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Obamacare 2023 Rates for Saint Genevieve County

Obamacare > Rates > Missouri > Saint Genevieve County

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 Saint Genevieve County, MO.

The health insurance rates listed below are for calendar year 2023.

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, 72 Plans and 2023 Rates for Saint Genevieve County, Missouri

Below, you’ll find a summary of the 72 plans for Saint Genevieve County, Missouri and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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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 X 3100 ($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
$3,100 $6,200 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
$324.74
$368.58
$415.02
$579.99
$881.34
$573.17
$617.01
$663.45
$828.42
$821.60
$865.44
$911.88
$1,076.85
$1,070.03
$1,113.87
$1,160.31
$1,325.28
$248.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$649.48
$737.16
$830.04
$1,159.98
$1,762.68
$897.91
$985.59
$1,078.47
$1,408.41
$1,146.34
$1,234.02
$1,326.90
$1,656.84
$1,394.77
$1,482.45
$1,575.33
$1,905.27
$248.43
Toc - Plan #2 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 6800 ($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
$6,800 $13,600 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
$268.30
$304.52
$342.89
$479.18
$728.17
$473.55
$509.77
$548.14
$684.43
$678.80
$715.02
$753.39
$889.68
$884.05
$920.27
$958.64
$1,094.93
$205.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$536.60
$609.04
$685.78
$958.36
$1,456.34
$741.85
$814.29
$891.03
$1,163.61
$947.10
$1,019.54
$1,096.28
$1,368.86
$1,152.35
$1,224.79
$1,301.53
$1,574.11
$205.25
Toc - Plan #3 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 0% for HSA

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

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 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
$267.33
$303.42
$341.65
$477.45
$725.53
$471.84
$507.93
$546.16
$681.96
$676.35
$712.44
$750.67
$886.47
$880.86
$916.95
$955.18
$1,090.98
$204.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$534.66
$606.84
$683.30
$954.90
$1,451.06
$739.17
$811.35
$887.81
$1,159.41
$943.68
$1,015.86
$1,092.32
$1,363.92
$1,148.19
$1,220.37
$1,296.83
$1,568.43
$204.51
Toc - Plan #4 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 20% for HSA

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
$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
$270.50
$307.02
$345.70
$483.11
$734.14
$477.43
$513.95
$552.63
$690.04
$684.36
$720.88
$759.56
$896.97
$891.29
$927.81
$966.49
$1,103.90
$206.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541.00
$614.04
$691.40
$966.22
$1,468.28
$747.93
$820.97
$898.33
$1,173.15
$954.86
$1,027.90
$1,105.26
$1,380.08
$1,161.79
$1,234.83
$1,312.19
$1,587.01
$206.93
Toc - Plan #5 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway X 3900 ($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
$3,900 $7,800 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
$323.10
$366.72
$412.92
$577.06
$876.89
$570.27
$613.89
$660.09
$824.23
$817.44
$861.06
$907.26
$1,071.40
$1,064.61
$1,108.23
$1,154.43
$1,318.57
$247.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$646.20
$733.44
$825.84
$1,154.12
$1,753.78
$893.37
$980.61
$1,073.01
$1,401.29
$1,140.54
$1,227.78
$1,320.18
$1,648.46
$1,387.71
$1,474.95
$1,567.35
$1,895.63
$247.17
Toc - Plan #6 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway X 3000 for HSA

