Pulaski 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 Pulaski 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, 40 Plans and 2024 Rates for Pulaski County, Missouri

Below, you’ll find a summary of the 40 plans for Pulaski 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

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ADVERTISEMENT

Anthem Blue Cross and Blue Shield

Local: 1-855-738-6677 | Toll Free: 1-855-738-6677

Toc - Plan #1 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway 2950 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$2,950 $5,900 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
$560.03
$635.63
$715.72
$1,000.21
$1,519.92
$988.45
$1,064.05
$1,144.14
$1,428.63
$1,416.87
$1,492.47
$1,572.56
$1,857.05
$1,845.29
$1,920.89
$2,000.98
$2,285.47
$428.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,120.06
$1,271.26
$1,431.44
$2,000.42
$3,039.84
$1,548.48
$1,699.68
$1,859.86
$2,428.84
$1,976.90
$2,128.10
$2,288.28
$2,857.26
$2,405.32
$2,556.52
$2,716.70
$3,285.68
$428.42
Toc - Plan #2 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway 20% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$470.93
$534.51
$601.85
$841.08
$1,278.10
$831.19
$894.77
$962.11
$1,201.34
$1,191.45
$1,255.03
$1,322.37
$1,561.60
$1,551.71
$1,615.29
$1,682.63
$1,921.86
$360.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$941.86
$1,069.02
$1,203.70
$1,682.16
$2,556.20
$1,302.12
$1,429.28
$1,563.96
$2,042.42
$1,662.38
$1,789.54
$1,924.22
$2,402.68
$2,022.64
$2,149.80
$2,284.48
$2,762.94
$360.26
Toc - Plan #3 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway 3950 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$3,950 $7,900 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
$549.52
$623.71
$702.29
$981.44
$1,491.40
$969.90
$1,044.09
$1,122.67
$1,401.82
$1,390.28
$1,464.47
$1,543.05
$1,822.20
$1,810.66
$1,884.85
$1,963.43
$2,242.58
$420.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,099.04
$1,247.42
$1,404.58
$1,962.88
$2,982.80
$1,519.42
$1,667.80
$1,824.96
$2,383.26
$1,939.80
$2,088.18
$2,245.34
$2,803.64
$2,360.18
$2,508.56
$2,665.72
$3,224.02
$420.38
Toc - Plan #4 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$446.47
$506.74
$570.59
$797.40
$1,211.72
$788.02
$848.29
$912.14
$1,138.95
$1,129.57
$1,189.84
$1,253.69
$1,480.50
$1,471.12
$1,531.39
$1,595.24
$1,822.05
$341.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$892.94
$1,013.48
$1,141.18
$1,594.80
$2,423.44
$1,234.49
$1,355.03
$1,482.73
$1,936.35
$1,576.04
$1,696.58
$1,824.28
$2,277.90
$1,917.59
$2,038.13
$2,165.83
$2,619.45
$341.55
Toc - Plan #5 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway 4950 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 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
$547.09
$620.95
$699.18
$977.10
$1,484.80
$965.61
$1,039.47
$1,117.70
$1,395.62
$1,384.13
$1,457.99
$1,536.22
$1,814.14
$1,802.65
$1,876.51
$1,954.74
$2,232.66
$418.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,094.18
$1,241.90
$1,398.36
$1,954.20
$2,969.60
$1,512.70
$1,660.42
$1,816.88
$2,372.72
$1,931.22
$2,078.94
$2,235.40
$2,791.24
$2,349.74
$2,497.46
$2,653.92
$3,209.76
$418.52
Toc - Plan #6 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway 7050 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$8,750 $17,500 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
$538.25
$610.91
$687.88
$961.31
$1,460.81
$950.01
$1,022.67
$1,099.64
$1,373.07
$1,361.77
$1,434.43
$1,511.40
$1,784.83
$1,773.53
$1,846.19
$1,923.16
$2,196.59
$411.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,076.50
$1,221.82
$1,375.76
$1,922.62
$2,921.62
$1,488.26
$1,633.58
$1,787.52
$2,334.38
$1,900.02
$2,045.34
$2,199.28
$2,746.14
$2,311.78
$2,457.10
$2,611.04
$3,157.90
$411.76
Toc - Plan #7 Anthem Blue Cross and Blue Shield
Catastrophic

