Indiana Obamacare

2017 Obamacare Rates for Shelby County

Indiana 2017 Obamacare Rates for Shelby County

 
Shelbyville, IN

Providers for Zip Code 46176

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Obamacare Providers, Plans and 2017 Rates for Shelby County

The health insurance rates listed below are for calendar year 2017.

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Shelby County, Indiana.

Currently, there are 40 plans offered in Shelby County.

Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

 

The table below shows premiums for the following scenarios:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Shelby County

 

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Shelbyville, IN area accept this insurance coverage as within the plan's "network".

‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Shelby County here.

Anthem Ins Companies Inc(Anthem BCBS)

Local: 1-855-886-6152 | Toll Free: 1-855-886-6152

Plan: (HMO) Anthem Bronze Pathway X 5300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $5,300 : Family: $10,600
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $320.46
$363.72
$409.55
$572.34
$869.73		 $640.92
$727.44
$819.10
$1144.68
$1739.46		 $844.41
$930.93
$1022.59
$1348.17		 $1047.90
$1134.42
$1226.08
$1551.66		 $1251.39
$1337.91
$1429.57
$1755.15		 $523.95
$567.21
$613.04
$775.83		 $727.44
$770.70
$816.53
$979.32		 $930.93
$974.19
$1020.02
$1182.81		 $203.49

Plan: (HMO) Anthem Bronze Pathway X 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $326.38
$370.44
$417.11
$582.91
$885.80		 $652.76
$740.88
$834.22
$1165.82
$1771.60		 $860.01
$948.13
$1041.47
$1373.07		 $1067.26
$1155.38
$1248.72
$1580.32		 $1274.51
$1362.63
$1455.97
$1787.57		 $533.63
$577.69
$624.36
$790.16		 $740.88
$784.94
$831.61
$997.41		 $948.13
$992.19
$1038.86
$1204.66		 $207.25

Plan: (HMO) Anthem Bronze Pathway X 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $320.03
$363.23
$409.00
$571.57
$868.56		 $640.06
$726.46
$818.00
$1143.14
$1737.12		 $843.28
$929.68
$1021.22
$1346.36		 $1046.50
$1132.90
$1224.44
$1549.58		 $1249.72
$1336.12
$1427.66
$1752.80		 $523.25
$566.45
$612.22
$774.79		 $726.47
$769.67
$815.44
$978.01		 $929.69
$972.89
$1018.66
$1181.23		 $203.22

Plan: (HMO) Anthem Bronze Pathway X 20 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $326.95
$371.09
$417.84
$583.93
$887.34		 $653.90
$742.18
$835.68
$1167.86
$1774.68		 $861.51
$949.79
$1043.29
$1375.47		 $1069.12
$1157.40
$1250.90
$1583.08		 $1276.73
$1365.01
$1458.51
$1790.69		 $534.56
$578.70
$625.45
$791.54		 $742.17
$786.31
$833.06
$999.15		 $949.78
$993.92
$1040.67
$1206.76		 $207.61

Plan: (HMO) Anthem Silver Pathway X 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,150 : Family: $12,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $365.96
$415.36
$467.70
$653.60
$993.22		 $731.92
$830.72
$935.40
$1307.20
$1986.44		 $964.30
$1063.10
$1167.78
$1539.58		 $1196.68
$1295.48
$1400.16
$1771.96		 $1429.06
$1527.86
$1632.54
$2004.34		 $598.34
$647.74
$700.08
$885.98		 $830.72
$880.12
$932.46
$1118.36		 $1063.10
$1112.50
$1164.84
$1350.74		 $232.38

Plan: (HMO) Anthem Silver Pathway X 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $371.48
$421.63
$474.75
$663.46
$1008.20		 $742.96
$843.26
$949.50
$1326.92
$2016.40		 $978.85
$1079.15
$1185.39
$1562.81		 $1214.74
$1315.04
$1421.28
$1798.70		 $1450.63
$1550.93
$1657.17
$2034.59		 $607.37
$657.52
$710.64
$899.35		 $843.26
$893.41
$946.53
$1135.24		 $1079.15
$1129.30
$1182.42
$1371.13		 $235.89

