Sussex County, Delaware Obamacare 2024 Rates

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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 Sussex County, DE.

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, 54 Plans and 2024 Rates for Sussex County, Delaware

Below, you’ll find a summary of the 54 plans for Sussex County, Delaware 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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Ambetter Health of Delaware

Local: 1-833-919-3214 | Toll Free: 1-833-919-3214 | TTY: 1-833-919-3214
Toc - Plan #1 Ambetter Health of Delaware
Expanded Bronze

(EPO) Premier Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 Annual Deductible
$8,050 $16,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$384.10
$435.94
$490.87
$685.99
$1,042.42 		$677.93
$729.77
$784.70
$979.82 		$971.76
$1,023.60
$1,078.53
$1,273.65 		$1,265.59
$1,317.43
$1,372.36
$1,567.48 		$293.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768.20
$871.88
$981.74
$1,371.98
$2,084.84 		$1,062.03
$1,165.71
$1,275.57
$1,665.81 		$1,355.86
$1,459.54
$1,569.40
$1,959.64 		$1,649.69
$1,753.37
$1,863.23
$2,253.47 		$293.83
Toc - Plan #2 Ambetter Health of Delaware
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$384.28
$436.14
$491.09
$686.30
$1,042.90 		$678.25
$730.11
$785.06
$980.27 		$972.22
$1,024.08
$1,079.03
$1,274.24 		$1,266.19
$1,318.05
$1,373.00
$1,568.21 		$293.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768.56
$872.28
$982.18
$1,372.60
$2,085.80 		$1,062.53
$1,166.25
$1,276.15
$1,666.57 		$1,356.50
$1,460.22
$1,570.12
$1,960.54 		$1,650.47
$1,754.19
$1,864.09
$2,254.51 		$293.97
Toc - Plan #3 Ambetter Health of Delaware
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$440.92
$500.44
$563.49
$787.47
$1,196.64 		$778.22
$837.74
$900.79
$1,124.77 		$1,115.52
$1,175.04
$1,238.09
$1,462.07 		$1,452.82
$1,512.34
$1,575.39
$1,799.37 		$337.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$881.84
$1,000.88
$1,126.98
$1,574.94
$2,393.28 		$1,219.14
$1,338.18
$1,464.28
$1,912.24 		$1,556.44
$1,675.48
$1,801.58
$2,249.54 		$1,893.74
$2,012.78
$2,138.88
$2,586.84 		$337.30
Toc - Plan #4 Ambetter Health of Delaware
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$378.89
$430.03
$484.21
$676.68
$1,028.27 		$668.73
$719.87
$774.05
$966.52 		$958.57
$1,009.71
$1,063.89
$1,256.36 		$1,248.41
$1,299.55
$1,353.73
$1,546.20 		$289.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$757.78
$860.06
$968.42
$1,353.36
$2,056.54 		$1,047.62
$1,149.90
$1,258.26
$1,643.20 		$1,337.46
$1,439.74
$1,548.10
$1,933.04 		$1,627.30
$1,729.58
$1,837.94
$2,222.88 		$289.84
Toc - Plan #5 Ambetter Health of Delaware
Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$451.66
$512.62
$577.21
$806.64
$1,225.77 		$797.17
$858.13
$922.72
$1,152.15 		$1,142.68
$1,203.64
$1,268.23
$1,497.66 		$1,488.19
$1,549.15
$1,613.74
$1,843.17 		$345.51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$903.32
$1,025.24
$1,154.42
$1,613.28
$2,451.54 		$1,248.83
$1,370.75
$1,499.93
$1,958.79 		$1,594.34
$1,716.26
$1,845.44
$2,304.30 		$1,939.85
$2,061.77
$2,190.95
$2,649.81 		$345.51
Toc - Plan #6 Ambetter Health of Delaware
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$440.57
$500.03
$563.03
$786.84
$1,195.68 		$777.60
$837.06
$900.06
$1,123.87 		$1,114.63
$1,174.09
$1,237.09
$1,460.90 		$1,451.66
$1,511.12
$1,574.12
$1,797.93 		$337.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$881.14
$1,000.06
$1,126.06
$1,573.68
$2,391.36 		$1,218.17
$1,337.09
$1,463.09
$1,910.71 		$1,555.20
$1,674.12
$1,800.12
$2,247.74 		$1,892.23
$2,011.15
$2,137.15
$2,584.77 		$337.03
Toc - Plan #7 Ambetter Health of Delaware
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$448.70
$509.26
$573.42
$801.36
$1,217.74 		$791.95
$852.51
$916.67
$1,144.61 		$1,135.20
$1,195.76
$1,259.92
$1,487.86 		$1,478.45
$1,539.01
$1,603.17
$1,831.11 		$343.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$897.40
$1,018.52
$1,146.84
$1,602.72
$2,435.48 		$1,240.65
$1,361.77
$1,490.09
$1,945.97 		$1,583.90
$1,705.02
$1,833.34
$2,289.22 		$1,927.15
$2,048.27
$2,176.59
$2,632.47 		$343.25
Toc - Plan #8 Ambetter Health of Delaware
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$441.85
$501.49
$564.67
$789.13
$1,199.15 		$779.86
$839.50
$902.68
$1,127.14 		$1,117.87
$1,177.51
$1,240.69
$1,465.15 		$1,455.88
$1,515.52
$1,578.70
$1,803.16 		$338.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$883.70
$1,002.98
$1,129.34
$1,578.26
$2,398.30 		$1,221.71
$1,340.99
$1,467.35
$1,916.27 		$1,559.72
$1,679.00
$1,805.36
$2,254.28 		$1,897.73
$2,017.01
$2,143.37
$2,592.29 		$338.01
Toc - Plan #9 Ambetter Health of Delaware
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$512.01
$581.12
$654.34
$914.44
$1,389.58 		$903.69
$972.80
$1,046.02
$1,306.12 		$1,295.37
$1,364.48
$1,437.70
$1,697.80 		$1,687.05
$1,756.16
$1,829.38
$2,089.48 		$391.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,024.02
$1,162.24
$1,308.68
$1,828.88
$2,779.16 		$1,415.70
$1,553.92
$1,700.36
$2,220.56 		$1,807.38
$1,945.60
$2,092.04
$2,612.24 		$2,199.06
$2,337.28
$2,483.72
$3,003.92 		$391.68
Toc - Plan #10 Ambetter Health of Delaware
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$491.03
$557.30
$627.52
$876.96
$1,332.62 		$866.66
$932.93
$1,003.15
$1,252.59 		$1,242.29
$1,308.56
$1,378.78
$1,628.22 		$1,617.92
$1,684.19
$1,754.41
$2,003.85 		$375.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$982.06
$1,114.60
$1,255.04
$1,753.92
$2,665.24 		$1,357.69
$1,490.23
$1,630.67
$2,129.55 		$1,733.32
$1,865.86
$2,006.30
$2,505.18 		$2,108.95
$2,241.49
$2,381.93
$2,880.81 		$375.63
Toc - Plan #11 Ambetter Health of Delaware
Gold

