Clinton County, Missouri Obamacare 2024 Rates

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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 Clinton County, MO.

The health insurance rates listed below are for calendar year 2024.

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, 78 Plans and 2024 Rates for Clinton County, Missouri

Below, you’ll find a summary of the 78 plans for Clinton County, Missouri and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |



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Blue Cross and Blue Shield of Kansas City

Local: 1-816-395-3558 | Toll Free: 1-888-800-4478

Toc - Plan #1 Blue Cross and Blue Shield of Kansas City
Expanded Bronze

(EPO) Blue KC Saver Bronze Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,000 $16,000 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
$511.11
$580.11
$653.20
$912.84
$1,387.15
$902.11
$971.11
$1,044.20
$1,303.84
$1,293.11
$1,362.11
$1,435.20
$1,694.84
$1,684.11
$1,753.11
$1,826.20
$2,085.84
$391.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,022.22
$1,160.22
$1,306.40
$1,825.68
$2,774.30
$1,413.22
$1,551.22
$1,697.40
$2,216.68
$1,804.22
$1,942.22
$2,088.40
$2,607.68
$2,195.22
$2,333.22
$2,479.40
$2,998.68
$391.00
Toc - Plan #2 Blue Cross and Blue Shield of Kansas City
Silver

(EPO) Blue KC Community Silver Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,200 $16,400 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
$628.65
$713.52
$803.42
$1,122.78
$1,706.17
$1,109.57
$1,194.44
$1,284.34
$1,603.70
$1,590.49
$1,675.36
$1,765.26
$2,084.62
$2,071.41
$2,156.28
$2,246.18
$2,565.54
$480.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,257.30
$1,427.04
$1,606.84
$2,245.56
$3,412.34
$1,738.22
$1,907.96
$2,087.76
$2,726.48
$2,219.14
$2,388.88
$2,568.68
$3,207.40
$2,700.06
$2,869.80
$3,049.60
$3,688.32
$480.92
Toc - Plan #3 Blue Cross and Blue Shield of Kansas City
Expanded Bronze

(EPO) Blue KC First Bronze Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,450 $18,900 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
$503.30
$571.25
$643.22
$898.90
$1,365.97
$888.33
$956.28
$1,028.25
$1,283.93
$1,273.36
$1,341.31
$1,413.28
$1,668.96
$1,658.39
$1,726.34
$1,798.31
$2,053.99
$385.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,006.60
$1,142.50
$1,286.44
$1,797.80
$2,731.94
$1,391.63
$1,527.53
$1,671.47
$2,182.83
$1,776.66
$1,912.56
$2,056.50
$2,567.86
$2,161.69
$2,297.59
$2,441.53
$2,952.89
$385.03
Toc - Plan #4 Blue Cross and Blue Shield of Kansas City
Gold

(EPO) Blue KC Standard Gold Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$699.30
$793.70
$893.70
$1,248.95
$1,897.90
$1,234.26
$1,328.66
$1,428.66
$1,783.91
$1,769.22
$1,863.62
$1,963.62
$2,318.87
$2,304.18
$2,398.58
$2,498.58
$2,853.83
$534.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,398.60
$1,587.40
$1,787.40
$2,497.90
$3,795.80
$1,933.56
$2,122.36
$2,322.36
$3,032.86
$2,468.52
$2,657.32
$2,857.32
$3,567.82
$3,003.48
$3,192.28
$3,392.28
$4,102.78
$534.96
Toc - Plan #5 Blue Cross and Blue Shield of Kansas City
Silver

(EPO) Blue KC Standard Silver Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$604.06
$685.60
$771.98
$1,078.84
$1,639.41
$1,066.16
$1,147.70
$1,234.08
$1,540.94
$1,528.26
$1,609.80
$1,696.18
$2,003.04
$1,990.36
$2,071.90
$2,158.28
$2,465.14
$462.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,208.12
$1,371.20
$1,543.96
$2,157.68
$3,278.82
$1,670.22
$1,833.30
$2,006.06
$2,619.78
$2,132.32
$2,295.40
$2,468.16
$3,081.88
$2,594.42
$2,757.50
$2,930.26
$3,543.98
$462.10
Toc - Plan #6 Blue Cross and Blue Shield of Kansas City
Expanded Bronze

(EPO) Blue KC Standard Bronze Preferred-Care Blue EPO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-800-4478

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$483.30
$548.54
$617.65
$863.17
$1,311.67
$853.02
$918.26
$987.37
$1,232.89
$1,222.74
$1,287.98
$1,357.09
$1,602.61
$1,592.46
$1,657.70
$1,726.81
$1,972.33
$369.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$966.60
$1,097.08
$1,235.30
$1,726.34
$2,623.34
$1,336.32
$1,466.80
$1,605.02
$2,096.06
$1,706.04
$1,836.52
$1,974.74
$2,465.78
$2,075.76
$2,206.24
$2,344.46
$2,835.50
$369.72

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Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #7 Aetna CVS Health
Expanded Bronze

(EPO) Bronze 2 HSA: Aetna network of doctors & hospitals + MinuteClinic + Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 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
$365.73
$415.11
$467.40
$653.19
$992.59
$645.52
$694.90
$747.19
$932.98
$925.31
$974.69
$1,026.98
$1,212.77
$1,205.10
$1,254.48
$1,306.77
$1,492.56
$279.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$731.46
$830.22
$934.80
$1,306.38
$1,985.18
$1,011.25
$1,110.01
$1,214.59
$1,586.17
$1,291.04
$1,389.80
$1,494.38
$1,865.96
$1,570.83
$1,669.59
$1,774.17
$2,145.75
$279.79
Toc - Plan #8 Aetna CVS Health
Silver

(EPO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 Annual Deductible
$8,850 $17,700 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
$458.78
$520.72
$586.32
$819.38
$1,245.12
$809.75
$871.69
$937.29
$1,170.35
$1,160.72
$1,222.66
$1,288.26
$1,521.32
$1,511.69
$1,573.63
$1,639.23
$1,872.29
$350.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$917.56
$1,041.44
$1,172.64
$1,638.76
$2,490.24
$1,268.53
$1,392.41
$1,523.61
$1,989.73
$1,619.50
$1,743.38
$1,874.58
$2,340.70
$1,970.47
$2,094.35
$2,225.55
$2,691.67
$350.97
Toc - Plan #9 Aetna CVS Health
Expanded Bronze

