Obamacare 2023 Rates for Jasper County
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Obamacare > Rates > Missouri > Jasper County
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Aetna CVS HealthLocal: 1-877-336-3915 | Toll Free: 1-877-336-3915 | TTY: 1-877-336-3915 |
Toc - Plan #1 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$363.53 $412.60 $464.59 $649.26 $986.62 |
$641.63 $690.70 $742.69 $927.36 |
$919.73 $968.80 $1,020.79 $1,205.46 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$727.06 $825.20 $929.18 $1,298.52 $1,973.24 |
$1,005.16 $1,103.30 $1,207.28 $1,576.62 |
$1,283.26 $1,381.40 $1,485.38 $1,854.72 |
Toc - Plan #2 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.99 $413.13 $465.18 $650.08 $987.86 |
$642.44 $691.58 $743.63 $928.53 |
$920.89 $970.03 $1,022.08 $1,206.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$727.98 $826.26 $930.36 $1,300.16 $1,975.72 |
$1,006.43 $1,104.71 $1,208.81 $1,578.61 |
$1,284.88 $1,383.16 $1,487.26 $1,857.06 |
Toc - Plan #3 Aetna CVS Health | ||||||||||||||||||||
Gold
(EPO) Gold: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$560.99 $636.73 $716.95 $1,001.93 $1,522.53 |
$990.15 $1,065.89 $1,146.11 $1,431.09 |
$1,419.31 $1,495.05 $1,575.27 $1,860.25 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,121.98 $1,273.46 $1,433.90 $2,003.86 $3,045.06 |
$1,551.14 $1,702.62 $1,863.06 $2,433.02 |
$1,980.30 $2,131.78 $2,292.22 $2,862.18 |
Toc - Plan #4 Aetna CVS Health | ||||||||||||||||||||
Silver
(EPO) Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$452.05 $513.08 $577.72 $807.36 $1,226.86 |
$797.87 $858.90 $923.54 $1,153.18 |
$1,143.69 $1,204.72 $1,269.36 $1,499.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$904.10 $1,026.16 $1,155.44 $1,614.72 $2,453.72 |
$1,249.92 $1,371.98 $1,501.26 $1,960.54 |
$1,595.74 $1,717.80 $1,847.08 $2,306.36 |
Toc - Plan #5 Aetna CVS Health | ||||||||||||||||||||
Silver
(EPO) Silver 1: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$454.65 $516.03 $581.05 $812.01 $1,233.93 |
$802.46 $863.84 $928.86 $1,159.82 |
$1,150.27 $1,211.65 $1,276.67 $1,507.63 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$909.30 $1,032.06 $1,162.10 $1,624.02 $2,467.86 |
$1,257.11 $1,379.87 $1,509.91 $1,971.83 |
$1,604.92 $1,727.68 $1,857.72 $2,319.64 |
Toc - Plan #6 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$352.01 $399.54 $449.87 $628.70 $955.37 |
$621.30 $668.83 $719.16 $897.99 |
$890.59 $938.12 $988.45 $1,167.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$704.02 $799.08 $899.74 $1,257.40 $1,910.74 |
$973.31 $1,068.37 $1,169.03 $1,526.69 |
$1,242.60 $1,337.66 $1,438.32 $1,795.98 |
Toc - Plan #7 Aetna CVS Health | ||||||||||||||||||||
Gold
(EPO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$511.91 $581.02 $654.22 $914.27 $1,389.32 |
$903.52 $972.63 $1,045.83 $1,305.88 |
$1,295.13 $1,364.24 $1,437.44 $1,697.49 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,023.82 $1,162.04 $1,308.44 $1,828.54 $2,778.64 |
$1,415.43 $1,553.65 $1,700.05 $2,220.15 |
$1,807.04 $1,945.26 $2,091.66 $2,611.76 |
Toc - Plan #8 Aetna CVS Health | ||||||||||||||||||||
Silver
(EPO) Silver 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$430.27 $488.35 $549.88 $768.46 $1,167.74 |
$759.42 $817.50 $879.03 $1,097.61 |
$1,088.57 $1,146.65 $1,208.18 $1,426.76 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$860.54 $976.70 $1,099.76 $1,536.92 $2,335.48 |