(EPO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$900 $1,800 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$485.50
$551.04
$620.46
$867.09
$1,317.63 		$856.90
$922.44
$991.86
$1,238.49 		$1,228.30
$1,293.84
$1,363.26
$1,609.89 		$1,599.70
$1,665.24
$1,734.66
$1,981.29 		$371.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$971.00
$1,102.08
$1,240.92
$1,734.18
$2,635.26 		$1,342.40
$1,473.48
$1,612.32
$2,105.58 		$1,713.80
$1,844.88
$1,983.72
$2,476.98 		$2,085.20
$2,216.28
$2,355.12
$2,848.38 		$371.40
Toc - Plan #12 Ambetter Health of Delaware
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$493.37
$559.96
$630.51
$881.14
$1,338.98 		$870.79
$937.38
$1,007.93
$1,258.56 		$1,248.21
$1,314.80
$1,385.35
$1,635.98 		$1,625.63
$1,692.22
$1,762.77
$2,013.40 		$377.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$986.74
$1,119.92
$1,261.02
$1,762.28
$2,677.96 		$1,364.16
$1,497.34
$1,638.44
$2,139.70 		$1,741.58
$1,874.76
$2,015.86
$2,517.12 		$2,119.00
$2,252.18
$2,393.28
$2,894.54 		$377.42
Toc - Plan #13 Ambetter Health of Delaware
Expanded Bronze