Plan: (HMO) Anthem Silver Pathway X for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $376.18
$426.96
$480.76
$671.86
$1020.95		 $752.36
$853.92
$961.52
$1343.72
$2041.90		 $991.23
$1092.79
$1200.39
$1582.59		 $1230.10
$1331.66
$1439.26
$1821.46		 $1468.97
$1570.53
$1678.13
$2060.33		 $615.05
$665.83
$719.63
$910.73		 $853.92
$904.70
$958.50
$1149.60		 $1092.79
$1143.57
$1197.37
$1388.47		 $238.87

Plan: (HMO) Anthem Catastrophic Pathway X 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $254.16
$288.47
$324.82
$453.93
$689.79		 $508.32
$576.94
$649.64
$907.86
$1379.58		 $669.71
$738.33
$811.03
$1069.25		 $831.10
$899.72
$972.42
$1230.64		 $992.49
$1061.11
$1133.81
$1392.03		 $415.55
$449.86
$486.21
$615.32		 $576.94
$611.25
$647.60
$776.71		 $738.33
$772.64
$808.99
$938.10		 $161.39

Plan: (HMO) Anthem Bronze Pathway X 5850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $5,850 : Family: $11,700
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $311.09
$353.09
$397.57
$555.61
$844.30		 $622.18
$706.18
$795.14
$1111.22
$1688.60		 $819.72
$903.72
$992.68
$1308.76		 $1017.26
$1101.26
$1190.22
$1506.30		 $1214.80
$1298.80
$1387.76
$1703.84		 $508.63
$550.63
$595.11
$753.15		 $706.17
$748.17
$792.65
$950.69		 $903.71
$945.71
$990.19
$1148.23		 $197.54

Plan: (HMO) Anthem Bronze Pathway X 4950

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $4,950 : Family: $9,900
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $314.62
$357.09
$402.08
$561.91
$853.88		 $629.24
$714.18
$804.16
$1123.82
$1707.76		 $829.02
$913.96
$1003.94
$1323.60		 $1028.80
$1113.74
$1203.72
$1523.38		 $1228.58
$1313.52
$1403.50
$1723.16		 $514.40
$556.87
$601.86
$761.69		 $714.18
$756.65
$801.64
$961.47		 $913.96
$956.43
$1001.42
$1161.25		 $199.78

Plan: (HMO) Anthem Bronze Pathway X 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $309.60
$351.40
$395.67
$552.95
$840.25		 $619.20
$702.80
$791.34
$1105.90
$1680.50		 $815.80
$899.40
$987.94
$1302.50		 $1012.40
$1096.00
$1184.54
$1499.10		 $1209.00
$1292.60
$1381.14
$1695.70		 $506.20
$548.00
$592.27
$749.55		 $702.80
$744.60
$788.87
$946.15		 $899.40
$941.20
$985.47
$1142.75		 $196.60

Plan: (HMO) Anthem Silver Pathway X 4350

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $4,350 : Family: $8,700
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $355.80
$403.83
$454.71
$635.46
$965.64		 $711.60
$807.66
$909.42
$1270.92
$1931.28		 $937.53
$1033.59
$1135.35
$1496.85		 $1163.46
$1259.52
$1361.28
$1722.78		 $1389.39
$1485.45
$1587.21
$1948.71		 $581.73
$629.76
$680.64
$861.39		 $807.66
$855.69
$906.57
$1087.32		 $1033.59
$1081.62
$1132.50
$1313.25		 $225.93

