$571.74
$868.82 		$565.02
$608.23
$654.01
$816.63 		$809.91
$853.12
$898.90
$1,061.52 		$1,054.80
$1,098.01
$1,143.79
$1,306.41 		$244.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640.26
$726.68
$818.24
$1,143.48
$1,737.64 		$885.15
$971.57
$1,063.13
$1,388.37 		$1,130.04
$1,216.46
$1,308.02
$1,633.26 		$1,374.93
$1,461.35
$1,552.91
$1,878.15 		$244.89
Toc - Plan #18 Ambetter from Louisiana Healthcare Connections
Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$341.00
$387.03
$435.79
$609.02
$925.46 		$601.86
$647.89
$696.65
$869.88 		$862.72
$908.75
$957.51
$1,130.74 		$1,123.58
$1,169.61
$1,218.37
$1,391.60 		$260.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$682.00
$774.06
$871.58
$1,218.04
$1,850.92 		$942.86
$1,034.92
$1,132.44
$1,478.90 		$1,203.72
$1,295.78
$1,393.30
$1,739.76 		$1,464.58
$1,556.64
$1,654.16
$2,000.62 		$260.86
Toc - Plan #19 Ambetter from Louisiana Healthcare Connections
Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$383.67
$435.45
$490.32
$685.21
$1,041.25 		$677.17
$728.95
$783.82
$978.71 		$970.67
$1,022.45
$1,077.32
$1,272.21 		$1,264.17
$1,315.95
$1,370.82
$1,565.71 		$293.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767.34
$870.90
$980.64
$1,370.42
$2,082.50 		$1,060.84
$1,164.40
$1,274.14
$1,663.92 		$1,354.34
$1,457.90
$1,567.64
$1,957.42 		$1,647.84
$1,751.40
$1,861.14
$2,250.92 		$293.50
Toc - Plan #20 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$402.13
$456.40
$513.90
$718.18
$1,091.34 		$709.75
$764.02
$821.52
$1,025.80 		$1,017.37
$1,071.64
$1,129.14
$1,333.42 		$1,324.99
$1,379.26
$1,436.76
$1,641.04 		$307.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$804.26
$912.80
$1,027.80
$1,436.36
$2,182.68 		$1,111.88
$1,220.42
$1,335.42
$1,743.98 		$1,419.50
$1,528.04
$1,643.04
$2,051.60 		$1,727.12
$1,835.66
$1,950.66
$2,359.22 		$307.62
Toc - Plan #21 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$398.99
$452.84
$509.90
$712.58
$1,082.83 		$704.21
$758.06
$815.12
$1,017.80 		$1,009.43
$1,063.28
$1,120.34
$1,323.02 		$1,314.65
$1,368.50
$1,425.56
$1,628.24 		$305.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$797.98
$905.68
$1,019.80
$1,425.16
$2,165.66 		$1,103.20
$1,210.90
$1,325.02
$1,730.38 		$1,408.42
$1,516.12
$1,630.24
$2,035.60 		$1,713.64
$1,821.34
$1,935.46
$2,340.82 		$305.22
Toc - Plan #22 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$400.56
$454.62
$511.90
$715.38
$1,087.08 		$706.98
$761.04
$818.32
$1,021.80 		$1,013.40
$1,067.46
$1,124.74
$1,328.22 		$1,319.82
$1,373.88
$1,431.16
$1,634.64 		$306.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$801.12
$909.24
$1,023.80
$1,430.76
$2,174.16 		$1,107.54
$1,215.66
$1,330.22
$1,737.18 		$1,413.96
$1,522.08
$1,636.64
$2,043.60 		$1,720.38
$1,828.50
$1,943.06
$2,350.02 		$306.42
Toc - Plan #23 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,600 $15,200 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 		$449.94
$510.67
$575.01
$803.57
$1,221.10 		$794.13
$854.86
$919.20
$1,147.76 		$1,138.32
$1,199.05
$1,263.39
$1,491.95 		$1,482.51
$1,543.24
$1,607.58
$1,836.14 		$344.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$899.88
$1,021.34
$1,150.02
$1,607.14
$2,442.20 		$1,244.07
$1,365.53
$1,494.21
$1,951.33 		$1,588.26
$1,709.72
$1,838.40
$2,295.52 		$1,932.45
$2,053.91
$2,182.59
$2,639.71 		$344.19
Toc - Plan #24 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$432.73
$491.13
$553.01
$772.83
$1,174.39 		$763.76
$822.16
$884.04
$1,103.86 		$1,094.79
$1,153.19
$1,215.07
$1,434.89 		$1,425.82
$1,484.22
$1,546.10
$1,765.92 		$331.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$865.46
$982.26
$1,106.02
$1,545.66
$2,348.78 		$1,196.49
$1,313.29
$1,437.05
$1,876.69 		$1,527.52
$1,644.32
$1,768.08
$2,207.72 		$1,858.55
$1,975.35
$2,099.11
$2,538.75 		$331.03
Toc - Plan #25 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Enhanced Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

