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Obamacare 2023 Rates for McDuffie County

Obamacare > Rates > Georgia > McDuffie County

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 McDuffie County, GA.

The health insurance rates listed below are for calendar year 2023.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 77 Plans and 2023 Rates for McDuffie County, Georgia

Below, you’ll find a summary of the 77 plans for McDuffie County, Georgia and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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UnitedHealthcare

Local: 1-800-609-9754 | Toll Free: 1-800-609-9754 | TTY: 1-800-609-9754

Toc - Plan #1 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$456.06
$517.63
$582.85
$814.53
$1,237.76
$804.95
$866.52
$931.74
$1,163.42
$1,153.84
$1,215.41
$1,280.63
$1,512.31
$1,502.73
$1,564.30
$1,629.52
$1,861.20
$348.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$912.12
$1,035.26
$1,165.70
$1,629.06
$2,475.52
$1,261.01
$1,384.15
$1,514.59
$1,977.95
$1,609.90
$1,733.04
$1,863.48
$2,326.84
$1,958.79
$2,081.93
$2,212.37
$2,675.73
$348.89
Toc - Plan #2 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$473.97
$537.95
$605.73
$846.51
$1,286.35
$836.56
$900.54
$968.32
$1,209.10
$1,199.15
$1,263.13
$1,330.91
$1,571.69
$1,561.74
$1,625.72
$1,693.50
$1,934.28
$362.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$947.94
$1,075.90
$1,211.46
$1,693.02
$2,572.70
$1,310.53
$1,438.49
$1,574.05
$2,055.61
$1,673.12
$1,801.08
$1,936.64
$2,418.20
$2,035.71
$2,163.67
$2,299.23
$2,780.79
$362.59
Toc - Plan #3 UnitedHealthcare
Gold

(HMO) UHC Gold Value $2,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.58
$494.38
$556.67
$777.94
$1,182.15
$768.80
$827.60
$889.89
$1,111.16
$1,102.02
$1,160.82
$1,223.11
$1,444.38
$1,435.24
$1,494.04
$1,556.33
$1,777.60
$333.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.16
$988.76
$1,113.34
$1,555.88
$2,364.30
$1,204.38
$1,321.98
$1,446.56
$1,889.10
$1,537.60
$1,655.20
$1,779.78
$2,222.32
$1,870.82
$1,988.42
$2,113.00
$2,555.54
$333.22
Toc - Plan #4 UnitedHealthcare
Gold

(HMO) UHC Gold Value $2,200 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.48
$494.27
$556.55
$777.77
$1,181.90
$768.62
$827.41
$889.69
$1,110.91
$1,101.76
$1,160.55
$1,222.83
$1,444.05
$1,434.90
$1,493.69
$1,555.97
$1,777.19
$333.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$870.96
$988.54
$1,113.10
$1,555.54
$2,363.80
$1,204.10
$1,321.68
$1,446.24
$1,888.68
$1,537.24
$1,654.82
$1,779.38
$2,221.82
$1,870.38
$1,987.96
$2,112.52
$2,554.96
$333.14
Toc - Plan #5 UnitedHealthcare
Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$403.18
$457.60
$515.26
$720.07
$1,094.22
$711.61
$766.03
$823.69
$1,028.50
$1,020.04
$1,074.46
$1,132.12
$1,336.93
$1,328.47
$1,382.89
$1,440.55
$1,645.36
$308.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806.36
$915.20
$1,030.52
$1,440.14
$2,188.44
$1,114.79
$1,223.63
$1,338.95
$1,748.57
$1,423.22
$1,532.06
$1,647.38
$2,057.00
$1,731.65
$1,840.49
$1,955.81
$2,365.43
$308.43
Toc - Plan #6 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351.76
$399.25
$449.55
$628.24
$954.68
$620.86
$668.35
$718.65
$897.34
$889.96
$937.45
$987.75
$1,166.44
$1,159.06
$1,206.55
$1,256.85
$1,435.54
$269.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703.52
$798.50
$899.10
$1,256.48
$1,909.36
$972.62
$1,067.60
$1,168.20
$1,525.58
$1,241.72
$1,336.70
$1,437.30
$1,794.68
$1,510.82
$1,605.80
$1,706.40
$2,063.78
$269.10
Toc - Plan #7 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$338.80
$384.54
$432.99
$605.10
$919.51
$597.98
$643.72
$692.17
$864.28
$857.16
$902.90
$951.35
$1,123.46
$1,116.34
$1,162.08
$1,210.53
$1,382.64
$259.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$677.60
$769.08
$865.98
$1,210.20
$1,839.02
$936.78
$1,028.26
$1,125.16
$1,469.38
$1,195.96
$1,287.44
$1,384.34
$1,728.56
$1,455.14
$1,546.62
$1,643.52
$1,987.74
$259.18
Toc - Plan #8 UnitedHealthcare
Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$444.31
$504.30
$567.83
$793.55
$1,205.87
$784.21
$844.20
$907.73
$1,133.45
$1,124.11
$1,184.10
$1,247.63
$1,473.35
$1,464.01
$1,524.00
$1,587.53
$1,813.25
$339.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$888.62
$1,008.60
$1,135.66
$1,587.10
$2,411.74
$1,228.52
$1,348.50
$1,475.56
$1,927.00
$1,568.42
$1,688.40
$1,815.46
$2,266.90
$1,908.32
$2,028.30
$2,155.36
$2,606.80
$339.90
Toc - Plan #9 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage $0 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413.87
$469.75
$528.93
$739.18
$1,123.25
$730.48
$786.36
$845.54
$1,055.79
$1,047.09
$1,102.97
$1,162.15
$1,372.40
$1,363.70
$1,419.58
$1,478.76
$1,689.01
$316.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827.74
$939.50
$1,057.86
$1,478.36
$2,246.50
$1,144.35
$1,256.11
$1,374.47
$1,794.97
$1,460.96
$1,572.72
$1,691.08
$2,111.58
$1,777.57
$1,889.33
$2,007.69
$2,428.19
$316.61
Toc - Plan #10 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$425.97
$483.47
$544.38
$760.78
$1,156.07
$751.83
$809.33
$870.24
$1,086.64
$1,077.69
$1,135.19
$1,196.10
$1,412.50
$1,403.55
$1,461.05
$1,521.96
$1,738.36
$325.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$851.94
$966.94
$1,088.76
$1,521.56
$2,312.14
$1,177.80
$1,292.80
$1,414.62
$1,847.42
$1,503.66
$1,618.66
$1,740.48
$2,173.28
$1,829.52
$1,944.52
$2,066.34
$2,499.14
$325.86
Toc - Plan #11 UnitedHealthcare
Silver