(EPO) Anthem Catastrophic Pathway 9450

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

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
$324.11
$367.86
$414.21
$578.86
$879.63
$572.05
$615.80
$662.15
$826.80
$819.99
$863.74
$910.09
$1,074.74
$1,067.93
$1,111.68
$1,158.03
$1,322.68
$247.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$648.22
$735.72
$828.42
$1,157.72
$1,759.26
$896.16
$983.66
$1,076.36
$1,405.66
$1,144.10
$1,231.60
$1,324.30
$1,653.60
$1,392.04
$1,479.54
$1,572.24
$1,901.54
$247.94
Toc - Plan #8 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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
$459.61
$521.66
$587.38
$820.86
$1,247.38
$811.21
$873.26
$938.98
$1,172.46
$1,162.81
$1,224.86
$1,290.58
$1,524.06
$1,514.41
$1,576.46
$1,642.18
$1,875.66
$351.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$919.22
$1,043.32
$1,174.76
$1,641.72
$2,494.76
$1,270.82
$1,394.92
$1,526.36
$1,993.32
$1,622.42
$1,746.52
$1,877.96
$2,344.92
$1,974.02
$2,098.12
$2,229.56
$2,696.52
$351.60
Toc - Plan #9 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

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
$446.37
$506.63
$570.46
$797.22
$1,211.45
$787.84
$848.10
$911.93
$1,138.69
$1,129.31
$1,189.57
$1,253.40
$1,480.16
$1,470.78
$1,531.04
$1,594.87
$1,821.63
$341.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$892.74
$1,013.26
$1,140.92
$1,594.44
$2,422.90
$1,234.21
$1,354.73
$1,482.39
$1,935.91
$1,575.68
$1,696.20
$1,823.86
$2,277.38
$1,917.15
$2,037.67
$2,165.33
$2,618.85
$341.47
Toc - Plan #10 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway 5900/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

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
$533.55
$605.58
$681.88
$952.92
$1,448.05
$941.72
$1,013.75
$1,090.05
$1,361.09
$1,349.89
$1,421.92
$1,498.22
$1,769.26
$1,758.06
$1,830.09
$1,906.39
$2,177.43
$408.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,067.10
$1,211.16
$1,363.76
$1,905.84
$2,896.10
$1,475.27
$1,619.33
$1,771.93
$2,314.01
$1,883.44
$2,027.50
$2,180.10
$2,722.18
$2,291.61
$2,435.67
$2,588.27
$3,130.35
$408.17
Toc - Plan #11 Anthem Blue Cross and Blue Shield
Gold

(EPO) Anthem Gold Pathway 1500/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

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
$660.46
$749.62
$844.07
$1,179.58
$1,792.49
$1,165.71
$1,254.87
$1,349.32
$1,684.83
$1,670.96
$1,760.12
$1,854.57
$2,190.08
$2,176.21
$2,265.37
$2,359.82
$2,695.33
$505.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,320.92
$1,499.24
$1,688.14
$2,359.16
$3,584.98
$1,826.17
$2,004.49
$2,193.39
$2,864.41
$2,331.42
$2,509.74
$2,698.64
$3,369.66
$2,836.67
$3,014.99
$3,203.89
$3,874.91
$505.25
Toc - Plan #12 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6677

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
$422.36
$479.38
$539.78
$754.33
$1,146.29
$745.47
$802.49
$862.89
$1,077.44
$1,068.58
$1,125.60
$1,186.00
$1,400.55
$1,391.69
$1,448.71
$1,509.11
$1,723.66
$323.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.72
$958.76
$1,079.56
$1,508.66
$2,292.58
$1,167.83
$1,281.87
$1,402.67
$1,831.77
$1,490.94
$1,604.98
$1,725.78
$2,154.88
$1,814.05
$1,928.09
$2,048.89
$2,477.99
$323.11