Plan: (HMO) Anthem Silver Core Pathway X 5300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $5,300 : Family: $10,600
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $323.78
$367.49
$413.79
$578.27
$878.74		 $647.56
$734.98
$827.58
$1156.54
$1757.48		 $853.16
$940.58
$1033.18
$1362.14		 $1058.76
$1146.18
$1238.78
$1567.74		 $1264.36
$1351.78
$1444.38
$1773.34		 $529.38
$573.09
$619.39
$783.87		 $734.98
$778.69
$824.99
$989.47		 $940.58
$984.29
$1030.59
$1195.07		 $205.60

Plan: (POS) Anthem Bronze Pathway X POS 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $316.33
$359.03
$404.27
$564.97
$858.52		 $632.66
$718.06
$808.54
$1129.94
$1717.04		 $833.53
$918.93
$1009.41
$1330.81		 $1034.40
$1119.80
$1210.28
$1531.68		 $1235.27
$1320.67
$1411.15
$1732.55		 $517.20
$559.90
$605.14
$765.84		 $718.07
$760.77
$806.01
$966.71		 $918.94
$961.64
$1006.88
$1167.58		 $200.87

Plan: (HMO) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $379.21
$430.40
$484.63
$677.27
$1029.18		 $758.42
$860.80
$969.26
$1354.54
$2058.36		 $999.22
$1101.60
$1210.06
$1595.34		 $1240.02
$1342.40
$1450.86
$1836.14		 $1480.82
$1583.20
$1691.66
$2076.94		 $620.01
$671.20
$725.43
$918.07		 $860.81
$912.00
$966.23
$1158.87		 $1101.61
$1152.80
$1207.03
$1399.67		 $240.80

Plan: (HMO) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $506.08
$574.40
$646.77
$903.86
$1373.50		 $1012.16
$1148.80
$1293.54
$1807.72
$2747.00		 $1333.52
$1470.16
$1614.90
$2129.08		 $1654.88
$1791.52
$1936.26
$2450.44		 $1976.24
$2112.88
$2257.62
$2771.80		 $827.44
$895.76
$968.13
$1225.22		 $1148.80
$1217.12
$1289.49
$1546.58		 $1470.16
$1538.48
$1610.85
$1867.94		 $321.36

CareSource Indiana, Inc.

Local: 1-800-479-9502 | Toll Free: 1-877-806-9284

Plan: (HMO) CareSource Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $311.32
$353.35
$397.86
$556.01
$844.92		 $622.64
$706.70
$795.72
$1112.02
$1689.84		 $820.33
$904.39
$993.41
$1309.71		 $1018.02
$1102.08
$1191.10
$1507.40		 $1215.71
$1299.77
$1388.79
$1705.09		 $509.01
$551.04
$595.55
$753.70		 $706.70
$748.73
$793.24
$951.39		 $904.39
$946.42
$990.93
$1149.08		 $197.69

Plan: (HMO) CareSource Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $3,300 : Family: $6,600
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $259.80
$294.87
$332.02
$464.00
$705.09		 $519.60
$589.74
$664.04
$928.00
$1410.18		 $684.57
$754.71
$829.01
$1092.97		 $849.54
$919.68
$993.98
$1257.94		 $1014.51
$1084.65
$1158.95
$1422.91		 $424.77
$459.84
$496.99
$628.97		 $589.74
$624.81
$661.96
$793.94		 $754.71
$789.78
$826.93
$958.91		 $164.97

Plan: (HMO) CareSource Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $226.79
$257.40
$289.83
$405.04
$615.50		 $453.58
$514.80
$579.66
$810.08
$1231.00		 $597.59
$658.81
$723.67
$954.09		 $741.60
$802.82
$867.68
$1098.10		 $885.61
$946.83
$1011.69
$1242.11		 $370.80
$401.41
$433.84
$549.05		 $514.81
$545.42
$577.85
$693.06		 $658.82
$689.43
$721.86
$837.07		 $144.01