(HMO) UHC Silver Value $4,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410.68
$466.12
$524.85
$733.48
$1,114.59
$724.85
$780.29
$839.02
$1,047.65
$1,039.02
$1,094.46
$1,153.19
$1,361.82
$1,353.19
$1,408.63
$1,467.36
$1,675.99
$314.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$821.36
$932.24
$1,049.70
$1,466.96
$2,229.18
$1,135.53
$1,246.41
$1,363.87
$1,781.13
$1,449.70
$1,560.58
$1,678.04
$2,095.30
$1,763.87
$1,874.75
$1,992.21
$2,409.47
$314.17
Toc - Plan #12 UnitedHealthcare
Silver

(HMO) UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.76
$467.35
$526.23
$735.40
$1,117.52
$726.76
$782.35
$841.23
$1,050.40
$1,041.76
$1,097.35
$1,156.23
$1,365.40
$1,356.76
$1,412.35
$1,471.23
$1,680.40
$315.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$823.52
$934.70
$1,052.46
$1,470.80
$2,235.04
$1,138.52
$1,249.70
$1,367.46
$1,785.80
$1,453.52
$1,564.70
$1,682.46
$2,100.80
$1,768.52
$1,879.70
$1,997.46
$2,415.80
$315.00
Toc - Plan #13 UnitedHealthcare
Silver

(HMO) UHC Silver Value $3,350 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$3,350 $6,700 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410.07
$465.42
$524.06
$732.38
$1,112.92
$723.77
$779.12
$837.76
$1,046.08
$1,037.47
$1,092.82
$1,151.46
$1,359.78
$1,351.17
$1,406.52
$1,465.16
$1,673.48
$313.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820.14
$930.84
$1,048.12
$1,464.76
$2,225.84
$1,133.84
$1,244.54
$1,361.82
$1,778.46
$1,447.54
$1,558.24
$1,675.52
$2,092.16
$1,761.24
$1,871.94
$1,989.22
$2,405.86
$313.70
Toc - Plan #14 UnitedHealthcare
Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.94
$467.55
$526.46
$735.72
$1,118.00
$727.07
$782.68
$841.59
$1,050.85
$1,042.20
$1,097.81
$1,156.72
$1,365.98
$1,357.33
$1,412.94
$1,471.85
$1,681.11
$315.13
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
$1,471.44
$2,236.00
$1,139.01
$1,250.23
$1,368.05
$1,786.57
$1,454.14
$1,565.36
$1,683.18
$2,101.70
$1,769.27
$1,880.49
$1,998.31
$2,416.83
$315.13
Toc - Plan #15 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential $9,100 Deductible ($3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.53
$386.50
$435.20
$608.19
$924.20
$601.04
$647.01
$695.71
$868.70
$861.55
$907.52
$956.22
$1,129.21
$1,122.06
$1,168.03
$1,216.73
$1,389.72
$260.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681.06
$773.00
$870.40
$1,216.38
$1,848.40
$941.57
$1,033.51
$1,130.91
$1,476.89
$1,202.08
$1,294.02
$1,391.42
$1,737.40
$1,462.59
$1,554.53
$1,651.93
$1,997.91
$260.51
Toc - Plan #16 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$339.15
$384.94
$433.44
$605.73
$920.46
$598.60
$644.39
$692.89
$865.18
$858.05
$903.84
$952.34
$1,124.63
$1,117.50
$1,163.29
$1,211.79
$1,384.08
$259.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.30
$769.88
$866.88
$1,211.46
$1,840.92
$937.75
$1,029.33
$1,126.33
$1,470.91
$1,197.20
$1,288.78
$1,385.78
$1,730.36
$1,456.65
$1,548.23
$1,645.23
$1,989.81
$259.45
Toc - Plan #17 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$349.81
$397.03
$447.05
$624.76
$949.38
$617.41
$664.63
$714.65
$892.36
$885.01
$932.23
$982.25
$1,159.96
$1,152.61
$1,199.83
$1,249.85
$1,427.56
$267.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$699.62
$794.06
$894.10
$1,249.52
$1,898.76
$967.22
$1,061.66
$1,161.70
$1,517.12
$1,234.82
$1,329.26
$1,429.30
$1,784.72
$1,502.42
$1,596.86
$1,696.90
$2,052.32
$267.60
Toc - Plan #18 UnitedHealthcare
Bronze

(HMO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$332.11
$376.95
$424.44
$593.15
$901.35
$586.17
$631.01
$678.50
$847.21
$840.23
$885.07
$932.56
$1,101.27
$1,094.29
$1,139.13
$1,186.62
$1,355.33
$254.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$664.22
$753.90
$848.88
$1,186.30
$1,802.70
$918.28
$1,007.96
$1,102.94
$1,440.36
$1,172.34
$1,262.02
$1,357.00
$1,694.42
$1,426.40
$1,516.08
$1,611.06
$1,948.48
$254.06
Toc - Plan #19 UnitedHealthcare
Gold

(HMO) UHC Gold Value $2,100 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-609-9754

Annual Out of Pocket Expenses:

Individual Family
$2,100 $4,200 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$434.96
$493.68
$555.88
$776.84
$1,180.48
$767.70
$826.42
$888.62
$1,109.58
$1,100.44
$1,159.16
$1,221.36
$1,442.32
$1,433.18
$1,491.90
$1,554.10
$1,775.06
$332.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.92
$987.36
$1,111.76
$1,553.68
$2,360.96
$1,202.66
$1,320.10
$1,444.50
$1,886.42
$1,535.40
$1,652.84
$1,777.24
$2,219.16
$1,868.14
$1,985.58
$2,109.98
$2,551.90
$332.74