ADVERTISEMENT

Ambetter from Home State Health

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

Toc - Plan #13 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
$441.04
$500.56
$563.63
$787.67
$1,196.94
$778.42
$837.94
$901.01
$1,125.05
$1,115.80
$1,175.32
$1,238.39
$1,462.43
$1,453.18
$1,512.70
$1,575.77
$1,799.81
$337.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$882.08
$1,001.12
$1,127.26
$1,575.34
$2,393.88
$1,219.46
$1,338.50
$1,464.64
$1,912.72
$1,556.84
$1,675.88
$1,802.02
$2,250.10
$1,894.22
$2,013.26
$2,139.40
$2,587.48
$337.38
Toc - Plan #14 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
$449.04
$509.65
$573.86
$801.97
$1,218.68
$792.55
$853.16
$917.37
$1,145.48
$1,136.06
$1,196.67
$1,260.88
$1,488.99
$1,479.57
$1,540.18
$1,604.39
$1,832.50
$343.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$898.08
$1,019.30
$1,147.72
$1,603.94
$2,437.36
$1,241.59
$1,362.81
$1,491.23
$1,947.45
$1,585.10
$1,706.32
$1,834.74
$2,290.96
$1,928.61
$2,049.83
$2,178.25
$2,634.47
$343.51
Toc - Plan #15 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
$480.60
$545.47
$614.19
$858.33
$1,304.31
$848.25
$913.12
$981.84
$1,225.98
$1,215.90
$1,280.77
$1,349.49
$1,593.63
$1,583.55
$1,648.42
$1,717.14
$1,961.28
$367.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$961.20
$1,090.94
$1,228.38
$1,716.66
$2,608.62
$1,328.85
$1,458.59
$1,596.03
$2,084.31
$1,696.50
$1,826.24
$1,963.68
$2,451.96
$2,064.15
$2,193.89
$2,331.33
$2,819.61
$367.65
Toc - Plan #16 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
$365.44
$414.77
$467.02
$652.66
$991.79
$645.00
$694.33
$746.58
$932.22
$924.56
$973.89
$1,026.14
$1,211.78
$1,204.12
$1,253.45
$1,305.70
$1,491.34
$279.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$730.88
$829.54
$934.04
$1,305.32
$1,983.58
$1,010.44
$1,109.10
$1,213.60
$1,584.88
$1,290.00
$1,388.66
$1,493.16
$1,864.44
$1,569.56
$1,668.22
$1,772.72
$2,144.00
$279.56
Toc - Plan #17 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
$369.88
$419.80
$472.69
$660.58
$1,003.82
$652.83
$702.75
$755.64
$943.53
$935.78
$985.70
$1,038.59
$1,226.48
$1,218.73
$1,268.65
$1,321.54
$1,509.43
$282.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$739.76
$839.60
$945.38
$1,321.16
$2,007.64
$1,022.71
$1,122.55
$1,228.33
$1,604.11
$1,305.66
$1,405.50
$1,511.28
$1,887.06
$1,588.61
$1,688.45
$1,794.23
$2,170.01
$282.95
Toc - Plan #18 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
$412.54
$468.22
$527.21
$736.78
$1,119.60
$728.12
$783.80
$842.79
$1,052.36
$1,043.70
$1,099.38
$1,158.37
$1,367.94
$1,359.28
$1,414.96
$1,473.95
$1,683.52
$315.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.08
$936.44
$1,054.42
$1,473.56
$2,239.20
$1,140.66
$1,252.02
$1,370.00
$1,789.14
$1,456.24
$1,567.60
$1,685.58
$2,104.72
$1,771.82
$1,883.18
$2,001.16
$2,420.30
$315.58
Toc - Plan #19 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
$433.72
$492.26
$554.28
$774.60
$1,177.08
$765.51
$824.05
$886.07
$1,106.39
$1,097.30
$1,155.84
$1,217.86
$1,438.18
$1,429.09
$1,487.63
$1,549.65
$1,769.97
$331.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$867.44
$984.52
$1,108.56
$1,549.20
$2,354.16
$1,199.23
$1,316.31
$1,440.35
$1,880.99
$1,531.02
$1,648.10
$1,772.14
$2,212.78
$1,862.81
$1,979.89
$2,103.93
$2,544.57
$331.79
