Obamacare 2024 Rates for Ripley County, Indiana

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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 Osgood, IN.

The health insurance rates listed below are for calendar year 2024.

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, 47 Plans and 2024 Rates for Ripley County, Indiana

Below, you’ll find a summary of the 47 plans for Ripley County, Indiana and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Obamacare Rates and Providers for Other Years

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CareSource

Local: 1-833-230-2099 | Toll Free: 1-833-230-2099 | TTY: 1-800-743-3333
Toc - Plan #1 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$318.61
$361.62
$407.18
$569.03
$864.70 		$562.34
$605.35
$650.91
$812.76 		$806.07
$849.08
$894.64
$1,056.49 		$1,049.80
$1,092.81
$1,138.37
$1,300.22 		$243.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$637.22
$723.24
$814.36
$1,138.06
$1,729.40 		$880.95
$966.97
$1,058.09
$1,381.79 		$1,124.68
$1,210.70
$1,301.82
$1,625.52 		$1,368.41
$1,454.43
$1,545.55
$1,869.25 		$243.73
Toc - Plan #2 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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 		$336.22
$381.61
$429.69
$600.49
$912.50 		$593.43
$638.82
$686.90
$857.70 		$850.64
$896.03
$944.11
$1,114.91 		$1,107.85
$1,153.24
$1,201.32
$1,372.12 		$257.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$672.44
$763.22
$859.38
$1,200.98
$1,825.00 		$929.65
$1,020.43
$1,116.59
$1,458.19 		$1,186.86
$1,277.64
$1,373.80
$1,715.40 		$1,444.07
$1,534.85
$1,631.01
$1,972.61 		$257.21
Toc - Plan #3 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$539.47
$612.30
$689.44
$963.49
$1,464.12 		$952.16
$1,024.99
$1,102.13
$1,376.18 		$1,364.85
$1,437.68
$1,514.82
$1,788.87 		$1,777.54
$1,850.37
$1,927.51
$2,201.56 		$412.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,078.94
$1,224.60
$1,378.88
$1,926.98
$2,928.24 		$1,491.63
$1,637.29
$1,791.57
$2,339.67 		$1,904.32
$2,049.98
$2,204.26
$2,752.36 		$2,317.01
$2,462.67
$2,616.95
$3,165.05 		$412.69
Toc - Plan #4 CareSource
Silver

(HMO) CareSource Marketplace Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$332.29
$377.14
$424.66
$593.46
$901.82 		$586.49
$631.34
$678.86
$847.66 		$840.69
$885.54
$933.06
$1,101.86 		$1,094.89
$1,139.74
$1,187.26
$1,356.06 		$254.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$664.58
$754.28
$849.32
$1,186.92
$1,803.64 		$918.78
$1,008.48
$1,103.52
$1,441.12 		$1,172.98
$1,262.68
$1,357.72
$1,695.32 		$1,427.18
$1,516.88
$1,611.92
$1,949.52 		$254.20
Toc - Plan #5 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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 		$289.76
$328.87
$370.31
$517.51
$786.40 		$511.42
$550.53
$591.97
$739.17 		$733.08
$772.19
$813.63
$960.83 		$954.74
$993.85
$1,035.29
$1,182.49 		$221.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$579.52
$657.74
$740.62
$1,035.02
$1,572.80 		$801.18
$879.40
$962.28
$1,256.68 		$1,022.84
$1,101.06
$1,183.94
$1,478.34 		$1,244.50
$1,322.72
$1,405.60
$1,700.00 		$221.66
Toc - Plan #6 CareSource
Bronze

(HMO) CareSource Marketplace Low Premium Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$283.87
$322.18
$362.78
$506.98
$770.40 		$501.03
$539.34
$579.94
$724.14 		$718.19
$756.50
$797.10
$941.30 		$935.35
$973.66
$1,014.26
$1,158.46 		$217.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$567.74
$644.36
$725.56
$1,013.96
$1,540.80 		$784.90
$861.52
$942.72
$1,231.12 		$1,002.06
$1,078.68
$1,159.88
$1,448.28 		$1,219.22
$1,295.84
$1,377.04
$1,665.44 		$217.16
Toc - Plan #7 CareSource
Silver