Annual Out of Pocket Expenses:

Individual Family
$3,850 $7,700 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 		$402.97
$457.36
$514.98
$719.69
$1,093.63 		$711.23
$765.62
$823.24
$1,027.95 		$1,019.49
$1,073.88
$1,131.50
$1,336.21 		$1,327.75
$1,382.14
$1,439.76
$1,644.47 		$308.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805.94
$914.72
$1,029.96
$1,439.38
$2,187.26 		$1,114.20
$1,222.98
$1,338.22
$1,747.64 		$1,422.46
$1,531.24
$1,646.48
$2,055.90 		$1,730.72
$1,839.50
$1,954.74
$2,364.16 		$308.26
Toc - Plan #26 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$493.57
$560.19
$630.77
$881.49
$1,339.51 		$871.14
$937.76
$1,008.34
$1,259.06 		$1,248.71
$1,315.33
$1,385.91
$1,636.63 		$1,626.28
$1,692.90
$1,763.48
$2,014.20 		$377.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$987.14
$1,120.38
$1,261.54
$1,762.98
$2,679.02 		$1,364.71
$1,497.95
$1,639.11
$2,140.55 		$1,742.28
$1,875.52
$2,016.68
$2,518.12 		$2,119.85
$2,253.09
$2,394.25
$2,895.69 		$377.57
Toc - Plan #27 Ambetter from Louisiana Healthcare Connections
Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$306.34
$347.69
$391.49
$547.11
$831.38 		$540.68
$582.03
$625.83
$781.45 		$775.02
$816.37
$860.17
$1,015.79 		$1,009.36
$1,050.71
$1,094.51
$1,250.13 		$234.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$612.68
$695.38
$782.98
$1,094.22
$1,662.76 		$847.02
$929.72
$1,017.32
$1,328.56 		$1,081.36
$1,164.06
$1,251.66
$1,562.90 		$1,315.70
$1,398.40
$1,486.00
$1,797.24 		$234.34
Toc - Plan #28 Ambetter from Louisiana Healthcare Connections
Expanded Bronze