Toc - Plan #20 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
$443.15
$502.96
$566.33
$791.44
$1,202.67
$782.15
$841.96
$905.33
$1,130.44
$1,121.15
$1,180.96
$1,244.33
$1,469.44
$1,460.15
$1,519.96
$1,583.33
$1,808.44
$339.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$886.30
$1,005.92
$1,132.66
$1,582.88
$2,405.34
$1,225.30
$1,344.92
$1,471.66
$1,921.88
$1,564.30
$1,683.92
$1,810.66
$2,260.88
$1,903.30
$2,022.92
$2,149.66
$2,599.88
$339.00
Toc - Plan #21 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
$460.84
$523.04
$588.94
$823.04
$1,250.69
$813.37
$875.57
$941.47
$1,175.57
$1,165.90
$1,228.10
$1,294.00
$1,528.10
$1,518.43
$1,580.63
$1,646.53
$1,880.63
$352.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$921.68
$1,046.08
$1,177.88
$1,646.08
$2,501.38
$1,274.21
$1,398.61
$1,530.41
$1,998.61
$1,626.74
$1,751.14
$1,882.94
$2,351.14
$1,979.27
$2,103.67
$2,235.47
$2,703.67
$352.53
Toc - Plan #22 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
$452.87
$514.00
$578.76
$808.82
$1,229.07
$799.31
$860.44
$925.20
$1,155.26
$1,145.75
$1,206.88
$1,271.64
$1,501.70
$1,492.19
$1,553.32
$1,618.08
$1,848.14
$346.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$905.74
$1,028.00
$1,157.52
$1,617.64
$2,458.14
$1,252.18
$1,374.44
$1,503.96
$1,964.08
$1,598.62
$1,720.88
$1,850.40
$2,310.52
$1,945.06
$2,067.32
$2,196.84
$2,656.96
$346.44
Toc - Plan #23 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
$523.30
$593.93
$668.77
$934.60
$1,420.21
$923.62
$994.25
$1,069.09
$1,334.92
$1,323.94
$1,394.57
$1,469.41
$1,735.24
$1,724.26
$1,794.89
$1,869.73
$2,135.56
$400.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,046.60
$1,187.86
$1,337.54
$1,869.20
$2,840.42
$1,446.92
$1,588.18
$1,737.86
$2,269.52
$1,847.24
$1,988.50
$2,138.18
$2,669.84
$2,247.56
$2,388.82
$2,538.50
$3,070.16
$400.32
Toc - Plan #24 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
$355.80
$403.82
$454.70
$635.44
$965.62
$627.98
$676.00
$726.88
$907.62
$900.16
$948.18
$999.06
$1,179.80
$1,172.34
$1,220.36
$1,271.24
$1,451.98
$272.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$711.60
$807.64
$909.40
$1,270.88
$1,931.24
$983.78
$1,079.82
$1,181.58
$1,543.06
$1,255.96
$1,352.00
$1,453.76
$1,815.24
$1,528.14
$1,624.18
$1,725.94
$2,087.42
$272.18
Toc - Plan #25 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
$430.49
$488.59
$550.15
$768.84
$1,168.32
$759.81
$817.91
$879.47
$1,098.16
$1,089.13
$1,147.23
$1,208.79
$1,427.48
$1,418.45
$1,476.55
$1,538.11
$1,756.80
$329.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$860.98
$977.18
$1,100.30
$1,537.68
$2,336.64
$1,190.30
$1,306.50
$1,429.62
$1,867.00
$1,519.62
$1,635.82
$1,758.94
$2,196.32
$1,848.94
$1,965.14
$2,088.26
$2,525.64
$329.32
Toc - Plan #26 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
$459.80
$521.87
$587.62
$821.19
$1,247.88
$811.54
$873.61
$939.36
$1,172.93
$1,163.28
$1,225.35
$1,291.10
$1,524.67
$1,515.02
$1,577.09
$1,642.84
$1,876.41
$351.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$919.60
$1,043.74
$1,175.24
$1,642.38
$2,495.76
$1,271.34
$1,395.48
$1,526.98
$1,994.12
$1,623.08
$1,747.22
$1,878.72
$2,345.86
$1,974.82
$2,098.96
$2,230.46
$2,697.60
$351.74
Toc - Plan #27 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
$375.11
$425.74
$479.37
$669.92
$1,018.01
$662.06
$712.69
