Maine Obamacare

2017 Obamacare Rates for Franklin County

Maine 2017 Obamacare Rates for Franklin County

 
Farmington, ME

Providers for Zip Code 04938

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Obamacare Providers, Plans and 2017 Rates for Franklin 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 Franklin County, Maine.

Currently, there are 28 plans offered in Franklin 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 Franklin 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 Farmington, ME 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 Franklin County here.

Maine Community Health Options

Local: 1-855-624-6463 | Toll Free: 1-855-624-6463

Plan: (PPO) Community Safe Harbor

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

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		 $199.18
$226.07
$254.56
$355.74
$540.58		 $398.36
$452.14
$509.12
$711.48
$1081.16		 $524.84
$578.62
$635.60
$837.96		 $651.32
$705.10
$762.08
$964.44		 $777.80
$831.58
$888.56
$1090.92		 $325.66
$352.55
$381.04
$482.22		 $452.14
$479.03
$507.52
$608.70		 $578.62
$605.51
$634.00
$735.18		 $126.48

Plan: (PPO) Communty Focus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $5,500 : Family: $11,000
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		 $267.44
$303.54
$341.79
$477.65
$725.83		 $534.88
$607.08
$683.58
$955.30
$1451.66		 $704.70
$776.90
$853.40
$1125.12		 $874.52
$946.72
$1023.22
$1294.94		 $1044.34
$1116.54
$1193.04
$1464.76		 $437.26
$473.36
$511.61
$647.47		 $607.08
$643.18
$681.43
$817.29		 $776.90
$813.00
$851.25
$987.11		 $169.82

Plan: (PPO) Community Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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		 $333.02
$377.98
$425.60
$594.77
$903.81		 $666.04
$755.96
$851.20
$1189.54
$1807.62		 $877.51
$967.43
$1062.67
$1401.01		 $1088.98
$1178.90
$1274.14
$1612.48		 $1300.45
$1390.37
$1485.61
$1823.95		 $544.49
$589.45
$637.07
$806.24		 $755.96
$800.92
$848.54
$1017.71		 $967.43
$1012.39
$1060.01
$1229.18		 $211.47

Plan: (PPO) Community Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

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		 $317.55
$360.42
$405.83
$567.15
$861.83		 $635.10
$720.84
$811.66
$1134.30
$1723.66		 $836.74
$922.48
$1013.30
$1335.94		 $1038.38
$1124.12
$1214.94
$1537.58		 $1240.02
$1325.76
$1416.58
$1739.22		 $519.19
$562.06
$607.47
$768.79		 $720.83
$763.70
$809.11
$970.43		 $922.47
$965.34
$1010.75
$1172.07		 $201.64

Plan: (PPO) Community Edge

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $4,300 : Family: $8,600

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		 $430.01
$488.06
$549.55
$768.00
$1167.05		 $860.02
$976.12
$1099.10
$1536.00
$2334.10		 $1133.08
$1249.18
$1372.16
$1809.06		 $1406.14
$1522.24
$1645.22
$2082.12		 $1679.20
$1795.30
$1918.28
$2355.18		 $703.07
$761.12
$822.61
$1041.06		 $976.13
$1034.18
$1095.67
$1314.12		 $1249.19
$1307.24
$1368.73
$1587.18		 $273.06

Plan: (PPO) Community Reliant HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $5,500 : Family: $11,000
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		 $277.87
$315.38
$355.12
$496.27
$754.14		 $555.74
$630.76
$710.24
$992.54
$1508.28		 $732.19
$807.21
$886.69
$1168.99		 $908.64
$983.66
$1063.14
$1345.44		 $1085.09
$1160.11
$1239.59
$1521.89		 $454.32
$491.83
$531.57
$672.72		 $630.77
$668.28
$708.02
$849.17		 $807.22
$844.73
$884.47
$1025.62		 $176.45

Plan: (PPO) Community Align

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $5,500 : Family: $11,000
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		 $284.62
$323.04
$363.74
$508.33
$772.45		 $569.24
$646.08
$727.48
$1016.66
$1544.90		 $749.97
$826.81
$908.21
$1197.39		 $930.70
$1007.54
$1088.94
$1378.12		 $1111.43
$1188.27
$1269.67
$1558.85		 $465.35
$503.77
$544.47
$689.06		 $646.08
$684.50
$725.20
$869.79		 $826.81
$865.23
$905.93
$1050.52		 $180.73