(HMO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$334.57
$379.73
$427.57
$597.52
$908.00 		$590.51
$635.67
$683.51
$853.46 		$846.45
$891.61
$939.45
$1,109.40 		$1,102.39
$1,147.55
$1,195.39
$1,365.34 		$255.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$669.14
$759.46
$855.14
$1,195.04
$1,816.00 		$925.08
$1,015.40
$1,111.08
$1,450.98 		$1,181.02
$1,271.34
$1,367.02
$1,706.92 		$1,436.96
$1,527.28
$1,622.96
$1,962.86 		$255.94
Toc - Plan #29 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$397.46
$451.11
$507.94
$709.85
$1,078.68 		$701.51
$755.16
$811.99
$1,013.90 		$1,005.56
$1,059.21
$1,116.04
$1,317.95 		$1,309.61
$1,363.26
$1,420.09
$1,622.00 		$304.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$794.92
$902.22
$1,015.88
$1,419.70
$2,157.36 		$1,098.97
$1,206.27
$1,319.93
$1,723.75 		$1,403.02
$1,510.32
$1,623.98
$2,027.80 		$1,707.07
$1,814.37
$1,928.03
$2,331.85 		$304.05
Toc - Plan #30 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$423.92
$481.14
$541.76
$757.10
$1,150.49 		$748.21
$805.43
$866.05
$1,081.39 		$1,072.50
$1,129.72
$1,190.34
$1,405.68 		$1,396.79
$1,454.01
$1,514.63
$1,729.97 		$324.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$847.84
$962.28
$1,083.52
$1,514.20
$2,300.98 		$1,172.13
$1,286.57
$1,407.81
$1,838.49 		$1,496.42
$1,610.86
$1,732.10
$2,162.78 		$1,820.71
$1,935.15
$2,056.39
$2,487.07 		$324.29
Toc - Plan #31 Ambetter from Louisiana Healthcare Connections
Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$332.07
$376.89
$424.38
$593.06
$901.22 		$586.10
$630.92
$678.41
$847.09 		$840.13
$884.95
$932.44
$1,101.12 		$1,094.16
$1,138.98
$1,186.47
$1,355.15 		$254.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$664.14
$753.78
$848.76
$1,186.12
$1,802.44 		$918.17
$1,007.81
$1,102.79
$1,440.15 		$1,172.20
$1,261.84
$1,356.82
$1,694.18 		$1,426.23
$1,515.87
$1,610.85
$1,948.21 		$254.03
Toc - Plan #32 Ambetter from Louisiana Healthcare Connections
Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$353.72
$401.46
$452.04
$631.73
$959.97 		$624.31
$672.05
$722.63
$902.32 		$894.90
$942.64
$993.22
$1,172.91 		$1,165.49
$1,213.23
$1,263.81
$1,443.50 		$270.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$707.44
$802.92
$904.08
$1,263.46
$1,919.94 		$978.03
$1,073.51
$1,174.67
$1,534.05 		$1,248.62
$1,344.10
$1,445.26
$1,804.64 		$1,519.21
$1,614.69
$1,715.85
$2,075.23 		$270.59
Toc - Plan #33 Ambetter from Louisiana Healthcare Connections
Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$397.98
$451.69
$508.60
$710.77
$1,080.08 		$702.42
$756.13
$813.04
$1,015.21 		$1,006.86
$1,060.57
$1,117.48
$1,319.65 		$1,311.30
$1,365.01
$1,421.92
$1,624.09 		$304.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795.96
$903.38
$1,017.20
$1,421.54
$2,160.16 		$1,100.40
$1,207.82
$1,321.64
$1,725.98 		$1,404.84
$1,512.26
$1,626.08
$2,030.42 		$1,709.28
$1,816.70
$1,930.52
$2,334.86 		$304.44
Toc - Plan #34 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$417.12
$473.42
$533.07
$744.96
$1,132.04 		$736.21
$792.51
$852.16
$1,064.05 		$1,055.30
$1,111.60
$1,171.25
$1,383.14 		$1,374.39
$1,430.69
$1,490.34
$1,702.23 		$319.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$834.24
$946.84
$1,066.14
$1,489.92
$2,264.08 		$1,153.33
$1,265.93
$1,385.23
$1,809.01 		$1,472.42
$1,585.02
$1,704.32
$2,128.10 		$1,791.51
$1,904.11
$2,023.41
$2,447.19 		$319.09
Toc - Plan #35 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$415.49
$471.58
$530.99
$742.06
$1,127.63 		$733.34
$789.43
$848.84
$1,059.91 		$1,051.19
$1,107.28
$1,166.69
$1,377.76 		$1,369.04
$1,425.13
$1,484.54
$1,695.61 		$317.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$830.98
$943.16
$1,061.98
$1,484.12
$2,255.26 		$1,148.83
$1,261.01
$1,379.83
$1,801.97 		$1,466.68
$1,578.86
$1,697.68
$2,119.82 		$1,784.53
$1,896.71
$2,015.53
$2,437.67 		$317.85
Toc - Plan #36 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,600 $15,200 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 		$466.72
$529.71
$596.45
$833.54
$1,266.64 		$823.75
$886.74
$953.48
$1,190.57 		$1,180.78
$1,243.77
$1,310.51
$1,547.60 		$1,537.81
$1,600.80
$1,667.54
$1,904.63 		$357.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$933.44
$1,059.42
$1,192.90
$1,667.08
$2,533.28 		$1,290.47
$1,416.45
$1,549.93
$2,024.11 		$1,647.50
$1,773.48
$1,906.96
$2,381.14 		$2,004.53
$2,130.51
$2,263.99
$2,738.17 		$357.03
Toc - Plan #37 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$448.86
$509.45
$573.63
$801.65
$1,218.19 		$792.23
$852.82
$917.00
$1,145.02 		$1,135.60
$1,196.19
$1,260.37
$1,488.39 		$1,478.97
$1,539.56
$1,603.74
$1,831.76 		$343.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$897.72
$1,018.90
$1,147.26
$1,603.30
$2,436.38 		$1,241.09
$1,362.27
$1,490.63
$1,946.67 		$1,584.46
$1,705.64
$1,834.00
$2,290.04 		$1,927.83
$2,049.01
$2,177.37
$2,633.41 		$343.37
Toc - Plan #38 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$413.87
$469.73
$528.91
$739.15
$1,123.21 		$730.47
$786.33
$845.51
$1,055.75 		$1,047.07
$1,102.93
$1,162.11
$1,372.35 		$1,363.67
$1,419.53
$1,478.71
$1,688.95 		$316.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$827.74
$939.46
$1,057.82
$1,478.30
$2,246.42 		$1,144.34
$1,256.06
$1,374.42
$1,794.90 		$1,460.94
$1,572.66
$1,691.02
$2,111.50 		$1,777.54
$1,889.26
$2,007.62
$2,428.10 		$316.60
Toc - Plan #39 Ambetter from Louisiana Healthcare Connections
Silver