(EPO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$378.42
$429.51
$483.63
$675.86
$1,027.04
$667.92
$719.01
$773.13
$965.36
$957.42
$1,008.51
$1,062.63
$1,254.86
$1,246.92
$1,298.01
$1,352.13
$1,544.36
$289.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$756.84
$859.02
$967.26
$1,351.72
$2,054.08
$1,046.34
$1,148.52
$1,256.76
$1,641.22
$1,335.84
$1,438.02
$1,546.26
$1,930.72
$1,625.34
$1,727.52
$1,835.76
$2,220.22
$289.50
Toc - Plan #10 Aetna CVS Health
Gold

(EPO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$493.85
$560.51
$631.13
$882.00
$1,340.29
$871.64
$938.30
$1,008.92
$1,259.79
$1,249.43
$1,316.09
$1,386.71
$1,637.58
$1,627.22
$1,693.88
$1,764.50
$2,015.37
$377.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$987.70
$1,121.02
$1,262.26
$1,764.00
$2,680.58
$1,365.49
$1,498.81
$1,640.05
$2,141.79
$1,743.28
$1,876.60
$2,017.84
$2,519.58
$2,121.07
$2,254.39
$2,395.63
$2,897.37
$377.79
Toc - Plan #11 Aetna CVS Health
Silver

(EPO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$447.94
$508.41
$572.46
$800.01
$1,215.69
$790.61
$851.08
$915.13
$1,142.68
$1,133.28
$1,193.75
$1,257.80
$1,485.35
$1,475.95
$1,536.42
$1,600.47
$1,828.02
$342.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.88
$1,016.82
$1,144.92
$1,600.02
$2,431.38
$1,238.55
$1,359.49
$1,487.59
$1,942.69
$1,581.22
$1,702.16
$1,830.26
$2,285.36
$1,923.89
$2,044.83
$2,172.93
$2,628.03
$342.67
Toc - Plan #12 Aetna CVS Health
Expanded Bronze

(EPO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$412.89
$468.63
$527.67
$737.42
$1,120.58
$728.75
$784.49
$843.53
$1,053.28
$1,044.61
$1,100.35
$1,159.39
$1,369.14
$1,360.47
$1,416.21
$1,475.25
$1,685.00
$315.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.78
$937.26
$1,055.34
$1,474.84
$2,241.16
$1,141.64
$1,253.12
$1,371.20
$1,790.70
$1,457.50
$1,568.98
$1,687.06
$2,106.56
$1,773.36
$1,884.84
$2,002.92
$2,422.42
$315.86
Toc - Plan #13 Aetna CVS Health
Gold

(EPO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,195 $18,390 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
$490.76
$557.01
$627.19
$876.49
$1,331.91
$866.19
$932.44
$1,002.62
$1,251.92
$1,241.62
$1,307.87
$1,378.05
$1,627.35
$1,617.05
$1,683.30
$1,753.48
$2,002.78
$375.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$981.52
$1,114.02
$1,254.38
$1,752.98
$2,663.82
$1,356.95
$1,489.45
$1,629.81
$2,128.41
$1,732.38
$1,864.88
$2,005.24
$2,503.84
$2,107.81
$2,240.31
$2,380.67
$2,879.27
$375.43
Toc - Plan #14 Aetna CVS Health
Silver

(EPO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,445 $16,890 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
$459.74
$521.80
$587.54
$821.08
$1,247.71
$811.44
$873.50
$939.24
$1,172.78
$1,163.14
$1,225.20
$1,290.94
$1,524.48
$1,514.84
$1,576.90
$1,642.64
$1,876.18
$351.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$919.48
$1,043.60
$1,175.08
$1,642.16
$2,495.42
$1,271.18
$1,395.30
$1,526.78
$1,993.86
$1,622.88
$1,747.00
$1,878.48
$2,345.56
$1,974.58
$2,098.70
$2,230.18
$2,697.26
$351.70
Toc - Plan #15 Aetna CVS Health
Silver

(EPO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,845 $17,690 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
$458.73
$520.66
$586.26
$819.29
$1,244.99
$809.66
$871.59
$937.19
$1,170.22
$1,160.59
$1,222.52
$1,288.12
$1,521.15
$1,511.52
$1,573.45
$1,639.05
$1,872.08
$350.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$917.46
$1,041.32
$1,172.52
$1,638.58
$2,489.98
$1,268.39
$1,392.25
$1,523.45
$1,989.51
$1,619.32
$1,743.18
$1,874.38
$2,340.44
$1,970.25
$2,094.11
$2,225.31
$2,691.37
$350.93

ADVERTISEMENT

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777

Toc - Plan #16 Medica
Catastrophic

(EPO) Select by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 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
$275.95
$313.21
$352.67
$492.85
$748.94
$487.05
$524.31
$563.77
$703.95
$698.15
$735.41
$774.87
$915.05
$909.25
$946.51
$985.97
$1,126.15
$211.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$551.90
$626.42
$705.34
$985.70
$1,497.88
$763.00
$837.52
$916.44
$1,196.80
$974.10
$1,048.62
$1,127.54
$1,407.90
$1,185.20
$1,259.72
$1,338.64
$1,619.00
$211.10
Toc - Plan #17 Medica
Expanded Bronze

(EPO) Select by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 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
$421.83
$478.78
$539.10
$753.39
$1,144.85
$744.53
$801.48
$861.80
$1,076.09
$1,067.23
$1,124.18
$1,184.50
$1,398.79
$1,389.93
$1,446.88
$1,507.20
$1,721.49
$322.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$843.66
$957.56
$1,078.20
$1,506.78
$2,289.70
$1,166.36
$1,280.26
$1,400.90
$1,829.48
$1,489.06
$1,602.96
$1,723.60
$2,152.18
$1,811.76
$1,925.66
$2,046.30
$2,474.88
$322.70
Toc - Plan #18 Medica
Expanded Bronze

(EPO) Select by Medica Bronze Copay $0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,850 $15,700 Annual Deductible
$9,450 $18,900 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
$411.84
$467.44
$526.34
$735.55
$1,117.74
$726.90
$782.50
$841.40
$1,050.61
$1,041.96
$1,097.56
$1,156.46
$1,365.67
$1,357.02
$1,412.62
$1,471.52
$1,680.73
$315.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$823.68
$934.88
$1,052.68
$1,471.10
$2,235.48
$1,138.74
$1,249.94
$1,367.74
$1,786.16
$1,453.80
$1,565.00
$1,682.80
$2,101.22
$1,768.86
$1,880.06
$1,997.86
$2,416.28
$315.06
Toc - Plan #19 Medica
Gold

