Obamacare 2022 Rates and Health Insurance Providers for Brevard County , Florida

Obamacare > Rates > Florida > Brevard County

Obamacare Rates and Providers for Other Years

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

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 Brevard County, FL.

The health insurance rates listed below are for calendar year 2022.

For detailed information on available 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

The table below shows premiums for the following profiles at various ages:

  • Individuals
  • Couples
  • Couples with 1, 2, or 3 children
  • Individuals with 1, 2, or 3 children
  • A child alone

Each plan links to the insurance provider's website. You can find the following:

  • Summary of plan benefits and costs
  • Plan brochure
  • Provider Directory where you can find out which doctors and hospitals in the Melbourne, FL area accept this insurance coverage as within the plan's network.

Obamacare Providers, Plans and 2022 Rates for Brevard County, Florida

Below, you’ll find a summary of the 131 plans for Brevard County, Florida 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

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

You may also be interested in:

How To Sign Up for Obamacare in Florida

For 2022 health plans, Florida open enrollment has ended. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period. For example, if you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a 60-day special enrollment period that will allow you to sign up for a new health insurance plan. (See What Happens If I Missed the Enrollment Deadline for 2022?)

To get covered, you can go directly to the online health insurance marketplace for Florida. If you need personalized help, you can reach out to an enrollment assistant. Most enrollment helpers are working remotely during the COVID crisis.

Where's the Florida Health Care Exchange?

You can find the health insurance exchange for Florida at Healthcare.gov. This is where you can learn about the various health insurance options available to you under the Affordable Care Act. If you see a plan you like, you'll be guided through the enrollment process online.

more...  

Florida Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Florida in 2021, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of October 2021, 12 states have not expanded their programs.

Florida Has Not Expanded Medicaid

Florida may put Medicaid expansion on the ballot in 2022. For now, because Florida has not yet expanded Medicaid eligibility, you may have fewer options for health coverage than people in states where Medicaid is more inclusive.

The Medicaid Coverage Gap

The Affordable Care Act assumed that Medicaid would be expanded to cover all Americans with incomes at or below 138% of the federal poverty level. And it created health plan subsidies for people with incomes between 100% - 400% of the poverty level.

That means Florida residents with incomes below the poverty level may fall into a coverage gap where they can get neither Medicaid nor ACA subsidies.

more...  

Get Help Finding a Health Insurance Plan in Florida

Get Help From Florida's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Healthcare.gov, the health insurance marketplace for Florida.

Help by phone: 800-318-2596 (TTY: 855-889-4325)

In-person help: Go to Find Local Help, where you can enter your city and state or zip code to find an application assister, insurance agent, or health insurance broker in your area.

Get Help From a Licensed Insurance Broker

To directly connect with a Florida insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Florida?

  • Brevard County, FL Obamacare Rates
  • General Info
  • Rates

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Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueOptions Silver 1423 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,950 $11,900 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$583,45
$662,22
$745,65
$1 042,04
$1 583,48
$1 029,79
$1 108,56
$1 191,99
$1 488,38
$1 476,13
$1 554,90
$1 638,33
$1 934,72
$1 922,47
$2 001,24
$2 084,67
$2 381,06
$446,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 166,90
$1 324,44
$1 491,30
$2 084,08
$3 166,96
$1 613,24
$1 770,78
$1 937,64
$2 530,42
$2 059,58
$2 217,12
$2 383,98
$2 976,76
$2 505,92
$2 663,46
$2 830,32
$3 423,10
$446,34
Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)
Bronze

(EPO) BlueOptions Bronze 1419 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$360,73
$409,43
$461,01
$644,26
$979,02
$636,69
$685,39
$736,97
$920,22
$912,65
$961,35
$1 012,93
$1 196,18
$1 188,61
$1 237,31
$1 288,89
$1 472,14
$275,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721,46
$818,86
$922,02
$1 288,52
$1 958,04
$997,42
$1 094,82
$1 197,98
$1 564,48
$1 273,38
$1 370,78
$1 473,94
$1 840,44
$1 549,34
$1 646,74
$1 749,90
$2 116,40
$275,96
Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueOptions Silver 1431 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,600 $11,200 Annual Deductible
$7,800 $15,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$600,84
$681,95
$767,87
$1 073,10
$1 630,68
$1 060,48
$1 141,59
$1 227,51
$1 532,74
$1 520,12
$1 601,23
$1 687,15
$1 992,38
$1 979,76
$2 060,87
$2 146,79
$2 452,02
$459,64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 201,68
$1 363,90
$1 535,74
$2 146,20
$3 261,36
$1 661,32
$1 823,54
$1 995,38
$2 605,84
$2 120,96
$2 283,18
$2 455,02
$3 065,48
$2 580,60
$2 742,82
$2 914,66
$3 525,12
$459,64
Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueOptions Platinum 1418 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,250 $2,500 Annual Deductible
$4,250 $8,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$703,28
$798,22
$898,79
$1 256,06
$1 908,70
$1 241,29
$1 336,23
$1 436,80
$1 794,07
$1 779,30
$1 874,24
$1 974,81
$2 332,08
$2 317,31
$2 412,25
$2 512,82
$2 870,09
$538,01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 406,56
$1 596,44
$1 797,58
$2 512,12
$3 817,40
$1 944,57
$2 134,45
$2 335,59
$3 050,13
$2 482,58
$2 672,46
$2 873,60
$3 588,14
$3 020,59
$3 210,47
$3 411,61
$4 126,15
$538,01
Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueOptions Bronze 1416 ($0 Virtual Visits / 3 PCP Visits for $20)

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388,78
$441,27
$496,86
$694,36
$1 055,15
$686,20
$738,69
$794,28
$991,78
$983,62
$1 036,11
$1 091,70
$1 289,20
$1 281,04
$1 333,53
$1 389,12
$1 586,62
$297,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777,56
$882,54
$993,72
$1 388,72
$2 110,30
$1 074,98
$1 179,96
$1 291,14
$1 686,14
$1 372,40
$1 477,38
$1 588,56
$1 983,56
$1 669,82
$1 774,80
$1 885,98
$2 280,98
$297,42
Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueOptions Platinum 1424 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$745,23
$845,84
$952,40
$1 330,98
$2 022,55
$1 315,33
$1 415,94
$1 522,50
$1 901,08
$1 885,43
$1 986,04
$2 092,60
$2 471,18
$2 455,53
$2 556,14
$2 662,70
$3 041,28
$570,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 490,46
$1 691,68
$1 904,80
$2 661,96
$4 045,10
$2 060,56
$2 261,78
$2 474,90
$3 232,06
$2 630,66
$2 831,88
$3 045,00
$3 802,16
$3 200,76
$3 401,98
$3 615,10
$4 372,26
$570,10
Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueOptions Silver 1410 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$531,87
$603,67
$679,73
$949,92
$1 443,50
$938,75
$1 010,55
$1 086,61
$1 356,80
$1 345,63
$1 417,43
$1 493,49
$1 763,68
$1 752,51
$1 824,31
$1 900,37
$2 170,56
$406,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 063,74
$1 207,34
$1 359,46
$1 899,84
$2 887,00
$1 470,62
$1 614,22
$1 766,34
$2 306,72
$1 877,50
$2 021,10
$2 173,22
$2 713,60
$2 284,38
$2 427,98
$2 580,10
$3 120,48
$406,88
Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueOptions Gold 1505 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$592,04
$671,97
$756,63
$1 057,38
$1 606,80
$1 044,95
$1 124,88
$1 209,54
$1 510,29
$1 497,86
$1 577,79
$1 662,45
$1 963,20
$1 950,77
$2 030,70
$2 115,36
$2 416,11
$452,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 184,08
$1 343,94
$1 513,26
$2 114,76
$3 213,60
$1 636,99
$1 796,85
$1 966,17
$2 567,67
$2 089,90
$2 249,76
$2 419,08
$3 020,58
$2 542,81
$2 702,67
$2 871,99
$3 473,49
$452,91
Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueOptions Bronze (HSA) 1705 ($100+ in Rewards / $4 Condition Care Rx)

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376,73
$427,59
$481,46
$672,84
$1 022,45
$664,93
$715,79
$769,66
$961,04
$953,13
$1 003,99
$1 057,86
$1 249,24
$1 241,33
$1 292,19
$1 346,06
$1 537,44
$288,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753,46
$855,18
$962,92
$1 345,68
$2 044,90
$1 041,66
$1 143,38
$1 251,12
$1 633,88
$1 329,86
$1 431,58
$1 539,32
$1 922,08
$1 618,06
$1 719,78
$1 827,52
$2 210,28
$288,20
Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueOptions Silver 1706S ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$3,600 $7,200 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$594,67
$674,95
$759,99
$1 062,08
$1 613,93
$1 049,59
$1 129,87
$1 214,91
$1 517,00
$1 504,51
$1 584,79
$1 669,83
$1 971,92
$1 959,43
$2 039,71
$2 124,75
$2 426,84
$454,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 189,34
$1 349,90
$1 519,98
$2 124,16
$3 227,86
$1 644,26
$1 804,82
$1 974,90
$2 579,08
$2 099,18
$2 259,74
$2 429,82
$3 034,00
$2 554,10
$2 714,66
$2 884,74
$3 488,92
$454,92
Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueOptions Bronze 1707S ($0 Virtual Visits / $40 PCP Visits)

Annual Out of Pocket Expenses
Individual Family
$8,150 $16,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387,74
$440,08
$495,53
$692,50
$1 052,33
$684,36
$736,70
$792,15
$989,12
$980,98
$1 033,32
$1 088,77
$1 285,74
$1 277,60
$1 329,94
$1 385,39
$1 582,36
$296,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$775,48
$880,16
$991,06
$1 385,00
$2 104,66
$1 072,10
$1 176,78
$1 287,68
$1 681,62
$1 368,72
$1 473,40
$1 584,30
$1 978,24
$1 665,34
$1 770,02
$1 880,92
$2 274,86
$296,62
Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueOptions Gold 1805 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$573,31
$650,71
$732,69
$1 023,93
$1 555,96
$1 011,89
$1 089,29
$1 171,27
$1 462,51
$1 450,47
$1 527,87
$1 609,85
$1 901,09
$1 889,05
$1 966,45
$2 048,43
$2 339,67
$438,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 146,62
$1 301,42
$1 465,38
$2 047,86
$3 111,92
$1 585,20
$1 740,00
$1 903,96
$2 486,44
$2 023,78
$2 178,58
$2 342,54
$2 925,02
$2 462,36
$2 617,16
$2 781,12
$3 363,60
$438,58
Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueOptions Bronze 2119 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$414,82
$470,82
$530,14
$740,87
$1 125,82
$732,16
$788,16
$847,48
$1 058,21
$1 049,50
$1 105,50
$1 164,82
$1 375,55
$1 366,84
$1 422,84
$1 482,16
$1 692,89
$317,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829,64
$941,64
$1 060,28
$1 481,74
$2 251,64
$1 146,98
$1 258,98
$1 377,62
$1 799,08
$1 464,32
$1 576,32
$1 694,96
$2 116,42
$1 781,66
$1 893,66
$2 012,30
$2 433,76
$317,34
Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1456 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,950 $11,900 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$379,79
$431,06
$485,37
$678,30
$1 030,75
$670,33
$721,60
$775,91
$968,84
$960,87
$1 012,14
$1 066,45
$1 259,38
$1 251,41
$1 302,68
$1 356,99
$1 549,92
$290,54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$759,58
$862,12
$970,74
$1 356,60
$2 061,50
$1 050,12
$1 152,66
$1 261,28
$1 647,14
$1 340,66
$1 443,20
$1 551,82
$1 937,68
$1 631,20
$1 733,74
$1 842,36
$2 228,22
$290,54
Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)
Bronze