(EPO) Premier Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 Annual Deductible
$8,050 $16,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$399.49
$453.41
$510.53
$713.47
$1,084.18 		$705.09
$759.01
$816.13
$1,019.07 		$1,010.69
$1,064.61
$1,121.73
$1,324.67 		$1,316.29
$1,370.21
$1,427.33
$1,630.27 		$305.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$798.98
$906.82
$1,021.06
$1,426.94
$2,168.36 		$1,104.58
$1,212.42
$1,326.66
$1,732.54 		$1,410.18
$1,518.02
$1,632.26
$2,038.14 		$1,715.78
$1,823.62
$1,937.86
$2,343.74 		$305.60
Toc - Plan #14 Ambetter Health of Delaware
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$399.67
$453.62
$510.77
$713.80
$1,084.68 		$705.41
$759.36
$816.51
$1,019.54 		$1,011.15
$1,065.10
$1,122.25
$1,325.28 		$1,316.89
$1,370.84
$1,427.99
$1,631.02 		$305.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$799.34
$907.24
$1,021.54
$1,427.60
$2,169.36 		$1,105.08
$1,212.98
$1,327.28
$1,733.34 		$1,410.82
$1,518.72
$1,633.02
$2,039.08 		$1,716.56
$1,824.46
$1,938.76
$2,344.82 		$305.74
Toc - Plan #15 Ambetter Health of Delaware
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$458.58
$520.48
$586.06
$819.01
$1,244.57 		$809.39
$871.29
$936.87
$1,169.82 		$1,160.20
$1,222.10
$1,287.68
$1,520.63 		$1,511.01
$1,572.91
$1,638.49
$1,871.44 		$350.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$917.16
$1,040.96
$1,172.12
$1,638.02
$2,489.14 		$1,267.97
$1,391.77
$1,522.93
$1,988.83 		$1,618.78
$1,742.58
$1,873.74
$2,339.64 		$1,969.59
$2,093.39
$2,224.55
$2,690.45 		$350.81
Toc - Plan #16 Ambetter Health of Delaware
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$394.07
$447.25
$503.60
$703.78
$1,069.47 		$695.52
$748.70
$805.05
$1,005.23 		$996.97
$1,050.15
$1,106.50
$1,306.68 		$1,298.42
$1,351.60
$1,407.95
$1,608.13 		$301.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$788.14
$894.50
$1,007.20
$1,407.56
$2,138.94 		$1,089.59
$1,195.95
$1,308.65
$1,709.01 		$1,391.04
$1,497.40
$1,610.10
$2,010.46 		$1,692.49
$1,798.85
$1,911.55
$2,311.91 		$301.45
Toc - Plan #17 Ambetter Health of Delaware
Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$469.75
$533.16
$600.33
$838.96
$1,274.88 		$829.10
$892.51
$959.68
$1,198.31 		$1,188.45
$1,251.86
$1,319.03
$1,557.66 		$1,547.80
$1,611.21
$1,678.38
$1,917.01 		$359.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$939.50
$1,066.32
$1,200.66
$1,677.92
$2,549.76 		$1,298.85
$1,425.67
$1,560.01
$2,037.27 		$1,658.20
$1,785.02
$1,919.36
$2,396.62 		$2,017.55
$2,144.37
$2,278.71
$2,755.97 		$359.35
Toc - Plan #18 Ambetter Health of Delaware
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$458.22
$520.07
$585.59
$818.36
$1,243.57 		$808.75
$870.60
$936.12
$1,168.89 		$1,159.28
$1,221.13
$1,286.65
$1,519.42 		$1,509.81
$1,571.66
$1,637.18
$1,869.95 		$350.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$916.44
$1,040.14
$1,171.18
$1,636.72
$2,487.14 		$1,266.97
$1,390.67
$1,521.71
$1,987.25 		$1,617.50
$1,741.20
$1,872.24
$2,337.78 		$1,968.03
$2,091.73
$2,222.77
$2,688.31 		$350.53
Toc - Plan #19 Ambetter Health of Delaware
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$466.67
$529.66
$596.40
$833.46
$1,266.52 		$823.67
$886.66
$953.40
$1,190.46 		$1,180.67
$1,243.66
$1,310.40
$1,547.46 		$1,537.67
$1,600.66
$1,667.40
$1,904.46 		$357.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$933.34
$1,059.32
$1,192.80
$1,666.92
$2,533.04 		$1,290.34
$1,416.32
$1,549.80
$2,023.92 		$1,647.34
$1,773.32
$1,906.80
$2,380.92 		$2,004.34
$2,130.32
$2,263.80
$2,737.92 		$357.00
Toc - Plan #20 Ambetter Health of Delaware
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$459.55
$521.58
$587.29
$820.74
$1,247.19 		$811.10
$873.13
$938.84
$1,172.29 		$1,162.65
$1,224.68
$1,290.39
$1,523.84 		$1,514.20
$1,576.23
$1,641.94
$1,875.39 		$351.55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$919.10
$1,043.16
$1,174.58
$1,641.48
$2,494.38 		$1,270.65
$1,394.71
$1,526.13
$1,993.03 		$1,622.20
$1,746.26
$1,877.68
$2,344.58 		$1,973.75
$2,097.81
$2,229.23
$2,696.13 		$351.55
Toc - Plan #21 Ambetter Health of Delaware
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$532.52
$604.40
$680.55
$951.07
$1,445.25 		$939.89
$1,011.77
$1,087.92
$1,358.44 		$1,347.26
$1,419.14
$1,495.29
$1,765.81 		$1,754.63
$1,826.51
$1,902.66
$2,173.18 		$407.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,065.04
$1,208.80
$1,361.10
$1,902.14
$2,890.50 		$1,472.41
$1,616.17
$1,768.47
$2,309.51 		$1,879.78
$2,023.54
$2,175.84
$2,716.88 		$2,287.15
$2,430.91
$2,583.21
$3,124.25 		$407.37
Toc - Plan #22 Ambetter Health of Delaware
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$510.70
$579.63
$652.66
$912.09
$1,386.00 		$901.38
$970.31
$1,043.34
$1,302.77 		$1,292.06
$1,360.99
$1,434.02
$1,693.45 		$1,682.74
$1,751.67
$1,824.70
$2,084.13 		$390.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,021.40
$1,159.26
$1,305.32
$1,824.18
$2,772.00 		$1,412.08
$1,549.94
$1,696.00
$2,214.86 		$1,802.76
$1,940.62
$2,086.68
$2,605.54 		$2,193.44
$2,331.30
$2,477.36
$2,996.22 		$390.68
Toc - Plan #23 Ambetter Health of Delaware
Gold