Plan: (HMO) CareSource Hoosier Choice Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $327.01
$371.15
$417.91
$584.03
$887.49		 $654.02
$742.30
$835.82
$1168.06
$1774.98		 $861.67
$949.95
$1043.47
$1375.71		 $1069.32
$1157.60
$1251.12
$1583.36		 $1276.97
$1365.25
$1458.77
$1791.01		 $534.66
$578.80
$625.56
$791.68		 $742.31
$786.45
$833.21
$999.33		 $949.96
$994.10
$1040.86
$1206.98		 $207.65

Plan: (HMO) CareSource Hoosier Choice Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $3,300 : Family: $6,600
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $272.89
$309.73
$348.75
$487.38
$740.62		 $545.78
$619.46
$697.50
$974.76
$1481.24		 $719.06
$792.74
$870.78
$1148.04		 $892.34
$966.02
$1044.06
$1321.32		 $1065.62
$1139.30
$1217.34
$1494.60		 $446.17
$483.01
$522.03
$660.66		 $619.45
$656.29
$695.31
$833.94		 $792.73
$829.57
$868.59
$1007.22		 $173.28

Plan: (HMO) CareSource Hoosier Choice Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $238.21
$270.37
$304.43
$425.44
$646.50		 $476.42
$540.74
$608.86
$850.88
$1293.00		 $627.68
$692.00
$760.12
$1002.14		 $778.94
$843.26
$911.38
$1153.40		 $930.20
$994.52
$1062.64
$1304.66		 $389.47
$421.63
$455.69
$576.70		 $540.73
$572.89
$606.95
$727.96		 $691.99
$724.15
$758.21
$879.22		 $151.26

Plan: (HMO) CareSource Gold Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $334.15
$379.25
$427.03
$596.78
$906.86		 $668.30
$758.50
$854.06
$1193.56
$1813.72		 $880.48
$970.68
$1066.24
$1405.74		 $1092.66
$1182.86
$1278.42
$1617.92		 $1304.84
$1395.04
$1490.60
$1830.10		 $546.33
$591.43
$639.21
$808.96		 $758.51
$803.61
$851.39
$1021.14		 $970.69
$1015.79
$1063.57
$1233.32		 $212.18

Plan: (HMO) CareSource Silver Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $3,300 : Family: $6,600
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $282.61
$320.76
$361.18
$504.74
$767.01		 $565.22
$641.52
$722.36
$1009.48
$1534.02		 $744.68
$820.98
$901.82
$1188.94		 $924.14
$1000.44
$1081.28
$1368.40		 $1103.60
$1179.90
$1260.74
$1547.86		 $462.07
$500.22
$540.64
$684.20		 $641.53
$679.68
$720.10
$863.66		 $820.99
$859.14
$899.56
$1043.12		 $179.46

Plan: (HMO) CareSource Bronze Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $249.60
$283.30
$318.99
$445.79
$677.41		 $499.20
$566.60
$637.98
$891.58
$1354.82		 $657.70
$725.10
$796.48
$1050.08		 $816.20
$883.60
$954.98
$1208.58		 $974.70
$1042.10
$1113.48
$1367.08		 $408.10
$441.80
$477.49
$604.29		 $566.60
$600.30
$635.99
$762.79		 $725.10
$758.80
$794.49
$921.29		 $158.50

Plan: (HMO) CareSource Hoosier Choice Gold Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $350.88
$398.25
$448.42
$626.67
$952.29		 $701.76
$796.50
$896.84
$1253.34
$1904.58		 $924.57
$1019.31
$1119.65
$1476.15		 $1147.38
$1242.12
$1342.46
$1698.96		 $1370.19
$1464.93
$1565.27
$1921.77		 $573.69
$621.06
$671.23
$849.48		 $796.50
$843.87
$894.04
$1072.29		 $1019.31
$1066.68
$1116.85
$1295.10		 $222.81