(EPO) Select by Medica Gold Copay $0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 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
$584.56
$663.47
$747.07
$1,044.02
$1,586.49
$1,031.75
$1,110.66
$1,194.26
$1,491.21
$1,478.94
$1,557.85
$1,641.45
$1,938.40
$1,926.13
$2,005.04
$2,088.64
$2,385.59
$447.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,169.12
$1,326.94
$1,494.14
$2,088.04
$3,172.98
$1,616.31
$1,774.13
$1,941.33
$2,535.23
$2,063.50
$2,221.32
$2,388.52
$2,982.42
$2,510.69
$2,668.51
$2,835.71
$3,429.61
$447.19
Toc - Plan #20 Medica
Silver

(EPO) Select by Medica Silver Copay $0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,450 $18,900 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
$561.92
$637.78
$718.14
$1,003.59
$1,525.06
$991.79
$1,067.65
$1,148.01
$1,433.46
$1,421.66
$1,497.52
$1,577.88
$1,863.33
$1,851.53
$1,927.39
$2,007.75
$2,293.20
$429.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,123.84
$1,275.56
$1,436.28
$2,007.18
$3,050.12
$1,553.71
$1,705.43
$1,866.15
$2,437.05
$1,983.58
$2,135.30
$2,296.02
$2,866.92
$2,413.45
$2,565.17
$2,725.89
$3,296.79
$429.87
Toc - Plan #21 Medica
Expanded Bronze

(EPO) Select by Medica Bronze Premier

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$9,450 $18,900 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
$428.38
$486.21
$547.47
$765.08
$1,162.61
$756.09
$813.92
$875.18
$1,092.79
$1,083.80
$1,141.63
$1,202.89
$1,420.50
$1,411.51
$1,469.34
$1,530.60
$1,748.21
$327.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856.76
$972.42
$1,094.94
$1,530.16
$2,325.22
$1,184.47
$1,300.13
$1,422.65
$1,857.87
$1,512.18
$1,627.84
$1,750.36
$2,185.58
$1,839.89
$1,955.55
$2,078.07
$2,513.29
$327.71
Toc - Plan #22 Medica
Gold

(EPO) Select by Medica Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$607.08
$689.04
$775.85
$1,084.25
$1,647.63
$1,071.50
$1,153.46
$1,240.27
$1,548.67
$1,535.92
$1,617.88
$1,704.69
$2,013.09
$2,000.34
$2,082.30
$2,169.11
$2,477.51
$464.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,214.16
$1,378.08
$1,551.70
$2,168.50
$3,295.26
$1,678.58
$1,842.50
$2,016.12
$2,632.92
$2,143.00
$2,306.92
$2,480.54
$3,097.34
$2,607.42
$2,771.34
$2,944.96
$3,561.76
$464.42
Toc - Plan #23 Medica
Silver

(EPO) Select by Medica Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$589.11
$668.64
$752.88
$1,052.15
$1,598.84
$1,039.78
$1,119.31
$1,203.55
$1,502.82
$1,490.45
$1,569.98
$1,654.22
$1,953.49
$1,941.12
$2,020.65
$2,104.89
$2,404.16
$450.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,178.22
$1,337.28
$1,505.76
$2,104.30
$3,197.68
$1,628.89
$1,787.95
$1,956.43
$2,554.97
$2,079.56
$2,238.62
$2,407.10
$3,005.64
$2,530.23
$2,689.29
$2,857.77
$3,456.31
$450.67
Toc - Plan #24 Medica
Bronze

(EPO) Select by Medica Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,450 $18,900 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
$372.12
$422.35
$475.57
$664.60
$1,009.93
$656.79
$707.02
$760.24
$949.27
$941.46
$991.69
$1,044.91
$1,233.94
$1,226.13
$1,276.36
$1,329.58
$1,518.61
$284.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744.24
$844.70
$951.14
$1,329.20
$2,019.86
$1,028.91
$1,129.37
$1,235.81
$1,613.87
$1,313.58
$1,414.04
$1,520.48
$1,898.54
$1,598.25
$1,698.71
$1,805.15
$2,183.21
$284.67
Toc - Plan #25 Medica
Expanded Bronze

(EPO) Select by Medica Expanded Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$398.31
$452.08
$509.03
$711.37
$1,081.00
$703.01
$756.78
$813.73
$1,016.07
$1,007.71
$1,061.48
$1,118.43
$1,320.77
$1,312.41
$1,366.18
$1,423.13
$1,625.47
$304.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796.62
$904.16
$1,018.06
$1,422.74
$2,162.00
$1,101.32
$1,208.86
$1,322.76
$1,727.44
$1,406.02
$1,513.56
$1,627.46
$2,032.14
$1,710.72
$1,818.26
$1,932.16
$2,336.84
$304.70