(EPO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

Annual Out of Pocket Expenses:

Individual Family
$900 $1,800 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$504.95
$573.11
$645.32
$901.83
$1,370.41 		$891.23
$959.39
$1,031.60
$1,288.11 		$1,277.51
$1,345.67
$1,417.88
$1,674.39 		$1,663.79
$1,731.95
$1,804.16
$2,060.67 		$386.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,009.90
$1,146.22
$1,290.64
$1,803.66
$2,740.82 		$1,396.18
$1,532.50
$1,676.92
$2,189.94 		$1,782.46
$1,918.78
$2,063.20
$2,576.22 		$2,168.74
$2,305.06
$2,449.48
$2,962.50 		$386.28
Toc - Plan #24 Ambetter Health of Delaware
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-919-3214

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 		$513.13
$582.39
$655.77
$916.44
$1,392.61 		$905.67
$974.93
$1,048.31
$1,308.98 		$1,298.21
$1,367.47
$1,440.85
$1,701.52 		$1,690.75
$1,760.01
$1,833.39
$2,094.06 		$392.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,026.26
$1,164.78
$1,311.54
$1,832.88
$2,785.22 		$1,418.80
$1,557.32
$1,704.08
$2,225.42 		$1,811.34
$1,949.86
$2,096.62
$2,617.96 		$2,203.88
$2,342.40
$2,489.16
$3,010.50 		$392.54

ADVERTISEMENT

Aetna CVS Health

Local: 1-855-586-6960 | Toll Free: 1-855-586-6960 | TTY: 1-855-586-6960
Toc - Plan #25 Aetna CVS Health
Silver

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 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 		$439.45
$498.77
$561.61
$784.85
$1,192.65 		$775.63
$834.95
$897.79
$1,121.03 		$1,111.81
$1,171.13
$1,233.97
$1,457.21 		$1,447.99
$1,507.31
$1,570.15
$1,793.39 		$336.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878.90
$997.54
$1,123.22
$1,569.70
$2,385.30 		$1,215.08
$1,333.72
$1,459.40
$1,905.88 		$1,551.26
$1,669.90
$1,795.58
$2,242.06 		$1,887.44
$2,006.08
$2,131.76
$2,578.24 		$336.18
Toc - Plan #26 Aetna CVS Health
Gold

(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

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 		$418.68
$475.20
$535.07
$747.76
$1,136.29 		$738.97
$795.49
$855.36
$1,068.05 		$1,059.26
$1,115.78
$1,175.65
$1,388.34 		$1,379.55
$1,436.07
$1,495.94
$1,708.63 		$320.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$837.36
$950.40
$1,070.14
$1,495.52
$2,272.58 		$1,157.65
$1,270.69
$1,390.43
$1,815.81 		$1,477.94
$1,590.98
$1,710.72
$2,136.10 		$1,798.23
$1,911.27
$2,031.01
$2,456.39 		$320.29
Toc - Plan #27 Aetna CVS Health
Silver

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

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 		$433.50
$492.02
$554.01
$774.22
$1,176.50 		$765.13
$823.65
$885.64
$1,105.85 		$1,096.76
$1,155.28
$1,217.27
$1,437.48 		$1,428.39
$1,486.91
$1,548.90
$1,769.11 		$331.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$867.00
$984.04
$1,108.02
$1,548.44
$2,353.00 		$1,198.63
$1,315.67
$1,439.65
$1,880.07 		$1,530.26
$1,647.30
$1,771.28
$2,211.70 		$1,861.89
$1,978.93
$2,102.91
$2,543.33 		$331.63
Toc - Plan #28 Aetna CVS Health
Gold

(HMO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,395 $18,790 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 		$414.19
$470.11
$529.34
$739.75
$1,124.12 		$731.05
$786.97
$846.20
$1,056.61 		$1,047.91
$1,103.83
$1,163.06
$1,373.47 		$1,364.77
$1,420.69
$1,479.92
$1,690.33 		$316.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$828.38
$940.22
$1,058.68
$1,479.50
$2,248.24 		$1,145.24
$1,257.08
$1,375.54
$1,796.36 		$1,462.10
$1,573.94
$1,692.40
$2,113.22 		$1,778.96
$1,890.80
$2,009.26
$2,430.08 		$316.86
Toc - Plan #29 Aetna CVS Health
Silver

