ADVERTISEMENT
|
HMO Louisiana, Inc.
Local: 1-800-392-4087 | Toll Free: 1-800-392-4087 | TTY: 1-800-392-4087
|
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$1,000 |
$3,000 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$1,000
| Family:
$3,000
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$489.11
$555.14
$625.08
$873.55
$1,327.44 |
$978.22
$1,110.28
$1,250.16
$1,747.10
$2,654.88 |
$1,352.39
$1,484.45
$1,624.33
$2,121.27 |
$1,726.56
$1,858.62
$1,998.50
$2,495.44 |
$2,100.73
$2,232.79
$2,372.67
$2,869.61 |
$863.28
$929.31
$999.25
$1,247.72 |
$1,237.45
$1,303.48
$1,373.42
$1,621.89 |
$1,611.62
$1,677.65
$1,747.59
$1,996.06 |
$374.17 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,200 |
$12,600 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$4,200
| Family:
$12,600
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$467.82
$530.98
$597.87
$835.53
$1,269.66 |
$935.64
$1,061.96
$1,195.74
$1,671.06
$2,539.32 |
$1,293.52
$1,419.84
$1,553.62
$2,028.94 |
$1,651.40
$1,777.72
$1,911.50
$2,386.82 |
$2,009.28
$2,135.60
$2,269.38
$2,744.70 |
$825.70
$888.86
$955.75
$1,193.41 |
$1,183.58
$1,246.74
$1,313.63
$1,551.29 |
$1,541.46
$1,604.62
$1,671.51
$1,909.17 |
$357.88 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,500 |
$10,500 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$3,500
| Family:
$10,500
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$455.73
$517.25
$582.42
$813.93
$1,236.85 |
$911.46
$1,034.50
$1,164.84
$1,627.86
$2,473.70 |
$1,260.09
$1,383.13
$1,513.47
$1,976.49 |
$1,608.72
$1,731.76
$1,862.10
$2,325.12 |
$1,957.35
$2,080.39
$2,210.73
$2,673.75 |
$804.36
$865.88
$931.05
$1,162.56 |
$1,152.99
$1,214.51
$1,279.68
$1,511.19 |
$1,501.62
$1,563.14
$1,628.31
$1,859.82 |
$348.63 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$6,500 |
$16,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$6,500
| Family:
$16,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$309.50
$351.28
$395.54
$552.77
$839.98 |
$619.00
$702.56
$791.08
$1,105.54
$1,679.96 |
$855.77
$939.33
$1,027.85
$1,342.31 |
$1,092.54
$1,176.10
$1,264.62
$1,579.08 |
$1,329.31
$1,412.87
$1,501.39
$1,815.85 |
$546.27
$588.05
$632.31
$789.54 |
$783.04
$824.82
$869.08
$1,026.31 |
$1,019.81
$1,061.59
$1,105.85
$1,263.08 |
$236.77 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,550 |
$13,650 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$4,550
| Family:
$13,650
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$330.03
$374.58
$421.78
$589.43
$895.70 |
$660.06
$749.16
$843.56
$1,178.86
$1,791.40 |
$912.53
$1,001.63
$1,096.03
$1,431.33 |
$1,165.00
$1,254.10
$1,348.50
$1,683.80 |
$1,417.47
$1,506.57
$1,600.97
$1,936.27 |
$582.50
$627.05
$674.25
$841.90 |
$834.97
$879.52
$926.72
$1,094.37 |
$1,087.44
$1,131.99
$1,179.19
$1,346.84 |
$252.47 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,400 |
$10,200 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$3,400
| Family:
$10,200
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$395.53