(HMO) Enhanced Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

Annual Out of Pocket Expenses:

Individual Family
$3,850 $7,700 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 		$418.00
$474.42
$534.19
$746.53
$1,134.42 		$737.76
$794.18
$853.95
$1,066.29 		$1,057.52
$1,113.94
$1,173.71
$1,386.05 		$1,377.28
$1,433.70
$1,493.47
$1,705.81 		$319.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$836.00
$948.84
$1,068.38
$1,493.06
$2,268.84 		$1,155.76
$1,268.60
$1,388.14
$1,812.82 		$1,475.52
$1,588.36
$1,707.90
$2,132.58 		$1,795.28
$1,908.12
$2,027.66
$2,452.34 		$319.76
Toc - Plan #40 Ambetter from Louisiana Healthcare Connections
Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-635-0450

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 		$511.97
$581.08
$654.29
$914.37
$1,389.47 		$903.62
$972.73
$1,045.94
$1,306.02 		$1,295.27
$1,364.38
$1,437.59
$1,697.67 		$1,686.92
$1,756.03
$1,829.24
$2,089.32 		$391.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,023.94
$1,162.16
$1,308.58
$1,828.74
$2,778.94 		$1,415.59
$1,553.81
$1,700.23
$2,220.39 		$1,807.24
$1,945.46
$2,091.88
$2,612.04 		$2,198.89
$2,337.11
$2,483.53
$3,003.69 		$391.65

ADVERTISEMENT

Vantage Health Plan

Local: 1-318-361-0900 | Toll Free: 1-888-823-1910 | TTY: 1-866-524-5144
Toc - Plan #41 Vantage Health Plan
Silver

(POS) Freedom Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

Annual Out of Pocket Expenses:

Individual Family
$4,000 $12,000 Annual Deductible
$8,200 $16,400 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 		$640.24
$726.67
$818.22
$1,143.47
$1,737.61 		$1,130.02
$1,216.45
$1,308.00
$1,633.25 		$1,619.80
$1,706.23
$1,797.78
$2,123.03 		$2,109.58
$2,196.01
$2,287.56
$2,612.81 		$489.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,280.48
$1,453.34
$1,636.44
$2,286.94
$3,475.22 		$1,770.26
$1,943.12
$2,126.22
$2,776.72 		$2,260.04
$2,432.90
$2,616.00
$3,266.50 		$2,749.82
$2,922.68
$3,105.78
$3,756.28 		$489.78
Toc - Plan #42 Vantage Health Plan
Expanded Bronze

(POS) Essential Bronze 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

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 		$384.11
$435.97
$490.90
$686.03
$1,042.49 		$677.96
$729.82
$784.75
$979.88 		$971.81
$1,023.67
$1,078.60
$1,273.73 		$1,265.66
$1,317.52
$1,372.45
$1,567.58 		$293.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768.22
$871.94
$981.80
$1,372.06
$2,084.98 		$1,062.07
$1,165.79
$1,275.65
$1,665.91 		$1,355.92
$1,459.64
$1,569.50
$1,959.76 		$1,649.77
$1,753.49
$1,863.35
$2,253.61 		$293.85
Toc - Plan #43 Vantage Health Plan
Gold

(POS) Essential Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

Annual Out of Pocket Expenses:

Individual Family
$1,500 $4,500 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 		$579.04
$657.21
$740.01
$1,034.17
$1,571.52 		$1,022.01
$1,100.18
$1,182.98
$1,477.14 		$1,464.98
$1,543.15
$1,625.95
$1,920.11 		$1,907.95
$1,986.12
$2,068.92
$2,363.08 		$442.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,158.08
$1,314.42
$1,480.02
$2,068.34
$3,143.04 		$1,601.05
$1,757.39
$1,922.99
$2,511.31 		$2,044.02
$2,200.36
$2,365.96
$2,954.28 		$2,486.99
$2,643.33
$2,808.93
$3,397.25 		$442.97
Toc - Plan #44 Vantage Health Plan
Expanded Bronze