$766.32
$956.87
$949.01
$999.64
$1,053.27
$1,243.82
$1,235.96
$1,286.59
$1,340.22
$1,530.77
$286.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$750.22
$851.48
$958.74
$1,339.84
$2,036.02
$1,037.17
$1,138.43
$1,245.69
$1,626.79
$1,324.12
$1,425.38
$1,532.64
$1,913.74
$1,611.07
$1,712.33
$1,819.59
$2,200.69
$286.95
Toc - Plan #28 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
$493.31
$559.89
$630.43
$881.03
$1,338.80
$870.68
$937.26
$1,007.80
$1,258.40
$1,248.05
$1,314.63
$1,385.17
$1,635.77
$1,625.42
$1,692.00
$1,762.54
$2,013.14
$377.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$986.62
$1,119.78
$1,260.86
$1,762.06
$2,677.60
$1,363.99
$1,497.15
$1,638.23
$2,139.43
$1,741.36
$1,874.52
$2,015.60
$2,516.80
$2,118.73
$2,251.89
$2,392.97
$2,894.17
$377.37
Toc - Plan #29 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
$460.92
$523.13
$589.04
$823.18
$1,250.90
$813.51
$875.72
$941.63
$1,175.77
$1,166.10
$1,228.31
$1,294.22
$1,528.36
$1,518.69
$1,580.90
$1,646.81
$1,880.95
$352.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$921.84
$1,046.26
$1,178.08
$1,646.36
$2,501.80
$1,274.43
$1,398.85
$1,530.67
$1,998.95
$1,627.02
$1,751.44
$1,883.26
$2,351.54
$1,979.61
$2,104.03
$2,235.85
$2,704.13
$352.59
Toc - Plan #30 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
$452.70
$513.80
$578.54
$808.50
$1,228.60
$799.01
$860.11
$924.85
$1,154.81
$1,145.32
$1,206.42
$1,271.16
$1,501.12
$1,491.63
$1,552.73
$1,617.47
$1,847.43
$346.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$905.40
$1,027.60
$1,157.08
$1,617.00
$2,457.20
$1,251.71
$1,373.91
$1,503.39
$1,963.31
$1,598.02
$1,720.22
$1,849.70
$2,309.62
$1,944.33
$2,066.53
$2,196.01
$2,655.93
$346.31
Toc - Plan #31 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
$379.66
$430.90
$485.19
$678.05
$1,030.37
$670.09
$721.33
$775.62
$968.48
$960.52
$1,011.76
$1,066.05
$1,258.91
$1,250.95
$1,302.19
$1,356.48
$1,549.34
$290.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$759.32
$861.80
$970.38
$1,356.10
$2,060.74
$1,049.75
$1,152.23
$1,260.81
$1,646.53
$1,340.18
$1,442.66
$1,551.24
$1,936.96
$1,630.61
$1,733.09
$1,841.67
$2,227.39
$290.43
Toc - Plan #32 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
$423.45
$480.60
$541.15
$756.26
$1,149.21
$747.38
$804.53
$865.08
$1,080.19
$1,071.31
$1,128.46
$1,189.01
$1,404.12
$1,395.24
$1,452.39
$1,512.94
$1,728.05
$323.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$846.90
$961.20
$1,082.30
$1,512.52
$2,298.42
$1,170.83
$1,285.13
$1,406.23
$1,836.45
$1,494.76
$1,609.06
$1,730.16
$2,160.38
$1,818.69
$1,932.99
$2,054.09
$2,484.31
$323.93
Toc - Plan #33 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
$454.86
$516.26
$581.30
$812.37
$1,234.47
$802.82
$864.22
$929.26
$1,160.33
$1,150.78
$1,212.18
$1,277.22
$1,508.29
$1,498.74
$1,560.14
$1,625.18
$1,856.25
$347.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$909.72
$1,032.52
$1,162.60
$1,624.74
$2,468.94
$1,257.68
$1,380.48
$1,510.56
$1,972.70
$1,605.64
$1,728.44
$1,858.52
$2,320.66
$1,953.60
$2,076.40
$2,206.48
$2,668.62
$347.96
Toc - Plan #34 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
$473.02
$536.87
$604.51
$844.80
$1,283.76
$834.88
$898.73
$966.37
$1,206.66
$1,196.74
$1,260.59
$1,328.23
$1,568.52
$1,558.60
$1,622.45
$1,690.09
$1,930.38