(EPO) BlueSelect Bronze 1452 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$270,74
$307,29
$346,01
$483,54
$734,79
$477,86
$514,41
$553,13
$690,66
$684,98
$721,53
$760,25
$897,78
$892,10
$928,65
$967,37
$1 104,90
$207,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541,48
$614,58
$692,02
$967,08
$1 469,58
$748,60
$821,70
$899,14
$1 174,20
$955,72
$1 028,82
$1 106,26
$1 381,32
$1 162,84
$1 235,94
$1 313,38
$1 588,44
$207,12
Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1464 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,600 $11,200 Annual Deductible
$7,800 $15,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393,64
$446,78
$503,07
$703,04
$1 068,34
$694,77
$747,91
$804,20
$1 004,17
$995,90
$1 049,04
$1 105,33
$1 305,30
$1 297,03
$1 350,17
$1 406,46
$1 606,43
$301,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787,28
$893,56
$1 006,14
$1 406,08
$2 136,68
$1 088,41
$1 194,69
$1 307,27
$1 707,21
$1 389,54
$1 495,82
$1 608,40
$2 008,34
$1 690,67
$1 796,95
$1 909,53
$2 309,47
$301,13
Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,250 $2,500 Annual Deductible
$4,250 $8,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$465,11
$527,90
$594,41
$830,69
$1 262,31
$820,92
$883,71
$950,22
$1 186,50
$1 176,73
$1 239,52
$1 306,03
$1 542,31
$1 532,54
$1 595,33
$1 661,84
$1 898,12
$355,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$930,22
$1 055,80
$1 188,82
$1 661,38
$2 524,62
$1 286,03
$1 411,61
$1 544,63
$2 017,19
$1 641,84
$1 767,42
$1 900,44
$2 373,00
$1 997,65
$2 123,23
$2 256,25
$2 728,81
$355,81
Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $20)

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$289,64
$328,74
$370,16
$517,30
$786,08
$511,21
$550,31
$591,73
$738,87
$732,78
$771,88
$813,30
$960,44
$954,35
$993,45
$1 034,87
$1 182,01
$221,57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$579,28
$657,48
$740,32
$1 034,60
$1 572,16
$800,85
$879,05
$961,89
$1 256,17
$1 022,42
$1 100,62
$1 183,46
$1 477,74
$1 243,99
$1 322,19
$1 405,03
$1 699,31
$221,57
Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$499,30
$566,71
$638,11
$891,75
$1 355,10
$881,26
$948,67
$1 020,07
$1 273,71
$1 263,22
$1 330,63
$1 402,03
$1 655,67
$1 645,18
$1 712,59
$1 783,99
$2 037,63
$381,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$998,60
$1 133,42
$1 276,22
$1 783,50
$2 710,20
$1 380,56
$1 515,38
$1 658,18
$2 165,46
$1 762,52
$1 897,34
$2 040,14
$2 547,42
$2 144,48
$2 279,30
$2 422,10
$2 929,38
$381,96
Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1443 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$345,19
$391,79
$441,15
$616,51
$936,85
$609,26
$655,86
$705,22
$880,58
$873,33
$919,93
$969,29
$1 144,65
$1 137,40
$1 184,00
$1 233,36
$1 408,72
$264,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$690,38
$783,58
$882,30
$1 233,02
$1 873,70
$954,45
$1 047,65
$1 146,37
$1 497,09
$1 218,52
$1 311,72
$1 410,44
$1 761,16
$1 482,59
$1 575,79
$1 674,51
$2 025,23
$264,07
Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$405,14
$459,83
$517,77
$723,58
$1 099,55
$715,07
$769,76
$827,70
$1 033,51
$1 025,00
$1 079,69
$1 137,63
$1 343,44
$1 334,93
$1 389,62
$1 447,56
$1 653,37
$309,93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$810,28
$919,66
$1 035,54
$1 447,16
$2 199,10
$1 120,21
$1 229,59
$1 345,47
$1 757,09
$1 430,14
$1 539,52
$1 655,40
$2 067,02
$1 740,07
$1 849,45
$1 965,33
$2 376,95
$309,93
Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze (HSA) 1735 ($100+ in Rewards / $4 Condition Care Rx)

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$282,31
$320,42
$360,79
$504,21
$766,19
$498,28
$536,39
$576,76
$720,18
$714,25
$752,36
$792,73
$936,15
$930,22
$968,33
$1 008,70
$1 152,12
$215,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$564,62
$640,84
$721,58
$1 008,42
$1 532,38
$780,59
$856,81
$937,55
$1 224,39
$996,56
$1 072,78
$1 153,52
$1 440,36
$1 212,53
$1 288,75
$1 369,49
$1 656,33
$215,97
Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1736S ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$3,600 $7,200 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$384,88
$436,84
$491,88
$687,40
$1 044,56
$679,31
$731,27
$786,31
$981,83
$973,74
$1 025,70
$1 080,74
$1 276,26
$1 268,17
$1 320,13
$1 375,17
$1 570,69
$294,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$769,76
$873,68
$983,76
$1 374,80
$2 089,12
$1 064,19
$1 168,11
$1 278,19
$1 669,23
$1 358,62
$1 462,54
$1 572,62
$1 963,66
$1 653,05
$1 756,97
$1 867,05
$2 258,09
$294,43
Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 1737S ($0 Virtual Visits / $40 PCP Visits)

Annual Out of Pocket Expenses
Individual Family
$8,150 $16,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$289,19
$328,23
$369,58
$516,49
$784,86
$510,42
$549,46
$590,81
$737,72
$731,65
$770,69
$812,04
$958,95
$952,88
$991,92
$1 033,27
$1 180,18
$221,23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$578,38
$656,46
$739,16
$1 032,98
$1 569,72
$799,61
$877,69
$960,39
$1 254,21
$1 020,84
$1 098,92
$1 181,62
$1 475,44
$1 242,07
$1 320,15
$1 402,85
$1 696,67
$221,23
Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387,04
$439,29
$494,64
$691,25
$1 050,43
$683,13
$735,38
$790,73
$987,34
$979,22
$1 031,47
$1 086,82
$1 283,43
$1 275,31
$1 327,56
$1 382,91
$1 579,52
$296,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774,08
$878,58
$989,28
$1 382,50
$2 100,86
$1 070,17
$1 174,67
$1 285,37
$1 678,59
$1 366,26
$1 470,76
$1 581,46
$1 974,68
$1 662,35
$1 766,85
$1 877,55
$2 270,77
$296,09
Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 2139 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309,06
$350,78
$394,98
$551,98
$838,79
$545,49
$587,21
$631,41
$788,41
$781,92
$823,64
$867,84
$1 024,84
$1 018,35
$1 060,07
$1 104,27
$1 261,27
$236,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618,12
$701,56
$789,96
$1 103,96
$1 677,58
$854,55
$937,99
$1 026,39
$1 340,39
$1 090,98
$1 174,42
$1 262,82
$1 576,82
$1 327,41
$1 410,85
$1 499,25
$1 813,25
$236,43

ADVERTISEMENT

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #27 Ambetter from Sunshine Health
Gold

(EPO) Ambetter Secure Care 5 (2021)

Annual Out of Pocket Expenses
Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386,84
$439,05
$494,37
$690,88
$1 049,85
$682,76
$734,97
$790,29
$986,80
$978,68
$1 030,89
$1 086,21
$1 282,72
$1 274,60
$1 326,81
$1 382,13
$1 578,64
$295,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773,68
$878,10
$988,74
$1 381,76
$2 099,70
$1 069,60
$1 174,02
$1 284,66
$1 677,68
$1 365,52
$1 469,94
$1 580,58
$1 973,60
$1 661,44
$1 765,86
$1 876,50
$2 269,52
$295,92
Toc - Plan #28 Ambetter from Sunshine Health
Bronze

(EPO) Ambetter Essential Care 1 (2021)

Annual Out of Pocket Expenses
Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$270,55
$307,06
$345,75
$483,18
$734,24
$477,51
$514,02
$552,71
$690,14
$684,47
$720,98
$759,67
$897,10
$891,43
$927,94
$966,63
$1 104,06
$206,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541,10
$614,12
$691,50
$966,36
$1 468,48
$748,06
$821,08
$898,46
$1 173,32
$955,02
$1 028,04
$1 105,42
$1 380,28
$1 161,98
$1 235,00
$1 312,38
$1 587,24
$206,96
Toc - Plan #29 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$276,74
$314,08
$353,66
$494,23
$751,04
$488,44
$525,78
$565,36
$705,93
$700,14
$737,48
$777,06
$917,63
$911,84
$949,18
$988,76
$1 129,33
$211,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$553,48
$628,16
$707,32
$988,46
$1 502,08
$765,18
$839,86
$919,02
$1 200,16
$976,88
$1 051,56
$1 130,72
$1 411,86
$1 188,58
$1 263,26
$1 342,42
$1 623,56
$211,70
Toc - Plan #30 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021)

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,24
$314,66
$354,30
$495,13
$752,40
$489,32
$526,74
$566,38
$707,21
$701,40
$738,82
$778,46
$919,29
$913,48
$950,90
$990,54
$1 131,37
$212,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554,48
$629,32
$708,60
$990,26
$1 504,80
$766,56
$841,40
$920,68
$1 202,34
$978,64
$1 053,48
$1 132,76
$1 414,42
$1 190,72
$1 265,56
$1 344,84
$1 626,50
$212,08
Toc - Plan #31 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 4 (2021)

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386,88
$439,09
$494,42
$690,95
$1 049,96
$682,83
$735,04
$790,37
$986,90
$978,78
$1 030,99
$1 086,32
$1 282,85
$1 274,73
$1 326,94
$1 382,27
$1 578,80
$295,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773,76
$878,18
$988,84
$1 381,90
$2 099,92
$1 069,71
$1 174,13
$1 284,79
$1 677,85
$1 365,66
$1 470,08
$1 580,74
$1 973,80
$1 661,61
$1 766,03
$1 876,69
$2 269,75
$295,95
Toc - Plan #32 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 11 (2021)