(POS) Savings Bronze 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$376.09
$426.86
$480.64
$671.69
$1,020.70 		$663.80
$714.57
$768.35
$959.40 		$951.51
$1,002.28
$1,056.06
$1,247.11 		$1,239.22
$1,289.99
$1,343.77
$1,534.82 		$287.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$752.18
$853.72
$961.28
$1,343.38
$2,041.40 		$1,039.89
$1,141.43
$1,248.99
$1,631.09 		$1,327.60
$1,429.14
$1,536.70
$1,918.80 		$1,615.31
$1,716.85
$1,824.41
$2,206.51 		$287.71
Toc - Plan #45 Vantage Health Plan
Expanded Bronze

(POS) Savings Bronze 7200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

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 		$377.18
$428.10
$482.03
$673.64
$1,023.66 		$665.72
$716.64
$770.57
$962.18 		$954.26
$1,005.18
$1,059.11
$1,250.72 		$1,242.80
$1,293.72
$1,347.65
$1,539.26 		$288.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$754.36
$856.20
$964.06
$1,347.28
$2,047.32 		$1,042.90
$1,144.74
$1,252.60
$1,635.82 		$1,331.44
$1,433.28
$1,541.14
$1,924.36 		$1,619.98
$1,721.82
$1,829.68
$2,212.90 		$288.54
Toc - Plan #46 Vantage Health Plan
Gold

(POS) Standard Gold 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

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 		$596.40
$676.92
$762.20
$1,065.18
$1,618.64 		$1,052.65
$1,133.17
$1,218.45
$1,521.43 		$1,508.90
$1,589.42
$1,674.70
$1,977.68 		$1,965.15
$2,045.67
$2,130.95
$2,433.93 		$456.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,192.80
$1,353.84
$1,524.40
$2,130.36
$3,237.28 		$1,649.05
$1,810.09
$1,980.65
$2,586.61 		$2,105.30
$2,266.34
$2,436.90
$3,042.86 		$2,561.55
$2,722.59
$2,893.15
$3,499.11 		$456.25
Toc - Plan #47 Vantage Health Plan
Silver

(POS) Standard Silver 5800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

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 		$600.60
$681.68
$767.57
$1,072.67
$1,630.03 		$1,060.06
$1,141.14
$1,227.03
$1,532.13 		$1,519.52
$1,600.60
$1,686.49
$1,991.59 		$1,978.98
$2,060.06
$2,145.95
$2,451.05 		$459.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,201.20
$1,363.36
$1,535.14
$2,145.34
$3,260.06 		$1,660.66
$1,822.82
$1,994.60
$2,604.80 		$2,120.12
$2,282.28
$2,454.06
$3,064.26 		$2,579.58
$2,741.74
$2,913.52
$3,523.72 		$459.46
Toc - Plan #48 Vantage Health Plan
Expanded Bronze

(POS) Standard Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-823-1910

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 		$393.84
$447.01
$503.33
$703.40
$1,068.88 		$695.13
$748.30
$804.62
$1,004.69 		$996.42
$1,049.59
$1,105.91
$1,305.98 		$1,297.71
$1,350.88
$1,407.20
$1,607.27 		$301.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$787.68
$894.02
$1,006.66
$1,406.80
$2,137.76 		$1,088.97
$1,195.31
$1,307.95
$1,708.09 		$1,390.26
$1,496.60
$1,609.24
$2,009.38 		$1,691.55
$1,797.89
$1,910.53
$2,310.67 		$301.29

ADVERTISEMENT

UnitedHealthcare

Local: 1-866-268-6438 | Toll Free: 1-866-268-6438 | TTY: 1-866-268-6438
Toc - Plan #49 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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 		$432.44
$490.81
$552.65
$772.33
$1,173.63 		$763.25
$821.62
$883.46
$1,103.14 		$1,094.06
$1,152.43
$1,214.27
$1,433.95 		$1,424.87
$1,483.24
$1,545.08
$1,764.76 		$330.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$864.88
$981.62
$1,105.30
$1,544.66
$2,347.26 		$1,195.69
$1,312.43
$1,436.11
$1,875.47 		$1,526.50
$1,643.24
$1,766.92
$2,206.28 		$1,857.31
$1,974.05
$2,097.73
$2,537.09 		$330.81
Toc - Plan #50 UnitedHealthcare
Bronze

(EPO) UHC Bronze Essential ($3 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$416.61
$472.85
$532.43
$744.07
$1,130.68 		$735.32
$791.56
$851.14
$1,062.78 		$1,054.03
$1,110.27
$1,169.85
$1,381.49 		$1,372.74
$1,428.98
$1,488.56
$1,700.20 		$318.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.22
$945.70
$1,064.86
$1,488.14
$2,261.36 		$1,151.93
$1,264.41
$1,383.57
$1,806.85 		$1,470.64
$1,583.12
$1,702.28
$2,125.56 		$1,789.35
$1,901.83
$2,020.99
$2,444.27 		$318.71
Toc - Plan #51 UnitedHealthcare
Gold