$1,189.69 $1,305.85 $1,428.91 $1,866.07 |
$1,518.84 $1,635.00 $1,758.06 $2,195.22 |
Toc - Plan #9 Aetna CVS Health | ||||||||||||||||||||
Silver
(EPO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$421.85 $478.80 $539.13 $753.43 $1,144.91 |
$744.57 $801.52 $861.85 $1,076.15 |
$1,067.29 $1,124.24 $1,184.57 $1,398.87 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$843.70 $957.60 $1,078.26 $1,506.86 $2,289.82 |
$1,166.42 $1,280.32 $1,400.98 $1,829.58 |
$1,489.14 $1,603.04 $1,723.70 $2,152.30 |
ADVERTISEMENT
MedicaLocal: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777 |
Toc - Plan #10 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Balance by Medica Bronze HSA ($0 Virtual Care after Deductible with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.78 $442.39 $498.12 $696.13 $1,057.83 |
$687.95 $740.56 $796.29 $994.30 |
$986.12 $1,038.73 $1,094.46 $1,292.47 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$779.56 $884.78 $996.24 $1,392.26 $2,115.66 |
$1,077.73 $1,182.95 $1,294.41 $1,690.43 |
$1,375.90 $1,481.12 $1,592.58 $1,988.60 |
Toc - Plan #11 Medica | ||||||||||||||||||||
Catastrophic
(EPO) Balance by Medica Catastrophic ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$229.89 $260.92 $293.79 $410.57 $623.91 |
$405.75 $436.78 $469.65 $586.43 |
$581.61 $612.64 $645.51 $762.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$459.78 $521.84 $587.58 $821.14 $1,247.82 |
$635.64 $697.70 $763.44 $997.00 |
$811.50 $873.56 $939.30 $1,172.86 |
Toc - Plan #12 Medica | ||||||||||||||||||||
Silver
(EPO) Balance by Medica Silver Share ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$454.55 $515.90 $580.90 $811.80 $1,233.61 |
$802.27 $863.62 $928.62 $1,159.52 |
$1,149.99 $1,211.34 $1,276.34 $1,507.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$909.10 $1,031.80 $1,161.80 $1,623.60 $2,467.22 |
$1,256.82 $1,379.52 $1,509.52 $1,971.32 |
$1,604.54 $1,727.24 $1,857.24 $2,319.04 |
Toc - Plan #13 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Balance by Medica Bronze Share Plus ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$331.83 $376.62 $424.07 $592.63 $900.56 |
$585.67 $630.46 $677.91 $846.47 |
$839.51 $884.30 $931.75 $1,100.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$663.66 $753.24 $848.14 $1,185.26 $1,801.12 |
$917.50 $1,007.08 $1,101.98 $1,439.10 |
$1,171.34 $1,260.92 $1,355.82 $1,692.94 |
Toc - Plan #14 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Balance by Medica Bronze Copay $0 PCP ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$322.39 $365.91 $412.01 $575.78 $874.95 |
$569.01 $612.53 $658.63 $822.40 |
$815.63 $859.15 $905.25 $1,069.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644.78 $731.82 $824.02 $1,151.56 $1,749.90 |
$891.40 $978.44 $1,070.64 $1,398.18 |
$1,138.02 $1,225.06 $1,317.26 $1,644.80 |
Toc - Plan #15 Medica | ||||||||||||||||||||
Gold
(EPO) Balance by Medica Gold Copay $0 PCP ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$481.04 $545.97 $614.76 $859.12 $1,305.51 |
$849.03 $913.96 $982.75 $1,227.11 |
$1,217.02 $1,281.95 $1,350.74 $1,595.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$962.08 $1,091.94 $1,229.52 $1,718.24 $2,611.02 |
$1,330.07 $1,459.93 $1,597.51 $2,086.23 |
$1,698.06 $1,827.92 $1,965.50 $2,454.22 |