Plan: (PPO) Community Advance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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		 $354.10
$401.91
$452.54
$632.43
$961.04		 $708.20
$803.82
$905.08
$1264.86
$1922.08		 $933.06
$1028.68
$1129.94
$1489.72		 $1157.92
$1253.54
$1354.80
$1714.58		 $1382.78
$1478.40
$1579.66
$1939.44		 $578.96
$626.77
$677.40
$857.29		 $803.82
$851.63
$902.26
$1082.15		 $1028.68
$1076.49
$1127.12
$1307.01		 $224.86

Plan: (PPO) Community Complete

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-624-6463 - Provider Directory for This Plan: (Maine Community Health Options)

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		 $334.68
$379.86
$427.72
$597.74
$908.32		 $669.36
$759.72
$855.44
$1195.48
$1816.64		 $881.88
$972.24
$1067.96
$1408.00		 $1094.40
$1184.76
$1280.48
$1620.52		 $1306.92
$1397.28
$1493.00
$1833.04		 $547.20
$592.38
$640.24
$810.26		 $759.72
$804.90
$852.76
$1022.78		 $972.24
$1017.42
$1065.28
$1235.30		 $212.52

Anthem Health Plans of ME(Anthem BCBS)

Local: 1-855-738-6674 | Toll Free: 1-855-738-6674

Plan: (HMO) Anthem Bronze X HMO 6250 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $6,250 : Family: $12,500
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		 $264.14
$299.80
$337.57
$471.75
$716.88		 $528.28
$599.60
$675.14
$943.50
$1433.76		 $696.01
$767.33
$842.87
$1111.23		 $863.74
$935.06
$1010.60
$1278.96		 $1031.47
$1102.79
$1178.33
$1446.69		 $431.87
$467.53
$505.30
$639.48		 $599.60
$635.26
$673.03
$807.21		 $767.33
$802.99
$840.76
$974.94		 $167.73

Plan: (HMO) Anthem Silver X HMO 3850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $3,850 : Family: $7,700
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		 $297.87
$338.08
$380.68
$532.00
$808.42		 $595.74
$676.16
$761.36
$1064.00
$1616.84		 $784.89
$865.31
$950.51
$1253.15		 $974.04
$1054.46
$1139.66
$1442.30		 $1163.19
$1243.61
$1328.81
$1631.45		 $487.02
$527.23
$569.83
$721.15		 $676.17
$716.38
$758.98
$910.30		 $865.32
$905.53
$948.13
$1099.45		 $189.15

Plan: (HMO) Anthem Catastrophic X HMO 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(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		 $210.64
$239.08
$269.20
$376.20
$571.68		 $421.28
$478.16
$538.40
$752.40
$1143.36		 $555.04
$611.92
$672.16
$886.16		 $688.80
$745.68
$805.92
$1019.92		 $822.56
$879.44
$939.68
$1153.68		 $344.40
$372.84
$402.96
$509.96		 $478.16
$506.60
$536.72
$643.72		 $611.92
$640.36
$670.48
$777.48		 $133.76

Plan: (HMO) Anthem Bronze X HMO 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(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		 $269.78
$306.20
$344.78
$481.83
$732.18		 $539.56
$612.40
$689.56
$963.66
$1464.36		 $710.87
$783.71
$860.87
$1134.97		 $882.18
$955.02
$1032.18
$1306.28		 $1053.49
$1126.33
$1203.49
$1477.59		 $441.09
$477.51
$516.09
$653.14		 $612.40
$648.82
$687.40
$824.45		 $783.71
$820.13
$858.71
$995.76		 $171.31

Plan: (HMO) Anthem Bronze X HMO 5000 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $5,000 : Family: $10,000
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		 $273.21
$310.09
$349.16
$487.95
$741.49		 $546.42
$620.18
$698.32
$975.90
$1482.98		 $719.91
$793.67
$871.81
$1149.39		 $893.40
$967.16
$1045.30
$1322.88		 $1066.89
$1140.65
$1218.79
$1496.37		 $446.70
$483.58
$522.65
$661.44		 $620.19
$657.07
$696.14
$834.93		 $793.68
$830.56
$869.63
$1008.42		 $173.49