ADVERTISEMENT

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Toc - Plan #20 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$268.45
$304.69
$343.08
$479.45
$728.57
$473.81
$510.05
$548.44
$684.81
$679.17
$715.41
$753.80
$890.17
$884.53
$920.77
$959.16
$1,095.53
$205.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$536.90
$609.38
$686.16
$958.90
$1,457.14
$742.26
$814.74
$891.52
$1,164.26
$947.62
$1,020.10
$1,096.88
$1,369.62
$1,152.98
$1,225.46
$1,302.24
$1,574.98
$205.36
Toc - Plan #21 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$390.22
$442.90
$498.70
$696.93
$1,059.06
$688.74
$741.42
$797.22
$995.45
$987.26
$1,039.94
$1,095.74
$1,293.97
$1,285.78
$1,338.46
$1,394.26
$1,592.49
$298.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.44
$885.80
$997.40
$1,393.86
$2,118.12
$1,078.96
$1,184.32
$1,295.92
$1,692.38
$1,377.48
$1,482.84
$1,594.44
$1,990.90
$1,676.00
$1,781.36
$1,892.96
$2,289.42
$298.52
Toc - Plan #22 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,600 $11,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$377.95
$428.97
$483.02
$675.02
$1,025.76
$667.08
$718.10
$772.15
$964.15
$956.21
$1,007.23
$1,061.28
$1,253.28
$1,245.34
$1,296.36
$1,350.41
$1,542.41
$289.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755.90
$857.94
$966.04
$1,350.04
$2,051.52
$1,045.03
$1,147.07
$1,255.17
$1,639.17
$1,334.16
$1,436.20
$1,544.30
$1,928.30
$1,623.29
$1,725.33
$1,833.43
$2,217.43
$289.13
Toc - Plan #23 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.51
$421.66
$474.79
$663.52
$1,008.28
$655.72
$705.87
$759.00
$947.73
$939.93
$990.08
$1,043.21
$1,231.94
$1,224.14
$1,274.29
$1,327.42
$1,516.15
$284.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.02
$843.32
$949.58
$1,327.04
$2,016.56
$1,027.23
$1,127.53
$1,233.79
$1,611.25
$1,311.44
$1,411.74
$1,518.00
$1,895.46
$1,595.65
$1,695.95
$1,802.21
$2,179.67
$284.21
Toc - Plan #24 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 3000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$466.30
$529.25
$595.93
$832.81
$1,265.54
$823.02
$885.97
$952.65
$1,189.53
$1,179.74
$1,242.69
$1,309.37
$1,546.25
$1,536.46
$1,599.41
$1,666.09
$1,902.97
$356.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$932.60
$1,058.50
$1,191.86
$1,665.62
$2,531.08
$1,289.32
$1,415.22
$1,548.58
$2,022.34
$1,646.04
$1,771.94
$1,905.30
$2,379.06
$2,002.76
$2,128.66
$2,262.02
$2,735.78
$356.72
Toc - Plan #25 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$469.82
$533.25
$600.43
$839.10
$1,275.09
$829.23
$892.66
$959.84
$1,198.51
$1,188.64
$1,252.07
$1,319.25
$1,557.92
$1,548.05
$1,611.48
$1,678.66
$1,917.33
$359.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$939.64
$1,066.50
$1,200.86
$1,678.20
$2,550.18
$1,299.05
$1,425.91
$1,560.27
$2,037.61
$1,658.46
$1,785.32
$1,919.68
$2,397.02
$2,017.87
$2,144.73
$2,279.09
$2,756.43
$359.41
Toc - Plan #26 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 8000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$356.79
$404.96
$455.98
$637.23
$968.33
$629.73
$677.90
$728.92
$910.17
$902.67
$950.84
$1,001.86
$1,183.11
$1,175.61
$1,223.78
$1,274.80
$1,456.05
$272.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$713.58
$809.92
$911.96
$1,274.46
$1,936.66
$986.52
$1,082.86
$1,184.90
$1,547.40
$1,259.46
$1,355.80
$1,457.84
$1,820.34
$1,532.40
$1,628.74
$1,730.78
$2,093.28
$272.94
Toc - Plan #27 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 4950($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$472.75
$536.57
$604.17
$844.33
$1,283.04
$834.40
$898.22
$965.82
$1,205.98
$1,196.05
$1,259.87
$1,327.47
$1,567.63
$1,557.70
$1,621.52
$1,689.12
$1,929.28
$361.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$945.50
$1,073.14
$1,208.34
$1,688.66
$2,566.08
$1,307.15
$1,434.79
$1,569.99
$2,050.31
$1,668.80
$1,796.44
$1,931.64
$2,411.96
$2,030.45
$2,158.09
$2,293.29
$2,773.61
$361.65
Toc - Plan #28 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 6500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$464.30
$526.98
$593.38
$829.24
$1,260.11
$819.49
$882.17
$948.57
$1,184.43
$1,174.68
$1,237.36
$1,303.76
$1,539.62
$1,529.87
$1,592.55
$1,658.95
$1,894.81
$355.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$928.60
$1,053.96
$1,186.76
$1,658.48
$2,520.22
$1,283.79
$1,409.15
$1,541.95
$2,013.67
$1,638.98
$1,764.34
$1,897.14
$2,368.86
$1,994.17
$2,119.53
$2,252.33
$2,724.05
$355.19
Toc - Plan #29 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 1600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 Annual Deductible
$8,800 $17,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$518.85
$588.89
$663.09
$926.67
$1,408.16
$915.77
$985.81
$1,060.01
$1,323.59
$1,312.69
$1,382.73
$1,456.93
$1,720.51
$1,709.61
$1,779.65
$1,853.85
$2,117.43
$396.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,037.70
$1,177.78
$1,326.18
$1,853.34
$2,816.32
$1,434.62
$1,574.70
$1,723.10
$2,250.26
$1,831.54
$1,971.62
$2,120.02
$2,647.18
$2,228.46
$2,368.54
$2,516.94
$3,044.10
$396.92
Toc - Plan #30 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.96
$447.14
$503.48
$703.61
$1,069.21
$695.34
$748.52
$804.86
$1,004.99
$996.72
$1,049.90
$1,106.24
$1,306.37
$1,298.10
$1,351.28
$1,407.62
$1,607.75
$301.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787.92
$894.28
$1,006.96
$1,407.22
$2,138.42
$1,089.30
$1,195.66
$1,308.34
$1,708.60
$1,390.68
$1,497.04
$1,609.72
$2,009.98
$1,692.06
$1,798.42
$1,911.10
$2,311.36
$301.38
Toc - Plan #31 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 2600($0 PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$495.28
$562.14
$632.97
$884.57
$1,344.19
$874.17
$941.03
$1,011.86
$1,263.46
$1,253.06
$1,319.92
$1,390.75
$1,642.35
$1,631.95
$1,698.81
$1,769.64
$2,021.24
$378.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$990.56
$1,124.28
$1,265.94
$1,769.14
$2,688.38
$1,369.45
$1,503.17
$1,644.83
$2,148.03
$1,748.34
$1,882.06
$2,023.72
$2,526.92
$2,127.23
$2,260.95
$2,402.61
$2,905.81
$378.89
Toc - Plan #32 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$367.47
$417.08
$469.63
$656.30
$997.31
$648.58
$698.19
$750.74
$937.41
$929.69
$979.30
$1,031.85
$1,218.52
$1,210.80
$1,260.41
$1,312.96
$1,499.63
$281.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$734.94
$834.16
$939.26
$1,312.60
$1,994.62
$1,016.05
$1,115.27
$1,220.37
$1,593.71
$1,297.16
$1,396.38
$1,501.48
$1,874.82
$1,578.27
$1,677.49
$1,782.59
$2,155.93
$281.11
Toc - Plan #33 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$401.97
$456.24
$513.72
$717.92
$1,090.95
$709.48
$763.75
$821.23
$1,025.43
$1,016.99
$1,071.26
$1,128.74
$1,332.94
$1,324.50
$1,378.77
$1,436.25
$1,640.45
$307.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$803.94
$912.48
$1,027.44
$1,435.84
$2,181.90
$1,111.45
$1,219.99
$1,334.95
$1,743.35
$1,418.96
$1,527.50
$1,642.46
$2,050.86
$1,726.47
$1,835.01
$1,949.97
$2,358.37
$307.51
Toc - Plan #34 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.53
$535.19
$602.62
$842.15
$1,279.73
$832.25
$895.91
$963.34
$1,202.87
$1,192.97
$1,256.63
$1,324.06
$1,563.59
$1,553.69
$1,617.35
$1,684.78
$1,924.31
$360.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$943.06
$1,070.38
$1,205.24
$1,684.30
$2,559.46
$1,303.78
$1,431.10
$1,565.96
$2,045.02
$1,664.50
$1,791.82
$1,926.68
$2,405.74
$2,025.22
$2,152.54
$2,287.40
$2,766.46
$360.72
Toc - Plan #35 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$533.19
$605.17
$681.42
$952.28
$1,447.08
$941.08
$1,013.06
$1,089.31
$1,360.17
$1,348.97
$1,420.95
$1,497.20
$1,768.06
$1,756.86
$1,828.84
$1,905.09
$2,175.95
$407.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,066.38
$1,210.34
$1,362.84
$1,904.56
$2,894.16
$1,474.27
$1,618.23
$1,770.73
$2,312.45
$1,882.16
$2,026.12
$2,178.62
$2,720.34
$2,290.05
$2,434.01
$2,586.51
$3,128.23
$407.89