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$377,28
$428,20
$482,15
$673,81
$1 023,92
$665,89
$716,81
$770,76
$962,42
$954,50
$1 005,42
$1 059,37
$1 251,03
$1 243,11
$1 294,03
$1 347,98
$1 539,64
$288,61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$754,56
$856,40
$964,30
$1 347,62
$2 047,84
$1 043,17
$1 145,01
$1 252,91
$1 636,23
$1 331,78
$1 433,62
$1 541,52
$1 924,84
$1 620,39
$1 722,23
$1 830,13
$2 213,45
$288,61
Toc - Plan #33 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 12 (2021)

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$369,00
$418,81
$471,57
$659,02
$1 001,45
$651,28
$701,09
$753,85
$941,30
$933,56
$983,37
$1 036,13
$1 223,58
$1 215,84
$1 265,65
$1 318,41
$1 505,86
$282,28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$738,00
$837,62
$943,14
$1 318,04
$2 002,90
$1 020,28
$1 119,90
$1 225,42
$1 600,32
$1 302,56
$1 402,18
$1 507,70
$1 882,60
$1 584,84
$1 684,46
$1 789,98
$2 164,88
$282,28
Toc - Plan #34 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 24 (2021)

Annual Out of Pocket Expenses
Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$382,54
$434,18
$488,88
$683,21
$1 038,20
$675,18
$726,82
$781,52
$975,85
$967,82
$1 019,46
$1 074,16
$1 268,49
$1 260,46
$1 312,10
$1 366,80
$1 561,13
$292,64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$765,08
$868,36
$977,76
$1 366,42
$2 076,40
$1 057,72
$1 161,00
$1 270,40
$1 659,06
$1 350,36
$1 453,64
$1 563,04
$1 951,70
$1 643,00
$1 746,28
$1 855,68
$2 244,34
$292,64
Toc - Plan #35 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 29 (2021)

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$365,68
$415,03
$467,32
$653,08
$992,42
$645,42
$694,77
$747,06
$932,82
$925,16
$974,51
$1 026,80
$1 212,56
$1 204,90
$1 254,25
$1 306,54
$1 492,30
$279,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$731,36
$830,06
$934,64
$1 306,16
$1 984,84
$1 011,10
$1 109,80
$1 214,38
$1 585,90
$1 290,84
$1 389,54
$1 494,12
$1 865,64
$1 570,58
$1 669,28
$1 773,86
$2 145,38
$279,74
Toc - Plan #36 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$381,54
$433,03
$487,59
$681,41
$1 035,47
$673,41
$724,90
$779,46
$973,28
$965,28
$1 016,77
$1 071,33
$1 265,15
$1 257,15
$1 308,64
$1 363,20
$1 557,02
$291,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$763,08
$866,06
$975,18
$1 362,82
$2 070,94
$1 054,95
$1 157,93
$1 267,05
$1 654,69
$1 346,82
$1 449,80
$1 558,92
$1 946,56
$1 638,69
$1 741,67
$1 850,79
$2 238,43
$291,87
Toc - Plan #37 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 26 (2021)

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389,01
$441,51
$497,14
$694,75
$1 055,73
$686,59
$739,09
$794,72
$992,33
$984,17
$1 036,67
$1 092,30
$1 289,91
$1 281,75
$1 334,25
$1 389,88
$1 587,49
$297,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778,02
$883,02
$994,28
$1 389,50
$2 111,46
$1 075,60
$1 180,60
$1 291,86
$1 687,08
$1 373,18
$1 478,18
$1 589,44
$1 984,66
$1 670,76
$1 775,76
$1 887,02
$2 282,24
$297,58
Toc - Plan #38 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 27 (2021)

Annual Out of Pocket Expenses
Individual Family
$2,750 $5,500 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$406,30
$461,14
$519,24
$725,63
$1 102,67
$717,11
$771,95
$830,05
$1 036,44
$1 027,92
$1 082,76
$1 140,86
$1 347,25
$1 338,73
$1 393,57
$1 451,67
$1 658,06
$310,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812,60
$922,28
$1 038,48
$1 451,26
$2 205,34
$1 123,41
$1 233,09
$1 349,29
$1 762,07
$1 434,22
$1 543,90
$1 660,10
$2 072,88
$1 745,03
$1 854,71
$1 970,91
$2 383,69
$310,81
Toc - Plan #39 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 28 (2021)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413,88
$469,74
$528,93
$739,17
$1 123,25
$730,49
$786,35
$845,54
$1 055,78
$1 047,10
$1 102,96
$1 162,15
$1 372,39
$1 363,71
$1 419,57
$1 478,76
$1 689,00
$316,61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827,76
$939,48
$1 057,86
$1 478,34
$2 246,50
$1 144,37
$1 256,09
$1 374,47
$1 794,95
$1 460,98
$1 572,70
$1 691,08
$2 111,56
$1 777,59
$1 889,31
$2 007,69
$2 428,17
$316,61
Toc - Plan #40 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383,53
$435,29
$490,14
$684,96
$1 040,87
$676,92
$728,68
$783,53
$978,35
$970,31
$1 022,07
$1 076,92
$1 271,74
$1 263,70
$1 315,46
$1 370,31
$1 565,13
$293,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$767,06
$870,58
$980,28
$1 369,92
$2 081,74
$1 060,45
$1 163,97
$1 273,67
$1 663,31
$1 353,84
$1 457,36
$1 567,06
$1 956,70
$1 647,23
$1 750,75
$1 860,45
$2 250,09
$293,39
Toc - Plan #41 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$287,63
$326,45
$367,58
$513,69
$780,60
$507,66
$546,48
$587,61
$733,72
$727,69
$766,51
$807,64
$953,75
$947,72
$986,54
$1 027,67
$1 173,78
$220,03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$575,26
$652,90
$735,16
$1 027,38
$1 561,20
$795,29
$872,93
$955,19
$1 247,41
$1 015,32
$1 092,96
$1 175,22
$1 467,44
$1 235,35
$1 312,99
$1 395,25
$1 687,47
$220,03
Toc - Plan #42 Ambetter from Sunshine Health
Gold

(EPO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$402,06
$456,33
$513,83
$718,07
$1 091,18
$709,63
$763,90
$821,40
$1 025,64
$1 017,20
$1 071,47
$1 128,97
$1 333,21
$1 324,77
$1 379,04
$1 436,54
$1 640,78
$307,57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$804,12
$912,66
$1 027,66
$1 436,14
$2 182,36
$1 111,69
$1 220,23
$1 335,23
$1 743,71
$1 419,26
$1 527,80
$1 642,80
$2 051,28
$1 726,83
$1 835,37
$1 950,37
$2 358,85
$307,57
Toc - Plan #43 Ambetter from Sunshine Health
Bronze

(EPO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$281,19
$319,14
$359,35
$502,20
$763,14
$496,30
$534,25
$574,46
$717,31
$711,41
$749,36
$789,57
$932,42
$926,52
$964,47
$1 004,68
$1 147,53
$215,11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$562,38
$638,28
$718,70
$1 004,40
$1 526,28
$777,49
$853,39
$933,81
$1 219,51
$992,60
$1 068,50
$1 148,92
$1 434,62
$1 207,71
$1 283,61
$1 364,03
$1 649,73
$215,11
Toc - Plan #44 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$288,15
$327,04
$368,24
$514,62
$782,01
$508,58
$547,47
$588,67
$735,05
$729,01
$767,90
$809,10
$955,48
$949,44
$988,33
$1 029,53
$1 175,91
$220,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$576,30
$654,08
$736,48
$1 029,24
$1 564,02
$796,73
$874,51
$956,91
$1 249,67
$1 017,16
$1 094,94
$1 177,34
$1 470,10
$1 237,59
$1 315,37
$1 397,77
$1 690,53
$220,43
Toc - Plan #45 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 4 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$402,10
$456,38
$513,88
$718,14
$1 091,29
$709,70
$763,98
$821,48
$1 025,74
$1 017,30
$1 071,58
$1 129,08
$1 333,34
$1 324,90
$1 379,18
$1 436,68
$1 640,94
$307,60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$804,20
$912,76
$1 027,76
$1 436,28
$2 182,58
$1 111,80
$1 220,36
$1 335,36
$1 743,88
$1 419,40
$1 527,96
$1 642,96
$2 051,48
$1 727,00
$1 835,56
$1 950,56
$2 359,08
$307,60
Toc - Plan #46 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$392,13
$445,06
$501,13
$700,33
$1 064,22
$692,10
$745,03
$801,10
$1 000,30
$992,07
$1 045,00
$1 101,07
$1 300,27
$1 292,04
$1 344,97
$1 401,04
$1 600,24
$299,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$784,26
$890,12
$1 002,26
$1 400,66
$2 128,44
$1 084,23
$1 190,09
$1 302,23
$1 700,63
$1 384,20
$1 490,06
$1 602,20
$2 000,60
$1 684,17
$1 790,03
$1 902,17
$2 300,57
$299,97
Toc - Plan #47 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 24 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$397,60
$451,27
$508,12
$710,10
$1 079,06
$701,76
$755,43
$812,28
$1 014,26
$1 005,92
$1 059,59
$1 116,44
$1 318,42
$1 310,08
$1 363,75
$1 420,60
$1 622,58
$304,16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$795,20
$902,54
$1 016,24
$1 420,20
$2 158,12
$1 099,36
$1 206,70
$1 320,40
$1 724,36
$1 403,52
$1 510,86
$1 624,56
$2 028,52
$1 707,68
$1 815,02
$1 928,72
$2 332,68
$304,16
Toc - Plan #48 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$396,56
$450,08
$506,79
$708,23
$1 076,23
$699,92
$753,44
$810,15
$1 011,59
$1 003,28
$1 056,80
$1 113,51
$1 314,95
$1 306,64
$1 360,16
$1 416,87
$1 618,31
$303,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$793,12
$900,16
$1 013,58
$1 416,46
$2 152,46
$1 096,48
$1 203,52
$1 316,94
$1 719,82
$1 399,84
$1 506,88
$1 620,30
$2 023,18
$1 703,20
$1 810,24
$1 923,66
$2 326,54
$303,36
Toc - Plan #49 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$404,32
$458,89
$516,70
$722,09
$1 097,29
$713,61
$768,18
$825,99
$1 031,38
$1 022,90
$1 077,47
$1 135,28
$1 340,67
$1 332,19
$1 386,76
$1 444,57
$1 649,96
$309,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808,64
$917,78
$1 033,40
$1 444,18
$2 194,58
$1 117,93
$1 227,07
$1 342,69
$1 753,47
$1 427,22
$1 536,36
$1 651,98
$2 062,76
$1 736,51
$1 845,65
$1 961,27
$2 372,05
$309,29
Toc - Plan #50 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 27 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$2,750 $5,500 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$422,29
$479,29
$539,67
$754,19
$1 146,07
$745,33
$802,33
$862,71
$1 077,23
$1 068,37
$1 125,37
$1 185,75
$1 400,27
$1 391,41
$1 448,41
$1 508,79
$1 723,31
$323,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844,58
$958,58
$1 079,34
$1 508,38
$2 292,14
$1 167,62
$1 281,62
$1 402,38
$1 831,42
$1 490,66
$1 604,66
$1 725,42
$2 154,46
$1 813,70
$1 927,70
$2 048,46
$2 477,50
$323,04
Toc - Plan #51 Ambetter from Sunshine Health
Silver