(HMO) CareSource Marketplace Essential Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$6,500 $13,000 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 		$361.53
$410.34
$462.03
$645.69
$981.19 		$638.10
$686.91
$738.60
$922.26 		$914.67
$963.48
$1,015.17
$1,198.83 		$1,191.24
$1,240.05
$1,291.74
$1,475.40 		$276.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$723.06
$820.68
$924.06
$1,291.38
$1,962.38 		$999.63
$1,097.25
$1,200.63
$1,567.95 		$1,276.20
$1,373.82
$1,477.20
$1,844.52 		$1,552.77
$1,650.39
$1,753.77
$2,121.09 		$276.57
Toc - Plan #8 CareSource
Gold

(HMO) CareSource Marketplace Core Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$507.02
$575.47
$647.97
$905.54
$1,376.05 		$894.89
$963.34
$1,035.84
$1,293.41 		$1,282.76
$1,351.21
$1,423.71
$1,681.28 		$1,670.63
$1,739.08
$1,811.58
$2,069.15 		$387.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,014.04
$1,150.94
$1,295.94
$1,811.08
$2,752.10 		$1,401.91
$1,538.81
$1,683.81
$2,198.95 		$1,789.78
$1,926.68
$2,071.68
$2,586.82 		$2,177.65
$2,314.55
$2,459.55
$2,974.69 		$387.87
Toc - Plan #9 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$350.74
$398.09
$448.24
$626.42
$951.91 		$619.06
$666.41
$716.56
$894.74 		$887.38
$934.73
$984.88
$1,163.06 		$1,155.70
$1,203.05
$1,253.20
$1,431.38 		$268.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$701.48
$796.18
$896.48
$1,252.84
$1,903.82 		$969.80
$1,064.50
$1,164.80
$1,521.16 		$1,238.12
$1,332.82
$1,433.12
$1,789.48 		$1,506.44
$1,601.14
$1,701.44
$2,057.80 		$268.32
Toc - Plan #10 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$556.22
$631.30
$710.84
$993.40
$1,509.56 		$981.72
$1,056.80
$1,136.34
$1,418.90 		$1,407.22
$1,482.30
$1,561.84
$1,844.40 		$1,832.72
$1,907.80
$1,987.34
$2,269.90 		$425.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,112.44
$1,262.60
$1,421.68
$1,986.80
$3,019.12 		$1,537.94
$1,688.10
$1,847.18
$2,412.30 		$1,963.44
$2,113.60
$2,272.68
$2,837.80 		$2,388.94
$2,539.10
$2,698.18
$3,263.30 		$425.50
Toc - Plan #11 CareSource
Silver

(HMO) CareSource Marketplace Core Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$341.54
$387.65
$436.49
$609.99
$926.94 		$602.82
$648.93
$697.77
$871.27 		$864.10
$910.21
$959.05
$1,132.55 		$1,125.38
$1,171.49
$1,220.33
$1,393.83 		$261.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$683.08
$775.30
$872.98
$1,219.98
$1,853.88 		$944.36
$1,036.58
$1,134.26
$1,481.26 		$1,205.64
$1,297.86
$1,395.54
$1,742.54 		$1,466.92
$1,559.14
$1,656.82
$2,003.82 		$261.28
Toc - Plan #12 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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 		$342.27
$388.47
$437.41
$611.28
$928.90 		$604.10
$650.30
$699.24
$873.11 		$865.93
$912.13
$961.07
$1,134.94 		$1,127.76
$1,173.96
$1,222.90
$1,396.77 		$261.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$684.54
$776.94
$874.82
$1,222.56
$1,857.80 		$946.37
$1,038.77
$1,136.65
$1,484.39 		$1,208.20
$1,300.60
$1,398.48
$1,746.22 		$1,470.03
$1,562.43
$1,660.31
$2,008.05 		$261.83
Toc - Plan #13 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$547.01
$620.85
$699.07
$976.95
$1,484.57 		$965.47
$1,039.31
$1,117.53
$1,395.41 		$1,383.93
$1,457.77
$1,535.99
$1,813.87 		$1,802.39
$1,876.23
$1,954.45
$2,232.33 		$418.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,094.02
$1,241.70
$1,398.14
$1,953.90
$2,969.14 		$1,512.48
$1,660.16
$1,816.60
$2,372.36 		$1,930.94
$2,078.62
$2,235.06
$2,790.82 		$2,349.40
$2,497.08
$2,653.52
$3,209.28 		$418.46
Toc - Plan #14 CareSource
Silver