ADVERTISEMENT

Ambetter from Peach State Health Plan

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180 | TTY: 1-877-941-9231

Toc - Plan #36 Ambetter from Peach State Health Plan
Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$327.31
$371.49
$418.29
$584.56
$888.30
$577.70
$621.88
$668.68
$834.95
$828.09
$872.27
$919.07
$1,085.34
$1,078.48
$1,122.66
$1,169.46
$1,335.73
$250.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654.62
$742.98
$836.58
$1,169.12
$1,776.60
$905.01
$993.37
$1,086.97
$1,419.51
$1,155.40
$1,243.76
$1,337.36
$1,669.90
$1,405.79
$1,494.15
$1,587.75
$1,920.29
$250.39
Toc - Plan #37 Ambetter from Peach State Health Plan
Silver

(HMO) Premier Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 Annual Deductible
$7,550 $15,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.07
$446.12
$502.33
$702.01
$1,066.77
$693.76
$746.81
$803.02
$1,002.70
$994.45
$1,047.50
$1,103.71
$1,303.39
$1,295.14
$1,348.19
$1,404.40
$1,604.08
$300.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$786.14
$892.24
$1,004.66
$1,404.02
$2,133.54
$1,086.83
$1,192.93
$1,305.35
$1,704.71
$1,387.52
$1,493.62
$1,606.04
$2,005.40
$1,688.21
$1,794.31
$1,906.73
$2,306.09
$300.69
Toc - Plan #38 Ambetter from Peach State Health Plan
Silver

(HMO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.71
$441.17
$496.76
$694.21
$1,054.93
$686.06
$738.52
$794.11
$991.56
$983.41
$1,035.87
$1,091.46
$1,288.91
$1,280.76
$1,333.22
$1,388.81
$1,586.26
$297.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777.42
$882.34
$993.52
$1,388.42
$2,109.86
$1,074.77
$1,179.69
$1,290.87
$1,685.77
$1,372.12
$1,477.04
$1,588.22
$1,983.12
$1,669.47
$1,774.39
$1,885.57
$2,280.47
$297.35
Toc - Plan #39 Ambetter from Peach State Health Plan
Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.27
$466.78
$525.59
$734.51
$1,116.16
$725.88
$781.39
$840.20
$1,049.12
$1,040.49
$1,096.00
$1,154.81
$1,363.73
$1,355.10
$1,410.61
$1,469.42
$1,678.34
$314.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822.54
$933.56
$1,051.18
$1,469.02
$2,232.32
$1,137.15
$1,248.17
$1,365.79
$1,783.63
$1,451.76
$1,562.78
$1,680.40
$2,098.24
$1,766.37
$1,877.39
$1,995.01
$2,412.85
$314.61
Toc - Plan #40 Ambetter from Peach State Health Plan
Silver