ADVERTISEMENT

Oscar Insurance Company

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

Toc - Plan #26 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 Annual Deductible
$9,450 $18,900 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
$395.44
$448.82
$505.36
$706.24
$1,073.20
$697.95
$751.33
$807.87
$1,008.75
$1,000.46
$1,053.84
$1,110.38
$1,311.26
$1,302.97
$1,356.35
$1,412.89
$1,613.77
$302.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790.88
$897.64
$1,010.72
$1,412.48
$2,146.40
$1,093.39
$1,200.15
$1,313.23
$1,714.99
$1,395.90
$1,502.66
$1,615.74
$2,017.50
$1,698.41
$1,805.17
$1,918.25
$2,320.01
$302.51
Toc - Plan #27 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite + PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$415.55
$471.63
$531.05
$742.15
$1,127.76
$733.43
$789.51
$848.93
$1,060.03
$1,051.31
$1,107.39
$1,166.81
$1,377.91
$1,369.19
$1,425.27
$1,484.69
$1,695.79
$317.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$831.10
$943.26
$1,062.10
$1,484.30
$2,255.52
$1,148.98
$1,261.14
$1,379.98
$1,802.18
$1,466.86
$1,579.02
$1,697.86
$2,120.06
$1,784.74
$1,896.90
$2,015.74
$2,437.94
$317.88
Toc - Plan #28 Oscar Insurance Company
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,650 $17,300 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
$445.38
$505.50
$569.18
$795.43
$1,208.74
$786.09
$846.21
$909.89
$1,136.14
$1,126.80
$1,186.92
$1,250.60
$1,476.85
$1,467.51
$1,527.63
$1,591.31
$1,817.56
$340.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890.76
$1,011.00
$1,138.36
$1,590.86
$2,417.48
$1,231.47
$1,351.71
$1,479.07
$1,931.57
$1,572.18
$1,692.42
$1,819.78
$2,272.28
$1,912.89
$2,033.13
$2,160.49
$2,612.99
$340.71
Toc - Plan #29 Oscar Insurance Company
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 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
$309.41
$351.16
$395.41
$552.58
$839.70
$546.10
$587.85
$632.10
$789.27
$782.79
$824.54
$868.79
$1,025.96
$1,019.48
$1,061.23
$1,105.48
$1,262.65
$236.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618.82
$702.32
$790.82
$1,105.16
$1,679.40
$855.51
$939.01
$1,027.51
$1,341.85
$1,092.20
$1,175.70
$1,264.20
$1,578.54
$1,328.89
$1,412.39
$1,500.89
$1,815.23
$236.69
Toc - Plan #30 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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
$395.58
$448.97
$505.53
$706.48
$1,073.56
$698.19
$751.58
$808.14
$1,009.09
$1,000.80
$1,054.19
$1,110.75
$1,311.70
$1,303.41
$1,356.80
$1,413.36
$1,614.31
$302.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.16
$897.94
$1,011.06
$1,412.96
$2,147.12
$1,093.77
$1,200.55
$1,313.67
$1,715.57
$1,396.38
$1,503.16
$1,616.28
$2,018.18
$1,698.99
$1,805.77
$1,918.89
$2,320.79
$302.61
Toc - Plan #31 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 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
$402.26
$456.55
$514.07
$718.41
$1,091.70
$709.98
$764.27
$821.79
$1,026.13
$1,017.70
$1,071.99
$1,129.51
$1,333.85
$1,325.42
$1,379.71
$1,437.23
$1,641.57
$307.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$804.52
$913.10
$1,028.14
$1,436.82
$2,183.40
$1,112.24
$1,220.82
$1,335.86
$1,744.54
$1,419.96
$1,528.54
$1,643.58
$2,052.26
$1,727.68
$1,836.26
$1,951.30
$2,359.98
$307.72
Toc - Plan #32 Oscar Insurance Company
Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 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
$434.63
$493.29
$555.44
$776.23
$1,179.55
$767.11
$825.77
$887.92
$1,108.71
$1,099.59
$1,158.25
$1,220.40
$1,441.19
$1,432.07
$1,490.73
$1,552.88
$1,773.67
$332.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.26
$986.58
$1,110.88
$1,552.46
$2,359.10
$1,201.74
$1,319.06
$1,443.36
$1,884.94
$1,534.22
$1,651.54
$1,775.84
$2,217.42
$1,866.70
$1,984.02
$2,108.32
$2,549.90
$332.48
Toc - Plan #33 Oscar Insurance Company
Silver

(EPO) Silver Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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
$455.84
$517.37
$582.56
$814.12
$1,237.13
$804.55
$866.08
$931.27
$1,162.83
$1,153.26
$1,214.79
$1,279.98
$1,511.54
$1,501.97
$1,563.50
$1,628.69
$1,860.25
$348.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.68
$1,034.74
$1,165.12
$1,628.24
$2,474.26
$1,260.39
$1,383.45
$1,513.83
$1,976.95
$1,609.10
$1,732.16
$1,862.54
$2,325.66
$1,957.81
$2,080.87
$2,211.25
$2,674.37
$348.71
Toc - Plan #34 Oscar Insurance Company
Silver

(EPO) Silver Simple Diabetes

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$6,450 $12,900 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
$444.11
$504.05
$567.55
$793.16
$1,205.28
$783.84
$843.78
$907.28
$1,132.89
$1,123.57
$1,183.51
$1,247.01
$1,472.62
$1,463.30
$1,523.24
$1,586.74
$1,812.35
$339.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$888.22
$1,008.10
$1,135.10
$1,586.32
$2,410.56
$1,227.95
$1,347.83
$1,474.83
$1,926.05
$1,567.68
$1,687.56
$1,814.56
$2,265.78
$1,907.41
$2,027.29
$2,154.29
$2,605.51
$339.73
Toc - Plan #35 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$393.37
$446.46
$502.71
$702.54
$1,067.58
$694.29
$747.38
$803.63
$1,003.46
$995.21
$1,048.30
$1,104.55
$1,304.38
$1,296.13
$1,349.22
$1,405.47
$1,605.30
$300.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$786.74
$892.92
$1,005.42
$1,405.08
$2,135.16
$1,087.66
$1,193.84
$1,306.34
$1,706.00
$1,388.58
$1,494.76
$1,607.26
$2,006.92
$1,689.50
$1,795.68
$1,908.18
$2,307.84
$300.92
Toc - Plan #36 Oscar Insurance Company
Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$431.84
$490.12
$551.87
$771.24
$1,171.98
$762.19
$820.47
$882.22
$1,101.59
$1,092.54
$1,150.82
$1,212.57
$1,431.94
$1,422.89
$1,481.17
$1,542.92
$1,762.29
$330.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$863.68
$980.24
$1,103.74
$1,542.48
$2,343.96
$1,194.03
$1,310.59
$1,434.09
$1,872.83
$1,524.38
$1,640.94
$1,764.44
$2,203.18
$1,854.73
$1,971.29
$2,094.79
$2,533.53
$330.35
Toc - Plan #37 Oscar Insurance Company
Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$503.99
$572.02
$644.09
$900.12
$1,367.81
$889.54
$957.57
$1,029.64
$1,285.67
$1,275.09
$1,343.12
$1,415.19
$1,671.22
$1,660.64
$1,728.67
$1,800.74
$2,056.77
$385.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,007.98
$1,144.04
$1,288.18
$1,800.24
$2,735.62
$1,393.53
$1,529.59
$1,673.73
$2,185.79
$1,779.08
$1,915.14
$2,059.28
$2,571.34
$2,164.63
$2,300.69
$2,444.83
$2,956.89
$385.55

ADVERTISEMENT

UnitedHealthcare

Local: 1-877-940-4172 | Toll Free: 1-877-940-4172 | TTY: 1-877-940-4172

Toc - Plan #38 UnitedHealthcare
Silver

(EPO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $5 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$493.87
$560.54
$631.17
$882.05
$1,340.36
$871.68
$938.35
$1,008.98
$1,259.86
$1,249.49
$1,316.16
$1,386.79
$1,637.67
$1,627.30
$1,693.97
$1,764.60
$2,015.48
$377.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$987.74
$1,121.08
$1,262.34
$1,764.10
$2,680.72
$1,365.55
$1,498.89
$1,640.15
$2,141.91
$1,743.36
$1,876.70
$2,017.96
$2,519.72
$2,121.17
$2,254.51
$2,395.77
$2,897.53
$377.81
Toc - Plan #39 UnitedHealthcare
Silver