(HMO) CareSource Marketplace Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$338.33
$384.00
$432.38
$604.25
$918.22 		$597.15
$642.82
$691.20
$863.07 		$855.97
$901.64
$950.02
$1,121.89 		$1,114.79
$1,160.46
$1,208.84
$1,380.71 		$258.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676.66
$768.00
$864.76
$1,208.50
$1,836.44 		$935.48
$1,026.82
$1,123.58
$1,467.32 		$1,194.30
$1,285.64
$1,382.40
$1,726.14 		$1,453.12
$1,544.46
$1,641.22
$1,984.96 		$258.82
Toc - Plan #15 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$295.41
$335.28
$377.53
$527.59
$801.73 		$521.39
$561.26
$603.51
$753.57 		$747.37
$787.24
$829.49
$979.55 		$973.35
$1,013.22
$1,055.47
$1,205.53 		$225.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$590.82
$670.56
$755.06
$1,055.18
$1,603.46 		$816.80
$896.54
$981.04
$1,281.16 		$1,042.78
$1,122.52
$1,207.02
$1,507.14 		$1,268.76
$1,348.50
$1,433.00
$1,733.12 		$225.98
Toc - Plan #16 CareSource
Bronze

(HMO) CareSource Marketplace Low Premium Bronze Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$289.23
$328.27
$369.63
$516.55
$784.95 		$510.49
$549.53
$590.89
$737.81 		$731.75
$770.79
$812.15
$959.07 		$953.01
$992.05
$1,033.41
$1,180.33 		$221.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$578.46
$656.54
$739.26
$1,033.10
$1,569.90 		$799.72
$877.80
$960.52
$1,254.36 		$1,020.98
$1,099.06
$1,181.78
$1,475.62 		$1,242.24
$1,320.32
$1,403.04
$1,696.88 		$221.26
Toc - Plan #17 CareSource
Silver

(HMO) CareSource Marketplace Essential Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$6,500 $13,000 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 		$367.40
$416.99
$469.53
$656.17
$997.11 		$648.46
$698.05
$750.59
$937.23 		$929.52
$979.11
$1,031.65
$1,218.29 		$1,210.58
$1,260.17
$1,312.71
$1,499.35 		$281.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$734.80
$833.98
$939.06
$1,312.34
$1,994.22 		$1,015.86
$1,115.04
$1,220.12
$1,593.40 		$1,296.92
$1,396.10
$1,501.18
$1,874.46 		$1,577.98
$1,677.16
$1,782.24
$2,155.52 		$281.06
Toc - Plan #18 CareSource
Gold

(HMO) CareSource Marketplace Core Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$514.55
$584.01
$657.59
$918.98
$1,396.48 		$908.18
$977.64
$1,051.22
$1,312.61 		$1,301.81
$1,371.27
$1,444.85
$1,706.24 		$1,695.44
$1,764.90
$1,838.48
$2,099.87 		$393.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,029.10
$1,168.02
$1,315.18
$1,837.96
$2,792.96 		$1,422.73
$1,561.65
$1,708.81
$2,231.59 		$1,816.36
$1,955.28
$2,102.44
$2,625.22 		$2,209.99
$2,348.91
$2,496.07
$3,018.85 		$393.63
Toc - Plan #19 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$356.78
$404.94
$455.95
$637.19
$968.28 		$629.71
$677.87
$728.88
$910.12 		$902.64
$950.80
$1,001.81
$1,183.05 		$1,175.57
$1,223.73
$1,274.74
$1,455.98 		$272.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$713.56
$809.88
$911.90
$1,274.38
$1,936.56 		$986.49
$1,082.81
$1,184.83
$1,547.31 		$1,259.42
$1,355.74
$1,457.76
$1,820.24 		$1,532.35
$1,628.67
$1,730.69
$2,093.17 		$272.93
Toc - Plan #20 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$563.74
$639.84
$720.46
$1,006.84
$1,529.99 		$995.00
$1,071.10
$1,151.72
$1,438.10 		$1,426.26
$1,502.36
$1,582.98
$1,869.36 		$1,857.52
$1,933.62
$2,014.24
$2,300.62 		$431.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,127.48
$1,279.68
$1,440.92
$2,013.68
$3,059.98 		$1,558.74
$1,710.94
$1,872.18
$2,444.94 		$1,990.00
$2,142.20
$2,303.44
$2,876.20 		$2,421.26
$2,573.46
$2,734.70
$3,307.46 		$431.26
Toc - Plan #21 CareSource
Silver