(EPO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$430,17
$488,23
$549,75
$768,27
$1 167,46
$759,24
$817,30
$878,82
$1 097,34
$1 088,31
$1 146,37
$1 207,89
$1 426,41
$1 417,38
$1 475,44
$1 536,96
$1 755,48
$329,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$860,34
$976,46
$1 099,50
$1 536,54
$2 334,92
$1 189,41
$1 305,53
$1 428,57
$1 865,61
$1 518,48
$1 634,60
$1 757,64
$2 194,68
$1 847,55
$1 963,67
$2 086,71
$2 523,75
$329,07

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Toc - Plan #52 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) BlueCare Silver 1490 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,950 $11,900 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$602,88
$684,27
$770,48
$1 076,74
$1 636,22
$1 064,08
$1 145,47
$1 231,68
$1 537,94
$1 525,28
$1 606,67
$1 692,88
$1 999,14
$1 986,48
$2 067,87
$2 154,08
$2 460,34
$461,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 205,76
$1 368,54
$1 540,96
$2 153,48
$3 272,44
$1 666,96
$1 829,74
$2 002,16
$2 614,68
$2 128,16
$2 290,94
$2 463,36
$3 075,88
$2 589,36
$2 752,14
$2 924,56
$3 537,08
$461,20
Toc - Plan #53 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze

(HMO) BlueCare Bronze 1486 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$382,27
$433,88
$488,54
$682,73
$1 037,48
$674,71
$726,32
$780,98
$975,17
$967,15
$1 018,76
$1 073,42
$1 267,61
$1 259,59
$1 311,20
$1 365,86
$1 560,05
$292,44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$764,54
$867,76
$977,08
$1 365,46
$2 074,96
$1 056,98
$1 160,20
$1 269,52
$1 657,90
$1 349,42
$1 452,64
$1 561,96
$1 950,34
$1 641,86
$1 745,08
$1 854,40
$2 242,78
$292,44
Toc - Plan #54 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) BlueCare Silver 1498 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$5,600 $11,200 Annual Deductible
$7,800 $15,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$607,89
$689,96
$776,88
$1 085,69
$1 649,81
$1 072,93
$1 155,00
$1 241,92
$1 550,73
$1 537,97
$1 620,04
$1 706,96
$2 015,77
$2 003,01
$2 085,08
$2 172,00
$2 480,81
$465,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 215,78
$1 379,92
$1 553,76
$2 171,38
$3 299,62
$1 680,82
$1 844,96
$2 018,80
$2 636,42
$2 145,86
$2 310,00
$2 483,84
$3 101,46
$2 610,90
$2 775,04
$2 948,88
$3 566,50
$465,04
Toc - Plan #55 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) BlueCare Platinum 1485 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,250 $2,500 Annual Deductible
$4,250 $8,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$656,64
$745,29
$839,19
$1 172,76
$1 782,12
$1 158,97
$1 247,62
$1 341,52
$1 675,09
$1 661,30
$1 749,95
$1 843,85
$2 177,42
$2 163,63
$2 252,28
$2 346,18
$2 679,75
$502,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 313,28
$1 490,58
$1 678,38
$2 345,52
$3 564,24
$1 815,61
$1 992,91
$2 180,71
$2 847,85
$2 317,94
$2 495,24
$2 683,04
$3 350,18
$2 820,27
$2 997,57
$3 185,37
$3 852,51
$502,33
Toc - Plan #56 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) BlueCare Bronze 1483 ($0 Virtual Visits / 3 PCP Visits for $20)

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$424,49
$481,80
$542,50
$758,14
$1 152,07
$749,22
$806,53
$867,23
$1 082,87
$1 073,95
$1 131,26
$1 191,96
$1 407,60
$1 398,68
$1 455,99
$1 516,69
$1 732,33
$324,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$848,98
$963,60
$1 085,00
$1 516,28
$2 304,14
$1 173,71
$1 288,33
$1 409,73
$1 841,01
$1 498,44
$1 613,06
$1 734,46
$2 165,74
$1 823,17
$1 937,79
$2 059,19
$2 490,47
$324,73
Toc - Plan #57 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) BlueCare Platinum 1491 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$708,75
$804,43
$905,78
$1 265,83
$1 923,55
$1 250,94
$1 346,62
$1 447,97
$1 808,02
$1 793,13
$1 888,81
$1 990,16
$2 350,21
$2 335,32
$2 431,00
$2 532,35
$2 892,40
$542,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 417,50
$1 608,86
$1 811,56
$2 531,66
$3 847,10
$1 959,69
$2 151,05
$2 353,75
$3 073,85
$2 501,88
$2 693,24
$2 895,94
$3 616,04
$3 044,07
$3 235,43
$3 438,13
$4 158,23
$542,19
Toc - Plan #58 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) BlueCare Silver 1477 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$515,46
$585,05
$658,76
$920,61
$1 398,96
$909,79
$979,38
$1 053,09
$1 314,94
$1 304,12
$1 373,71
$1 447,42
$1 709,27
$1 698,45
$1 768,04
$1 841,75
$2 103,60
$394,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 030,92
$1 170,10
$1 317,52
$1 841,22
$2 797,92
$1 425,25
$1 564,43
$1 711,85
$2 235,55
$1 819,58
$1 958,76
$2 106,18
$2 629,88
$2 213,91
$2 353,09
$2 500,51
$3 024,21
$394,33
Toc - Plan #59 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) BlueCare Gold 1565 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$606,20
$688,04
$774,72
$1 082,67
$1 645,23
$1 069,94
$1 151,78
$1 238,46
$1 546,41
$1 533,68
$1 615,52
$1 702,20
$2 010,15
$1 997,42
$2 079,26
$2 165,94
$2 473,89
$463,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 212,40
$1 376,08
$1 549,44
$2 165,34
$3 290,46
$1 676,14
$1 839,82
$2 013,18
$2 629,08
$2 139,88
$2 303,56
$2 476,92
$3 092,82
$2 603,62
$2 767,30
$2 940,66
$3 556,56
$463,74
Toc - Plan #60 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) BlueCare Bronze (HSA) 1765 ($100+ in Rewards / $4 Condition Care Rx)

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$403,88
$458,40
$516,16
$721,33
$1 096,13
$712,85
$767,37
$825,13
$1 030,30
$1 021,82
$1 076,34
$1 134,10
$1 339,27
$1 330,79
$1 385,31
$1 443,07
$1 648,24
$308,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$807,76
$916,80
$1 032,32
$1 442,66
$2 192,26
$1 116,73
$1 225,77
$1 341,29
$1 751,63
$1 425,70
$1 534,74
$1 650,26
$2 060,60
$1 734,67
$1 843,71
$1 959,23
$2 369,57
$308,97
Toc - Plan #61 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) BlueCare Silver 1766S ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$3,600 $7,200 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$598,16
$678,91
$764,45
$1 068,31
$1 623,41
$1 055,75
$1 136,50
$1 222,04
$1 525,90
$1 513,34
$1 594,09
$1 679,63
$1 983,49
$1 970,93
$2 051,68
$2 137,22
$2 441,08
$457,59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 196,32
$1 357,82
$1 528,90
$2 136,62
$3 246,82
$1 653,91
$1 815,41
$1 986,49
$2 594,21
$2 111,50
$2 273,00
$2 444,08
$3 051,80
$2 569,09
$2 730,59
$2 901,67
$3 509,39
$457,59
Toc - Plan #62 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) BlueCare Bronze 1767S ($0 Virtual Visits / $40 PCP Visits)

Annual Out of Pocket Expenses
Individual Family
$8,150 $16,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$422,29
$479,30
$539,69
$754,21
$1 146,10
$745,34
$802,35
$862,74
$1 077,26
$1 068,39
$1 125,40
$1 185,79
$1 400,31
$1 391,44
$1 448,45
$1 508,84
$1 723,36
$323,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844,58
$958,60
$1 079,38
$1 508,42
$2 292,20
$1 167,63
$1 281,65
$1 402,43
$1 831,47
$1 490,68
$1 604,70
$1 725,48
$2 154,52
$1 813,73
$1 927,75
$2 048,53
$2 477,57
$323,05
Toc - Plan #63 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) BlueCare Gold 1865 ($0 Virtual Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$581,27
$659,74
$742,86
$1 038,15
$1 577,57
$1 025,94
$1 104,41
$1 187,53
$1 482,82
$1 470,61
$1 549,08
$1 632,20
$1 927,49
$1 915,28
$1 993,75
$2 076,87
$2 372,16
$444,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 162,54
$1 319,48
$1 485,72
$2 076,30
$3 155,14
$1 607,21
$1 764,15
$1 930,39
$2 520,97
$2 051,88
$2 208,82
$2 375,06
$2 965,64
$2 496,55
$2 653,49
$2 819,73
$3 410,31
$444,67
Toc - Plan #64 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) BlueCare Bronze 2179 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$463,11
$525,63
$591,85
$827,11
$1 256,88
$817,39
$879,91
$946,13
$1 181,39
$1 171,67
$1 234,19
$1 300,41
$1 535,67
$1 525,95
$1 588,47
$1 654,69
$1 889,95
$354,28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$926,22
$1 051,26
$1 183,70
$1 654,22
$2 513,76
$1 280,50
$1 405,54
$1 537,98
$2 008,50
$1 634,78
$1 759,82
$1 892,26
$2 362,78
$1 989,06
$2 114,10
$2 246,54
$2 717,06
$354,28

ADVERTISEMENT

Health First Commercial Plans, Inc.

Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771

Toc - Plan #65 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 100 HSA 1658

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$292,57
$332,07
$373,91
$522,54
$794,05
$516,39
$555,89
$597,73
$746,36
$740,21
$779,71
$821,55
$970,18
$964,03
$1 003,53
$1 045,37
$1 194,00
$223,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$585,14
$664,14
$747,82
$1 045,08
$1 588,10
$808,96
$887,96
$971,64
$1 268,90
$1 032,78
$1 111,78
$1 195,46
$1 492,72
$1 256,60
$1 335,60
$1 419,28
$1 716,54
$223,82
Toc - Plan #66 Health First Commercial Plans, Inc.
Silver

(HMO) Health First GYM ACCESS Silver HMO 100 1664

Annual Out of Pocket Expenses
Individual Family
$5,750 $11,500 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411,94
$467,55
$526,46
$735,73
$1 118,01
$727,08
$782,69
$841,60
$1 050,87
$1 042,22
$1 097,83
$1 156,74
$1 366,01
$1 357,36
$1 412,97
$1 471,88
$1 681,15
$315,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$823,88
$935,10
$1 052,92
$1 471,46
$2 236,02
$1 139,02
$1 250,24
$1 368,06
$1 786,60
$1 454,16
$1 565,38
$1 683,20
$2 101,74
$1 769,30
$1 880,52
$1 998,34
$2 416,88
$315,14
Toc - Plan #67 Health First Commercial Plans, Inc.
Silver

(HMO) Health First GYM ACCESS Silver HMO 80 1688

Annual Out of Pocket Expenses
Individual Family
$4,950 $9,900 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$403,38
$457,84
$515,52
$720,44
$1 094,78
$711,97
$766,43
$824,11
$1 029,03
$1 020,56
$1 075,02
$1 132,70
$1 337,62
$1 329,15
$1 383,61
$1 441,29
$1 646,21
$308,59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806,76
$915,68
$1 031,04
$1 440,88
$2 189,56
$1 115,35
$1 224,27
$1 339,63
$1 749,47
$1 423,94
$1 532,86
$1 648,22
$2 058,06
$1 732,53
$1 841,45
$1 956,81
$2 366,65
$308,59
Toc - Plan #68 Health First Commercial Plans, Inc.
Gold

(HMO) Health First GYM ACCESS Gold HMO 100 1736

Annual Out of Pocket Expenses
Individual Family
$2,650 $5,300 Annual Deductible
$6,800 $13,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$377,56
$428,53
$482,52
$674,32
$1 024,69
$666,39
$717,36
$771,35
$963,15
$955,22
$1 006,19
$1 060,18
$1 251,98
$1 244,05
$1 295,02
$1 349,01
$1 540,81
$288,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755,12
$857,06
$965,04
$1 348,64
$2 049,38
$1 043,95
$1 145,89
$1 253,87
$1 637,47
$1 332,78
$1 434,72
$1 542,70
$1 926,30
$1 621,61
$1 723,55
$1 831,53
$2 215,13
$288,83
Toc - Plan #69 Health First Commercial Plans, Inc.
Gold

(HMO) Health First GYM ACCESS Gold HMO 80 1740

Annual Out of Pocket Expenses
Individual Family
$2,900 $5,800 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$367,58
$417,21
$469,77
$656,51
$997,62
$648,78
$698,41
$750,97
$937,71
$929,98
$979,61
$1 032,17
$1 218,91
$1 211,18
$1 260,81
$1 313,37
$1 500,11
$281,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735,16
$834,42
$939,54
$1 313,02
$1 995,24
$1 016,36
$1 115,62
$1 220,74
$1 594,22
$1 297,56
$1 396,82
$1 501,94
$1 875,42
$1 578,76
$1 678,02
$1 783,14
$2 156,62
$281,20
Toc - Plan #70 Health First Commercial Plans, Inc.
Gold

(HMO) Health First GYM ACCESS Gold HMO 70 1742

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,150 $10,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386,34
$438,50
$493,75
$690,01
$1 048,53
$681,89
$734,05
$789,30
$985,56
$977,44
$1 029,60
$1 084,85
$1 281,11
$1 272,99
$1 325,15
$1 380,40
$1 576,66
$295,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772,68
$877,00
$987,50
$1 380,02
$2 097,06
$1 068,23
$1 172,55
$1 283,05
$1 675,57
$1 363,78
$1 468,10
$1 578,60
$1 971,12
$1 659,33
$1 763,65
$1 874,15
$2 266,67
$295,55
Toc - Plan #71 Health First Commercial Plans, Inc.
Gold

(HMO) Health First GYM ACCESS Gold HMO 90 HSA 1744

Annual Out of Pocket Expenses
Individual Family
$1,700 $3,400 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$385,29
$437,30
$492,40
$688,13
$1 045,67
$680,04
$732,05
$787,15
$982,88
$974,79
$1 026,80
$1 081,90
$1 277,63
$1 269,54
$1 321,55
$1 376,65
$1 572,38
$294,75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$770,58
$874,60
$984,80
$1 376,26
$2 091,34
$1 065,33
$1 169,35
$1 279,55
$1 671,01
$1 360,08
$1 464,10
$1 574,30
$1 965,76
$1 654,83
$1 758,85
$1 869,05
$2 260,51
$294,75
Toc - Plan #72 Health First Commercial Plans, Inc.
Catastrophic

(HMO) Health First GYM ACCESS Catastrophic HMO 1746

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$156,72
$177,88
$200,29
$279,91
$425,35
$276,61
$297,77
$320,18
$399,80
$396,50
$417,66
$440,07
$519,69
$516,39
$537,55
$559,96
$639,58
$119,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$313,44
$355,76
$400,58
$559,82
$850,70
$433,33
$475,65
$520,47
$679,71
$553,22
$595,54
$640,36
$799,60
$673,11
$715,43
$760,25
$919,49
$119,89
Toc - Plan #73 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 50 1796

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$284,16
$322,53
$363,16
$507,52
$771,22
$501,54
$539,91
$580,54
$724,90
$718,92
$757,29
$797,92
$942,28
$936,30
$974,67
$1 015,30
$1 159,66
$217,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$568,32
$645,06
$726,32
$1 015,04
$1 542,44
$785,70
$862,44
$943,70
$1 232,42
$1 003,08
$1 079,82
$1 161,08
$1 449,80
$1 220,46
$1 297,20
$1 378,46
$1 667,18
$217,38
Toc - Plan #74 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First GYM ACCESS Bronze HMO 60 1656

Annual Out of Pocket Expenses
Individual Family
$7,550 $15,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$288,62
$327,58
$368,86
$515,48
$783,32
$509,41
$548,37
$589,65
$736,27
$730,20
$769,16
$810,44
$957,06
$950,99
$989,95
$1 031,23
$1 177,85
$220,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$577,24
$655,16
$737,72
$1 030,96
$1 566,64
$798,03
$875,95
$958,51
$1 251,75
$1 018,82
$1 096,74
$1 179,30
$1 472,54
$1 239,61
$1 317,53
$1 400,09
$1 693,33
$220,79
Toc - Plan #75 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First Bronze HMO 60 1750

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$284,11
$322,46
$363,09
$507,42
$771,07
$501,45
$539,80
$580,43
$724,76
$718,79
$757,14
$797,77
$942,10
$936,13
$974,48
$1 015,11
$1 159,44
$217,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$568,22
$644,92
$726,18
$1 014,84
$1 542,14
$785,56
$862,26
$943,52
$1 232,18
$1 002,90
$1 079,60
$1 160,86
$1 449,52
$1 220,24
$1 296,94
$1 378,20
$1 666,86
$217,34
Toc - Plan #76 Health First Commercial Plans, Inc.
Gold

(HMO) Health First Gold HMO 80 1770

Annual Out of Pocket Expenses
Individual Family
$1,600 $3,200 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$369,14
$418,98
$471,76
$659,29
$1 001,85
$651,53
$701,37
$754,15
$941,68
$933,92
$983,76
$1 036,54
$1 224,07
$1 216,31
$1 266,15
$1 318,93
$1 506,46
$282,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$738,28
$837,96
$943,52
$1 318,58
$2 003,70
$1 020,67
$1 120,35
$1 225,91
$1 600,97
$1 303,06
$1 402,74
$1 508,30
$1 883,36
$1 585,45
$1 685,13
$1 790,69
$2 165,75
$282,39
Toc - Plan #77 Health First Commercial Plans, Inc.
Bronze

(HMO) Health First Bronze HMO 100 1774

Annual Out of Pocket Expenses
Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$278,81
$316,45
$356,32
$497,96
$756,69
$492,10
$529,74
$569,61
$711,25
$705,39
$743,03
$782,90
$924,54
$918,68
$956,32
$996,19
$1 137,83
$213,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$557,62
$632,90
$712,64
$995,92
$1 513,38
$770,91
$846,19
$925,93
$1 209,21
$984,20
$1 059,48
$1 139,22
$1 422,50
$1 197,49
$1 272,77
$1 352,51
$1 635,79
$213,29
Toc - Plan #78 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First Bronze HMO 100 HSA 1794

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$289,20
$328,24
$369,59
$516,51
$784,88
$510,44
$549,48
$590,83
$737,75
$731,68
$770,72
$812,07
$958,99
$952,92
$991,96
$1 033,31
$1 180,23
$221,24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$578,40
$656,48
$739,18
$1 033,02
$1 569,76
$799,64
$877,72
$960,42
$1 254,26
$1 020,88
$1 098,96
$1 181,66
$1 475,50
$1 242,12
$1 320,20
$1 402,90
$1 696,74
$221,24
Toc - Plan #79 Health First Commercial Plans, Inc.
Silver

(HMO) Health First Silver HMO 65 1806

Annual Out of Pocket Expenses
Individual Family
$2,900 $5,800 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$396,73
$450,29
$507,02
$708,56
$1 076,73
$700,23
$753,79
$810,52
$1 012,06
$1 003,73
$1 057,29
$1 114,02
$1 315,56
$1 307,23
$1 360,79
$1 417,52
$1 619,06
$303,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$793,46
$900,58
$1 014,04
$1 417,12
$2 153,46
$1 096,96
$1 204,08
$1 317,54
$1 720,62
$1 400,46
$1 507,58
$1 621,04
$2 024,12
$1 703,96
$1 811,08
$1 924,54
$2 327,62
$303,50
Toc - Plan #80 Health First Commercial Plans, Inc.
Expanded Bronze

(HMO) Health First Bronze VALUE 60 1814

Annual Out of Pocket Expenses
Individual Family
$8,300 $16,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$257,02
$291,72
$328,47
$459,04
$697,55
$453,64
$488,34
$525,09
$655,66
$650,26
$684,96
$721,71
$852,28
$846,88
$881,58
$918,33
$1 048,90
$196,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$514,04
$583,44
$656,94
$918,08
$1 395,10
$710,66
$780,06
$853,56
$1 114,70
$907,28
$976,68
$1 050,18
$1 311,32
$1 103,90
$1 173,30
$1 246,80
$1 507,94
$196,62
Toc - Plan #81 Health First Commercial Plans, Inc.
Silver

(HMO) Health First Silver VALUE 80 1815

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$341,82
$387,97
$436,85
$610,49
$927,70
$603,31
$649,46
$698,34
$871,98
$864,80
$910,95
$959,83
$1 133,47
$1 126,29
$1 172,44
$1 221,32
$1 394,96
$261,49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$683,64
$775,94
$873,70
$1 220,98
$1 855,40
$945,13
$1 037,43
$1 135,19
$1 482,47
$1 206,62
$1 298,92
$1 396,68
$1 743,96
$1 468,11
$1 560,41
$1 658,17
$2 005,45
$261,49
Toc - Plan #82 Health First Commercial Plans, Inc.
Gold