Toc - Plan #16 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Balance by Medica Bronze Premier ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$323.55 $367.21 $413.48 $577.84 $878.08 |
$571.06 $614.72 $660.99 $825.35 |
$818.57 $862.23 $908.50 $1,072.86 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$647.10 $734.42 $826.96 $1,155.68 $1,756.16 |
$894.61 $981.93 $1,074.47 $1,403.19 |
$1,142.12 $1,229.44 $1,321.98 $1,650.70 |
Toc - Plan #17 Medica | ||||||||||||||||||||
Gold
(EPO) Balance by Medica Gold Standard ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.52 $519.27 $584.69 $817.10 $1,241.67 |
$807.51 $869.26 $934.68 $1,167.09 |
$1,157.50 $1,219.25 $1,284.67 $1,517.08 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$915.04 $1,038.54 $1,169.38 $1,634.20 $2,483.34 |
$1,265.03 $1,388.53 $1,519.37 $1,984.19 |
$1,615.02 $1,738.52 $1,869.36 $2,334.18 |
Toc - Plan #18 Medica | ||||||||||||||||||||
Silver
(EPO) Balance by Medica Silver Standard ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$435.28 $494.03 $556.27 $777.38 $1,181.31 |
$768.26 $827.01 $889.25 $1,110.36 |
$1,101.24 $1,159.99 $1,222.23 $1,443.34 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$870.56 $988.06 $1,112.54 $1,554.76 $2,362.62 |
$1,203.54 $1,321.04 $1,445.52 $1,887.74 |
$1,536.52 $1,654.02 $1,778.50 $2,220.72 |
Toc - Plan #19 Medica | ||||||||||||||||||||
Bronze
(EPO) Balance by Medica Bronze Standard ($0 Virtual Care with Designated Providers) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.95 $351.78 $396.10 $553.55 $841.17 |
$547.05 $588.88 $633.20 $790.65 |
$784.15 $825.98 $870.30 $1,027.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$619.90 $703.56 $792.20 $1,107.10 $1,682.34 |
$857.00 $940.66 $1,029.30 $1,344.20 |
$1,094.10 $1,177.76 $1,266.40 $1,581.30 |
ADVERTISEMENT
UnitedHealthcareLocal: 1-877-632-4195 | Toll Free: 1-877-632-4195 | TTY: 1-877-940-4172 |
Toc - Plan #20 UnitedHealthcare | ||||||||||||||||||||
Gold
(EPO) UHC Gold Value (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.45 $486.29 $547.55 $765.21 $1,162.80 |
$756.21 $814.05 $875.31 $1,092.97 |
$1,083.97 $1,141.81 $1,203.07 $1,420.73 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$856.90 $972.58 $1,095.10 $1,530.42 $2,325.60 |
$1,184.66 $1,300.34 $1,422.86 $1,858.18 |
$1,512.42 $1,628.10 $1,750.62 $2,185.94 |
Toc - Plan #21 UnitedHealthcare | ||||||||||||||||||||
Gold
(EPO) UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, Dental + Vision) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$451.00 $511.89 $576.38 $805.49 $1,224.03 |
$796.02 $856.91 $921.40 $1,150.51 |
$1,141.04 $1,201.93 $1,266.42 $1,495.53 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$902.00 $1,023.78 $1,152.76 $1,610.98 $2,448.06 |
$1,247.02 $1,368.80 $1,497.78 $1,956.00 |
$1,592.04 $1,713.82 $1,842.80 $2,301.02 |
Toc - Plan #22 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Value $4,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.85 $451.56 $508.46 $710.57 $1,079.77 |
$702.21 $755.92 $812.82 $1,014.93 |
$1,006.57 $1,060.28 $1,117.18 $1,319.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.70 $903.12 $1,016.92 $1,421.14 $2,159.54 |
$1,100.06 $1,207.48 $1,321.28 $1,725.50 |
$1,404.42 $1,511.84 $1,625.64 $2,029.86 |
Toc - Plan #23 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.41 $446.52 $502.78 $702.63 $1,067.72 |
$694.37 $747.48 $803.74 $1,003.59 |