$361.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$946.04
$1,073.74
$1,209.02
$1,689.60
$2,567.52
$1,307.90
$1,435.60
$1,570.88
$2,051.46
$1,669.76
$1,797.46
$1,932.74
$2,413.32
$2,031.62
$2,159.32
$2,294.60
$2,775.18
$361.86
Toc - Plan #35 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
$445.19
$505.28
$568.94
$795.09
$1,208.21
$785.75
$845.84
$909.50
$1,135.65
$1,126.31
$1,186.40
$1,250.06
$1,476.21
$1,466.87
$1,526.96
$1,590.62
$1,816.77
$340.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890.38
$1,010.56
$1,137.88
$1,590.18
$2,416.42
$1,230.94
$1,351.12
$1,478.44
$1,930.74
$1,571.50
$1,691.68
$1,819.00
$2,271.30
$1,912.06
$2,032.24
$2,159.56
$2,611.86
$340.56
Toc - Plan #36 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
$464.85
$527.59
$594.07
$830.20
$1,261.58
$820.45
$883.19
$949.67
$1,185.80
$1,176.05
$1,238.79
$1,305.27
$1,541.40
$1,531.65
$1,594.39
$1,660.87
$1,897.00
$355.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$929.70
$1,055.18
$1,188.14
$1,660.40
$2,523.16
$1,285.30
$1,410.78
$1,543.74
$2,016.00
$1,640.90
$1,766.38
$1,899.34
$2,371.60
$1,996.50
$2,121.98
$2,254.94
$2,727.20
$355.60
Toc - Plan #37 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
$537.14
$609.64
$686.45
$959.31
$1,457.77
$948.04
$1,020.54
$1,097.35
$1,370.21
$1,358.94
$1,431.44
$1,508.25
$1,781.11
$1,769.84
$1,842.34
$1,919.15
$2,192.01
$410.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,074.28
$1,219.28
$1,372.90
$1,918.62
$2,915.54
$1,485.18
$1,630.18
$1,783.80
$2,329.52
$1,896.08
$2,041.08
$2,194.70
$2,740.42
$2,306.98
$2,451.98
$2,605.60
$3,151.32
$410.90
Toc - Plan #38 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
$365.21
$414.50
$466.73
$652.25
$991.15
$644.59
$693.88
$746.11
$931.63
$923.97
$973.26
$1,025.49
$1,211.01
$1,203.35
$1,252.64
$1,304.87
$1,490.39
$279.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$730.42
$829.00
$933.46
$1,304.50
$1,982.30
$1,009.80
$1,108.38
$1,212.84
$1,583.88
$1,289.18
$1,387.76
$1,492.22
$1,863.26
$1,568.56
$1,667.14
$1,771.60
$2,142.64
$279.38
Toc - Plan #39 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
$441.87
$501.51
$564.70
$789.17
$1,199.22
$779.90
$839.54
$902.73
$1,127.20
$1,117.93
$1,177.57
$1,240.76
$1,465.23
$1,455.96
$1,515.60
$1,578.79
$1,803.26
$338.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$883.74
$1,003.02
$1,129.40
$1,578.34
$2,398.44
$1,221.77
$1,341.05
$1,467.43
$1,916.37
$1,559.80
$1,679.08
$1,805.46
$2,254.40
$1,897.83
$2,017.11
$2,143.49
$2,592.43
$338.03
Toc - Plan #40 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
$471.96
$535.67
$603.16
$842.91
$1,280.88
$833.00
$896.71
$964.20
$1,203.95
$1,194.04
$1,257.75
$1,325.24
$1,564.99
$1,555.08
$1,618.79
$1,686.28
$1,926.03
$361.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$943.92
$1,071.34
$1,206.32
$1,685.82
$2,561.76
$1,304.96
$1,432.38
$1,567.36
$2,046.86
$1,666.00
$1,793.42
$1,928.40
$2,407.90
$2,027.04
$2,154.46
$2,289.44
$2,768.94
$361.04

‡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 Pulaski County here.

Pulaski County is in “Rating Area 9” of Missouri.

Currently, there are 40 plans offered in Rating Area 9.

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2024 Obamacare Plans for Pulaski County, MO

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