(HMO) Health First Gold VALUE 80 1819

Annual Out of Pocket Expenses
Individual Family
$2,900 $5,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363,59
$412,67
$464,66
$649,37
$986,77
$641,73
$690,81
$742,80
$927,51
$919,87
$968,95
$1 020,94
$1 205,65
$1 198,01
$1 247,09
$1 299,08
$1 483,79
$278,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727,18
$825,34
$929,32
$1 298,74
$1 973,54
$1 005,32
$1 103,48
$1 207,46
$1 576,88
$1 283,46
$1 381,62
$1 485,60
$1 855,02
$1 561,60
$1 659,76
$1 763,74
$2 133,16
$278,14

ADVERTISEMENT

Oscar Insurance Company of Florida

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #83 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze Simple

Annual Out of Pocket Expenses
Individual Family
$7,300 $14,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$260,73
$295,92
$333,20
$465,65
$707,60
$460,18
$495,37
$532,65
$665,10
$659,63
$694,82
$732,10
$864,55
$859,08
$894,27
$931,55
$1 064,00
$199,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$521,46
$591,84
$666,40
$931,30
$1 415,20
$720,91
$791,29
$865,85
$1 130,75
$920,36
$990,74
$1 065,30
$1 330,20
$1 119,81
$1 190,19
$1 264,75
$1 529,65
$199,45
Toc - Plan #84 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze Classic PCP Copay

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$272,26
$309,00
$347,94
$486,24
$738,89
$480,53
$517,27
$556,21
$694,51
$688,80
$725,54
$764,48
$902,78
$897,07
$933,81
$972,75
$1 111,05
$208,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$544,52
$618,00
$695,88
$972,48
$1 477,78
$752,79
$826,27
$904,15
$1 180,75
$961,06
$1 034,54
$1 112,42
$1 389,02
$1 169,33
$1 242,81
$1 320,69
$1 597,29
$208,27
Toc - Plan #85 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze Classic

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$263,36
$298,90
$336,56
$470,34
$714,73
$464,82
$500,36
$538,02
$671,80
$666,28
$701,82
$739,48
$873,26
$867,74
$903,28
$940,94
$1 074,72
$201,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$526,72
$597,80
$673,12
$940,68
$1 429,46
$728,18
$799,26
$874,58
$1 142,14
$929,64
$1 000,72
$1 076,04
$1 343,60
$1 131,10
$1 202,18
$1 277,50
$1 545,06
$201,46
Toc - Plan #86 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze Classic Next

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$310,22
$352,09
$396,45
$554,03
$841,91
$547,53
$589,40
$633,76
$791,34
$784,84
$826,71
$871,07
$1 028,65
$1 022,15
$1 064,02
$1 108,38
$1 265,96
$237,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$620,44
$704,18
$792,90
$1 108,06
$1 683,82
$857,75
$941,49
$1 030,21
$1 345,37
$1 095,06
$1 178,80
$1 267,52
$1 582,68
$1 332,37
$1 416,11
$1 504,83
$1 819,99
$237,31
Toc - Plan #87 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Classic

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344,11
$390,56
$439,76
$614,57
$933,90
$607,35
$653,80
$703,00
$877,81
$870,59
$917,04
$966,24
$1 141,05
$1 133,83
$1 180,28
$1 229,48
$1 404,29
$263,24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$688,22
$781,12
$879,52
$1 229,14
$1 867,80
$951,46
$1 044,36
$1 142,76
$1 492,38
$1 214,70
$1 307,60
$1 406,00
$1 755,62
$1 477,94
$1 570,84
$1 669,24
$2 018,86
$263,24
Toc - Plan #88 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Saver 2

Annual Out of Pocket Expenses
Individual Family
$6,200 $12,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340,41
$386,36
$435,04
$607,96
$923,86
$600,82
$646,77
$695,45
$868,37
$861,23
$907,18
$955,86
$1 128,78
$1 121,64
$1 167,59
$1 216,27
$1 389,19
$260,41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680,82
$772,72
$870,08
$1 215,92
$1 847,72
$941,23
$1 033,13
$1 130,49
$1 476,33
$1 201,64
$1 293,54
$1 390,90
$1 736,74
$1 462,05
$1 553,95
$1 651,31
$1 997,15
$260,41
Toc - Plan #89 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Classic Next

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$342,99
$389,29
$438,33
$612,57
$930,86
$605,37
$651,67
$700,71
$874,95
$867,75
$914,05
$963,09
$1 137,33
$1 130,13
$1 176,43
$1 225,47
$1 399,71
$262,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685,98
$778,58
$876,66
$1 225,14
$1 861,72
$948,36
$1 040,96
$1 139,04
$1 487,52
$1 210,74
$1 303,34
$1 401,42
$1 749,90
$1 473,12
$1 565,72
$1 663,80
$2 012,28
$262,38
Toc - Plan #90 Oscar Insurance Company of Florida
Catastrophic

(EPO) Oscar Secure

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$214,16
$243,06
$273,68
$382,47
$581,20
$377,98
$406,88
$437,50
$546,29
$541,80
$570,70
$601,32
$710,11
$705,62
$734,52
$765,14
$873,93
$163,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$428,32
$486,12
$547,36
$764,94
$1 162,40
$592,14
$649,94
$711,18
$928,76
$755,96
$813,76
$875,00
$1 092,58
$919,78
$977,58
$1 038,82
$1 256,40
$163,82
Toc - Plan #91 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze Classic Next 2

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$310,81
$352,76
$397,21
$555,10
$843,52
$548,57
$590,52
$634,97
$792,86
$786,33
$828,28
$872,73
$1 030,62
$1 024,09
$1 066,04
$1 110,49
$1 268,38
$237,76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$621,62
$705,52
$794,42
$1 110,20
$1 687,04
$859,38
$943,28
$1 032,18
$1 347,96
$1 097,14
$1 181,04
$1 269,94
$1 585,72
$1 334,90
$1 418,80
$1 507,70
$1 823,48
$237,76
Toc - Plan #92 Oscar Insurance Company of Florida
Gold

(EPO) Oscar Gold Classic

Annual Out of Pocket Expenses
Individual Family
$2,500 $5,000 Annual Deductible
$6,000 $12,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362,32
$411,22
$463,03
$647,09
$983,31
$639,49
$688,39
$740,20
$924,26
$916,66
$965,56
$1 017,37
$1 201,43
$1 193,83
$1 242,73
$1 294,54
$1 478,60
$277,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$724,64
$822,44
$926,06
$1 294,18
$1 966,62
$1 001,81
$1 099,61
$1 203,23
$1 571,35
$1 278,98
$1 376,78
$1 480,40
$1 848,52
$1 556,15
$1 653,95
$1 757,57
$2 125,69
$277,17
Toc - Plan #93 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Oscar Bronze HDHP

Annual Out of Pocket Expenses
Individual Family
$5,200 $10,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,27
$314,69
$354,34
$495,18
$752,48
$489,37
$526,79
$566,44
$707,28
$701,47
$738,89
$778,54
$919,38
$913,57
$950,99
$990,64
$1 131,48
$212,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554,54
$629,38
$708,68
$990,36
$1 504,96
$766,64
$841,48
$920,78
$1 202,46
$978,74
$1 053,58
$1 132,88
$1 414,56
$1 190,84
$1 265,68
$1 344,98
$1 626,66
$212,10
Toc - Plan #94 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Saver

Annual Out of Pocket Expenses
Individual Family
$4,200 $8,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$339,67
$385,52
$434,09
$606,64
$921,85
$599,51
$645,36
$693,93
$866,48
$859,35
$905,20
$953,77
$1 126,32
$1 119,19
$1 165,04
$1 213,61
$1 386,16
$259,84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$679,34
$771,04
$868,18
$1 213,28
$1 843,70
$939,18
$1 030,88
$1 128,02
$1 473,12
$1 199,02
$1 290,72
$1 387,86
$1 732,96
$1 458,86
$1 550,56
$1 647,70
$1 992,80
$259,84
Toc - Plan #95 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Classic Copay

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$349,34
$396,49
$446,45
$623,91
$948,09
$616,58
$663,73
$713,69
$891,15
$883,82
$930,97
$980,93
$1 158,39
$1 151,06
$1 198,21
$1 248,17
$1 425,63
$267,24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$698,68
$792,98
$892,90
$1 247,82
$1 896,18
$965,92
$1 060,22
$1 160,14
$1 515,06
$1 233,16
$1 327,46
$1 427,38
$1 782,30
$1 500,40
$1 594,70
$1 694,62
$2 049,54
$267,24
Toc - Plan #96 Oscar Insurance Company of Florida
Silver

(EPO) Oscar Silver Classic $0 Ded

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351,86
$399,35
$449,67
$628,41
$954,92
$621,03
$668,52
$718,84
$897,58
$890,20
$937,69
$988,01
$1 166,75
$1 159,37
$1 206,86
$1 257,18
$1 435,92
$269,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703,72
$798,70
$899,34
$1 256,82
$1 909,84
$972,89
$1 067,87
$1 168,51
$1 525,99
$1 242,06
$1 337,04
$1 437,68
$1 795,16
$1 511,23
$1 606,21
$1 706,85
$2 064,33
$269,17

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Florida Health Care Plans

Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

Toc - Plan #97 Florida Health Care Plans
Catastrophic

(HMO) Gym Access IND Essential Plus Catastrophic HMO 36

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$195,42
$221,81
$249,75
$349,02
$530,37
$344,92
$371,31
$399,25
$498,52
$494,42
$520,81
$548,75
$648,02
$643,92
$670,31
$698,25
$797,52
$149,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$390,84
$443,62
$499,50
$698,04
$1 060,74
$540,34
$593,12
$649,00
$847,54
$689,84
$742,62
$798,50
$997,04
$839,34
$892,12
$948,00
$1 146,54
$149,50
Toc - Plan #98 Florida Health Care Plans
Catastrophic

(POS) Gym Access IND Essential Plus Catastrophic POS 37

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$211,06
$239,55
$269,73
$376,95
$572,80
$372,52
$401,01
$431,19
$538,41
$533,98
$562,47
$592,65
$699,87
$695,44
$723,93
$754,11
$861,33
$161,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$422,12
$479,10
$539,46
$753,90
$1 145,60
$583,58
$640,56
$700,92
$915,36
$745,04
$802,02
$862,38
$1 076,82
$906,50
$963,48
$1 023,84
$1 238,28
$161,46
Toc - Plan #99 Florida Health Care Plans
Silver

(HMO) Gym Access IND Essential Plus Silver HMO 53

Annual Out of Pocket Expenses
Individual Family
$2,900 $5,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$365,63
$414,99
$467,28
$653,02
$992,32
$645,34
$694,70
$746,99
$932,73
$925,05
$974,41
$1 026,70
$1 212,44
$1 204,76
$1 254,12
$1 306,41
$1 492,15
$279,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$731,26
$829,98
$934,56
$1 306,04
$1 984,64
$1 010,97
$1 109,69
$1 214,27
$1 585,75
$1 290,68
$1 389,40
$1 493,98
$1 865,46
$1 570,39
$1 669,11
$1 773,69
$2 145,17
$279,71
Toc - Plan #100 Florida Health Care Plans
Gold