(HMO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,825 $17,650 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 		$441.53
$501.13
$564.27
$788.56
$1,198.30 		$779.30
$838.90
$902.04
$1,126.33 		$1,117.07
$1,176.67
$1,239.81
$1,464.10 		$1,454.84
$1,514.44
$1,577.58
$1,801.87 		$337.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$883.06
$1,002.26
$1,128.54
$1,577.12
$2,396.60 		$1,220.83
$1,340.03
$1,466.31
$1,914.89 		$1,558.60
$1,677.80
$1,804.08
$2,252.66 		$1,896.37
$2,015.57
$2,141.85
$2,590.43 		$337.77
Toc - Plan #30 Aetna CVS Health
Silver

(HMO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-586-6960

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$9,125 $18,250 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 		$440.89
$500.41
$563.46
$787.43
$1,196.57 		$778.17
$837.69
$900.74
$1,124.71 		$1,115.45
$1,174.97
$1,238.02
$1,461.99 		$1,452.73
$1,512.25
$1,575.30
$1,799.27 		$337.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$881.78
$1,000.82
$1,126.92
$1,574.86
$2,393.14 		$1,219.06
$1,338.10
$1,464.20
$1,912.14 		$1,556.34
$1,675.38
$1,801.48
$2,249.42 		$1,893.62
$2,012.66
$2,138.76
$2,586.70 		$337.28

ADVERTISEMENT

AmeriHealth Caritas Next

Local: 1-833-590-3300 | Toll Free: 1-833-590-3300

Toc - Plan #31 AmeriHealth Caritas Next
Bronze

(HMO) AmeriHealth Caritas Next Bronze Classic + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

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 		$300.13
$340.65
$383.57
$536.04
$814.56 		$529.73
$570.25
$613.17
$765.64 		$759.33
$799.85
$842.77
$995.24 		$988.93
$1,029.45
$1,072.37
$1,224.84 		$229.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600.26
$681.30
$767.14
$1,072.08
$1,629.12 		$829.86
$910.90
$996.74
$1,301.68 		$1,059.46
$1,140.50
$1,226.34
$1,531.28 		$1,289.06
$1,370.10
$1,455.94
$1,760.88 		$229.60
Toc - Plan #32 AmeriHealth Caritas Next
Expanded Bronze

(HMO) AmeriHealth Caritas Next Expanded Bronze Classic + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

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 		$338.52
$384.22
$432.63
$604.59
$918.73 		$597.49
$643.19
$691.60
$863.56 		$856.46
$902.16
$950.57
$1,122.53 		$1,115.43
$1,161.13
$1,209.54
$1,381.50 		$258.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$677.04
$768.44
$865.26
$1,209.18
$1,837.46 		$936.01
$1,027.41
$1,124.23
$1,468.15 		$1,194.98
$1,286.38
$1,383.20
$1,727.12 		$1,453.95
$1,545.35
$1,642.17
$1,986.09 		$258.97
Toc - Plan #33 AmeriHealth Caritas Next
Silver

(HMO) AmeriHealth Caritas Next Silver Classic + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

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 		$413.52
$469.34
$528.47
$738.54
$1,122.27 		$729.86
$785.68
$844.81
$1,054.88 		$1,046.20
$1,102.02
$1,161.15
$1,371.22 		$1,362.54
$1,418.36
$1,477.49
$1,687.56 		$316.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$827.04
$938.68
$1,056.94
$1,477.08
$2,244.54 		$1,143.38
$1,255.02
$1,373.28
$1,793.42 		$1,459.72
$1,571.36
$1,689.62
$2,109.76 		$1,776.06
$1,887.70
$2,005.96
$2,426.10 		$316.34
Toc - Plan #34 AmeriHealth Caritas Next
Gold

(HMO) AmeriHealth Caritas Next Gold Classic + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

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 		$411.62
$467.19
$526.05
$735.16
$1,117.14 		$726.51
$782.08
$840.94
$1,050.05 		$1,041.40
$1,096.97
$1,155.83
$1,364.94 		$1,356.29
$1,411.86
$1,470.72
$1,679.83 		$314.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$823.24
$934.38
$1,052.10
$1,470.32
$2,234.28 		$1,138.13
$1,249.27
$1,366.99
$1,785.21 		$1,453.02
$1,564.16
$1,681.88
$2,100.10 		$1,767.91
$1,879.05
$1,996.77
$2,414.99 		$314.89
Toc - Plan #35 AmeriHealth Caritas Next
Expanded Bronze

(HMO) AmeriHealth Caritas Next Expanded Bronze Premier + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