(EPO) UHC Gold Value ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$1,550 $3,100 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 		$579.01
$657.17
$739.97
$1,034.11
$1,571.43 		$1,021.95
$1,100.11
$1,182.91
$1,477.05 		$1,464.89
$1,543.05
$1,625.85
$1,919.99 		$1,907.83
$1,985.99
$2,068.79
$2,362.93 		$442.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,158.02
$1,314.34
$1,479.94
$2,068.22
$3,142.86 		$1,600.96
$1,757.28
$1,922.88
$2,511.16 		$2,043.90
$2,200.22
$2,365.82
$2,954.10 		$2,486.84
$2,643.16
$2,808.76
$3,397.04 		$442.94
Toc - Plan #52 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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 		$586.94
$666.18
$750.11
$1,048.27
$1,592.96 		$1,035.95
$1,115.19
$1,199.12
$1,497.28 		$1,484.96
$1,564.20
$1,648.13
$1,946.29 		$1,933.97
$2,013.21
$2,097.14
$2,395.30 		$449.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,173.88
$1,332.36
$1,500.22
$2,096.54
$3,185.92 		$1,622.89
$1,781.37
$1,949.23
$2,545.55 		$2,071.90
$2,230.38
$2,398.24
$2,994.56 		$2,520.91
$2,679.39
$2,847.25
$3,443.57 		$449.01
Toc - Plan #53 UnitedHealthcare
Gold

(EPO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$584.52
$663.43
$747.02
$1,043.95
$1,586.38 		$1,031.68
$1,110.59
$1,194.18
$1,491.11 		$1,478.84
$1,557.75
$1,641.34
$1,938.27 		$1,926.00
$2,004.91
$2,088.50
$2,385.43 		$447.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,169.04
$1,326.86
$1,494.04
$2,087.90
$3,172.76 		$1,616.20
$1,774.02
$1,941.20
$2,535.06 		$2,063.36
$2,221.18
$2,388.36
$2,982.22 		$2,510.52
$2,668.34
$2,835.52
$3,429.38 		$447.16
Toc - Plan #54 UnitedHealthcare
Silver

(EPO) UHC Silver Value $4,000 Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$545.92
$619.62
$697.69
$975.02
$1,481.64 		$963.55
$1,037.25
$1,115.32
$1,392.65 		$1,381.18
$1,454.88
$1,532.95
$1,810.28 		$1,798.81
$1,872.51
$1,950.58
$2,227.91 		$417.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,091.84
$1,239.24
$1,395.38
$1,950.04
$2,963.28 		$1,509.47
$1,656.87
$1,813.01
$2,367.67 		$1,927.10
$2,074.50
$2,230.64
$2,785.30 		$2,344.73
$2,492.13
$2,648.27
$3,202.93 		$417.63
Toc - Plan #55 UnitedHealthcare
Silver

(EPO) UHC Silver Value $3,350 Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$3,350 $6,700 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 		$544.68
$618.22
$696.11
$972.81
$1,478.27 		$961.36
$1,034.90
$1,112.79
$1,389.49 		$1,378.04
$1,451.58
$1,529.47
$1,806.17 		$1,794.72
$1,868.26
$1,946.15
$2,222.85 		$416.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,089.36
$1,236.44
$1,392.22
$1,945.62
$2,956.54 		$1,506.04
$1,653.12
$1,808.90
$2,362.30 		$1,922.72
$2,069.80
$2,225.58
$2,778.98 		$2,339.40
$2,486.48
$2,642.26
$3,195.66 		$416.68
Toc - Plan #56 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$536.28
$608.68
$685.36
$957.79
$1,455.46 		$946.53
$1,018.93
$1,095.61
$1,368.04 		$1,356.78
$1,429.18
$1,505.86
$1,778.29 		$1,767.03
$1,839.43
$1,916.11
$2,188.54 		$410.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,072.56
$1,217.36
$1,370.72
$1,915.58
$2,910.92 		$1,482.81
$1,627.61
$1,780.97
$2,325.83 		$1,893.06
$2,037.86
$2,191.22
$2,736.08 		$2,303.31
$2,448.11
$2,601.47
$3,146.33 		$410.25
Toc - Plan #57 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$550.88
$625.25
$704.03
$983.88
$1,495.10 		$972.31
$1,046.68
$1,125.46
$1,405.31 		$1,393.74
$1,468.11
$1,546.89
$1,826.74 		$1,815.17
$1,889.54
$1,968.32
$2,248.17 		$421.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,101.76
$1,250.50
$1,408.06
$1,967.76
$2,990.20 		$1,523.19
$1,671.93
$1,829.49
$2,389.19 		$1,944.62
$2,093.36
$2,250.92
$2,810.62 		$2,366.05
$2,514.79
$2,672.35
$3,232.05 		$421.43
Toc - Plan #58 UnitedHealthcare
Silver