(HMO) Gym Access IND Essential Plus Gold HMO 63

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363,60
$412,68
$464,67
$649,38
$986,79
$641,75
$690,83
$742,82
$927,53
$919,90
$968,98
$1 020,97
$1 205,68
$1 198,05
$1 247,13
$1 299,12
$1 483,83
$278,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727,20
$825,36
$929,34
$1 298,76
$1 973,58
$1 005,35
$1 103,51
$1 207,49
$1 576,91
$1 283,50
$1 381,66
$1 485,64
$1 855,06
$1 561,65
$1 659,81
$1 763,79
$2 133,21
$278,15
Toc - Plan #101 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Essential Plus Platinum HMO 65

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$496,51
$563,54
$634,53
$886,76
$1 347,51
$876,34
$943,37
$1 014,36
$1 266,59
$1 256,17
$1 323,20
$1 394,19
$1 646,42
$1 636,00
$1 703,03
$1 774,02
$2 026,25
$379,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$993,02
$1 127,08
$1 269,06
$1 773,52
$2 695,02
$1 372,85
$1 506,91
$1 648,89
$2 153,35
$1 752,68
$1 886,74
$2 028,72
$2 533,18
$2 132,51
$2 266,57
$2 408,55
$2 913,01
$379,83
Toc - Plan #102 Florida Health Care Plans
Silver

(POS) Gym Access IND Essential Plus Silver POS 54

Annual Out of Pocket Expenses
Individual Family
$2,900 $5,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$377,72
$428,71
$482,72
$674,60
$1 025,12
$666,67
$717,66
$771,67
$963,55
$955,62
$1 006,61
$1 060,62
$1 252,50
$1 244,57
$1 295,56
$1 349,57
$1 541,45
$288,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755,44
$857,42
$965,44
$1 349,20
$2 050,24
$1 044,39
$1 146,37
$1 254,39
$1 638,15
$1 333,34
$1 435,32
$1 543,34
$1 927,10
$1 622,29
$1 724,27
$1 832,29
$2 216,05
$288,95
Toc - Plan #103 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Platinum HMO 4000

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$485,91
$551,51
$620,99
$867,83
$1 318,75
$857,63
$923,23
$992,71
$1 239,55
$1 229,35
$1 294,95
$1 364,43
$1 611,27
$1 601,07
$1 666,67
$1 736,15
$1 982,99
$371,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$971,82
$1 103,02
$1 241,98
$1 735,66
$2 637,50
$1 343,54
$1 474,74
$1 613,70
$2 107,38
$1 715,26
$1 846,46
$1 985,42
$2 479,10
$2 086,98
$2 218,18
$2 357,14
$2 850,82
$371,72
Toc - Plan #104 Florida Health Care Plans
Platinum

(POS) Gym Access IND Platinum POS 4000

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$524,78
$595,63
$670,67
$937,25
$1 424,25
$926,24
$997,09
$1 072,13
$1 338,71
$1 327,70
$1 398,55
$1 473,59
$1 740,17
$1 729,16
$1 800,01
$1 875,05
$2 141,63
$401,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 049,56
$1 191,26
$1 341,34
$1 874,50
$2 848,50
$1 451,02
$1 592,72
$1 742,80
$2 275,96
$1 852,48
$1 994,18
$2 144,26
$2 677,42
$2 253,94
$2 395,64
$2 545,72
$3 078,88
$401,46
Toc - Plan #105 Florida Health Care Plans
Gold

(HMO) Gym Access IND Gold HMO 55001

Annual Out of Pocket Expenses
Individual Family
$2,800 $5,600 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362,67
$411,63
$463,49
$647,73
$984,28
$640,12
$689,08
$740,94
$925,18
$917,57
$966,53
$1 018,39
$1 202,63
$1 195,02
$1 243,98
$1 295,84
$1 480,08
$277,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$725,34
$823,26
$926,98
$1 295,46
$1 968,56
$1 002,79
$1 100,71
$1 204,43
$1 572,91
$1 280,24
$1 378,16
$1 481,88
$1 850,36
$1 557,69
$1 655,61
$1 759,33
$2 127,81
$277,45
Toc - Plan #106 Florida Health Care Plans
Gold

(POS) Gym Access IND Gold POS 55001

Annual Out of Pocket Expenses
Individual Family
$2,800 $5,600 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$391,69
$444,56
$500,57
$699,55
$1 063,03
$691,33
$744,20
$800,21
$999,19
$990,97
$1 043,84
$1 099,85
$1 298,83
$1 290,61
$1 343,48
$1 399,49
$1 598,47
$299,64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$783,38
$889,12
$1 001,14
$1 399,10
$2 126,06
$1 083,02
$1 188,76
$1 300,78
$1 698,74
$1 382,66
$1 488,40
$1 600,42
$1 998,38
$1 682,30
$1 788,04
$1 900,06
$2 298,02
$299,64
Toc - Plan #107 Florida Health Care Plans
Gold

(HMO) Gym Access IND Gold HMO 4500

Annual Out of Pocket Expenses
Individual Family
$2,550 $5,100 Annual Deductible
$4,500 $9,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$364,02
$413,16
$465,21
$650,13
$987,93
$642,49
$691,63
$743,68
$928,60
$920,96
$970,10
$1 022,15
$1 207,07
$1 199,43
$1 248,57
$1 300,62
$1 485,54
$278,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728,04
$826,32
$930,42
$1 300,26
$1 975,86
$1 006,51
$1 104,79
$1 208,89
$1 578,73
$1 284,98
$1 383,26
$1 487,36
$1 857,20
$1 563,45
$1 661,73
$1 765,83
$2 135,67
$278,47
Toc - Plan #108 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO HSA 5065

Annual Out of Pocket Expenses
Individual Family
$6,300 $12,600 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$266,84
$302,86
$341,01
$476,56
$724,18
$470,97
$506,99
$545,14
$680,69
$675,10
$711,12
$749,27
$884,82
$879,23
$915,25
$953,40
$1 088,95
$204,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$533,68
$605,72
$682,02
$953,12
$1 448,36
$737,81
$809,85
$886,15
$1 157,25
$941,94
$1 013,98
$1 090,28
$1 361,38
$1 146,07
$1 218,11
$1 294,41
$1 565,51
$204,13
Toc - Plan #109 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO HSA 6060

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$267,38
$303,48
$341,72
$477,54
$725,67
$471,93
$508,03
$546,27
$682,09
$676,48
$712,58
$750,82
$886,64
$881,03
$917,13
$955,37
$1 091,19
$204,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$534,76
$606,96
$683,44
$955,08
$1 451,34
$739,31
$811,51
$887,99
$1 159,63
$943,86
$1 016,06
$1 092,54
$1 364,18
$1 148,41
$1 220,61
$1 297,09
$1 568,73
$204,55
Toc - Plan #110 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO BC 3841

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$284,48
$322,89
$363,57
$508,09
$772,08
$502,11
$540,52
$581,20
$725,72
$719,74
$758,15
$798,83
$943,35
$937,37
$975,78
$1 016,46
$1 160,98
$217,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$568,96
$645,78
$727,14
$1 016,18
$1 544,16
$786,59
$863,41
$944,77
$1 233,81
$1 004,22
$1 081,04
$1 162,40
$1 451,44
$1 221,85
$1 298,67
$1 380,03
$1 669,07
$217,63
Toc - Plan #111 Florida Health Care Plans
Expanded Bronze

(POS) Gym Access IND Bronze POS BC 3841

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$307,24
$348,72
$392,65
$548,73
$833,85
$542,28
$583,76
$627,69
$783,77
$777,32
$818,80
$862,73
$1 018,81
$1 012,36
$1 053,84
$1 097,77
$1 253,85
$235,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$614,48
$697,44
$785,30
$1 097,46
$1 667,70
$849,52
$932,48
$1 020,34
$1 332,50
$1 084,56
$1 167,52
$1 255,38
$1 567,54
$1 319,60
$1 402,56
$1 490,42
$1 802,58
$235,04
Toc - Plan #112 Florida Health Care Plans
Silver

(HMO) Gym Access IND Silver HMO BC 0941

Annual Out of Pocket Expenses
Individual Family
$5,600 $11,200 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352,96
$400,61
$451,08
$630,39
$957,93
$622,98
$670,63
$721,10
$900,41
$893,00
$940,65
$991,12
$1 170,43
$1 163,02
$1 210,67
$1 261,14
$1 440,45
$270,02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705,92
$801,22
$902,16
$1 260,78
$1 915,86
$975,94
$1 071,24
$1 172,18
$1 530,80
$1 245,96
$1 341,26
$1 442,20
$1 800,82
$1 515,98
$1 611,28
$1 712,22
$2 070,84
$270,02
Toc - Plan #113 Florida Health Care Plans
Silver

(POS) Gym Access IND Silver POS BC 0941

Annual Out of Pocket Expenses
Individual Family
$5,600 $11,200 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$381,20
$432,66
$487,17
$680,82
$1 034,57
$672,82
$724,28
$778,79
$972,44
$964,44
$1 015,90
$1 070,41
$1 264,06
$1 256,06
$1 307,52
$1 362,03
$1 555,68
$291,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$762,40
$865,32
$974,34
$1 361,64
$2 069,14
$1 054,02
$1 156,94
$1 265,96
$1 653,26
$1 345,64
$1 448,56
$1 557,58
$1 944,88
$1 637,26
$1 740,18
$1 849,20
$2 236,50
$291,62
Toc - Plan #114 Florida Health Care Plans
Silver

(HMO) Gym Access IND Silver HMO BC 7741

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$335,67
$380,98
$428,98
$599,50
$910,99
$592,46
$637,77
$685,77
$856,29
$849,25
$894,56
$942,56
$1 113,08
$1 106,04
$1 151,35
$1 199,35
$1 369,87
$256,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$671,34
$761,96
$857,96
$1 199,00
$1 821,98
$928,13
$1 018,75
$1 114,75
$1 455,79
$1 184,92
$1 275,54
$1 371,54
$1 712,58
$1 441,71
$1 532,33
$1 628,33
$1 969,37
$256,79
Toc - Plan #115 Florida Health Care Plans
Silver

(POS) Gym Access IND Silver POS BC 7741

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:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362,52
$411,46
$463,30
$647,45
$983,87
$639,85
$688,79
$740,63
$924,78
$917,18
$966,12
$1 017,96
$1 202,11
$1 194,51
$1 243,45
$1 295,29
$1 479,44
$277,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$725,04
$822,92
$926,60
$1 294,90
$1 967,74
$1 002,37
$1 100,25
$1 203,93
$1 572,23
$1 279,70
$1 377,58
$1 481,26
$1 849,56
$1 557,03
$1 654,91
$1 758,59
$2 126,89
$277,33
Toc - Plan #116 Florida Health Care Plans
Gold