Plan: (HMO) Anthem Silver X HMO 2900 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $2,900 : Family: $5,800
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
Silver 21
30
40
50
60		 $311.04
$353.03
$397.51
$555.52
$844.16		 $622.08
$706.06
$795.02
$1111.04
$1688.32		 $819.59
$903.57
$992.53
$1308.55		 $1017.10
$1101.08
$1190.04
$1506.06		 $1214.61
$1298.59
$1387.55
$1703.57		 $508.55
$550.54
$595.02
$753.03		 $706.06
$748.05
$792.53
$950.54		 $903.57
$945.56
$990.04
$1148.05		 $197.51

Plan: (HMO) Anthem Silver X HMO 2250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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		 $306.56
$347.95
$391.78
$547.52
$832.00		 $613.12
$695.90
$783.56
$1095.04
$1664.00		 $807.79
$890.57
$978.23
$1289.71		 $1002.46
$1085.24
$1172.90
$1484.38		 $1197.13
$1279.91
$1367.57
$1679.05		 $501.23
$542.62
$586.45
$742.19		 $695.90
$737.29
$781.12
$936.86		 $890.57
$931.96
$975.79
$1131.53		 $194.67

Plan: (HMO) Anthem Bronze X HMO 6250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $6,250 : Family: $12,500
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		 $258.91
$293.86
$330.89
$462.41
$702.68		 $517.82
$587.72
$661.78
$924.82
$1405.36		 $682.23
$752.13
$826.19
$1089.23		 $846.64
$916.54
$990.60
$1253.64		 $1011.05
$1080.95
$1155.01
$1418.05		 $423.32
$458.27
$495.30
$626.82		 $587.73
$622.68
$659.71
$791.23		 $752.14
$787.09
$824.12
$955.64		 $164.41

Plan: (HMO) Anthem Silver Core X HMO 4650

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $4,650 : Family: $9,300
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

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
Silver 21
30
40
50
60		 $291.96
$331.37
$373.12
$521.44
$792.38		 $583.92
$662.74
$746.24
$1042.88
$1584.76		 $769.31
$848.13
$931.63
$1228.27		 $954.70
$1033.52
$1117.02
$1413.66		 $1140.09
$1218.91
$1302.41
$1599.05		 $477.35
$516.76
$558.51
$706.83		 $662.74
$702.15
$743.90
$892.22		 $848.13
$887.54
$929.29
$1077.61		 $185.39

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $2,800 : Family: $5,600
Out of Pocket Maximum per year: Individual: $6,950 : Family: $13,900

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		 $318.26
$361.23
$406.74
$568.41
$863.76		 $636.52
$722.46
$813.48
$1136.82
$1727.52		 $838.62
$924.56
$1015.58
$1338.92		 $1040.72
$1126.66
$1217.68
$1541.02		 $1242.82
$1328.76
$1419.78
$1743.12		 $520.36
$563.33
$608.84
$770.51		 $722.46
$765.43
$810.94
$972.61		 $924.56
$967.53
$1013.04
$1174.71		 $202.10

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6674 - Provider Directory for This Plan: (Anthem Health Plans of ME(Anthem BCBS))

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,050 : Family: $12,100

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
Gold 21
30
40
50
60		 $435.02
$493.75
$555.96
$776.95
$1180.64		 $870.04
$987.50
$1111.92
$1553.90
$2361.28		 $1146.28
$1263.74
$1388.16
$1830.14		 $1422.52
$1539.98
$1664.40
$2106.38		 $1698.76
$1816.22
$1940.64
$2382.62		 $711.26
$769.99
$832.20
$1053.19		 $987.50
$1046.23
$1108.44
$1329.43		 $1263.74
$1322.47
$1384.68
$1605.67		 $276.24

Harvard Pilgrim Health Care Inc.