(HMO) CareSource Marketplace Core Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347.59
$394.51
$444.21
$620.79
$943.34 		$613.49
$660.41
$710.11
$886.69 		$879.39
$926.31
$976.01
$1,152.59 		$1,145.29
$1,192.21
$1,241.91
$1,418.49 		$265.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.18
$789.02
$888.42
$1,241.58
$1,886.68 		$961.08
$1,054.92
$1,154.32
$1,507.48 		$1,226.98
$1,320.82
$1,420.22
$1,773.38 		$1,492.88
$1,586.72
$1,686.12
$2,039.28 		$265.90

ADVERTISEMENT

Ambetter from MHS

Local: 1-877-687-1182 | Toll Free: 1-877-687-1182 | TTY: 1-800-743-3333
Toc - Plan #22 Ambetter from MHS
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$339.80
$385.66
$434.25
$606.86
$922.18 		$599.74
$645.60
$694.19
$866.80 		$859.68
$905.54
$954.13
$1,126.74 		$1,119.62
$1,165.48
$1,214.07
$1,386.68 		$259.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$679.60
$771.32
$868.50
$1,213.72
$1,844.36 		$939.54
$1,031.26
$1,128.44
$1,473.66 		$1,199.48
$1,291.20
$1,388.38
$1,733.60 		$1,459.42
$1,551.14
$1,648.32
$1,993.54 		$259.94
Toc - Plan #23 Ambetter from MHS
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.20
$474.64
$534.44
$746.88
$1,134.96 		$738.11
$794.55
$854.35
$1,066.79 		$1,058.02
$1,114.46
$1,174.26
$1,386.70 		$1,377.93
$1,434.37
$1,494.17
$1,706.61 		$319.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$836.40
$949.28
$1,068.88
$1,493.76
$2,269.92 		$1,156.31
$1,269.19
$1,388.79
$1,813.67 		$1,476.22
$1,589.10
$1,708.70
$2,133.58 		$1,796.13
$1,909.01
$2,028.61
$2,453.49 		$319.91
Toc - Plan #24 Ambetter from MHS
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 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 		$359.27
$407.75
$459.13
$641.63
$975.02 		$634.10
$682.58
$733.96
$916.46 		$908.93
$957.41
$1,008.79
$1,191.29 		$1,183.76
$1,232.24
$1,283.62
$1,466.12 		$274.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718.54
$815.50
$918.26
$1,283.26
$1,950.04 		$993.37
$1,090.33
$1,193.09
$1,558.09 		$1,268.20
$1,365.16
$1,467.92
$1,832.92 		$1,543.03
$1,639.99
$1,742.75
$2,107.75 		$274.83
Toc - Plan #25 Ambetter from MHS
Silver