$995.33 $1,048.44 $1,104.70 $1,304.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786.82 $893.04 $1,005.56 $1,405.26 $2,135.44 |
$1,087.78 $1,194.00 $1,306.52 $1,706.22 |
$1,388.74 $1,494.96 $1,607.48 $2,007.18 |
Toc - Plan #24 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.09 $465.45 $524.09 $732.42 $1,112.98 |
$723.81 $779.17 $837.81 $1,046.14 |
$1,037.53 $1,092.89 $1,151.53 $1,359.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$820.18 $930.90 $1,048.18 $1,464.84 $2,225.96 |
$1,133.90 $1,244.62 $1,361.90 $1,778.56 |
$1,447.62 $1,558.34 $1,675.62 $2,092.28 |
Toc - Plan #25 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Advantage $0 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.28 $457.72 $515.39 $720.26 $1,094.50 |
$711.79 $766.23 $823.90 $1,028.77 |
$1,020.30 $1,074.74 $1,132.41 $1,337.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806.56 $915.44 $1,030.78 $1,440.52 $2,189.00 |
$1,115.07 $1,223.95 $1,339.29 $1,749.03 |
$1,423.58 $1,532.46 $1,647.80 $2,057.54 |
Toc - Plan #26 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Value HSA $5,400 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$400.99 $455.13 $512.47 $716.18 $1,088.30 |
$707.75 $761.89 $819.23 $1,022.94 |
$1,014.51 $1,068.65 $1,125.99 $1,329.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$801.98 $910.26 $1,024.94 $1,432.36 $2,176.60 |
$1,108.74 $1,217.02 $1,331.70 $1,739.12 |
$1,415.50 $1,523.78 $1,638.46 $2,045.88 |
Toc - Plan #27 UnitedHealthcare | ||||||||||||||||||||
Silver
(EPO) UHC Silver Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.90 $453.89 $511.08 $714.23 $1,085.34 |
$705.83 $759.82 $817.01 $1,020.16 |
$1,011.76 $1,065.75 $1,122.94 $1,326.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.80 $907.78 $1,022.16 $1,428.46 $2,170.68 |
$1,105.73 $1,213.71 $1,328.09 $1,734.39 |
$1,411.66 $1,519.64 $1,634.02 $2,040.32 |
Toc - Plan #28 UnitedHealthcare | ||||||||||||||||||||
Gold
(EPO) UHC Gold Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$438.82 $498.06 $560.81 $783.73 $1,190.96 |
$774.52 $833.76 $896.51 $1,119.43 |
$1,110.22 $1,169.46 $1,232.21 $1,455.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$877.64 $996.12 $1,121.62 $1,567.46 $2,381.92 |
$1,213.34 $1,331.82 $1,457.32 $1,903.16 |
$1,549.04 $1,667.52 $1,793.02 $2,238.86 |
Toc - Plan #29 UnitedHealthcare | ||||||||||||||||||||
Bronze
(EPO) UHC Bronze Essential ($3 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.25 $373.70 $420.78 $588.04 $893.58 |
$581.13 $625.58 $672.66 $839.92 |
$833.01 $877.46 $924.54 $1,091.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$658.50 $747.40 $841.56 $1,176.08 $1,787.16 |
$910.38 $999.28 $1,093.44 $1,427.96 |
$1,162.26 $1,251.16 $1,345.32 $1,679.84 |
Toc - Plan #30 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(EPO) UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.87 $389.16 $438.19 $612.36 $930.55 |
$605.16 $651.45 $700.48 $874.65 |
$867.45 $913.74 $962.77 $1,136.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$685.74 $778.32 $876.38 $1,224.72 $1,861.10 |
$948.03 $1,040.61 $1,138.67 $1,487.01 |
$1,210.32 $1,302.90 $1,400.96 $1,749.30 |
Toc - Plan #31 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(EPO) UHC Bronze Value HSA $6,700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.30 $387.37 $436.18 $609.55 $926.28 |
$602.39 $648.46 $697.27 $870.64 |