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 		$346.03
$392.75
$442.23
$618.01
$939.12 		$610.75
$657.47
$706.95
$882.73 		$875.47
$922.19
$971.67
$1,147.45 		$1,140.19
$1,186.91
$1,236.39
$1,412.17 		$264.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.06
$785.50
$884.46
$1,236.02
$1,878.24 		$956.78
$1,050.22
$1,149.18
$1,500.74 		$1,221.50
$1,314.94
$1,413.90
$1,765.46 		$1,486.22
$1,579.66
$1,678.62
$2,030.18 		$264.72
Toc - Plan #36 AmeriHealth Caritas Next
Silver

(HMO) AmeriHealth Caritas Next Silver Premier + $0 Virtual Care 24/7 + $0 Preventive Care + No-Referrals Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-590-3300

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$416.85
$473.12
$532.73
$744.49
$1,131.32 		$735.74
$792.01
$851.62
$1,063.38 		$1,054.63
$1,110.90
$1,170.51
$1,382.27 		$1,373.52
$1,429.79
$1,489.40
$1,701.16 		$318.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.70
$946.24
$1,065.46
$1,488.98
$2,262.64 		$1,152.59
$1,265.13
$1,384.35
$1,807.87 		$1,471.48
$1,584.02
$1,703.24
$2,126.76 		$1,790.37
$1,902.91
$2,022.13
$2,445.65 		$318.89

ADVERTISEMENT

Highmark Blue Cross Blue Shield Delaware

Local: 1-877-959-2563 | Toll Free: 1-877-959-2563 | TTY: 1-800-232-5460
Toc - Plan #37 Highmark Blue Cross Blue Shield Delaware
Expanded Bronze

(PPO) my Blue Access PPO Bronze 3800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$9,200 $18,400 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 		$352.78
$400.41
$450.85
$630.07
$957.44 		$622.66
$670.29
$720.73
$899.95 		$892.54
$940.17
$990.61
$1,169.83 		$1,162.42
$1,210.05
$1,260.49
$1,439.71 		$269.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705.56
$800.82
$901.70
$1,260.14
$1,914.88 		$975.44
$1,070.70
$1,171.58
$1,530.02 		$1,245.32
$1,340.58
$1,441.46
$1,799.90 		$1,515.20
$1,610.46
$1,711.34
$2,069.78 		$269.88
Toc - Plan #38 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Gold 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$452.80
$513.93
$578.68
$808.70
$1,228.90 		$799.19
$860.32
$925.07
$1,155.09 		$1,145.58
$1,206.71
$1,271.46
$1,501.48 		$1,491.97
$1,553.10
$1,617.85
$1,847.87 		$346.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$905.60
$1,027.86
$1,157.36
$1,617.40
$2,457.80 		$1,251.99
$1,374.25
$1,503.75
$1,963.79 		$1,598.38
$1,720.64
$1,850.14
$2,310.18 		$1,944.77
$2,067.03
$2,196.53
$2,656.57 		$346.39
Toc - Plan #39 Highmark Blue Cross Blue Shield Delaware
Platinum

(PPO) my Blue Access PPO Platinum 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$612.75
$695.47
$783.09
$1,094.37
$1,663.00 		$1,081.50
$1,164.22
$1,251.84
$1,563.12 		$1,550.25
$1,632.97
$1,720.59
$2,031.87 		$2,019.00
$2,101.72
$2,189.34
$2,500.62 		$468.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,225.50
$1,390.94
$1,566.18
$2,188.74
$3,326.00 		$1,694.25
$1,859.69
$2,034.93
$2,657.49 		$2,163.00
$2,328.44
$2,503.68
$3,126.24 		$2,631.75
$2,797.19
$2,972.43
$3,594.99 		$468.75
Toc - Plan #40 Highmark Blue Cross Blue Shield Delaware
Silver

(PPO) my Blue Access PPO Silver 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$444.24
$504.21
$567.74
$793.41
$1,205.67 		$784.08
$844.05
$907.58
$1,133.25 		$1,123.92
$1,183.89
$1,247.42
$1,473.09 		$1,463.76
$1,523.73
$1,587.26
$1,812.93 		$339.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$888.48
$1,008.42
$1,135.48
$1,586.82
$2,411.34 		$1,228.32
$1,348.26
$1,475.32
$1,926.66 		$1,568.16
$1,688.10
$1,815.16
$2,266.50 		$1,908.00
$2,027.94
$2,155.00
$2,606.34 		$339.84
Toc - Plan #41 Highmark Blue Cross Blue Shield Delaware
Expanded Bronze

(PPO) my Blue Access PPO Bronze 8900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$328.46
$372.80
$419.77
$586.63
$891.44 		$579.73
$624.07
$671.04
$837.90 		$831.00
$875.34
$922.31
$1,089.17 		$1,082.27
$1,126.61
$1,173.58
$1,340.44 		$251.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656.92
$745.60
$839.54
$1,173.26
$1,782.88 		$908.19
$996.87
$1,090.81
$1,424.53 		$1,159.46
$1,248.14
$1,342.08
$1,675.80 		$1,410.73
$1,499.41
$1,593.35
$1,927.07 		$251.27
Toc - Plan #42 Highmark Blue Cross Blue Shield Delaware
Expanded Bronze