Plan: (HMO) CareSource Hoosier Choice Silver Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $3,300 : Family: $6,600
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $296.77
$336.83
$379.26
$530.02
$805.42		 $593.54
$673.66
$758.52
$1060.04
$1610.84		 $781.98
$862.10
$946.96
$1248.48		 $970.42
$1050.54
$1135.40
$1436.92		 $1158.86
$1238.98
$1323.84
$1625.36		 $485.21
$525.27
$567.70
$718.46		 $673.65
$713.71
$756.14
$906.90		 $862.09
$902.15
$944.58
$1095.34		 $188.44

Plan: (HMO) CareSource Hoosier Choice Bronze Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $262.08
$297.45
$334.93
$468.06
$711.27		 $524.16
$594.90
$669.86
$936.12
$1422.54		 $690.58
$761.32
$836.28
$1102.54		 $857.00
$927.74
$1002.70
$1268.96		 $1023.42
$1094.16
$1169.12
$1435.38		 $428.50
$463.87
$501.35
$634.48		 $594.92
$630.29
$667.77
$800.90		 $761.34
$796.71
$834.19
$967.32		 $166.42

Plan: (HMO) CareSource Federal Simple Choice Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $285.09
$323.57
$364.34
$509.16
$773.72		 $570.18
$647.14
$728.68
$1018.32
$1547.44		 $751.21
$828.17
$909.71
$1199.35		 $932.24
$1009.20
$1090.74
$1380.38		 $1113.27
$1190.23
$1271.77
$1561.41		 $466.12
$504.60
$545.37
$690.19		 $647.15
$685.63
$726.40
$871.22		 $828.18
$866.66
$907.43
$1052.25		 $181.03

Plan: (HMO) CareSource Federal Simple Choice Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $237.82
$269.92
$303.93
$424.74
$645.43		 $475.64
$539.84
$607.86
$849.48
$1290.86		 $626.65
$690.85
$758.87
$1000.49		 $777.66
$841.86
$909.88
$1151.50		 $928.67
$992.87
$1060.89
$1302.51		 $388.83
$420.93
$454.94
$575.75		 $539.84
$571.94
$605.95
$726.76		 $690.85
$722.95
$756.96
$877.77		 $151.01

Plan: (HMO) CareSource Federal Simple Choice Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $211.69
$240.26
$270.53
$378.07
$574.51		 $423.38
$480.52
$541.06
$756.14
$1149.02		 $557.80
$614.94
$675.48
$890.56		 $692.22
$749.36
$809.90
$1024.98		 $826.64
$883.78
$944.32
$1159.40		 $346.11
$374.68
$404.95
$512.49		 $480.53
$509.10
$539.37
$646.91		 $614.95
$643.52
$673.79
$781.33		 $134.42

Plan: (HMO) CareSource Low Premium Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-806-9284 - Provider Directory for This Plan: (CareSource Indiana, Inc.)

Deductible: Individual: $6,150 : Family: $12,300
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $223.78
$253.99
$285.99
$399.67
$607.33		 $447.56
$507.98
$571.98
$799.34
$1214.66		 $589.66
$650.08
$714.08
$941.44		 $731.76
$792.18
$856.18
$1083.54		 $873.86
$934.28
$998.28
$1225.64		 $365.88
$396.09
$428.09
$541.77		 $507.98
$538.19
$570.19
$683.87		 $650.08
$680.29
$712.29
$825.97		 $142.10

MDwise Marketplace, Inc.

Local: 1-855-417-5615 | Toll Free: 1-855-417-5615

TTY: 1-800-743-3333

Plan: (HMO) MDwise Marketplace Bronze Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $5,400 : Family: $10,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $234.08
$265.68
$299.15
$418.06
$635.29		 $468.16
$531.36
$598.30
$836.12
$1270.58		 $616.80
$680.00
$746.94
$984.76		 $765.44
$828.64
$895.58
$1133.40		 $914.08
$977.28
$1044.22
$1282.04		 $382.72
$414.32
$447.79
$566.70		 $531.36
$562.96
$596.43
$715.34		 $680.00
$711.60
$745.07
$863.98		 $148.64