$863.48 $909.55 $958.36 $1,131.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$682.60 $774.74 $872.36 $1,219.10 $1,852.56 |
$943.69 $1,035.83 $1,133.45 $1,480.19 |
$1,204.78 $1,296.92 $1,394.54 $1,741.28 |
Toc - Plan #32 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(EPO) UHC Bronze Standard $7,500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.14 $391.73 $441.09 $616.42 $936.71 |
$609.17 $655.76 $705.12 $880.45 |
$873.20 $919.79 $969.15 $1,144.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$690.28 $783.46 $882.18 $1,232.84 $1,873.42 |
$954.31 $1,047.49 $1,146.21 $1,496.87 |
$1,218.34 $1,311.52 $1,410.24 $1,760.90 |
Toc - Plan #33 UnitedHealthcare | ||||||||||||||||||||
Bronze
(EPO) UHC Bronze Standard $9,100 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-632-4195
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.55 $363.83 $409.66 $572.50 $869.97 |
$565.77 $609.05 $654.88 $817.72 |
$810.99 $854.27 $900.10 $1,062.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$641.10 $727.66 $819.32 $1,145.00 $1,739.94 |
$886.32 $972.88 $1,064.54 $1,390.22 |
$1,131.54 $1,218.10 $1,309.76 $1,635.44 |
ADVERTISEMENT
Ambetter from Home State HealthLocal: 1-855-650-3789 | Toll Free: 1-855-650-3789 | TTY: 1-855-650-3789 |
Toc - Plan #34 Ambetter from Home State Health | ||||||||||||||||||||
Bronze
(EPO) Clear Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.77 $392.44 $441.89 $617.53 $938.40 |
$610.28 $656.95 $706.40 $882.04 |
$874.79 $921.46 $970.91 $1,146.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$691.54 $784.88 $883.78 $1,235.06 $1,876.80 |
$956.05 $1,049.39 $1,148.29 $1,499.57 |
$1,220.56 $1,313.90 $1,412.80 $1,764.08 |
Toc - Plan #35 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Premier Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$400.48 $454.53 $511.80 $715.24 $1,086.87 |
$706.84 $760.89 $818.16 $1,021.60 |
$1,013.20 $1,067.25 $1,124.52 $1,327.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$800.96 $909.06 $1,023.60 $1,430.48 $2,173.74 |
$1,107.32 $1,215.42 $1,329.96 $1,736.84 |
$1,413.68 $1,521.78 $1,636.32 $2,043.20 |
Toc - Plan #36 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Complete Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.00 $452.85 $509.90 $712.59 $1,082.85 |
$704.22 $758.07 $815.12 $1,017.81 |
$1,009.44 $1,063.29 $1,120.34 $1,323.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.00 $905.70 $1,019.80 $1,425.18 $2,165.70 |
$1,103.22 $1,210.92 $1,325.02 $1,730.40 |
$1,408.44 $1,516.14 $1,630.24 $2,035.62 |
Toc - Plan #37 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Complete Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$496.11 $563.07 $634.02 $886.03 $1,346.41 |
$875.63 $942.59 $1,013.54 $1,265.55 |
$1,255.15 $1,322.11 $1,393.06 $1,645.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$992.22 $1,126.14 $1,268.04 $1,772.06 $2,692.82 |
$1,371.74 $1,505.66 $1,647.56 $2,151.58 |
$1,751.26 $1,885.18 $2,027.08 $2,531.10 |
Toc - Plan #38 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Everyday Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374.41 $424.94 $478.48 $668.67 $1,016.11 |
$660.82 $711.35 $764.89 $955.08 |
$947.23 $997.76 $1,051.30 $1,241.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$748.82 $849.88 $956.96 $1,337.34 $2,032.22 |
$1,035.23 $1,136.29 $1,243.37 $1,623.75 |
$1,321.64 $1,422.70 $1,529.78 $1,910.16 |