(HMO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$384.66
$436.58
$491.58
$686.98
$1,043.94
$678.92
$730.84
$785.84
$981.24
$973.18
$1,025.10
$1,080.10
$1,275.50
$1,267.44
$1,319.36
$1,374.36
$1,569.76
$294.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$769.32
$873.16
$983.16
$1,373.96
$2,087.88
$1,063.58
$1,167.42
$1,277.42
$1,668.22
$1,357.84
$1,461.68
$1,571.68
$1,962.48
$1,652.10
$1,755.94
$1,865.94
$2,256.74
$294.26
Toc - Plan #41 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$359.66
$408.20
$459.63
$642.34
$976.09
$634.79
$683.33
$734.76
$917.47
$909.92
$958.46
$1,009.89
$1,192.60
$1,185.05
$1,233.59
$1,285.02
$1,467.73
$275.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719.32
$816.40
$919.26
$1,284.68
$1,952.18
$994.45
$1,091.53
$1,194.39
$1,559.81
$1,269.58
$1,366.66
$1,469.52
$1,834.94
$1,544.71
$1,641.79
$1,744.65
$2,110.07
$275.13
Toc - Plan #42 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352.15
$399.68
$450.04
$628.93
$955.72
$621.54
$669.07
$719.43
$898.32
$890.93
$938.46
$988.82
$1,167.71
$1,160.32
$1,207.85
$1,258.21
$1,437.10
$269.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$704.30
$799.36
$900.08
$1,257.86
$1,911.44
$973.69
$1,068.75
$1,169.47
$1,527.25
$1,243.08
$1,338.14
$1,438.86
$1,796.64
$1,512.47
$1,607.53
$1,708.25
$2,066.03
$269.39
Toc - Plan #43 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398.46
$452.24
$509.21
$711.62
$1,081.38
$703.27
$757.05
$814.02
$1,016.43
$1,008.08
$1,061.86
$1,118.83
$1,321.24
$1,312.89
$1,366.67
$1,423.64
$1,626.05
$304.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796.92
$904.48
$1,018.42
$1,423.24
$2,162.76
$1,101.73
$1,209.29
$1,323.23
$1,728.05
$1,406.54
$1,514.10
$1,628.04
$2,032.86
$1,711.35
$1,818.91
$1,932.85
$2,337.67
$304.81
Toc - Plan #44 Ambetter from Peach State Health Plan
Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$378.92
$430.06
$484.25
$676.73
$1,028.36
$668.79
$719.93
$774.12
$966.60
$958.66
$1,009.80
$1,063.99
$1,256.47
$1,248.53
$1,299.67
$1,353.86
$1,546.34
$289.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757.84
$860.12
$968.50
$1,353.46
$2,056.72
$1,047.71
$1,149.99
$1,258.37
$1,643.33
$1,337.58
$1,439.86
$1,548.24
$1,933.20
$1,627.45
$1,729.73
$1,838.11
$2,223.07
$289.87
Toc - Plan #45 Ambetter from Peach State Health Plan
Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383.20
$434.93
$489.72
$684.39
$1,039.99
$676.34
$728.07
$782.86
$977.53
$969.48
$1,021.21
$1,076.00
$1,270.67
$1,262.62
$1,314.35
$1,369.14
$1,563.81
$293.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766.40
$869.86
$979.44
$1,368.78
$2,079.98
$1,059.54
$1,163.00
$1,272.58
$1,661.92
$1,352.68
$1,456.14
$1,565.72
$1,955.06
$1,645.82
$1,749.28
$1,858.86
$2,248.20
$293.14
Toc - Plan #46 Ambetter from Peach State Health Plan
Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.11
$446.17
$502.38
$702.08
$1,066.87
$693.83
$746.89
$803.10
$1,002.80
$994.55
$1,047.61
$1,103.82
$1,303.52
$1,295.27
$1,348.33
$1,404.54
$1,604.24
$300.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$786.22
$892.34
$1,004.76
$1,404.16
$2,133.74
$1,086.94
$1,193.06
$1,305.48
$1,704.88
$1,387.66
$1,493.78
$1,606.20
$2,005.60
$1,688.38
$1,794.50
$1,906.92
$2,306.32
$300.72
Toc - Plan #47 Ambetter from Peach State Health Plan
Gold