Plan: (HMO) MDwise Marketplace Bronze Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $5,400 : Family: $10,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $238.58
$270.79
$304.90
$426.10
$647.50		 $477.16
$541.58
$609.80
$852.20
$1295.00		 $628.66
$693.08
$761.30
$1003.70		 $780.16
$844.58
$912.80
$1155.20		 $931.66
$996.08
$1064.30
$1306.70		 $390.08
$422.29
$456.40
$577.60		 $541.58
$573.79
$607.90
$729.10		 $693.08
$725.29
$759.40
$880.60		 $151.50

Plan: (HMO) MDwise Marketplace Silver Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $3,100 : Family: $6,200
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $264.41
$300.10
$337.91
$472.23
$717.61		 $528.82
$600.20
$675.82
$944.46
$1435.22		 $696.72
$768.10
$843.72
$1112.36		 $864.62
$936.00
$1011.62
$1280.26		 $1032.52
$1103.90
$1179.52
$1448.16		 $432.31
$468.00
$505.81
$640.13		 $600.21
$635.90
$673.71
$808.03		 $768.11
$803.80
$841.61
$975.93		 $167.90

Plan: (HMO) MDwise Marketplace Bronze Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $228.79
$259.68
$292.40
$408.62
$620.94		 $457.58
$519.36
$584.80
$817.24
$1241.88		 $602.86
$664.64
$730.08
$962.52		 $748.14
$809.92
$875.36
$1107.80		 $893.42
$955.20
$1020.64
$1253.08		 $374.07
$404.96
$437.68
$553.90		 $519.35
$550.24
$582.96
$699.18		 $664.63
$695.52
$728.24
$844.46		 $145.28

Plan: (HMO) MDwise Marketplace Silver Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $248.37
$281.91
$317.42
$443.60
$674.09		 $496.74
$563.82
$634.84
$887.20
$1348.18		 $654.46
$721.54
$792.56
$1044.92		 $812.18
$879.26
$950.28
$1202.64		 $969.90
$1036.98
$1108.00
$1360.36		 $406.09
$439.63
$475.14
$601.32		 $563.81
$597.35
$632.86
$759.04		 $721.53
$755.07
$790.58
$916.76		 $157.72

Plan: (HMO) MDwise Marketplace Silver Coinsurance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $3,600 : Family: $7,200
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $266.22
$302.16
$340.23
$475.47
$722.53		 $532.44
$604.32
$680.46
$950.94
$1445.06		 $701.49
$773.37
$849.51
$1119.99		 $870.54
$942.42
$1018.56
$1289.04		 $1039.59
$1111.47
$1187.61
$1458.09		 $435.27
$471.21
$509.28
$644.52		 $604.32
$640.26
$678.33
$813.57		 $773.37
$809.31
$847.38
$982.62		 $169.05

Plan: (HMO) MDwise Marketplace Silver Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $3,100 : Family: $6,200
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $268.91
$305.21
$343.67
$480.27
$729.82		 $537.82
$610.42
$687.34
$960.54
$1459.64		 $708.58
$781.18
$858.10
$1131.30		 $879.34
$951.94
$1028.86
$1302.06		 $1050.10
$1122.70
$1199.62
$1472.82		 $439.67
$475.97
$514.43
$651.03		 $610.43
$646.73
$685.19
$821.79		 $781.19
$817.49
$855.95
$992.55		 $170.76

Plan: (HMO) MDwise Marketplace Gold Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $332.03
$376.85
$424.33
$593.00
$901.12		 $664.06
$753.70
$848.66
$1186.00
$1802.24		 $874.90
$964.54
$1059.50
$1396.84		 $1085.74
$1175.38
$1270.34
$1607.68		 $1296.58
$1386.22
$1481.18
$1818.52		 $542.87
$587.69
$635.17
$803.84		 $753.71
$798.53
$846.01
$1014.68		 $964.55
$1009.37
$1056.85
$1225.52		 $210.84