Toc - Plan #39 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Choice Bronze HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$380.05 $431.35 $485.70 $678.76 $1,031.44 |
$670.78 $722.08 $776.43 $969.49 |
$961.51 $1,012.81 $1,067.16 $1,260.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$760.10 $862.70 $971.40 $1,357.52 $2,062.88 |
$1,050.83 $1,153.43 $1,262.13 $1,648.25 |
$1,341.56 $1,444.16 $1,552.86 $1,938.98 |
Toc - Plan #40 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Elite Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.34 $475.94 $535.90 $748.92 $1,138.06 |
$740.13 $796.73 $856.69 $1,069.71 |
$1,060.92 $1,117.52 $1,177.48 $1,390.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$838.68 $951.88 $1,071.80 $1,497.84 $2,276.12 |
$1,159.47 $1,272.67 $1,392.59 $1,818.63 |
$1,480.26 $1,593.46 $1,713.38 $2,139.42 |
Toc - Plan #41 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Clear Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.10 $438.21 $493.42 $689.56 $1,047.85 |
$681.46 $733.57 $788.78 $984.92 |
$976.82 $1,028.93 $1,084.14 $1,280.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$772.20 $876.42 $986.84 $1,379.12 $2,095.70 |
$1,067.56 $1,171.78 $1,282.20 $1,674.48 |
$1,362.92 $1,467.14 $1,577.56 $1,969.84 |
Toc - Plan #42 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Focused Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.35 $446.44 $502.69 $702.50 $1,067.52 |
$694.25 $747.34 $803.59 $1,003.40 |
$995.15 $1,048.24 $1,104.49 $1,304.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786.70 $892.88 $1,005.38 $1,405.00 $2,135.04 |
$1,087.60 $1,193.78 $1,306.28 $1,705.90 |
$1,388.50 $1,494.68 $1,607.18 $2,006.80 |
Toc - Plan #43 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Everyday Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$475.17 $539.30 $607.25 $848.63 $1,289.57 |
$838.66 $902.79 $970.74 $1,212.12 |
$1,202.15 $1,266.28 $1,334.23 $1,575.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$950.34 $1,078.60 $1,214.50 $1,697.26 $2,579.14 |
$1,313.83 $1,442.09 $1,577.99 $2,060.75 |
$1,677.32 $1,805.58 $1,941.48 $2,424.24 |
Toc - Plan #44 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Clear Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$468.12 $531.30 $598.24 $836.04 $1,270.44 |
$826.22 $889.40 $956.34 $1,194.14 |
$1,184.32 $1,247.50 $1,314.44 $1,552.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$936.24 $1,062.60 $1,196.48 $1,672.08 $2,540.88 |
$1,294.34 $1,420.70 $1,554.58 $2,030.18 |
$1,652.44 $1,778.80 $1,912.68 $2,388.28 |
Toc - Plan #45 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Elite Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$543.00 $616.30 $693.95 $969.79 $1,473.69 |
$958.39 $1,031.69 $1,109.34 $1,385.18 |
$1,373.78 $1,447.08 $1,524.73 $1,800.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,086.00 $1,232.60 $1,387.90 $1,939.58 $2,947.38 |
$1,501.39 $1,647.99 $1,803.29 $2,354.97 |
$1,916.78 $2,063.38 $2,218.68 $2,770.36 |
Toc - Plan #46 Ambetter from Home State Health | ||||||||||||||||||||
Bronze
(EPO) CMS Standard Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.64 $374.12 $421.26 $588.71 $894.60 |
$581.80 $626.28 $673.42 $840.87 |
$833.96 $878.44 $925.58 $1,093.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$659.28 $748.24 $842.52 $1,177.42 $1,789.20 |
$911.44 $1,000.40 $1,094.68 $1,429.58 |