(EPO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$547.43
$621.33
$699.61
$977.70
$1,485.71 		$966.21
$1,040.11
$1,118.39
$1,396.48 		$1,384.99
$1,458.89
$1,537.17
$1,815.26 		$1,803.77
$1,877.67
$1,955.95
$2,234.04 		$418.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,094.86
$1,242.66
$1,399.22
$1,955.40
$2,971.42 		$1,513.64
$1,661.44
$1,818.00
$2,374.18 		$1,932.42
$2,080.22
$2,236.78
$2,792.96 		$2,351.20
$2,499.00
$2,655.56
$3,211.74 		$418.78
Toc - Plan #59 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$435.52
$494.31
$556.59
$777.83
$1,181.99 		$768.69
$827.48
$889.76
$1,111.00 		$1,101.86
$1,160.65
$1,222.93
$1,444.17 		$1,435.03
$1,493.82
$1,556.10
$1,777.34 		$333.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$871.04
$988.62
$1,113.18
$1,555.66
$2,363.98 		$1,204.21
$1,321.79
$1,446.35
$1,888.83 		$1,537.38
$1,654.96
$1,779.52
$2,222.00 		$1,870.55
$1,988.13
$2,112.69
$2,555.17 		$333.17
Toc - Plan #60 UnitedHealthcare
Bronze

(EPO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-268-6438

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 		$407.74
$462.78
$521.09
$728.22
$1,106.60 		$719.66
$774.70
$833.01
$1,040.14 		$1,031.58
$1,086.62
$1,144.93
$1,352.06 		$1,343.50
$1,398.54
$1,456.85
$1,663.98 		$311.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815.48
$925.56
$1,042.18
$1,456.44
$2,213.20 		$1,127.40
$1,237.48
$1,354.10
$1,768.36 		$1,439.32
$1,549.40
$1,666.02
$2,080.28 		$1,751.24
$1,861.32
$1,977.94
$2,392.20 		$311.92

ADVERTISEMENT

Blue Cross and Blue Shield of Louisiana

Local: 1-800-392-4087 | Toll Free: 1-800-392-4087 | TTY: 1-800-392-4087
Toc - Plan #61 Blue Cross and Blue Shield of Louisiana
Silver

(PPO) Blue Max Copay 50/50 $3200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,200 $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 		$576.63
$654.48
$736.93
$1,029.86
$1,564.97 		$1,017.75
$1,095.60
$1,178.05
$1,470.98 		$1,458.87
$1,536.72
$1,619.17
$1,912.10 		$1,899.99
$1,977.84
$2,060.29
$2,353.22 		$441.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,153.26
$1,308.96
$1,473.86
$2,059.72
$3,129.94 		$1,594.38
$1,750.08
$1,914.98
$2,500.84 		$2,035.50
$2,191.20
$2,356.10
$2,941.96 		$2,476.62
$2,632.32
$2,797.22
$3,383.08 		$441.12
Toc - Plan #62 Blue Cross and Blue Shield of Louisiana
Gold

(PPO) Blue Max 90/70 $1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$1,500 $4,500 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 		$644.06
$731.01
$823.11
$1,150.29
$1,747.98 		$1,136.77
$1,223.72
$1,315.82
$1,643.00 		$1,629.48
$1,716.43
$1,808.53
$2,135.71 		$2,122.19
$2,209.14
$2,301.24
$2,628.42 		$492.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,288.12
$1,462.02
$1,646.22
$2,300.58
$3,495.96 		$1,780.83
$1,954.73
$2,138.93
$2,793.29 		$2,273.54
$2,447.44
$2,631.64
$3,286.00 		$2,766.25
$2,940.15
$3,124.35
$3,778.71 		$492.71
Toc - Plan #63 Blue Cross and Blue Shield of Louisiana
Bronze