$448.93
$505.49
$706.42
$1,073.47 |
$791.06
$897.86
$1,010.98
$1,412.84
$2,146.94 |
$1,093.64
$1,200.44
$1,313.56
$1,715.42 |
$1,396.22
$1,503.02
$1,616.14
$2,018.00 |
$1,698.80
$1,805.60
$1,918.72
$2,320.58 |
$698.11
$751.51
$808.07
$1,009.00 |
$1,000.69
$1,054.09
$1,110.65
$1,311.58 |
$1,303.27
$1,356.67
$1,413.23
$1,614.16 |
$302.58 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$2,500 |
$7,500 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$2,500
| Family:
$7,500
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$437.05
$496.05
$558.55
$780.57
$1,186.15 |
$874.10
$992.10
$1,117.10
$1,561.14
$2,372.30 |
$1,208.44
$1,326.44
$1,451.44
$1,895.48 |
$1,542.78
$1,660.78
$1,785.78
$2,229.82 |
$1,877.12
$1,995.12
$2,120.12
$2,564.16 |
$771.39
$830.39
$892.89
$1,114.91 |
$1,105.73
$1,164.73
$1,227.23
$1,449.25 |
$1,440.07
$1,499.07
$1,561.57
$1,783.59 |
$334.34 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,400 |
$10,200 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$3,400
| Family:
$10,200
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$375.76
$426.49
$480.22
$671.11
$1,019.81 |
$751.52
$852.98
$960.44
$1,342.22
$2,039.62 |
$1,038.98
$1,140.44
$1,247.90
$1,629.68 |
$1,326.44
$1,427.90
$1,535.36
$1,917.14 |
$1,613.90
$1,715.36
$1,822.82
$2,204.60 |
$663.22
$713.95
$767.68
$958.57 |
$950.68
$1,001.41
$1,055.14
$1,246.03 |
$1,238.14
$1,288.87
$1,342.60
$1,533.49 |
$287.46 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,550 |
$13,650 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$4,550
| Family:
$13,650
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$313.53
$355.86
$400.69
$559.96
$850.92 |
$627.06
$711.72
$801.38
$1,119.92
$1,701.84 |
$866.91
$951.57
$1,041.23
$1,359.77 |
$1,106.76
$1,191.42
$1,281.08
$1,599.62 |
$1,346.61
$1,431.27
$1,520.93
$1,839.47 |
$553.38
$595.71
$640.54
$799.81 |
$793.23
$835.56
$880.39
$1,039.66 |
$1,033.08
$1,075.41
$1,120.24
$1,279.51 |
$239.85 |
ADVERTISEMENT
|
Vantage Health Plan, Inc.
Local: 1-318-361-0900 | Toll Free: 1-888-823-1910 | TTY: 1-866-524-5144
|
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,500 |
$13,500 |
Maximum Out of Pocket Per Year |
$8,000 |
$16,000 |
Deductible: Individual:
$4,500
| Family:
$13,500
Out of Pocket Maximum per year: Individual:
$8,000
| Family:
$16,000
Monthly Premiums:
|
21
30
40
50
60
|
$586.29
$665.44
$749.28
$1,047.11
$1,591.19 |
$1,172.58
$1,330.88
$1,498.56
$2,094.22
$3,182.38 |
$1,621.09
$1,779.39
$1,947.07
$2,542.73 |
$2,069.60
$2,227.90
$2,395.58
$2,991.24 |
$2,518.11
$2,676.41
$2,844.09
$3,439.75 |
$1,034.80
$1,113.95
$1,197.79
$1,495.62 |
$1,483.31
$1,562.46
$1,646.30
$1,944.13 |
$1,931.82
$2,010.97
$2,094.81
$2,392.64 |
$448.51 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$6,500 |
$13,000 |
Maximum Out of Pocket Per Year |
$8,000 |
$16,000 |
Deductible: Individual:
$6,500
| Family:
$13,000
Out of Pocket Maximum per year: Individual:
$8,000
| Family:
$16,000
Monthly Premiums:
|
21
30
40