$1,163.60 $1,252.56 $1,346.84 $1,681.74 |
Toc - Plan #47 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) CMS Standard Expanded Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.63 $411.58 $463.43 $647.65 $984.16 |
$640.04 $688.99 $740.84 $925.06 |
$917.45 $966.40 $1,018.25 $1,202.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$725.26 $823.16 $926.86 $1,295.30 $1,968.32 |
$1,002.67 $1,100.57 $1,204.27 $1,572.71 |
$1,280.08 $1,377.98 $1,481.68 $1,850.12 |
Toc - Plan #48 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) CMS Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.38 $437.40 $492.50 $688.27 $1,045.90 |
$680.19 $732.21 $787.31 $983.08 |
$975.00 $1,027.02 $1,082.12 $1,277.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$770.76 $874.80 $985.00 $1,376.54 $2,091.80 |
$1,065.57 $1,169.61 $1,279.81 $1,671.35 |
$1,360.38 $1,464.42 $1,574.62 $1,966.16 |
Toc - Plan #49 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) CMS Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$468.44 $531.67 $598.65 $836.61 $1,271.31 |
$826.79 $890.02 $957.00 $1,194.96 |
$1,185.14 $1,248.37 $1,315.35 $1,553.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$936.88 $1,063.34 $1,197.30 $1,673.22 $2,542.62 |
$1,295.23 $1,421.69 $1,555.65 $2,031.57 |
$1,653.58 $1,780.04 $1,914.00 $2,389.92 |
Toc - Plan #50 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Clear Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.03 $405.22 $456.27 $637.64 $968.95 |
$630.15 $678.34 $729.39 $910.76 |
$903.27 $951.46 $1,002.51 $1,183.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.06 $810.44 $912.54 $1,275.28 $1,937.90 |
$987.18 $1,083.56 $1,185.66 $1,548.40 |
$1,260.30 $1,356.68 $1,458.78 $1,821.52 |
Toc - Plan #51 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Everyday Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.60 $438.78 $494.06 $690.44 $1,049.20 |
$682.34 $734.52 $789.80 $986.18 |
$978.08 $1,030.26 $1,085.54 $1,281.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.20 $877.56 $988.12 $1,380.88 $2,098.40 |
$1,068.94 $1,173.30 $1,283.86 $1,676.62 |
$1,364.68 $1,469.04 $1,579.60 $1,972.36 |
Toc - Plan #52 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Complete Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$512.26 $581.40 $654.66 $914.88 $1,390.25 |
$904.13 $973.27 $1,046.53 $1,306.75 |
$1,296.00 $1,365.14 $1,438.40 $1,698.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,024.52 $1,162.80 $1,309.32 $1,829.76 $2,780.50 |
$1,416.39 $1,554.67 $1,701.19 $2,221.63 |
$1,808.26 $1,946.54 $2,093.06 $2,613.50 |
Toc - Plan #53 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Complete Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.99 $467.59 $526.50 $735.79 $1,118.10 |
$727.15 $782.75 $841.66 $1,050.95 |
$1,042.31 $1,097.91 $1,156.82 $1,366.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$823.98 $935.18 $1,053.00 $1,471.58 $2,236.20 |
$1,139.14 $1,250.34 $1,368.16 $1,786.74 |
$1,454.30 $1,565.50 $1,683.32 $2,101.90 |
Toc - Plan #54 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Premier Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.52 $469.33 $528.46 $738.52 $1,122.25 |
$729.85 $785.66 $844.79 $1,054.85 |
$1,046.18 $1,101.99 $1,161.12 $1,371.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827.04 $938.66 $1,056.92 $1,477.04 $2,244.50 |