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

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,450 $12,900 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
$324.13
$367.89
$414.24
$578.90
$879.69
$572.09
$615.85
$662.20
$826.86
$820.05
$863.81
$910.16
$1,074.82
$1,068.01
$1,111.77
$1,158.12
$1,322.78
$247.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$648.26
$735.78
$828.48
$1,157.80
$1,759.38
$896.22
$983.74
$1,076.44
$1,405.76
$1,144.18
$1,231.70
$1,324.40
$1,653.72
$1,392.14
$1,479.66
$1,572.36
$1,901.68
$247.96
Toc - Plan #7 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 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
$9,100 $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
$266.43
$302.40
$340.50
$475.84
$723.09
$470.25
$506.22
$544.32
$679.66
$674.07
$710.04
$748.14
$883.48
$877.89
$913.86
$951.96
$1,087.30
$203.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$532.86
$604.80
$681.00
$951.68
$1,446.18
$736.68
$808.62
$884.82
$1,155.50
$940.50
$1,012.44
$1,088.64
$1,359.32
$1,144.32
$1,216.26
$1,292.46
$1,563.14
$203.82
Toc - Plan #8 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway X 5400 ($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
$5,400 $10,800 Annual Deductible
$8,300 $16,600 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
$317.63
$360.51
$405.93
$567.29
$862.05
$560.62
$603.50
$648.92
$810.28
$803.61
$846.49
$891.91
$1,053.27
$1,046.60
$1,089.48
$1,134.90
$1,296.26
$242.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$635.26
$721.02
$811.86
$1,134.58
$1,724.10
$878.25
$964.01
$1,054.85
$1,377.57
$1,121.24
$1,207.00
$1,297.84
$1,620.56
$1,364.23
$1,449.99
$1,540.83
$1,863.55
$242.99
Toc - Plan #9 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway X 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
$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
$315.57
$358.17
$403.30
$563.61
$856.46
$556.98
$599.58
$644.71
$805.02
$798.39
$840.99
$886.12
$1,046.43
$1,039.80
$1,082.40
$1,127.53
$1,287.84
$241.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$631.14
$716.34
$806.60
$1,127.22
$1,712.92
$872.55
$957.75
$1,048.01
$1,368.63
$1,113.96
$1,199.16
$1,289.42
$1,610.04
$1,355.37
$1,440.57
$1,530.83
$1,851.45
$241.41
Toc - Plan #10 Anthem Blue Cross and Blue Shield
Catastrophic

(EPO) Anthem Catastrophic Pathway X 9100

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

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$194.90
$221.21
$249.08
$348.09
$528.96
$344.00
$370.31
$398.18
$497.19
$493.10
$519.41
$547.28
$646.29
$642.20
$668.51
$696.38
$795.39
$149.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$389.80
$442.42
$498.16
$696.18
$1,057.92
$538.90
$591.52
$647.26
$845.28
$688.00
$740.62
$796.36
$994.38
$837.10
$889.72
$945.46
$1,143.48
$149.10
Toc - Plan #11 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 4350 ($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
$4,350 $8,700 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
$277.23
$314.66
$354.30
$495.13
$752.40
$489.31
$526.74
$566.38
$707.21
$701.39
$738.82
$778.46
$919.29
$913.47
$950.90
$990.54
$1,131.37
$212.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554.46
$629.32
$708.60
$990.26
$1,504.80
$766.54
$841.40
$920.68
$1,202.34
$978.62
$1,053.48
$1,132.76
$1,414.42
$1,190.70
$1,265.56
$1,344.84
$1,626.50
$212.08
Toc - Plan #12 Anthem Blue Cross and Blue Shield
Bronze

(EPO) Anthem Bronze Pathway X 9100/0% Standard

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

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$251.66
$285.63
$321.62
$449.46
$683.01
$444.18
$478.15
$514.14
$641.98
$636.70
$670.67
$706.66
$834.50
$829.22
$863.19
$899.18
$1,027.02
$192.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$503.32
$571.26
$643.24
$898.92
$1,366.02
$695.84
$763.78
$835.76
$1,091.44
$888.36
$956.30
$1,028.28
$1,283.96
$1,080.88
$1,148.82
$1,220.80
$1,476.48
$192.52
Toc - Plan #13 Anthem Blue Cross and Blue Shield
Expanded Bronze

(EPO) Anthem Bronze Pathway X 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
$9,000 $18,000 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
$275.83
$313.07
$352.51
$492.63
$748.60
$486.84
$524.08
$563.52
$703.64
$697.85
$735.09
$774.53
$914.65
$908.86
$946.10
$985.54
$1,125.66
$211.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$551.66
$626.14
$705.02
$985.26
$1,497.20
$762.67
$837.15
$916.03
$1,196.27
$973.68
$1,048.16
$1,127.04
$1,407.28
$1,184.69
$1,259.17
$1,338.05
$1,618.29
$211.01
Toc - Plan #14 Anthem Blue Cross and Blue Shield
Silver