(HMO) Gym Access IND Gold HMO BC 5651

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$5,800 $11,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383,25
$434,99
$489,79
$684,48
$1 040,13
$676,44
$728,18
$782,98
$977,67
$969,63
$1 021,37
$1 076,17
$1 270,86
$1 262,82
$1 314,56
$1 369,36
$1 564,05
$293,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766,50
$869,98
$979,58
$1 368,96
$2 080,26
$1 059,69
$1 163,17
$1 272,77
$1 662,15
$1 352,88
$1 456,36
$1 565,96
$1 955,34
$1 646,07
$1 749,55
$1 859,15
$2 248,53
$293,19
Toc - Plan #117 Florida Health Care Plans
Gold

(POS) Gym Access IND Gold POS BC 5651

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$5,800 $11,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413,91
$469,79
$528,98
$739,24
$1 123,34
$730,55
$786,43
$845,62
$1 055,88
$1 047,19
$1 103,07
$1 162,26
$1 372,52
$1 363,83
$1 419,71
$1 478,90
$1 689,16
$316,64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827,82
$939,58
$1 057,96
$1 478,48
$2 246,68
$1 144,46
$1 256,22
$1 374,60
$1 795,12
$1 461,10
$1 572,86
$1 691,24
$2 111,76
$1 777,74
$1 889,50
$2 007,88
$2 428,40
$316,64
Toc - Plan #118 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Platinum HMO BC 5841

Annual Out of Pocket Expenses
Individual Family
$800 $1,600 Annual Deductible
$2,500 $5,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$476,60
$540,94
$609,09
$851,20
$1 293,48
$841,20
$905,54
$973,69
$1 215,80
$1 205,80
$1 270,14
$1 338,29
$1 580,40
$1 570,40
$1 634,74
$1 702,89
$1 945,00
$364,60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$953,20
$1 081,88
$1 218,18
$1 702,40
$2 586,96
$1 317,80
$1 446,48
$1 582,78
$2 067,00
$1 682,40
$1 811,08
$1 947,38
$2 431,60
$2 047,00
$2 175,68
$2 311,98
$2 796,20
$364,60
Toc - Plan #119 Florida Health Care Plans
Platinum

(POS) Gym Access IND Platinum POS BC 5841

Annual Out of Pocket Expenses
Individual Family
$800 $1,600 Annual Deductible
$2,500 $5,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$514,73
$584,22
$657,82
$919,30
$1 396,96
$908,50
$977,99
$1 051,59
$1 313,07
$1 302,27
$1 371,76
$1 445,36
$1 706,84
$1 696,04
$1 765,53
$1 839,13
$2 100,61
$393,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 029,46
$1 168,44
$1 315,64
$1 838,60
$2 793,92
$1 423,23
$1 562,21
$1 709,41
$2 232,37
$1 817,00
$1 955,98
$2 103,18
$2 626,14
$2 210,77
$2 349,75
$2 496,95
$3 019,91
$393,77
Toc - Plan #120 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Platinum HMO BC 1941

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$496,33
$563,34
$634,31
$886,45
$1 347,04
$876,03
$943,04
$1 014,01
$1 266,15
$1 255,73
$1 322,74
$1 393,71
$1 645,85
$1 635,43
$1 702,44
$1 773,41
$2 025,55
$379,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$992,66
$1 126,68
$1 268,62
$1 772,90
$2 694,08
$1 372,36
$1 506,38
$1 648,32
$2 152,60
$1 752,06
$1 886,08
$2 028,02
$2 532,30
$2 131,76
$2 265,78
$2 407,72
$2 912,00
$379,70
Toc - Plan #121 Florida Health Care Plans
Platinum

(POS) Gym Access IND Platinum POS BC 1941

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$536,04
$608,40
$685,06
$957,36
$1 454,80
$946,11
$1 018,47
$1 095,13
$1 367,43
$1 356,18
$1 428,54
$1 505,20
$1 777,50
$1 766,25
$1 838,61
$1 915,27
$2 187,57
$410,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 072,08
$1 216,80
$1 370,12
$1 914,72
$2 909,60
$1 482,15
$1 626,87
$1 780,19
$2 324,79
$1 892,22
$2 036,94
$2 190,26
$2 734,86
$2 302,29
$2 447,01
$2 600,33
$3 144,93
$410,07
Toc - Plan #122 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Platinum HMO 91

Annual Out of Pocket Expenses
Individual Family
$250 $500 Annual Deductible
$2,500 $5,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$494,46
$561,22
$631,92
$883,11
$1 341,97
$872,73
$939,49
$1 010,19
$1 261,38
$1 251,00
$1 317,76
$1 388,46
$1 639,65
$1 629,27
$1 696,03
$1 766,73
$2 017,92
$378,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$988,92
$1 122,44
$1 263,84
$1 766,22
$2 683,94
$1 367,19
$1 500,71
$1 642,11
$2 144,49
$1 745,46
$1 878,98
$2 020,38
$2 522,76
$2 123,73
$2 257,25
$2 398,65
$2 901,03
$378,27
Toc - Plan #123 Florida Health Care Plans
Platinum

(HMO) Gym Access IND Platinum HMO 92

Annual Out of Pocket Expenses
Individual Family
$500 $1,000 Annual Deductible
$3,000 $6,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$493,32
$559,91
$630,46
$881,06
$1 338,85
$870,71
$937,30
$1 007,85
$1 258,45
$1 248,10
$1 314,69
$1 385,24
$1 635,84
$1 625,49
$1 692,08
$1 762,63
$2 013,23
$377,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$986,64
$1 119,82
$1 260,92
$1 762,12
$2 677,70
$1 364,03
$1 497,21
$1 638,31
$2 139,51
$1 741,42
$1 874,60
$2 015,70
$2 516,90
$2 118,81
$2 251,99
$2 393,09
$2 894,29
$377,39
Toc - Plan #124 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze Standardized HMO

Annual Out of Pocket Expenses
Individual Family
$7,150 $14,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$268,46
$304,71
$343,10
$479,47
$728,60
$473,84
$510,09
$548,48
$684,85
$679,22
$715,47
$753,86
$890,23
$884,60
$920,85
$959,24
$1 095,61
$205,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$536,92
$609,42
$686,20
$958,94
$1 457,20
$742,30
$814,80
$891,58
$1 164,32
$947,68
$1 020,18
$1 096,96
$1 369,70
$1 153,06
$1 225,56
$1 302,34
$1 575,08
$205,38
Toc - Plan #125 Florida Health Care Plans
Silver

(HMO) Gym Access IND Silver Standardized HMO 1

Annual Out of Pocket Expenses
Individual Family
$3,800 $7,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368,79
$418,57
$471,31
$658,65
$1 000,88
$650,91
$700,69
$753,43
$940,77
$933,03
$982,81
$1 035,55
$1 222,89
$1 215,15
$1 264,93
$1 317,67
$1 505,01
$282,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737,58
$837,14
$942,62
$1 317,30
$2 001,76
$1 019,70
$1 119,26
$1 224,74
$1 599,42
$1 301,82
$1 401,38
$1 506,86
$1 881,54
$1 583,94
$1 683,50
$1 788,98
$2 163,66
$282,12
Toc - Plan #126 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO 1340

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$247,94
$281,41
$316,86
$442,81
$672,89
$437,61
$471,08
$506,53
$632,48
$627,28
$660,75
$696,20
$822,15
$816,95
$850,42
$885,87
$1 011,82
$189,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$495,88
$562,82
$633,72
$885,62
$1 345,78
$685,55
$752,49
$823,39
$1 075,29
$875,22
$942,16
$1 013,06
$1 264,96
$1 064,89
$1 131,83
$1 202,73
$1 454,63
$189,67
Toc - Plan #127 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO 1041

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,57
$315,04
$354,73
$495,73
$753,31
$489,91
$527,38
$567,07
$708,07
$702,25
$739,72
$779,41
$920,41
$914,59
$952,06
$991,75
$1 132,75
$212,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$555,14
$630,08
$709,46
$991,46
$1 506,62
$767,48
$842,42
$921,80
$1 203,80
$979,82
$1 054,76
$1 134,14
$1 416,14
$1 192,16
$1 267,10
$1 346,48
$1 628,48
$212,34
Toc - Plan #128 Florida Health Care Plans
Expanded Bronze

(POS) Gym Access IND Bronze POS 1042

Annual Out of Pocket Expenses
Individual Family
$7,550 $15,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$299,77
$340,24
$383,11
$535,39
$813,57
$529,10
$569,57
$612,44
$764,72
$758,43
$798,90
$841,77
$994,05
$987,76
$1 028,23
$1 071,10
$1 223,38
$229,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$599,54
$680,48
$766,22
$1 070,78
$1 627,14
$828,87
$909,81
$995,55
$1 300,11
$1 058,20
$1 139,14
$1 224,88
$1 529,44
$1 287,53
$1 368,47
$1 454,21
$1 758,77
$229,33
Toc - Plan #129 Florida Health Care Plans
Gold

(HMO) Gym Access IND Gold HMO H.S.A 9010

Annual Out of Pocket Expenses
Individual Family
$1,700 $3,400 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352,19
$399,74
$450,10
$629,01
$955,84
$621,62
$669,17
$719,53
$898,44
$891,05
$938,60
$988,96
$1 167,87
$1 160,48
$1 208,03
$1 258,39
$1 437,30
$269,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$704,38
$799,48
$900,20
$1 258,02
$1 911,68
$973,81
$1 068,91
$1 169,63
$1 527,45
$1 243,24
$1 338,34
$1 439,06
$1 796,88
$1 512,67
$1 607,77
$1 708,49
$2 066,31
$269,43
Toc - Plan #130 Florida Health Care Plans
Expanded Bronze

(HMO) Gym Access IND Bronze HMO OA 1211

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$304,46
$345,57
$389,10
$543,77
$826,31
$537,38
$578,49
$622,02
$776,69
$770,30
$811,41
$854,94
$1 009,61
$1 003,22
$1 044,33
$1 087,86
$1 242,53
$232,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$608,92
$691,14
$778,20
$1 087,54
$1 652,62
$841,84
$924,06
$1 011,12
$1 320,46
$1 074,76
$1 156,98
$1 244,04
$1 553,38
$1 307,68
$1 389,90
$1 476,96
$1 786,30
$232,92
Toc - Plan #131 Florida Health Care Plans
Silver

(HMO) Gym Access IND Silver HMO OA 1009

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$365,81
$415,19
$467,50
$653,33
$992,80
$645,65
$695,03
$747,34
$933,17
$925,49
$974,87
$1 027,18
$1 213,01
$1 205,33
$1 254,71
$1 307,02
$1 492,85
$279,84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$731,62
$830,38
$935,00
$1 306,66
$1 985,60
$1 011,46
$1 110,22
$1 214,84
$1 586,50
$1 291,30
$1 390,06
$1 494,68
$1 866,34
$1 571,14
$1 669,90
$1 774,52
$2 146,18
$279,84

‡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 Brevard County here.

Brevard County is in “Rating Area 5” of Florida.

Currently, there are 131 plans offered in Rating Area 5.

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2022 Obamacare Rates for Brevard County