$1,143.37 $1,254.99 $1,373.25 $1,793.37 |
$1,459.70 $1,571.32 $1,689.58 $2,109.70 |
Toc - Plan #55 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Choice Bronze HSA + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$392.43 $445.39 $501.51 $700.86 $1,065.02 |
$692.63 $745.59 $801.71 $1,001.06 |
$992.83 $1,045.79 $1,101.91 $1,301.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$784.86 $890.78 $1,003.02 $1,401.72 $2,130.04 |
$1,085.06 $1,190.98 $1,303.22 $1,701.92 |
$1,385.26 $1,491.18 $1,603.42 $2,002.12 |
Toc - Plan #56 Ambetter from Home State Health | ||||||||||||||||||||
Expanded Bronze
(EPO) Elite Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$432.99 $491.43 $553.35 $773.31 $1,175.11 |
$764.22 $822.66 $884.58 $1,104.54 |
$1,095.45 $1,153.89 $1,215.81 $1,435.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$865.98 $982.86 $1,106.70 $1,546.62 $2,350.22 |
$1,197.21 $1,314.09 $1,437.93 $1,877.85 |
$1,528.44 $1,645.32 $1,769.16 $2,209.08 |
Toc - Plan #57 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Focused Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.16 $460.97 $519.05 $725.38 $1,102.28 |
$716.86 $771.67 $829.75 $1,036.08 |
$1,027.56 $1,082.37 $1,140.45 $1,346.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.32 $921.94 $1,038.10 $1,450.76 $2,204.56 |
$1,123.02 $1,232.64 $1,348.80 $1,761.46 |
$1,433.72 $1,543.34 $1,659.50 $2,072.16 |
Toc - Plan #58 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Everyday Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$490.63 $556.86 $627.02 $876.26 $1,331.55 |
$865.96 $932.19 $1,002.35 $1,251.59 |
$1,241.29 $1,307.52 $1,377.68 $1,626.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$981.26 $1,113.72 $1,254.04 $1,752.52 $2,663.10 |
$1,356.59 $1,489.05 $1,629.37 $2,127.85 |
$1,731.92 $1,864.38 $2,004.70 $2,503.18 |
Toc - Plan #59 Ambetter from Home State Health | ||||||||||||||||||||
Silver
(EPO) Clear Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.67 $452.48 $509.49 $712.01 $1,081.97 |
$703.65 $757.46 $814.47 $1,016.99 |
$1,008.63 $1,062.44 $1,119.45 $1,321.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.34 $904.96 $1,018.98 $1,424.02 $2,163.94 |
$1,102.32 $1,209.94 $1,323.96 $1,729.00 |
$1,407.30 $1,514.92 $1,628.94 $2,033.98 |
Toc - Plan #60 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Clear Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$483.36 $548.60 $617.72 $863.26 $1,311.80 |
$853.12 $918.36 $987.48 $1,233.02 |
$1,222.88 $1,288.12 $1,357.24 $1,602.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$966.72 $1,097.20 $1,235.44 $1,726.52 $2,623.60 |
$1,336.48 $1,466.96 $1,605.20 $2,096.28 |
$1,706.24 $1,836.72 $1,974.96 $2,466.04 |
Toc - Plan #61 Ambetter from Home State Health | ||||||||||||||||||||
Gold
(EPO) Elite Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-650-3789
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$560.68 $636.36 $716.54 $1,001.36 $1,521.66 |
$989.59 $1,065.27 $1,145.45 $1,430.27 |
$1,418.50 $1,494.18 $1,574.36 $1,859.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,121.36 $1,272.72 $1,433.08 $2,002.72 $3,043.32 |
$1,550.27 $1,701.63 $1,861.99 $2,431.63 |
$1,979.18 $2,130.54 $2,290.90 $2,860.54 |
‡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 Jasper County here.
Jasper County is in “Rating Area 7” of Missouri.
Currently, there are 61 plans offered in Rating Area 7.