(EPO) Anthem Silver Pathway X 5800/40% Standard

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

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$314.81
$357.31
$402.33
$562.25
$854.39
$555.64
$598.14
$643.16
$803.08
$796.47
$838.97
$883.99
$1,043.91
$1,037.30
$1,079.80
$1,124.82
$1,284.74
$240.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$629.62
$714.62
$804.66
$1,124.50
$1,708.78
$870.45
$955.45
$1,045.49
$1,365.33
$1,111.28
$1,196.28
$1,286.32
$1,606.16
$1,352.11
$1,437.11
$1,527.15
$1,846.99
$240.83
Toc - Plan #15 Anthem Blue Cross and Blue Shield
Gold

(EPO) Anthem Gold Pathway X 2000/25% Standard

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

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$483.47
$548.74
$617.87
$863.48
$1,312.14
$853.32
$918.59
$987.72
$1,233.33
$1,223.17
$1,288.44
$1,357.57
$1,603.18
$1,593.02
$1,658.29
$1,727.42
$1,973.03
$369.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$966.94
$1,097.48
$1,235.74
$1,726.96
$2,624.28
$1,336.79
$1,467.33
$1,605.59
$2,096.81
$1,706.64
$1,837.18
$1,975.44
$2,466.66
$2,076.49
$2,207.03
$2,345.29
$2,836.51
$369.85

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Aetna CVS Health

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

Toc - Plan #16 Aetna CVS Health
Expanded Bronze

(EPO) Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,100 $14,200 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
$296.56
$336.60
$379.01
$529.66
$804.87
$523.43
$563.47
$605.88
$756.53
$750.30
$790.34
$832.75
$983.40
$977.17
$1,017.21
$1,059.62
$1,210.27
$226.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$593.12
$673.20
$758.02
$1,059.32
$1,609.74
$819.99
$900.07
$984.89
$1,286.19
$1,046.86
$1,126.94
$1,211.76
$1,513.06
$1,273.73
$1,353.81
$1,438.63
$1,739.93
$226.87
Toc - Plan #17 Aetna CVS Health
Expanded Bronze

(EPO) Bronze: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$296.94
$337.02
$379.49
$530.33
$805.89
$524.10
$564.18
$606.65
$757.49
$751.26
$791.34
$833.81
$984.65
$978.42
$1,018.50
$1,060.97
$1,211.81
$227.16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$593.88
$674.04
$758.98
$1,060.66
$1,611.78
$821.04
$901.20
$986.14
$1,287.82
$1,048.20
$1,128.36
$1,213.30
$1,514.98
$1,275.36
$1,355.52
$1,440.46
$1,742.14
$227.16
Toc - Plan #18 Aetna CVS Health
Gold

(EPO) Gold: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 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
$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
$457.65
$519.44
$584.88
$817.37
$1,242.07
$807.75
$869.54
$934.98
$1,167.47
$1,157.85
$1,219.64
$1,285.08
$1,517.57
$1,507.95
$1,569.74
$1,635.18
$1,867.67
$350.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$915.30
$1,038.88
$1,169.76
$1,634.74
$2,484.14
$1,265.40
$1,388.98
$1,519.86
$1,984.84
$1,615.50
$1,739.08
$1,869.96
$2,334.94
$1,965.60
$2,089.18
$2,220.06
$2,685.04
$350.10
Toc - Plan #19 Aetna CVS Health
Silver

(EPO) Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$368.78
$418.56
$471.30
$658.64
$1,000.86
$650.89
$700.67
$753.41
$940.75
$933.00
$982.78
$1,035.52
$1,222.86
$1,215.11
$1,264.89
$1,317.63
$1,504.97
$282.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737.56
$837.12
$942.60
$1,317.28
$2,001.72
$1,019.67
$1,119.23
$1,224.71
$1,599.39
$1,301.78
$1,401.34
$1,506.82
$1,881.50
$1,583.89
$1,683.45
$1,788.93
$2,163.61
$282.11
Toc - Plan #20 Aetna CVS Health
Silver

(EPO) Silver 1: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$4,425 $8,850 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
$370.90
$420.97
$474.01
$662.43
$1,006.63
$654.64
$704.71
$757.75
$946.17
$938.38
$988.45
$1,041.49
$1,229.91
$1,222.12
$1,272.19
$1,325.23
$1,513.65
$283.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$741.80
$841.94
$948.02
$1,324.86
$2,013.26
$1,025.54
$1,125.68
$1,231.76
$1,608.60
$1,309.28
$1,409.42
$1,515.50
$1,892.34
$1,593.02
$1,693.16
$1,799.24
$2,176.08
$283.74
Toc - Plan #21 Aetna CVS Health
Expanded Bronze