(PPO) my Blue Access PPO Bronze 3800 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$9,200 $18,400 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 		$374.63
$425.21
$478.78
$669.09
$1,016.75 		$661.22
$711.80
$765.37
$955.68 		$947.81
$998.39
$1,051.96
$1,242.27 		$1,234.40
$1,284.98
$1,338.55
$1,528.86 		$286.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$749.26
$850.42
$957.56
$1,338.18
$2,033.50 		$1,035.85
$1,137.01
$1,244.15
$1,624.77 		$1,322.44
$1,423.60
$1,530.74
$1,911.36 		$1,609.03
$1,710.19
$1,817.33
$2,197.95 		$286.59
Toc - Plan #43 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Gold 0 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$474.65
$538.73
$606.60
$847.72
$1,288.20 		$837.76
$901.84
$969.71
$1,210.83 		$1,200.87
$1,264.95
$1,332.82
$1,573.94 		$1,563.98
$1,628.06
$1,695.93
$1,937.05 		$363.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$949.30
$1,077.46
$1,213.20
$1,695.44
$2,576.40 		$1,312.41
$1,440.57
$1,576.31
$2,058.55 		$1,675.52
$1,803.68
$1,939.42
$2,421.66 		$2,038.63
$2,166.79
$2,302.53
$2,784.77 		$363.11
Toc - Plan #44 Highmark Blue Cross Blue Shield Delaware
Platinum

(PPO) my Blue Access PPO Platinum 0 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$634.60
$720.27
$811.02
$1,133.40
$1,722.30 		$1,120.07
$1,205.74
$1,296.49
$1,618.87 		$1,605.54
$1,691.21
$1,781.96
$2,104.34 		$2,091.01
$2,176.68
$2,267.43
$2,589.81 		$485.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,269.20
$1,440.54
$1,622.04
$2,266.80
$3,444.60 		$1,754.67
$1,926.01
$2,107.51
$2,752.27 		$2,240.14
$2,411.48
$2,592.98
$3,237.74 		$2,725.61
$2,896.95
$3,078.45
$3,723.21 		$485.47
Toc - Plan #45 Highmark Blue Cross Blue Shield Delaware
Expanded Bronze

(PPO) my Blue Access PPO Bronze 7100 HSA - Custom Drug Benefit

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$357.76
$406.06
$457.22
$638.96
$970.96 		$631.45
$679.75
$730.91
$912.65 		$905.14
$953.44
$1,004.60
$1,186.34 		$1,178.83
$1,227.13
$1,278.29
$1,460.03 		$273.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$715.52
$812.12
$914.44
$1,277.92
$1,941.92 		$989.21
$1,085.81
$1,188.13
$1,551.61 		$1,262.90
$1,359.50
$1,461.82
$1,825.30 		$1,536.59
$1,633.19
$1,735.51
$2,098.99 		$273.69
Toc - Plan #46 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Gold 1700 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 Annual Deductible
$5,700 $11,400 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 		$432.28
$490.64
$552.45
$772.05
$1,173.21 		$762.97
$821.33
$883.14
$1,102.74 		$1,093.66
$1,152.02
$1,213.83
$1,433.43 		$1,424.35
$1,482.71
$1,544.52
$1,764.12 		$330.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$864.56
$981.28
$1,104.90
$1,544.10
$2,346.42 		$1,195.25
$1,311.97
$1,435.59
$1,874.79 		$1,525.94
$1,642.66
$1,766.28
$2,205.48 		$1,856.63
$1,973.35
$2,096.97
$2,536.17 		$330.69
Toc - Plan #47 Highmark Blue Cross Blue Shield Delaware
Catastrophic

(PPO) my Blue Access Major Events PPO Catastrophic 9450 - 3 Free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

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 		$270.10
$306.56
$345.19
$482.40
$733.05 		$476.73
$513.19
$551.82
$689.03 		$683.36
$719.82
$758.45
$895.66 		$889.99
$926.45
$965.08
$1,102.29 		$206.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$540.20
$613.12
$690.38
$964.80
$1,466.10 		$746.83
$819.75
$897.01
$1,171.43 		$953.46
$1,026.38
$1,103.64
$1,378.06 		$1,160.09
$1,233.01
$1,310.27
$1,584.69 		$206.63
Toc - Plan #48 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Premier Gold 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,700 $13,400 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 		$463.39
$525.95
$592.21
$827.61
$1,257.64 		$817.88
$880.44
$946.70
$1,182.10 		$1,172.37
$1,234.93
$1,301.19
$1,536.59 		$1,526.86
$1,589.42
$1,655.68
$1,891.08 		$354.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$926.78
$1,051.90
$1,184.42
$1,655.22
$2,515.28 		$1,281.27
$1,406.39
$1,538.91
$2,009.71 		$1,635.76
$1,760.88
$1,893.40
$2,364.20 		$1,990.25
$2,115.37
$2,247.89
$2,718.69 		$354.49
Toc - Plan #49 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Premier Gold 0 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,700 $13,400 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 		$485.24
$550.75
$620.14
$866.64
$1,316.94 		$856.45
$921.96
$991.35
$1,237.85 		$1,227.66
$1,293.17
$1,362.56
$1,609.06 		$1,598.87
$1,664.38
$1,733.77
$1,980.27 		$371.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$970.48
$1,101.50
$1,240.28
$1,733.28
$2,633.88 		$1,341.69
$1,472.71
$1,611.49
$2,104.49 		$1,712.90
$1,843.92
$1,982.70
$2,475.70 		$2,084.11
$2,215.13
$2,353.91
$2,846.91 		$371.21
Toc - Plan #50 Highmark Blue Cross Blue Shield Delaware
Silver