(HMO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.55
$440.99
$496.55
$693.93
$1,054.50
$685.78
$738.22
$793.78
$991.16
$983.01
$1,035.45
$1,091.01
$1,288.39
$1,280.24
$1,332.68
$1,388.24
$1,585.62
$297.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777.10
$881.98
$993.10
$1,387.86
$2,109.00
$1,074.33
$1,179.21
$1,290.33
$1,685.09
$1,371.56
$1,476.44
$1,587.56
$1,982.32
$1,668.79
$1,773.67
$1,884.79
$2,279.55
$297.23
Toc - Plan #48 Ambetter from Peach State Health Plan
Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$453.72
$514.96
$579.84
$810.33
$1,231.37
$800.81
$862.05
$926.93
$1,157.42
$1,147.90
$1,209.14
$1,274.02
$1,504.51
$1,494.99
$1,556.23
$1,621.11
$1,851.60
$347.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$907.44
$1,029.92
$1,159.68
$1,620.66
$2,462.74
$1,254.53
$1,377.01
$1,506.77
$1,967.75
$1,601.62
$1,724.10
$1,853.86
$2,314.84
$1,948.71
$2,071.19
$2,200.95
$2,661.93
$347.09
Toc - Plan #49 Ambetter from Peach State Health Plan
Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$311.59
$353.64
$398.20
$556.48
$845.63
$549.95
$592.00
$636.56
$794.84
$788.31
$830.36
$874.92
$1,033.20
$1,026.67
$1,068.72
$1,113.28
$1,271.56
$238.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$623.18
$707.28
$796.40
$1,112.96
$1,691.26
$861.54
$945.64
$1,034.76
$1,351.32
$1,099.90
$1,184.00
$1,273.12
$1,589.68
$1,338.26
$1,422.36
$1,511.48
$1,828.04
$238.36
Toc - Plan #50 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344.76
$391.30
$440.59
$615.73
$935.66
$608.50
$655.04
$704.33
$879.47
$872.24
$918.78
$968.07
$1,143.21
$1,135.98
$1,182.52
$1,231.81
$1,406.95
$263.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$689.52
$782.60
$881.18
$1,231.46
$1,871.32
$953.26
$1,046.34
$1,144.92
$1,495.20
$1,217.00
$1,310.08
$1,408.66
$1,758.94
$1,480.74
$1,573.82
$1,672.40
$2,022.68
$263.74
Toc - Plan #51 Ambetter from Peach State Health Plan
Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$379.75
$431.00
$485.30
$678.21
$1,030.60
$670.25
$721.50
$775.80
$968.71
$960.75
$1,012.00
$1,066.30
$1,259.21
$1,251.25
$1,302.50
$1,356.80
$1,549.71
$290.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$759.50
$862.00
$970.60
$1,356.42
$2,061.20
$1,050.00
$1,152.50
$1,261.10
$1,646.92
$1,340.50
$1,443.00
$1,551.60
$1,937.42
$1,631.00
$1,733.50
$1,842.10
$2,227.92
$290.50
Toc - Plan #52 Ambetter from Peach State Health Plan
Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389.42
$441.97
$497.66
$695.48
$1,056.85
$687.31
$739.86
$795.55
$993.37
$985.20
$1,037.75
$1,093.44
$1,291.26
$1,283.09
$1,335.64
$1,391.33
$1,589.15
$297.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778.84
$883.94
$995.32
$1,390.96
$2,113.70
$1,076.73
$1,181.83
$1,293.21
$1,688.85
$1,374.62
$1,479.72
$1,591.10
$1,986.74
$1,672.51
$1,777.61
$1,888.99
$2,284.63
$297.89
Toc - Plan #53 Ambetter from Peach State Health Plan
Silver

(HMO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399.89
$453.87
$511.05
$714.19
$1,085.29
$705.80
$759.78
$816.96
$1,020.10
$1,011.71
$1,065.69
$1,122.87
$1,326.01
$1,317.62
$1,371.60
$1,428.78
$1,631.92
$305.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$799.78
$907.74
$1,022.10
$1,428.38
$2,170.58
$1,105.69
$1,213.65
$1,328.01
$1,734.29
$1,411.60
$1,519.56
$1,633.92
$2,040.20
$1,717.51
$1,825.47
$1,939.83
$2,346.11
$305.91
Toc - Plan #54 Ambetter from Peach State Health Plan
Silver

(HMO) Premier Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 Annual Deductible
$7,550 $15,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$408.64
$463.79
$522.23
$729.81
$1,109.02
$721.24
$776.39
$834.83
$1,042.41
$1,033.84
$1,088.99
$1,147.43
$1,355.01
$1,346.44
$1,401.59
$1,460.03
$1,667.61
$312.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$817.28
$927.58
$1,044.46
$1,459.62
$2,218.04
$1,129.88
$1,240.18
$1,357.06
$1,772.22
$1,442.48
$1,552.78
$1,669.66
$2,084.82
$1,755.08
$1,865.38
$1,982.26
$2,397.42
$312.60
Toc - Plan #55 Ambetter from Peach State Health Plan
Silver