Local: 1-877-907-4742 | Toll Free: 1-877-907-4742

TTY: 1-800-637-8257

Plan: (HMO) Gold HMO 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

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		 $487.03
$552.78
$622.43
$869.84
$1321.81		 $974.06
$1105.56
$1244.86
$1739.68
$2643.62		 $1283.33
$1414.83
$1554.13
$2048.95		 $1592.60
$1724.10
$1863.40
$2358.22		 $1901.87
$2033.37
$2172.67
$2667.49		 $796.30
$862.05
$931.70
$1179.11		 $1105.57
$1171.32
$1240.97
$1488.38		 $1414.84
$1480.59
$1550.24
$1797.65		 $309.27

Plan: (HMO) Bronze HMO 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $6,000 : Family: $12,000
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		 $261.75
$297.08
$334.51
$467.48
$710.39		 $523.50
$594.16
$669.02
$934.96
$1420.78		 $689.71
$760.37
$835.23
$1101.17		 $855.92
$926.58
$1001.44
$1267.38		 $1022.13
$1092.79
$1167.65
$1433.59		 $427.96
$463.29
$500.72
$633.69		 $594.17
$629.50
$666.93
$799.90		 $760.38
$795.71
$833.14
$966.11		 $166.21

Plan: (HMO) Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

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		 $368.15
$417.85
$470.49
$657.51
$999.15		 $736.30
$835.70
$940.98
$1315.02
$1998.30		 $970.07
$1069.47
$1174.75
$1548.79		 $1203.84
$1303.24
$1408.52
$1782.56		 $1437.61
$1537.01
$1642.29
$2016.33		 $601.92
$651.62
$704.26
$891.28		 $835.69
$885.39
$938.03
$1125.05		 $1069.46
$1119.16
$1171.80
$1358.82		 $233.77

Plan: (HMO) Best Buy HSA HMO 5400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $5,400 : Family: $10,800
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		 $267.24
$303.32
$341.54
$477.30
$725.30		 $534.48
$606.64
$683.08
$954.60
$1450.60		 $704.18
$776.34
$852.78
$1124.30		 $873.88
$946.04
$1022.48
$1294.00		 $1043.58
$1115.74
$1192.18
$1463.70		 $436.94
$473.02
$511.24
$647.00		 $606.64
$642.72
$680.94
$816.70		 $776.34
$812.42
$850.64
$986.40		 $169.70

Plan: (HMO) Maine's Choice Gold HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $750 : Family: $1,500
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		 $418.60
$475.11
$534.97
$747.62
$1136.08		 $837.20
$950.22
$1069.94
$1495.24
$2272.16		 $1103.01
$1216.03
$1335.75
$1761.05		 $1368.82
$1481.84
$1601.56
$2026.86		 $1634.63
$1747.65
$1867.37
$2292.67		 $684.41
$740.92
$800.78
$1013.43		 $950.22
$1006.73
$1066.59
$1279.24		 $1216.03
$1272.54
$1332.40
$1545.05		 $265.81

Plan: (HMO) Maine's Choice Casco Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $1,700 : Family: $3,400
Out of Pocket Maximum per year: Individual: $6,500 : 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		 $334.68
$379.86
$427.72
$597.74
$908.32		 $669.36
$759.72
$855.44
$1195.48
$1816.64		 $881.88
$972.24
$1067.96
$1408.00		 $1094.40
$1184.76
$1280.48
$1620.52		 $1306.92
$1397.28
$1493.00
$1833.04		 $547.20
$592.38
$640.24
$810.26		 $759.72
$804.90
$852.76
$1022.78		 $972.24
$1017.42
$1065.28
$1235.30		 $212.52

Plan: (HMO) Maine's Choice Sebago Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $323.69
$367.39
$413.67
$578.11
$878.49		 $647.38
$734.78
$827.34
$1156.22
$1756.98		 $852.92
$940.32
$1032.88
$1361.76		 $1058.46
$1145.86
$1238.42
$1567.30		 $1264.00
$1351.40
$1443.96
$1772.84		 $529.23
$572.93
$619.21
$783.65		 $734.77
$778.47
$824.75
$989.19		 $940.31
$984.01
$1030.29
$1194.73		 $205.54

Plan: (HMO) Maine's Choice Pemaquid Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $305.71
$346.98
$390.69
$545.99
$829.69		 $611.42
$693.96
$781.38
$1091.98
$1659.38		 $805.54
$888.08
$975.50
$1286.10		 $999.66
$1082.20
$1169.62
$1480.22		 $1193.78
$1276.32
$1363.74
$1674.34		 $499.83
$541.10
$584.81
$740.11		 $693.95
$735.22
$778.93
$934.23		 $888.07
$929.34
$973.05
$1128.35		 $194.12