(EPO) UHC Silver Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$489.18
$555.22
$625.17
$873.67
$1,327.63
$863.40
$929.44
$999.39
$1,247.89
$1,237.62
$1,303.66
$1,373.61
$1,622.11
$1,611.84
$1,677.88
$1,747.83
$1,996.33
$374.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$978.36
$1,110.44
$1,250.34
$1,747.34
$2,655.26
$1,352.58
$1,484.66
$1,624.56
$2,121.56
$1,726.80
$1,858.88
$1,998.78
$2,495.78
$2,101.02
$2,233.10
$2,373.00
$2,870.00
$374.22
Toc - Plan #40 UnitedHealthcare
Gold

(EPO) UHC Gold Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$568.58
$645.34
$726.65
$1,015.49
$1,543.14
$1,003.55
$1,080.31
$1,161.62
$1,450.46
$1,438.52
$1,515.28
$1,596.59
$1,885.43
$1,873.49
$1,950.25
$2,031.56
$2,320.40
$434.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,137.16
$1,290.68
$1,453.30
$2,030.98
$3,086.28
$1,572.13
$1,725.65
$1,888.27
$2,465.95
$2,007.10
$2,160.62
$2,323.24
$2,900.92
$2,442.07
$2,595.59
$2,758.21
$3,335.89
$434.97
Toc - Plan #41 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$8,250 $16,500 Annual Deductible
$9,450 $18,900 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
$396.37
$449.88
$506.56
$707.92
$1,075.75
$699.59
$753.10
$809.78
$1,011.14
$1,002.81
$1,056.32
$1,113.00
$1,314.36
$1,306.03
$1,359.54
$1,416.22
$1,617.58
$303.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$792.74
$899.76
$1,013.12
$1,415.84
$2,151.50
$1,095.96
$1,202.98
$1,316.34
$1,719.06
$1,399.18
$1,506.20
$1,619.56
$2,022.28
$1,702.40
$1,809.42
$1,922.78
$2,325.50
$303.22
Toc - Plan #42 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value HSA (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$8,050 $16,100 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
$390.03
$442.68
$498.46
$696.59
$1,058.54
$688.40
$741.05
$796.83
$994.96
$986.77
$1,039.42
$1,095.20
$1,293.33
$1,285.14
$1,337.79
$1,393.57
$1,591.70
$298.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.06
$885.36
$996.92
$1,393.18
$2,117.08
$1,078.43
$1,183.73
$1,295.29
$1,691.55
$1,376.80
$1,482.10
$1,593.66
$1,989.92
$1,675.17
$1,780.47
$1,892.03
$2,288.29
$298.37
Toc - Plan #43 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$403.38
$457.83
$515.52
$720.43
$1,094.77
$711.96
$766.41
$824.10
$1,029.01
$1,020.54
$1,074.99
$1,132.68
$1,337.59
$1,329.12
$1,383.57
$1,441.26
$1,646.17
$308.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806.76
$915.66
$1,031.04
$1,440.86
$2,189.54
$1,115.34
$1,224.24
$1,339.62
$1,749.44
$1,423.92
$1,532.82
$1,648.20
$2,058.02
$1,732.50
$1,841.40
$1,956.78
$2,366.60
$308.58
Toc - Plan #44 UnitedHealthcare
Silver

(EPO) UHC Silver Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$3,250 $6,500 Annual Deductible
$9,450 $18,900 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
$479.92
$544.71
$613.34
$857.13
$1,302.50
$847.06
$911.85
$980.48
$1,224.27
$1,214.20
$1,278.99
$1,347.62
$1,591.41
$1,581.34
$1,646.13
$1,714.76
$1,958.55
$367.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$959.84
$1,089.42
$1,226.68
$1,714.26
$2,605.00
$1,326.98
$1,456.56
$1,593.82
$2,081.40
$1,694.12
$1,823.70
$1,960.96
$2,448.54
$2,061.26
$2,190.84
$2,328.10
$2,815.68
$367.14
Toc - Plan #45 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,450 $18,900 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
$485.19
$550.69
$620.07
$866.55
$1,316.80
$856.36
$921.86
$991.24
$1,237.72
$1,227.53
$1,293.03
$1,362.41
$1,608.89
$1,598.70
$1,664.20
$1,733.58
$1,980.06
$371.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$970.38
$1,101.38
$1,240.14
$1,733.10
$2,633.60
$1,341.55
$1,472.55
$1,611.31
$2,104.27
$1,712.72
$1,843.72
$1,982.48
$2,475.44
$2,083.89
$2,214.89
$2,353.65
$2,846.61
$371.17
Toc - Plan #46 UnitedHealthcare
Gold

(EPO) UHC Gold Value ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$539.22
$612.02
$689.13
$963.05
$1,463.45
$951.73
$1,024.53
$1,101.64
$1,375.56
$1,364.24
$1,437.04
$1,514.15
$1,788.07
$1,776.75
$1,849.55
$1,926.66
$2,200.58
$412.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,078.44
$1,224.04
$1,378.26
$1,926.10
$2,926.90
$1,490.95
$1,636.55
$1,790.77
$2,338.61
$1,903.46
$2,049.06
$2,203.28
$2,751.12
$2,315.97
$2,461.57
$2,615.79
$3,163.63
$412.51
Toc - Plan #47 UnitedHealthcare
Gold

(EPO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$7,000 $14,000 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
$573.59
$651.03
$733.05
$1,024.43
$1,556.73
$1,012.39
$1,089.83
$1,171.85
$1,463.23
$1,451.19
$1,528.63
$1,610.65
$1,902.03
$1,889.99
$1,967.43
$2,049.45
$2,340.83
$438.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,147.18
$1,302.06
$1,466.10
$2,048.86
$3,113.46
$1,585.98
$1,740.86
$1,904.90
$2,487.66
$2,024.78
$2,179.66
$2,343.70
$2,926.46
$2,463.58
$2,618.46
$2,782.50
$3,365.26
$438.80
Toc - Plan #48 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Copay Focus $0 Indiv Med Ded (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$417.53
$473.89
$533.60
$745.70
$1,133.17
$736.94
$793.30
$853.01
$1,065.11
$1,056.35
$1,112.71
$1,172.42
$1,384.52
$1,375.76
$1,432.12
$1,491.83
$1,703.93
$319.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835.06
$947.78
$1,067.20
$1,491.40
$2,266.34
$1,154.47
$1,267.19
$1,386.61
$1,810.81
$1,473.88
$1,586.60
$1,706.02
$2,130.22
$1,793.29
$1,906.01
$2,025.43
$2,449.63
$319.41
Toc - Plan #49 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$7,000 $14,000 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
$578.75
$656.88
$739.64
$1,033.64
$1,570.72
$1,021.49
$1,099.62
$1,182.38
$1,476.38
$1,464.23
$1,542.36
$1,625.12
$1,919.12
$1,906.97
$1,985.10
$2,067.86
$2,361.86
$442.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,157.50
$1,313.76
$1,479.28
$2,067.28
$3,141.44
$1,600.24
$1,756.50
$1,922.02
$2,510.02
$2,042.98
$2,199.24
$2,364.76
$2,952.76
$2,485.72
$2,641.98
$2,807.50
$3,395.50
$442.74
Toc - Plan #50 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-940-4172