(EPO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 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
$9,000 $18,000 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
$287.17
$325.94
$367.00
$512.89
$779.38
$506.86
$545.63
$586.69
$732.58
$726.55
$765.32
$806.38
$952.27
$946.24
$985.01
$1,026.07
$1,171.96
$219.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$574.34
$651.88
$734.00
$1,025.78
$1,558.76
$794.03
$871.57
$953.69
$1,245.47
$1,013.72
$1,091.26
$1,173.38
$1,465.16
$1,233.41
$1,310.95
$1,393.07
$1,684.85
$219.69
Toc - Plan #22 Aetna CVS Health
Gold

(EPO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$417.61
$473.99
$533.71
$745.85
$1,133.40
$737.08
$793.46
$853.18
$1,065.32
$1,056.55
$1,112.93
$1,172.65
$1,384.79
$1,376.02
$1,432.40
$1,492.12
$1,704.26
$319.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835.22
$947.98
$1,067.42
$1,491.70
$2,266.80
$1,154.69
$1,267.45
$1,386.89
$1,811.17
$1,474.16
$1,586.92
$1,706.36
$2,130.64
$1,793.63
$1,906.39
$2,025.83
$2,450.11
$319.47
Toc - Plan #23 Aetna CVS Health
Silver

(EPO) Silver 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,800 $17,600 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
$351.01
$398.39
$448.59
$626.90
$952.63
$619.53
$666.91
$717.11
$895.42
$888.05
$935.43
$985.63
$1,163.94
$1,156.57
$1,203.95
$1,254.15
$1,432.46
$268.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$702.02
$796.78
$897.18
$1,253.80
$1,905.26
$970.54
$1,065.30
$1,165.70
$1,522.32
$1,239.06
$1,333.82
$1,434.22
$1,790.84
$1,507.58
$1,602.34
$1,702.74
$2,059.36
$268.52
Toc - Plan #24 Aetna CVS Health
Silver

(EPO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

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

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$344.14
$390.60
$439.82
$614.64
$934.01
$607.41
$653.87
$703.09
$877.91
$870.68
$917.14
$966.36
$1,141.18
$1,133.95
$1,180.41
$1,229.63
$1,404.45
$263.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$688.28
$781.20
$879.64
$1,229.28
$1,868.02
$951.55
$1,044.47
$1,142.91
$1,492.55
$1,214.82
$1,307.74
$1,406.18
$1,755.82
$1,478.09
$1,571.01
$1,669.45
$2,019.09
$263.27

ADVERTISEMENT

Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

Toc - Plan #25 Cigna Healthcare
Expanded Bronze

(EPO) Cigna Connect 6250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 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
$367.89
$417.56
$470.17
$657.05
$998.46
$649.33
$699.00
$751.61
$938.49
$930.77
$980.44
$1,033.05
$1,219.93
$1,212.21
$1,261.88
$1,314.49
$1,501.37
$281.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735.78
$835.12
$940.34
$1,314.10
$1,996.92
$1,017.22
$1,116.56
$1,221.78
$1,595.54
$1,298.66
$1,398.00
$1,503.22
$1,876.98
$1,580.10
$1,679.44
$1,784.66
$2,158.42
$281.44
Toc - Plan #26 Cigna Healthcare
Silver

(EPO) Cigna Connect 2800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$9,000 $18,000 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
$408.20
$463.30
$521.68
$729.04
$1,107.85
$720.47
$775.57
$833.95
$1,041.31
$1,032.74
$1,087.84
$1,146.22
$1,353.58
$1,345.01
$1,400.11
$1,458.49
$1,665.85
$312.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$816.40
$926.60
$1,043.36
$1,458.08
$2,215.70
$1,128.67
$1,238.87
$1,355.63
$1,770.35
$1,440.94
$1,551.14
$1,667.90
$2,082.62
$1,753.21
$1,863.41
$1,980.17
$2,394.89
$312.27
Toc - Plan #27 Cigna Healthcare
Gold