(HMO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$404.10
$458.65
$516.43
$721.71
$1,096.71
$713.23
$767.78
$825.56
$1,030.84
$1,022.36
$1,076.91
$1,134.69
$1,339.97
$1,331.49
$1,386.04
$1,443.82
$1,649.10
$309.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808.20
$917.30
$1,032.86
$1,443.42
$2,193.42
$1,117.33
$1,226.43
$1,341.99
$1,752.55
$1,426.46
$1,535.56
$1,651.12
$2,061.68
$1,735.59
$1,844.69
$1,960.25
$2,370.81
$309.13
Toc - Plan #56 Ambetter from Peach State Health Plan
Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.28
$386.20
$434.86
$607.71
$923.48
$600.58
$646.50
$695.16
$868.01
$860.88
$906.80
$955.46
$1,128.31
$1,121.18
$1,167.10
$1,215.76
$1,388.61
$260.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680.56
$772.40
$869.72
$1,215.42
$1,846.96
$940.86
$1,032.70
$1,130.02
$1,475.72
$1,201.16
$1,293.00
$1,390.32
$1,736.02
$1,461.46
$1,553.30
$1,650.62
$1,996.32
$260.30
Toc - Plan #57 Ambetter from Peach State Health Plan
Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$427.56
$485.27
$546.41
$763.60
$1,160.37
$754.64
$812.35
$873.49
$1,090.68
$1,081.72
$1,139.43
$1,200.57
$1,417.76
$1,408.80
$1,466.51
$1,527.65
$1,744.84
$327.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$855.12
$970.54
$1,092.82
$1,527.20
$2,320.74
$1,182.20
$1,297.62
$1,419.90
$1,854.28
$1,509.28
$1,624.70
$1,746.98
$2,181.36
$1,836.36
$1,951.78
$2,074.06
$2,508.44
$327.08
Toc - Plan #58 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373.91
$424.37
$477.84
$667.78
$1,014.75
$659.94
$710.40
$763.87
$953.81
$945.97
$996.43
$1,049.90
$1,239.84
$1,232.00
$1,282.46
$1,335.93
$1,525.87
$286.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$747.82
$848.74
$955.68
$1,335.56
$2,029.50
$1,033.85
$1,134.77
$1,241.71
$1,621.59
$1,319.88
$1,420.80
$1,527.74
$1,907.62
$1,605.91
$1,706.83
$1,813.77
$2,193.65
$286.03
Toc - Plan #59 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$366.10
$415.51
$467.86
$653.84
$993.57
$646.16
$695.57
$747.92
$933.90
$926.22
$975.63
$1,027.98
$1,213.96
$1,206.28
$1,255.69
$1,308.04
$1,494.02
$280.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$732.20
$831.02
$935.72
$1,307.68
$1,987.14
$1,012.26
$1,111.08
$1,215.78
$1,587.74
$1,292.32
$1,391.14
$1,495.84
$1,867.80
$1,572.38
$1,671.20
$1,775.90
$2,147.86
$280.06
Toc - Plan #60 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$414.24
$470.15
$529.38
$739.81
$1,124.21
$731.12
$787.03
$846.26
$1,056.69
$1,048.00
$1,103.91
$1,163.14
$1,373.57
$1,364.88
$1,420.79
$1,480.02
$1,690.45
$316.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$828.48
$940.30
$1,058.76
$1,479.62
$2,248.42
$1,145.36
$1,257.18
$1,375.64
$1,796.50
$1,462.24
$1,574.06
$1,692.52
$2,113.38
$1,779.12
$1,890.94
$2,009.40
$2,430.26
$316.88
Toc - Plan #61 Ambetter from Peach State Health Plan
Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398.38
$452.15
$509.12
$711.49
$1,081.18
$703.14
$756.91
$813.88
$1,016.25
$1,007.90
$1,061.67
$1,118.64
$1,321.01
$1,312.66
$1,366.43
$1,423.40
$1,625.77
$304.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796.76
$904.30
$1,018.24
$1,422.98
$2,162.36
$1,101.52
$1,209.06
$1,323.00
$1,727.74
$1,406.28
$1,513.82
$1,627.76
$2,032.50
$1,711.04
$1,818.58
$1,932.52
$2,337.26
$304.76
Toc - Plan #62 Ambetter from Peach State Health Plan
Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$408.68
$463.84
$522.28
$729.89
$1,109.13
$721.31
$776.47
$834.91
$1,042.52
$1,033.94
$1,089.10
$1,147.54
$1,355.15
$1,346.57
$1,401.73
$1,460.17
$1,667.78
$312.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$817.36
$927.68
$1,044.56
$1,459.78
$2,218.26
$1,129.99
$1,240.31
$1,357.19
$1,772.41
$1,442.62
$1,552.94
$1,669.82
$2,085.04
$1,755.25
$1,865.57
$1,982.45
$2,397.67
$312.63
Toc - Plan #63 Ambetter from Peach State Health Plan
Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.93
$447.10
$503.43
$703.54
$1,069.10
$695.28
$748.45
$804.78
$1,004.89
$996.63
$1,049.80
$1,106.13
$1,306.24
$1,297.98
$1,351.15
$1,407.48
$1,607.59
$301.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787.86
$894.20
$1,006.86
$1,407.08
$2,138.20
$1,089.21
$1,195.55
$1,308.21
$1,708.43
$1,390.56
$1,496.90
$1,609.56
$2,009.78
$1,691.91
$1,798.25
$1,910.91
$2,311.13
$301.35
Toc - Plan #64 Ambetter from Peach State Health Plan
Gold

(HMO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$403.94
$458.46
$516.22
$721.42
$1,096.27
$712.95
$767.47
$825.23
$1,030.43
$1,021.96
$1,076.48
$1,134.24
$1,339.44
$1,330.97
$1,385.49
$1,443.25
$1,648.45
$309.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$807.88
$916.92
$1,032.44
$1,442.84
$2,192.54
$1,116.89
$1,225.93
$1,341.45
$1,751.85
$1,425.90
$1,534.94
$1,650.46
$2,060.86
$1,734.91
$1,843.95
$1,959.47
$2,369.87
$309.01
Toc - Plan #65 Ambetter from Peach State Health Plan
Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.69
$535.36
$602.81
$842.42
$1,280.14
$832.53
$896.20
$963.65
$1,203.26
$1,193.37
$1,257.04
$1,324.49
$1,564.10
$1,554.21
$1,617.88
$1,685.33
$1,924.94
$360.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$943.38
$1,070.72
$1,205.62
$1,684.84
$2,560.28
$1,304.22
$1,431.56
$1,566.46
$2,045.68
$1,665.06
$1,792.40
$1,927.30
$2,406.52
$2,025.90
$2,153.24
$2,288.14
$2,767.36
$360.84
Toc - Plan #66 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$342.68
$388.93
$437.93
$612.01
$930.01
$604.82
$651.07
$700.07
$874.15
$866.96
$913.21
$962.21
$1,136.29
$1,129.10
$1,175.35
$1,224.35
$1,398.43
$262.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685.36
$777.86
$875.86
$1,224.02
$1,860.02
$947.50
$1,040.00
$1,138.00
$1,486.16
$1,209.64
$1,302.14
$1,400.14
$1,748.30
$1,471.78
$1,564.28
$1,662.28
$2,010.44
$262.14
Toc - Plan #67 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,400 $14,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$374.95
$425.56
$479.17
$669.64
$1,017.59
$661.78
$712.39
$766.00
$956.47
$948.61
$999.22
$1,052.83
$1,243.30
$1,235.44
$1,286.05
$1,339.66
$1,530.13
$286.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$749.90
$851.12
$958.34
$1,339.28
$2,035.18
$1,036.73
$1,137.95
$1,245.17
$1,626.11
$1,323.56
$1,424.78
$1,532.00
$1,912.94
$1,610.39
$1,711.61
$1,818.83
$2,199.77
$286.83
Toc - Plan #68 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$950 $1,900 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399.52
$453.44
$510.57
$713.52
$1,084.26
$705.14
$759.06
$816.19
$1,019.14
$1,010.76
$1,064.68
$1,121.81
$1,324.76
$1,316.38
$1,370.30
$1,427.43
$1,630.38
$305.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$799.04
$906.88
$1,021.14
$1,427.04
$2,168.52
$1,104.66
$1,212.50
$1,326.76
$1,732.66
$1,410.28
$1,518.12
$1,632.38
$2,038.28
$1,715.90
$1,823.74
$1,938.00
$2,343.90
$305.62

ADVERTISEMENT

Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Toc - Plan #69 Alliant Health Plans
Platinum