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,450 $18,900 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
$501.84
$569.59
$641.36
$896.29
$1,362.01
$885.75
$953.50
$1,025.27
$1,280.20
$1,269.66
$1,337.41
$1,409.18
$1,664.11
$1,653.57
$1,721.32
$1,793.09
$2,048.02
$383.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,003.68
$1,139.18
$1,282.72
$1,792.58
$2,724.02
$1,387.59
$1,523.09
$1,666.63
$2,176.49
$1,771.50
$1,907.00
$2,050.54
$2,560.40
$2,155.41
$2,290.91
$2,434.45
$2,944.31
$383.91

ADVERTISEMENT

Ambetter from Home State Health

Local: 1-855-650-3789 | Toll Free: 1-855-650-3789 | TTY: 1-855-650-3789

Toc - Plan #51 Ambetter from Home State Health
Silver

(EPO) Premier Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$8,350 $16,700 Annual Deductible
$8,350 $16,700 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
$501.19
$568.83
$640.50
$895.10
$1,360.19
$884.59
$952.23
$1,023.90
$1,278.50
$1,267.99
$1,335.63
$1,407.30
$1,661.90
$1,651.39
$1,719.03
$1,790.70
$2,045.30
$383.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,002.38
$1,137.66
$1,281.00
$1,790.20
$2,720.38
$1,385.78
$1,521.06
$1,664.40
$2,173.60
$1,769.18
$1,904.46
$2,047.80
$2,557.00
$2,152.58
$2,287.86
$2,431.20
$2,940.40
$383.40
Toc - Plan #52 Ambetter from Home State Health
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$510.28
$579.16
$652.13
$911.35
$1,384.88
$900.64
$969.52
$1,042.49
$1,301.71
$1,291.00
$1,359.88
$1,432.85
$1,692.07
$1,681.36
$1,750.24
$1,823.21
$2,082.43
$390.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,020.56
$1,158.32
$1,304.26
$1,822.70
$2,769.76
$1,410.92
$1,548.68
$1,694.62
$2,213.06
$1,801.28
$1,939.04
$2,084.98
$2,603.42
$2,191.64
$2,329.40
$2,475.34
$2,993.78
$390.36
Toc - Plan #53 Ambetter from Home State Health
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,700 $15,400 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
$546.14
$619.86
$697.96
$975.39
$1,482.20
$963.93
$1,037.65
$1,115.75
$1,393.18
$1,381.72
$1,455.44
$1,533.54
$1,810.97
$1,799.51
$1,873.23
$1,951.33
$2,228.76
$417.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,092.28
$1,239.72
$1,395.92
$1,950.78
$2,964.40
$1,510.07
$1,657.51
$1,813.71
$2,368.57
$1,927.86
$2,075.30
$2,231.50
$2,786.36
$2,345.65
$2,493.09
$2,649.29
$3,204.15
$417.79
Toc - Plan #54 Ambetter from Home State Health
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 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
$415.28
$471.34
$530.72
$741.68
$1,127.05
$732.96
$789.02
$848.40
$1,059.36
$1,050.64
$1,106.70
$1,166.08
$1,377.04
$1,368.32
$1,424.38
$1,483.76
$1,694.72
$317.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$830.56
$942.68
$1,061.44
$1,483.36
$2,254.10
$1,148.24
$1,260.36
$1,379.12
$1,801.04
$1,465.92
$1,578.04
$1,696.80
$2,118.72
$1,783.60
$1,895.72
$2,014.48
$2,436.40
$317.68
Toc - Plan #55 Ambetter from Home State Health
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 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
$420.32
$477.05
$537.16
$750.68
$1,140.73
$741.86
$798.59
$858.70
$1,072.22
$1,063.40
$1,120.13
$1,180.24
$1,393.76
$1,384.94
$1,441.67
$1,501.78
$1,715.30
$321.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$840.64
$954.10
$1,074.32
$1,501.36
$2,281.46
$1,162.18
$1,275.64
$1,395.86
$1,822.90
$1,483.72
$1,597.18
$1,717.40
$2,144.44
$1,805.26
$1,918.72
$2,038.94
$2,465.98
$321.54
Toc - Plan #56 Ambetter from Home State Health
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 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
$468.80
$532.08
$599.11
$837.26
$1,272.30
$827.43
$890.71
$957.74
$1,195.89
$1,186.06
$1,249.34
$1,316.37
$1,554.52
$1,544.69
$1,607.97
$1,675.00
$1,913.15
$358.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$937.60
$1,064.16
$1,198.22
$1,674.52
$2,544.60
$1,296.23
$1,422.79
$1,556.85
$2,033.15
$1,654.86
$1,781.42
$1,915.48
$2,391.78
$2,013.49
$2,140.05
$2,274.11
$2,750.41
$358.63
Toc - Plan #57 Ambetter from Home State Health
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$492.87
$559.40
$629.87
$880.25
$1,337.62
$869.91
$936.44
$1,006.91
$1,257.29
$1,246.95
$1,313.48
$1,383.95
$1,634.33
$1,623.99
$1,690.52
$1,760.99
$2,011.37
$377.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$985.74
$1,118.80
$1,259.74
$1,760.50
$2,675.24
$1,362.78
$1,495.84
$1,636.78
$2,137.54
$1,739.82
$1,872.88
$2,013.82
$2,514.58
$2,116.86
$2,249.92
$2,390.86
$2,891.62
$377.04
Toc - Plan #58 Ambetter from Home State Health
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 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
$503.58
$571.55
$643.57
$899.38
$1,366.70
$888.81
$956.78
$1,028.80
$1,284.61
$1,274.04
$1,342.01
$1,414.03
$1,669.84
$1,659.27
$1,727.24
$1,799.26
$2,055.07
$385.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,007.16
$1,143.10
$1,287.14
$1,798.76
$2,733.40
$1,392.39
$1,528.33
$1,672.37
$2,183.99
$1,777.62
$1,913.56
$2,057.60
$2,569.22
$2,162.85
$2,298.79
$2,442.83
$2,954.45
$385.23
Toc - Plan #59 Ambetter from Home State Health
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$523.69
$594.37
$669.26
$935.29
$1,421.26
$924.30
$994.98
$1,069.87
$1,335.90
$1,324.91
$1,395.59
$1,470.48
$1,736.51
$1,725.52
$1,796.20
$1,871.09
$2,137.12
$400.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,047.38
$1,188.74
$1,338.52
$1,870.58
$2,842.52
$1,447.99
$1,589.35
$1,739.13
$2,271.19
$1,848.60
$1,989.96
$2,139.74
$2,671.80
$2,249.21
$2,390.57
$2,540.35
$3,072.41
$400.61
Toc - Plan #60 Ambetter from Home State Health
Gold