50
60
|
$368.27
$417.98
$470.65
$657.73
$999.48 |
$736.54
$835.96
$941.30
$1,315.46
$1,998.96 |
$1,018.27
$1,117.69
$1,223.03
$1,597.19 |
$1,300.00
$1,399.42
$1,504.76
$1,878.92 |
$1,581.73
$1,681.15
$1,786.49
$2,160.65 |
$650.00
$699.71
$752.38
$939.46 |
$931.73
$981.44
$1,034.11
$1,221.19 |
$1,213.46
$1,263.17
$1,315.84
$1,502.92 |
$281.73 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,500 |
$13,500 |
Maximum Out of Pocket Per Year |
$8,000 |
$16,000 |
Deductible: Individual:
$4,500
| Family:
$13,500
Out of Pocket Maximum per year: Individual:
$8,000
| Family:
$16,000
Monthly Premiums:
|
21
30
40
50
60
|
$604.48
$686.09
$772.53
$1,079.60
$1,640.56 |
$1,208.96
$1,372.18
$1,545.06
$2,159.20
$3,281.12 |
$1,671.39
$1,834.61
$2,007.49
$2,621.63 |
$2,133.82
$2,297.04
$2,469.92
$3,084.06 |
$2,596.25
$2,759.47
$2,932.35
$3,546.49 |
$1,066.91
$1,148.52
$1,234.96
$1,542.03 |
$1,529.34
$1,610.95
$1,697.39
$2,004.46 |
$1,991.77
$2,073.38
$2,159.82
$2,466.89 |
$462.43 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$1,600 |
$4,800 |
Maximum Out of Pocket Per Year |
$6,500 |
$13,000 |
Deductible: Individual:
$1,600
| Family:
$4,800
Out of Pocket Maximum per year: Individual:
$6,500
| Family:
$13,000
Monthly Premiums:
|
21
30
40
50
60
|
$533.47
$605.49
$681.77
$952.78
$1,447.83 |
$1,066.94
$1,210.98
$1,363.54
$1,905.56
$2,895.66 |
$1,475.04
$1,619.08
$1,771.64
$2,313.66 |
$1,883.14
$2,027.18
$2,179.74
$2,721.76 |
$2,291.24
$2,435.28
$2,587.84
$3,129.86 |
$941.57
$1,013.59
$1,089.87
$1,360.88 |
$1,349.67
$1,421.69
$1,497.97
$1,768.98 |
$1,757.77
$1,829.79
$1,906.07
$2,177.08 |
$408.10 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$5,500 |
$11,000 |
Maximum Out of Pocket Per Year |
$6,900 |
$13,800 |
Deductible: Individual:
$5,500
| Family:
$11,000
Out of Pocket Maximum per year: Individual:
$6,900
| Family:
$13,800
Monthly Premiums:
|
21
30
40
50
60
|
$360.54
$409.21
$460.77
$643.92
$978.50 |
$721.08
$818.42
$921.54
$1,287.84
$1,957.00 |
$996.89
$1,094.23
$1,197.35
$1,563.65 |
$1,272.70
$1,370.04
$1,473.16
$1,839.46 |
$1,548.51
$1,645.85
$1,748.97
$2,115.27 |
$636.35
$685.02
$736.58
$919.73 |
$912.16
$960.83
$1,012.39
$1,195.54 |
$1,187.97
$1,236.64
$1,288.20
$1,471.35 |
$275.81 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$6,900 |
$13,800 |
Maximum Out of Pocket Per Year |
$6,900 |
$13,800 |
Deductible: Individual:
$6,900
| Family:
$13,800
Out of Pocket Maximum per year: Individual:
$6,900
| Family:
$13,800
Monthly Premiums:
|
21
30
40
50
60
|
$359.26
$407.76
$459.14
$641.64
$975.04 |
$718.52
$815.52
$918.28
$1,283.28
$1,950.08 |
$993.36
$1,090.36
$1,193.12
$1,558.12 |
$1,268.20
$1,365.20
$1,467.96
$1,832.96 |
$1,543.04
$1,640.04
$1,742.80
$2,107.80 |
$634.10
$682.60
$733.98
$916.48 |
$908.94
$957.44
$1,008.82
$1,191.32 |
$1,183.78
$1,232.28
$1,283.66
$1,466.16 |
$274.84 |
ADVERTISEMENT
|
Louisiana Health Service & Indemnity Company
Local: 1-800-392-4087 | Toll Free: 1-800-392-4087 | TTY: 1-800-392-4087
|