(EPO) Premier Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$8,150 $16,300 Annual Deductible
$8,150 $16,300 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 		$335.88
$381.22
$429.25
$599.87
$911.56 		$592.82
$638.16
$686.19
$856.81 		$849.76
$895.10
$943.13
$1,113.75 		$1,106.70
$1,152.04
$1,200.07
$1,370.69 		$256.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$671.76
$762.44
$858.50
$1,199.74
$1,823.12 		$928.70
$1,019.38
$1,115.44
$1,456.68 		$1,185.64
$1,276.32
$1,372.38
$1,713.62 		$1,442.58
$1,533.26
$1,629.32
$1,970.56 		$256.94
Toc - Plan #26 Ambetter from MHS
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 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 		$455.75
$517.27
$582.44
$813.96
$1,236.89 		$804.39
$865.91
$931.08
$1,162.60 		$1,153.03
$1,214.55
$1,279.72
$1,511.24 		$1,501.67
$1,563.19
$1,628.36
$1,859.88 		$348.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$911.50
$1,034.54
$1,164.88
$1,627.92
$2,473.78 		$1,260.14
$1,383.18
$1,513.52
$1,976.56 		$1,608.78
$1,731.82
$1,862.16
$2,325.20 		$1,957.42
$2,080.46
$2,210.80
$2,673.84 		$348.64
Toc - Plan #27 Ambetter from MHS
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 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 		$322.99
$366.58
$412.77
$576.84
$876.57 		$570.07
$613.66
$659.85
$823.92 		$817.15
$860.74
$906.93
$1,071.00 		$1,064.23
$1,107.82
$1,154.01
$1,318.08 		$247.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$645.98
$733.16
$825.54
$1,153.68
$1,753.14 		$893.06
$980.24
$1,072.62
$1,400.76 		$1,140.14
$1,227.32
$1,319.70
$1,647.84 		$1,387.22
$1,474.40
$1,566.78
$1,894.92 		$247.08
Toc - Plan #28 Ambetter from MHS
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 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 		$314.70
$357.18
$402.18
$562.04
$854.08 		$555.44
$597.92
$642.92
$802.78 		$796.18
$838.66
$883.66
$1,043.52 		$1,036.92
$1,079.40
$1,124.40
$1,284.26 		$240.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$629.40
$714.36
$804.36
$1,124.08
$1,708.16 		$870.14
$955.10
$1,045.10
$1,364.82 		$1,110.88
$1,195.84
$1,285.84
$1,605.56 		$1,351.62
$1,436.58
$1,526.58
$1,846.30 		$240.74
Toc - Plan #29 Ambetter from MHS
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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 		$330.59
$375.21
$422.48
$590.41
$897.19 		$583.48
$628.10
$675.37
$843.30 		$836.37
$880.99
$928.26
$1,096.19 		$1,089.26
$1,133.88
$1,181.15
$1,349.08 		$252.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$661.18
$750.42
$844.96
$1,180.82
$1,794.38 		$914.07
$1,003.31
$1,097.85
$1,433.71 		$1,166.96
$1,256.20
$1,350.74
$1,686.60 		$1,419.85
$1,509.09
$1,603.63
$1,939.49 		$252.89
Toc - Plan #30 Ambetter from MHS
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$334.99
$380.21
$428.11
$598.28
$909.15 		$591.25
$636.47
$684.37
$854.54 		$847.51
$892.73
$940.63
$1,110.80 		$1,103.77
$1,148.99
$1,196.89
$1,367.06 		$256.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$669.98
$760.42
$856.22
$1,196.56
$1,818.30 		$926.24
$1,016.68
$1,112.48
$1,452.82 		$1,182.50
$1,272.94
$1,368.74
$1,709.08 		$1,438.76
$1,529.20
$1,625.00
$1,965.34 		$256.26
Toc - Plan #31 Ambetter from MHS
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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 		$400.87
$454.97
$512.30
$715.93
$1,087.93 		$707.53
$761.63
$818.96
$1,022.59 		$1,014.19
$1,068.29
$1,125.62
$1,329.25 		$1,320.85
$1,374.95
$1,432.28
$1,635.91 		$306.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$801.74
$909.94
$1,024.60
$1,431.86
$2,175.86 		$1,108.40
$1,216.60
$1,331.26
$1,738.52 		$1,415.06
$1,523.26
$1,637.92
$2,045.18 		$1,721.72
$1,829.92
$1,944.58
$2,351.84 		$306.66
Toc - Plan #32 Ambetter from MHS
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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 		$309.90
$351.73
$396.04
$553.47
$841.05 		$546.97
$588.80
$633.11
$790.54 		$784.04
$825.87
$870.18
$1,027.61 		$1,021.11
$1,062.94
$1,107.25
$1,264.68 		$237.07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$619.80
$703.46
$792.08
$1,106.94
$1,682.10 		$856.87
$940.53
$1,029.15
$1,344.01 		$1,093.94
$1,177.60
$1,266.22
$1,581.08 		$1,331.01
$1,414.67
$1,503.29
$1,818.15 		$237.07
Toc - Plan #33 Ambetter from MHS
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$328.88
$373.26
$420.29
$587.36
$892.55 		$580.46
$624.84
$671.87
$838.94 		$832.04
$876.42
$923.45
$1,090.52 		$1,083.62
$1,128.00
$1,175.03
$1,342.10 		$251.58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$657.76
$746.52
$840.58
$1,174.72
$1,785.10 		$909.34
$998.10
$1,092.16
$1,426.30 		$1,160.92
$1,249.68
$1,343.74
$1,677.88 		$1,412.50
$1,501.26
$1,595.32
$1,929.46 		$251.58
Toc - Plan #34 Ambetter from MHS
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$403.27
$457.70
$515.36
$720.22
$1,094.44 		$711.76
$766.19
$823.85
$1,028.71 		$1,020.25
$1,074.68
$1,132.34
$1,337.20 		$1,328.74
$1,383.17
$1,440.83
$1,645.69 		$308.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806.54
$915.40
$1,030.72
$1,440.44
$2,188.88 		$1,115.03
$1,223.89
$1,339.21
$1,748.93 		$1,423.52
$1,532.38
$1,647.70
$2,057.42 		$1,732.01
$1,840.87
$1,956.19
$2,365.91 		$308.49
Toc - Plan #35 Ambetter from MHS
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352.62
$400.21
$450.63
$629.76
$956.98 		$622.37
$669.96
$720.38
$899.51 		$892.12
$939.71
$990.13
$1,169.26 		$1,161.87
$1,209.46
$1,259.88
$1,439.01 		$269.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705.24
$800.42
$901.26
$1,259.52
$1,913.96 		$974.99
$1,070.17
$1,171.01
$1,529.27 		$1,244.74
$1,339.92
$1,440.76
$1,799.02 		$1,514.49
$1,609.67
$1,710.51
$2,068.77 		$269.75
Toc - Plan #36 Ambetter from MHS
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$433.98
$492.56
$554.61
$775.07
$1,177.80 		$765.97
$824.55
$886.60
$1,107.06 		$1,097.96
$1,156.54
$1,218.59
$1,439.05 		$1,429.95
$1,488.53
$1,550.58
$1,771.04 		$331.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$867.96
$985.12
$1,109.22
$1,550.14
$2,355.60 		$1,199.95
$1,317.11
$1,441.21
$1,882.13 		$1,531.94
$1,649.10
$1,773.20
$2,214.12 		$1,863.93
$1,981.09
$2,105.19
$2,546.11 		$331.99
Toc - Plan #37 Ambetter from MHS
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 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 		$335.18
$380.42
$428.35
$598.61
$909.65 		$591.59
$636.83
$684.76
$855.02 		$848.00
$893.24
$941.17
$1,111.43 		$1,104.41
$1,149.65
$1,197.58
$1,367.84 		$256.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$670.36
$760.84
$856.70
$1,197.22
$1,819.30 		$926.77
$1,017.25
$1,113.11
$1,453.63 		$1,183.18
$1,273.66
$1,369.52
$1,710.04 		$1,439.59
$1,530.07
$1,625.93
$1,966.45 		$256.41
Toc - Plan #38 Ambetter from MHS
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326.58
$370.66
$417.36
$583.25
$886.31 		$576.41
$620.49
$667.19
$833.08 		$826.24
$870.32
$917.02
$1,082.91 		$1,076.07
$1,120.15
$1,166.85
$1,332.74 		$249.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$653.16
$741.32
$834.72
$1,166.50
$1,772.62 		$902.99
$991.15
$1,084.55
$1,416.33 		$1,152.82
$1,240.98
$1,334.38
$1,666.16 		$1,402.65
$1,490.81
$1,584.21
$1,915.99 		$249.83
Toc - Plan #39 Ambetter from MHS
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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 		$343.06
$389.37
$438.42
$612.69
$931.05 		$605.50
$651.81
$700.86
$875.13 		$867.94
$914.25
$963.30
$1,137.57 		$1,130.38
$1,176.69
$1,225.74
$1,400.01 		$262.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$686.12
$778.74
$876.84
$1,225.38
$1,862.10 		$948.56
$1,041.18
$1,139.28
$1,487.82 		$1,211.00
$1,303.62
$1,401.72
$1,750.26 		$1,473.44
$1,566.06
$1,664.16
$2,012.70 		$262.44
Toc - Plan #40 Ambetter from MHS
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347.64
$394.56
$444.27
$620.86
$943.46 		$613.57
$660.49
$710.20
$886.79 		$879.50
$926.42
$976.13
$1,152.72 		$1,145.43
$1,192.35
$1,242.06
$1,418.65 		$265.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.28
$789.12
$888.54
$1,241.72
$1,886.92 		$961.21
$1,055.05
$1,154.47
$1,507.65 		$1,227.14
$1,320.98
$1,420.40
$1,773.58 		$1,493.07
$1,586.91
$1,686.33
$2,039.51 		$265.93
Toc - Plan #41 Ambetter from MHS
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