(PPO) my Blue Access PPO Standard Silver 5900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

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 		$453.59
$514.82
$579.69
$810.11
$1,231.04 		$800.59
$861.82
$926.69
$1,157.11 		$1,147.59
$1,208.82
$1,273.69
$1,504.11 		$1,494.59
$1,555.82
$1,620.69
$1,851.11 		$347.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$907.18
$1,029.64
$1,159.38
$1,620.22
$2,462.08 		$1,254.18
$1,376.64
$1,506.38
$1,967.22 		$1,601.18
$1,723.64
$1,853.38
$2,314.22 		$1,948.18
$2,070.64
$2,200.38
$2,661.22 		$347.00
Toc - Plan #51 Highmark Blue Cross Blue Shield Delaware
Gold

(PPO) my Blue Access PPO Standard Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

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 		$427.37
$485.06
$546.18
$763.28
$1,159.88 		$754.31
$812.00
$873.12
$1,090.22 		$1,081.25
$1,138.94
$1,200.06
$1,417.16 		$1,408.19
$1,465.88
$1,527.00
$1,744.10 		$326.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$854.74
$970.12
$1,092.36
$1,526.56
$2,319.76 		$1,181.68
$1,297.06
$1,419.30
$1,853.50 		$1,508.62
$1,624.00
$1,746.24
$2,180.44 		$1,835.56
$1,950.94
$2,073.18
$2,507.38 		$326.94
Toc - Plan #52 Highmark Blue Cross Blue Shield Delaware
Platinum

(PPO) my Blue Access PPO Standard Platinum 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 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 		$621.05
$704.89
$793.70
$1,109.20
$1,685.53 		$1,096.15
$1,179.99
$1,268.80
$1,584.30 		$1,571.25
$1,655.09
$1,743.90
$2,059.40 		$2,046.35
$2,130.19
$2,219.00
$2,534.50 		$475.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,242.10
$1,409.78
$1,587.40
$2,218.40
$3,371.06 		$1,717.20
$1,884.88
$2,062.50
$2,693.50 		$2,192.30
$2,359.98
$2,537.60
$3,168.60 		$2,667.40
$2,835.08
$3,012.70
$3,643.70 		$475.10
Toc - Plan #53 Highmark Blue Cross Blue Shield Delaware
Expanded Bronze

(PPO) my Blue Access PPO Standard Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

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 		$342.14
$388.33
$437.25
$611.06
$928.57 		$603.88
$650.07
$698.99
$872.80 		$865.62
$911.81
$960.73
$1,134.54 		$1,127.36
$1,173.55
$1,222.47
$1,396.28 		$261.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$684.28
$776.66
$874.50
$1,222.12
$1,857.14 		$946.02
$1,038.40
$1,136.24
$1,483.86 		$1,207.76
$1,300.14
$1,397.98
$1,745.60 		$1,469.50
$1,561.88
$1,659.72
$2,007.34 		$261.74
Toc - Plan #54 Highmark Blue Cross Blue Shield Delaware
Silver

(PPO) my Blue Access PPO Standard Silver 5900 + Adult Dental and Vison

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-959-2563

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 		$475.44
$539.62
$607.61
$849.14
$1,290.34 		$839.15
$903.33
$971.32
$1,212.85 		$1,202.86
$1,267.04
$1,335.03
$1,576.56 		$1,566.57
$1,630.75
$1,698.74
$1,940.27 		$363.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$950.88
$1,079.24
$1,215.22
$1,698.28
$2,580.68 		$1,314.59
$1,442.95
$1,578.93
$2,061.99 		$1,678.30
$1,806.66
$1,942.64
$2,425.70 		$2,042.01
$2,170.37
$2,306.35
$2,789.41 		$363.71

‡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 Sussex County here.

Sussex County is in “Rating Area 1” of Delaware.

Currently, there are 54 plans offered in Rating Area 1.

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2024 Obamacare Plans for Sussex County, DE

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