(EPO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$514.64
$584.10
$657.69
$919.13
$1,396.70
$908.33
$977.79
$1,051.38
$1,312.82
$1,302.02
$1,371.48
$1,445.07
$1,706.51
$1,695.71
$1,765.17
$1,838.76
$2,100.20
$393.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,029.28
$1,168.20
$1,315.38
$1,838.26
$2,793.40
$1,422.97
$1,561.89
$1,709.07
$2,231.95
$1,816.66
$1,955.58
$2,102.76
$2,625.64
$2,210.35
$2,349.27
$2,496.45
$3,019.33
$393.69
Toc - Plan #61 Ambetter from Home State Health
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,800 $11,600 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
$594.67
$674.94
$759.98
$1,062.06
$1,613.91
$1,049.58
$1,129.85
$1,214.89
$1,516.97
$1,504.49
$1,584.76
$1,669.80
$1,971.88
$1,959.40
$2,039.67
$2,124.71
$2,426.79
$454.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,189.34
$1,349.88
$1,519.96
$2,124.12
$3,227.82
$1,644.25
$1,804.79
$1,974.87
$2,579.03
$2,099.16
$2,259.70
$2,429.78
$3,033.94
$2,554.07
$2,714.61
$2,884.69
$3,488.85
$454.91
Toc - Plan #62 Ambetter from Home State Health
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$404.33
$458.90
$516.72
$722.11
$1,097.31
$713.63
$768.20
$826.02
$1,031.41
$1,022.93
$1,077.50
$1,135.32
$1,340.71
$1,332.23
$1,386.80
$1,444.62
$1,650.01
$309.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808.66
$917.80
$1,033.44
$1,444.22
$2,194.62
$1,117.96
$1,227.10
$1,342.74
$1,753.52
$1,427.26
$1,536.40
$1,652.04
$2,062.82
$1,736.56
$1,845.70
$1,961.34
$2,372.12
$309.30
Toc - Plan #63 Ambetter from Home State Health
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$489.20
$555.23
$625.19
$873.69
$1,327.66
$863.43
$929.46
$999.42
$1,247.92
$1,237.66
$1,303.69
$1,373.65
$1,622.15
$1,611.89
$1,677.92
$1,747.88
$1,996.38
$374.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$978.40
$1,110.46
$1,250.38
$1,747.38
$2,655.32
$1,352.63
$1,484.69
$1,624.61
$2,121.61
$1,726.86
$1,858.92
$1,998.84
$2,495.84
$2,101.09
$2,233.15
$2,373.07
$2,870.07
$374.23
Toc - Plan #64 Ambetter from Home State Health
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$522.51
$593.04
$667.76
$933.19
$1,418.08
$922.23
$992.76
$1,067.48
$1,332.91
$1,321.95
$1,392.48
$1,467.20
$1,732.63
$1,721.67
$1,792.20
$1,866.92
$2,132.35
$399.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,045.02
$1,186.08
$1,335.52
$1,866.38
$2,836.16
$1,444.74
$1,585.80
$1,735.24
$2,266.10
$1,844.46
$1,985.52
$2,134.96
$2,665.82
$2,244.18
$2,385.24
$2,534.68
$3,065.54
$399.72
Toc - Plan #65 Ambetter from Home State Health
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 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
$426.27
$483.80
$544.75
$761.29
$1,156.86
$752.36
$809.89
$870.84
$1,087.38
$1,078.45
$1,135.98
$1,196.93
$1,413.47
$1,404.54
$1,462.07
$1,523.02
$1,739.56
$326.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$852.54
$967.60
$1,089.50
$1,522.58
$2,313.72
$1,178.63
$1,293.69
$1,415.59
$1,848.67
$1,504.72
$1,619.78
$1,741.68
$2,174.76
$1,830.81
$1,945.87
$2,067.77
$2,500.85
$326.09
Toc - Plan #66 Ambetter from Home State Health
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,700 $15,400 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
$560.58
$636.25
$716.41
$1,001.19
$1,521.40
$989.42
$1,065.09
$1,145.25
$1,430.03
$1,418.26
$1,493.93
$1,574.09
$1,858.87
$1,847.10
$1,922.77
$2,002.93
$2,287.71
$428.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,121.16
$1,272.50
$1,432.82
$2,002.38
$3,042.80
$1,550.00
$1,701.34
$1,861.66
$2,431.22
$1,978.84
$2,130.18
$2,290.50
$2,860.06
$2,407.68
$2,559.02
$2,719.34
$3,288.90
$428.84
Toc - Plan #67 Ambetter from Home State Health
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$523.78
$594.48
$669.38
$935.45
$1,421.51
$924.46
$995.16
$1,070.06
$1,336.13
$1,325.14
$1,395.84
$1,470.74
$1,736.81
$1,725.82
$1,796.52
$1,871.42
$2,137.49
$400.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,047.56
$1,188.96
$1,338.76
$1,870.90
$2,843.02
$1,448.24
$1,589.64
$1,739.44
$2,271.58
$1,848.92
$1,990.32
$2,140.12
$2,672.26
$2,249.60
$2,391.00
$2,540.80
$3,072.94
$400.68
Toc - Plan #68 Ambetter from Home State Health
Silver