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,000 |
$9,000 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$3,000
| Family:
$9,000
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$626.24
$710.78
$800.33
$1,118.46
$1,699.62 |
$1,252.48
$1,421.56
$1,600.66
$2,236.92
$3,399.24 |
$1,731.55
$1,900.63
$2,079.73
$2,715.99 |
$2,210.62
$2,379.70
$2,558.80
$3,195.06 |
$2,689.69
$2,858.77
$3,037.87
$3,674.13 |
$1,105.31
$1,189.85
$1,279.40
$1,597.53 |
$1,584.38
$1,668.92
$1,758.47
$2,076.60 |
$2,063.45
$2,147.99
$2,237.54
$2,555.67 |
$479.07 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$1,500 |
$4,500 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$1,500
| Family:
$4,500
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$677.31
$768.75
$865.60
$1,209.68
$1,838.22 |
$1,354.62
$1,537.50
$1,731.20
$2,419.36
$3,676.44 |
$1,872.76
$2,055.64
$2,249.34
$2,937.50 |
$2,390.90
$2,573.78
$2,767.48
$3,455.64 |
$2,909.04
$3,091.92
$3,285.62
$3,973.78 |
$1,195.45
$1,286.89
$1,383.74
$1,727.82 |
$1,713.59
$1,805.03
$1,901.88
$2,245.96 |
$2,231.73
$2,323.17
$2,420.02
$2,764.10 |
$518.14 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$5,100 |
$15,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$5,100
| Family:
$15,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$431.59
$489.85
$551.57
$770.82
$1,171.34 |
$863.18
$979.70
$1,103.14
$1,541.64
$2,342.68 |
$1,193.35
$1,309.87
$1,433.31
$1,871.81 |
$1,523.52
$1,640.04
$1,763.48
$2,201.98 |
$1,853.69
$1,970.21
$2,093.65
$2,532.15 |
$761.76
$820.02
$881.74
$1,100.99 |
$1,091.93
$1,150.19
$1,211.91
$1,431.16 |
$1,422.10
$1,480.36
$1,542.08
$1,761.33 |
$330.17 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,100 |
$6,200 |
Maximum Out of Pocket Per Year |
$6,750 |
$13,500 |
Deductible: Individual:
$3,100
| Family:
$6,200
Out of Pocket Maximum per year: Individual:
$6,750
| Family:
$13,500
Monthly Premiums:
|
21
30
40
50
60
|
$625.27
$709.68
$799.10
$1,116.73
$1,696.98 |
$1,250.54
$1,419.36
$1,598.20
$2,233.46
$3,393.96 |
$1,728.87
$1,897.69
$2,076.53
$2,711.79 |
$2,207.20
$2,376.02
$2,554.86
$3,190.12 |
$2,685.53
$2,854.35
$3,033.19
$3,668.45 |
$1,103.60
$1,188.01
$1,277.43
$1,595.06 |
$1,581.93
$1,666.34
$1,755.76
$2,073.39 |
$2,060.26
$2,144.67
$2,234.09
$2,551.72 |
$478.33 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,500 |
$9,000 |
Maximum Out of Pocket Per Year |
$6,750 |
$13,500 |
Deductible: Individual:
$4,500
| Family:
$9,000
Out of Pocket Maximum per year: Individual:
$6,750
| Family:
$13,500
Monthly Premiums:
|
21
30
40
50
60
|
$467.11
$530.17
$596.97
$834.26
$1,267.74 |
$934.22
$1,060.34
$1,193.94
$1,668.52
$2,535.48 |
$1,291.56
$1,417.68
$1,551.28
$2,025.86 |
$1,648.90
$1,775.02
$1,908.62
$2,383.20 |
$2,006.24
$2,132.36
$2,265.96
$2,740.54 |
$824.45
$887.51
$954.31
$1,191.60 |
$1,181.79
$1,244.85
$1,311.65
$1,548.94 |
$1,539.13
$1,602.19
$1,668.99
$1,906.28 |
$357.34 |
Iberia Parish is in “Rating Area 3” of Louisiana.
Currently, there are 20 plans offered in Rating Area 3.