(PPO) SoloCare Platinum PPO Copay Plan (3 Free PCP Visits) 40184

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$529.07
$600.48
$676.14
$944.90
$1,435.87
$933.80
$1,005.21
$1,080.87
$1,349.63
$1,338.53
$1,409.94
$1,485.60
$1,754.36
$1,743.26
$1,814.67
$1,890.33
$2,159.09
$404.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,058.14
$1,200.96
$1,352.28
$1,889.80
$2,871.74
$1,462.87
$1,605.69
$1,757.01
$2,294.53
$1,867.60
$2,010.42
$2,161.74
$2,699.26
$2,272.33
$2,415.15
$2,566.47
$3,103.99
$404.73
Toc - Plan #70 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay) 40331

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,050 $18,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395.75
$449.16
$505.75
$706.79
$1,074.03
$698.49
$751.90
$808.49
$1,009.53
$1,001.23
$1,054.64
$1,111.23
$1,312.27
$1,303.97
$1,357.38
$1,413.97
$1,615.01
$302.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.50
$898.32
$1,011.50
$1,413.58
$2,148.06
$1,094.24
$1,201.06
$1,314.24
$1,716.32
$1,396.98
$1,503.80
$1,616.98
$2,019.06
$1,699.72
$1,806.54
$1,919.72
$2,321.80
$302.74
Toc - Plan #71 Alliant Health Plans
Platinum

(PPO) SoloCare Platinum PPO Copay Plan (3 Free PCP Visits + Chiro + Dental) 40349

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$555.52
$630.51
$709.94
$992.14
$1,507.66
$980.49
$1,055.48
$1,134.91
$1,417.11
$1,405.46
$1,480.45
$1,559.88
$1,842.08
$1,830.43
$1,905.42
$1,984.85
$2,267.05
$424.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,111.04
$1,261.02
$1,419.88
$1,984.28
$3,015.32
$1,536.01
$1,685.99
$1,844.85
$2,409.25
$1,960.98
$2,110.96
$2,269.82
$2,834.22
$2,385.95
$2,535.93
$2,694.79
$3,259.19
$424.97
Toc - Plan #72 Alliant Health Plans
Platinum

(PPO) SoloCare PPO Platinum Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,000 $6,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$546.52
$620.29
$698.44
$976.07
$1,483.23
$964.60
$1,038.37
$1,116.52
$1,394.15
$1,382.68
$1,456.45
$1,534.60
$1,812.23
$1,800.76
$1,874.53
$1,952.68
$2,230.31
$418.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,093.04
$1,240.58
$1,396.88
$1,952.14
$2,966.46
$1,511.12
$1,658.66
$1,814.96
$2,370.22
$1,929.20
$2,076.74
$2,233.04
$2,788.30
$2,347.28
$2,494.82
$2,651.12
$3,206.38
$418.08
Toc - Plan #73 Alliant Health Plans
Gold

(PPO) SoloCare PPO Gold Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395.75
$449.16
$505.75
$706.79
$1,074.03
$698.49
$751.90
$808.49
$1,009.53
$1,001.23
$1,054.64
$1,111.23
$1,312.27
$1,303.97
$1,357.38
$1,413.97
$1,615.01
$302.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.50
$898.32
$1,011.50
$1,413.58
$2,148.06
$1,094.24
$1,201.06
$1,314.24
$1,716.32
$1,396.98
$1,503.80
$1,616.98
$2,019.06
$1,699.72
$1,806.54
$1,919.72
$2,321.80
$302.74
Toc - Plan #74 Alliant Health Plans
Silver

(PPO) SoloCare PPO Silver Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$375.65
$426.35
$480.06
$670.89
$1,019.48
$663.01
$713.71
$767.42
$958.25
$950.37
$1,001.07
$1,054.78
$1,245.61
$1,237.73
$1,288.43
$1,342.14
$1,532.97
$287.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$751.30
$852.70
$960.12
$1,341.78
$2,038.96
$1,038.66
$1,140.06
$1,247.48
$1,629.14
$1,326.02
$1,427.42
$1,534.84
$1,916.50
$1,613.38
$1,714.78
$1,822.20
$2,203.86
$287.36
Toc - Plan #75 Alliant Health Plans
Gold

(HMO) SoloCare Gold No Referral HMO (3 Free PCP Visits) 110003

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$402.10
$456.37
$513.87
$718.13
$1,091.27
$709.70
$763.97
$821.47
$1,025.73
$1,017.30
$1,071.57
$1,129.07
$1,333.33
$1,324.90
$1,379.17
$1,436.67
$1,640.93
$307.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$804.20
$912.74
$1,027.74
$1,436.26
$2,182.54
$1,111.80
$1,220.34
$1,335.34
$1,743.86
$1,419.40
$1,527.94
$1,642.94
$2,051.46
$1,727.00
$1,835.54
$1,950.54
$2,359.06
$307.60
Toc - Plan #76 Alliant Health Plans
Catastrophic

(HMO) SoloCare Catastropic No Referral HMO 110023

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$227.51
$258.21
$290.74
$406.31
$617.43
$401.55
$432.25
$464.78
$580.35
$575.59
$606.29
$638.82
$754.39
$749.63
$780.33
$812.86
$928.43
$174.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$455.02
$516.42
$581.48
$812.62
$1,234.86
$629.06
$690.46
$755.52
$986.66
$803.10
$864.50
$929.56
$1,160.70
$977.14
$1,038.54
$1,103.60
$1,334.74
$174.04
Toc - Plan #77 Alliant Health Plans
Gold

(HMO) SoloCare HMO Gold Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.63
$446.76
$503.05
$703.01
$1,068.30
$694.75
$747.88
$804.17
$1,004.13
$995.87
$1,049.00
$1,105.29
$1,305.25
$1,296.99
$1,350.12
$1,406.41
$1,606.37
$301.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787.26
$893.52
$1,006.10
$1,406.02
$2,136.60
$1,088.38
$1,194.64
$1,307.22
$1,707.14
$1,389.50
$1,495.76
$1,608.34
$2,008.26
$1,690.62
$1,796.88
$1,909.46
$2,309.38
$301.12

‡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 McDuffie County here.

McDuffie County is in “Rating Area 5” of Georgia.

Currently, there are 77 plans offered in Rating Area 5.

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2023 Obamacare Plans for McDuffie County, GA

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