(EPO) Premier Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$8,350 $16,700 Annual Deductible
$8,350 $16,700 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
$514.44
$583.88
$657.44
$918.77
$1,396.16
$907.98
$977.42
$1,050.98
$1,312.31
$1,301.52
$1,370.96
$1,444.52
$1,705.85
$1,695.06
$1,764.50
$1,838.06
$2,099.39
$393.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,028.88
$1,167.76
$1,314.88
$1,837.54
$2,792.32
$1,422.42
$1,561.30
$1,708.42
$2,231.08
$1,815.96
$1,954.84
$2,101.96
$2,624.62
$2,209.50
$2,348.38
$2,495.50
$3,018.16
$393.54
Toc - Plan #69 Ambetter from Home State Health
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 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
$431.44
$489.67
$551.36
$770.53
$1,170.89
$761.48
$819.71
$881.40
$1,100.57
$1,091.52
$1,149.75
$1,211.44
$1,430.61
$1,421.56
$1,479.79
$1,541.48
$1,760.65
$330.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$862.88
$979.34
$1,102.72
$1,541.06
$2,341.78
$1,192.92
$1,309.38
$1,432.76
$1,871.10
$1,522.96
$1,639.42
$1,762.80
$2,201.14
$1,853.00
$1,969.46
$2,092.84
$2,531.18
$330.04
Toc - Plan #70 Ambetter from Home State Health
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 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
$481.20
$546.15
$614.96
$859.40
$1,305.94
$849.31
$914.26
$983.07
$1,227.51
$1,217.42
$1,282.37
$1,351.18
$1,595.62
$1,585.53
$1,650.48
$1,719.29
$1,963.73
$368.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$962.40
$1,092.30
$1,229.92
$1,718.80
$2,611.88
$1,330.51
$1,460.41
$1,598.03
$2,086.91
$1,698.62
$1,828.52
$1,966.14
$2,455.02
$2,066.73
$2,196.63
$2,334.25
$2,823.13
$368.11
Toc - Plan #71 Ambetter from Home State Health
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 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
$516.90
$586.67
$660.58
$923.16
$1,402.84
$912.32
$982.09
$1,056.00
$1,318.58
$1,307.74
$1,377.51
$1,451.42
$1,714.00
$1,703.16
$1,772.93
$1,846.84
$2,109.42
$395.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,033.80
$1,173.34
$1,321.16
$1,846.32
$2,805.68
$1,429.22
$1,568.76
$1,716.58
$2,241.74
$1,824.64
$1,964.18
$2,112.00
$2,637.16
$2,220.06
$2,359.60
$2,507.42
$3,032.58
$395.42
Toc - Plan #72 Ambetter from Home State Health
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$537.54
$610.09
$686.96
$960.02
$1,458.85
$948.75
$1,021.30
$1,098.17
$1,371.23
$1,359.96
$1,432.51
$1,509.38
$1,782.44
$1,771.17
$1,843.72
$1,920.59
$2,193.65
$411.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,075.08
$1,220.18
$1,373.92
$1,920.04
$2,917.70
$1,486.29
$1,631.39
$1,785.13
$2,331.25
$1,897.50
$2,042.60
$2,196.34
$2,742.46
$2,308.71
$2,453.81
$2,607.55
$3,153.67
$411.21
Toc - Plan #73 Ambetter from Home State Health
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$505.90
$574.19
$646.53
$903.52
$1,372.99
$892.91
$961.20
$1,033.54
$1,290.53
$1,279.92
$1,348.21
$1,420.55
$1,677.54
$1,666.93
$1,735.22
$1,807.56
$2,064.55
$387.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,011.80
$1,148.38
$1,293.06
$1,807.04
$2,745.98
$1,398.81
$1,535.39
$1,680.07
$2,194.05
$1,785.82
$1,922.40
$2,067.08
$2,581.06
$2,172.83
$2,309.41
$2,454.09
$2,968.07
$387.01
Toc - Plan #74 Ambetter from Home State Health
Gold

(EPO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

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
$528.25
$599.55
$675.09
$943.43
$1,433.64
$932.35
$1,003.65
$1,079.19
$1,347.53
$1,336.45
$1,407.75
$1,483.29
$1,751.63
$1,740.55
$1,811.85
$1,887.39
$2,155.73
$404.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,056.50
$1,199.10
$1,350.18
$1,886.86
$2,867.28
$1,460.60
$1,603.20
$1,754.28
$2,290.96
$1,864.70
$2,007.30
$2,158.38
$2,695.06
$2,268.80
$2,411.40
$2,562.48
$3,099.16
$404.10
Toc - Plan #75 Ambetter from Home State Health
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,800 $11,600 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
$610.40
$692.79
$780.07
$1,090.15
$1,656.59
$1,077.34
$1,159.73
$1,247.01
$1,557.09
$1,544.28
$1,626.67
$1,713.95
$2,024.03
$2,011.22
$2,093.61
$2,180.89
$2,490.97
$466.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,220.80
$1,385.58
$1,560.14
$2,180.30
$3,313.18
$1,687.74
$1,852.52
$2,027.08
$2,647.24
$2,154.68
$2,319.46
$2,494.02
$3,114.18
$2,621.62
$2,786.40
$2,960.96
$3,581.12
$466.94
Toc - Plan #76 Ambetter from Home State Health
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$415.02
$471.03
$530.38
$741.20
$1,126.33
$732.50
$788.51
$847.86
$1,058.68
$1,049.98
$1,105.99
$1,165.34
$1,376.16
$1,367.46
$1,423.47
$1,482.82
$1,693.64
$317.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$830.04
$942.06
$1,060.76
$1,482.40
$2,252.66
$1,147.52
$1,259.54
$1,378.24
$1,799.88
$1,465.00
$1,577.02
$1,695.72
$2,117.36
$1,782.48
$1,894.50
$2,013.20
$2,434.84
$317.48
Toc - Plan #77 Ambetter from Home State Health
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$502.14
$569.91
$641.72
$896.80
$1,362.77
$886.27
$954.04
$1,025.85
$1,280.93
$1,270.40
$1,338.17
$1,409.98
$1,665.06
$1,654.53
$1,722.30
$1,794.11
$2,049.19
$384.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,004.28
$1,139.82
$1,283.44
$1,793.60
$2,725.54
$1,388.41
$1,523.95
$1,667.57
$2,177.73
$1,772.54
$1,908.08
$2,051.70
$2,561.86
$2,156.67
$2,292.21
$2,435.83
$2,945.99
$384.13
Toc - Plan #78 Ambetter from Home State Health
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$536.33
$608.72
$685.42
$957.87
$1,455.58
$946.62
$1,019.01
$1,095.71
$1,368.16
$1,356.91
$1,429.30
$1,506.00
$1,778.45
$1,767.20
$1,839.59
$1,916.29
$2,188.74
$410.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,072.66
$1,217.44
$1,370.84
$1,915.74
$2,911.16
$1,482.95
$1,627.73
$1,781.13
$2,326.03
$1,893.24
$2,038.02
$2,191.42
$2,736.32
$2,303.53
$2,448.31
$2,601.71
$3,146.61
$410.29

‡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 Clinton County here.

Clinton County is in “Rating Area 1” of Missouri.

Currently, there are 78 plans offered in Rating Area 1.

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2024 Obamacare Plans for Clinton County, MO

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