(PPO) Blue Max 70/50 $6700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$6,700 $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 		$384.14
$436.00
$490.93
$686.07
$1,042.56 		$678.01
$729.87
$784.80
$979.94 		$971.88
$1,023.74
$1,078.67
$1,273.81 		$1,265.75
$1,317.61
$1,372.54
$1,567.68 		$293.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768.28
$872.00
$981.86
$1,372.14
$2,085.12 		$1,062.15
$1,165.87
$1,275.73
$1,666.01 		$1,356.02
$1,459.74
$1,569.60
$1,959.88 		$1,649.89
$1,753.61
$1,863.47
$2,253.75 		$293.87
Toc - Plan #64 Blue Cross and Blue Shield of Louisiana
Bronze

(PPO) Blue Max 100/100 $9100 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$374.23
$424.75
$478.27
$668.37
$1,015.66 		$660.52
$711.04
$764.56
$954.66 		$946.81
$997.33
$1,050.85
$1,240.95 		$1,233.10
$1,283.62
$1,337.14
$1,527.24 		$286.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$748.46
$849.50
$956.54
$1,336.74
$2,031.32 		$1,034.75
$1,135.79
$1,242.83
$1,623.03 		$1,321.04
$1,422.08
$1,529.12
$1,909.32 		$1,607.33
$1,708.37
$1,815.41
$2,195.61 		$286.29
Toc - Plan #65 Blue Cross and Blue Shield of Louisiana
Gold

(PPO) Blue Max Copay 75/55 $2000 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$635.72
$721.54
$812.45
$1,135.40
$1,725.34 		$1,122.05
$1,207.87
$1,298.78
$1,621.73 		$1,608.38
$1,694.20
$1,785.11
$2,108.06 		$2,094.71
$2,180.53
$2,271.44
$2,594.39 		$486.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,271.44
$1,443.08
$1,624.90
$2,270.80
$3,450.68 		$1,757.77
$1,929.41
$2,111.23
$2,757.13 		$2,244.10
$2,415.74
$2,597.56
$3,243.46 		$2,730.43
$2,902.07
$3,083.89
$3,729.79 		$486.33
Toc - Plan #66 Blue Cross and Blue Shield of Louisiana
Silver

(PPO) Blue Max Copay 60/40 $5800 Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

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 		$580.71
$659.11
$742.15
$1,037.15
$1,576.05 		$1,024.95
$1,103.35
$1,186.39
$1,481.39 		$1,469.19
$1,547.59
$1,630.63
$1,925.63 		$1,913.43
$1,991.83
$2,074.87
$2,369.87 		$444.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,161.42
$1,318.22
$1,484.30
$2,074.30
$3,152.10 		$1,605.66
$1,762.46
$1,928.54
$2,518.54 		$2,049.90
$2,206.70
$2,372.78
$2,962.78 		$2,494.14
$2,650.94
$2,817.02
$3,407.02 		$444.24
Toc - Plan #67 Blue Cross and Blue Shield of Louisiana
Silver

(PPO) Blue Saver 90/70 $3200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$3,200 $6,400 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 		$581.48
$659.98
$743.13
$1,038.52
$1,578.14 		$1,026.31
$1,104.81
$1,187.96
$1,483.35 		$1,471.14
$1,549.64
$1,632.79
$1,928.18 		$1,915.97
$1,994.47
$2,077.62
$2,373.01 		$444.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,162.96
$1,319.96
$1,486.26
$2,077.04
$3,156.28 		$1,607.79
$1,764.79
$1,931.09
$2,521.87 		$2,052.62
$2,209.62
$2,375.92
$2,966.70 		$2,497.45
$2,654.45
$2,820.75
$3,411.53 		$444.83
Toc - Plan #68 Blue Cross and Blue Shield of Louisiana
Expanded Bronze

(PPO) Blue Saver 60/40 $6100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-4087

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 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 		$453.24
$514.43
$579.24
$809.49
$1,230.09 		$799.97
$861.16
$925.97
$1,156.22 		$1,146.70
$1,207.89
$1,272.70
$1,502.95 		$1,493.43
$1,554.62
$1,619.43
$1,849.68 		$346.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$906.48
$1,028.86
$1,158.48
$1,618.98
$2,460.18 		$1,253.21
$1,375.59
$1,505.21
$1,965.71 		$1,599.94
$1,722.32
$1,851.94
$2,312.44 		$1,946.67
$2,069.05
$2,198.67
$2,659.17 		$346.73

‡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 Orleans Parish here.

Orleans Parish is in “Rating Area 1” of Louisiana.

Currently, there are 68 plans offered in Rating Area 1.

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2023 Obamacare Plans for Orleans Parish, LA

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