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 		$415.99
$472.14
$531.63
$742.95
$1,128.98 		$734.22
$790.37
$849.86
$1,061.18 		$1,052.45
$1,108.60
$1,168.09
$1,379.41 		$1,370.68
$1,426.83
$1,486.32
$1,697.64 		$318.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$831.98
$944.28
$1,063.26
$1,485.90
$2,257.96 		$1,150.21
$1,262.51
$1,381.49
$1,804.13 		$1,468.44
$1,580.74
$1,699.72
$2,122.36 		$1,786.67
$1,898.97
$2,017.95
$2,440.59 		$318.23
Toc - Plan #42 Ambetter from MHS
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372.82
$423.14
$476.46
$665.84
$1,011.81 		$658.02
$708.34
$761.66
$951.04 		$943.22
$993.54
$1,046.86
$1,236.24 		$1,228.42
$1,278.74
$1,332.06
$1,521.44 		$285.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$745.64
$846.28
$952.92
$1,331.68
$2,023.62 		$1,030.84
$1,131.48
$1,238.12
$1,616.88 		$1,316.04
$1,416.68
$1,523.32
$1,902.08 		$1,601.24
$1,701.88
$1,808.52
$2,187.28 		$285.20
Toc - Plan #43 Ambetter from MHS
Silver

(EPO) Premier Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$8,150 $16,300 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$348.56
$395.60
$445.44
$622.51
$945.96 		$615.20
$662.24
$712.08
$889.15 		$881.84
$928.88
$978.72
$1,155.79 		$1,148.48
$1,195.52
$1,245.36
$1,422.43 		$266.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$697.12
$791.20
$890.88
$1,245.02
$1,891.92 		$963.76
$1,057.84
$1,157.52
$1,511.66 		$1,230.40
$1,324.48
$1,424.16
$1,778.30 		$1,497.04
$1,591.12
$1,690.80
$2,044.94 		$266.64
Toc - Plan #44 Ambetter from MHS
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 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 		$472.95
$536.79
$604.42
$844.68
$1,283.57 		$834.75
$898.59
$966.22
$1,206.48 		$1,196.55
$1,260.39
$1,328.02
$1,568.28 		$1,558.35
$1,622.19
$1,689.82
$1,930.08 		$361.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$945.90
$1,073.58
$1,208.84
$1,689.36
$2,567.14 		$1,307.70
$1,435.38
$1,570.64
$2,051.16 		$1,669.50
$1,797.18
$1,932.44
$2,412.96 		$2,031.30
$2,158.98
$2,294.24
$2,774.76 		$361.80
Toc - Plan #45 Ambetter from MHS
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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 		$321.60
$365.00
$410.99
$574.35
$872.79 		$567.61
$611.01
$657.00
$820.36 		$813.62
$857.02
$903.01
$1,066.37 		$1,059.63
$1,103.03
$1,149.02
$1,312.38 		$246.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$643.20
$730.00
$821.98
$1,148.70
$1,745.58 		$889.21
$976.01
$1,067.99
$1,394.71 		$1,135.22
$1,222.02
$1,314.00
$1,640.72 		$1,381.23
$1,468.03
$1,560.01
$1,886.73 		$246.01
Toc - Plan #46 Ambetter from MHS
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$341.29
$387.35
$436.15
$609.52
$926.23 		$602.37
$648.43
$697.23
$870.60 		$863.45
$909.51
$958.31
$1,131.68 		$1,124.53
$1,170.59
$1,219.39
$1,392.76 		$261.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$682.58
$774.70
$872.30
$1,219.04
$1,852.46 		$943.66
$1,035.78
$1,133.38
$1,480.12 		$1,204.74
$1,296.86
$1,394.46
$1,741.20 		$1,465.82
$1,557.94
$1,655.54
$2,002.28 		$261.08
Toc - Plan #47 Ambetter from MHS
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1182

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.49
$474.97
$534.81
$747.40
$1,135.74 		$738.62
$795.10
$854.94
$1,067.53 		$1,058.75
$1,115.23
$1,175.07
$1,387.66 		$1,378.88
$1,435.36
$1,495.20
$1,707.79 		$320.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$836.98
$949.94
$1,069.62
$1,494.80
$2,271.48 		$1,157.11
$1,270.07
$1,389.75
$1,814.93 		$1,477.24
$1,590.20
$1,709.88
$2,135.06 		$1,797.37
$1,910.33
$2,030.01
$2,455.19 		$320.13

‡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 Ripley County here.

Ripley County is in “Rating Area 14” of Indiana.

Currently, there are 47 plans offered in Rating Area 14.

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2024 Obamacare Plans for Ripley County, IN

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