(EPO) Cigna Connect 1250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$1,250 $2,500 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
$577.16
$655.07
$737.61
$1,030.80
$1,566.40
$1,018.68
$1,096.59
$1,179.13
$1,472.32
$1,460.20
$1,538.11
$1,620.65
$1,913.84
$1,901.72
$1,979.63
$2,062.17
$2,355.36
$441.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,154.32
$1,310.14
$1,475.22
$2,061.60
$3,132.80
$1,595.84
$1,751.66
$1,916.74
$2,503.12
$2,037.36
$2,193.18
$2,358.26
$2,944.64
$2,478.88
$2,634.70
$2,799.78
$3,386.16
$441.52
Toc - Plan #28 Cigna Healthcare
Bronze

(EPO) Cigna Simple Choice 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$352.81
$400.44
$450.89
$630.11
$957.52
$622.71
$670.34
$720.79
$900.01
$892.61
$940.24
$990.69
$1,169.91
$1,162.51
$1,210.14
$1,260.59
$1,439.81
$269.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705.62
$800.88
$901.78
$1,260.22
$1,915.04
$975.52
$1,070.78
$1,171.68
$1,530.12
$1,245.42
$1,340.68
$1,441.58
$1,800.02
$1,515.32
$1,610.58
$1,711.48
$2,069.92
$269.90
Toc - Plan #29 Cigna Healthcare
Silver

(EPO) Cigna Simple Choice 5800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$405.75
$460.52
$518.55
$724.67
$1,101.20
$716.15
$770.92
$828.95
$1,035.07
$1,026.55
$1,081.32
$1,139.35
$1,345.47
$1,336.95
$1,391.72
$1,449.75
$1,655.87
$310.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811.50
$921.04
$1,037.10
$1,449.34
$2,202.40
$1,121.90
$1,231.44
$1,347.50
$1,759.74
$1,432.30
$1,541.84
$1,657.90
$2,070.14
$1,742.70
$1,852.24
$1,968.30
$2,380.54
$310.40
Toc - Plan #30 Cigna Healthcare
Gold

(EPO) Cigna Simple Choice 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$575.05
$652.68
$734.91
$1,027.04
$1,560.69
$1,014.96
$1,092.59
$1,174.82
$1,466.95
$1,454.87
$1,532.50
$1,614.73
$1,906.86
$1,894.78
$1,972.41
$2,054.64
$2,346.77
$439.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,150.10
$1,305.36
$1,469.82
$2,054.08
$3,121.38
$1,590.01
$1,745.27
$1,909.73
$2,493.99
$2,029.92
$2,185.18
$2,349.64
$2,933.90
$2,469.83
$2,625.09
$2,789.55
$3,373.81
$439.91

ADVERTISEMENT

UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 1-877-632-4195 | TTY: 1-877-940-4172

Toc - Plan #31 UnitedHealthcare
Gold

(EPO) UHC Gold Value (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 Annual Deductible
$8,400 $16,800 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
$375.67
$426.39
$480.11
$670.95
$1,019.57
$663.06
$713.78
$767.50
$958.34
$950.45
$1,001.17
$1,054.89
$1,245.73
$1,237.84
$1,288.56
$1,342.28
$1,533.12
$287.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$751.34
$852.78
$960.22
$1,341.90
$2,039.14
$1,038.73
$1,140.17
$1,247.61
$1,629.29
$1,326.12
$1,427.56
$1,535.00
$1,916.68
$1,613.51
$1,714.95
$1,822.39
$2,204.07
$287.39
Toc - Plan #32 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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
$395.45
$448.84
$505.39
$706.27
$1,073.25
$697.97
$751.36
$807.91
$1,008.79
$1,000.49
$1,053.88
$1,110.43
$1,311.31
$1,303.01
$1,356.40
$1,412.95
$1,613.83
$302.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790.90
$897.68
$1,010.78
$1,412.54
$2,146.50
$1,093.42
$1,200.20
$1,313.30
$1,715.06
$1,395.94
$1,502.72
$1,615.82
$2,017.58
$1,698.46
$1,805.24
$1,918.34
$2,320.10
$302.52
Toc - Plan #33 UnitedHealthcare
Silver

(EPO) UHC Silver Value $4,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$348.85
$395.94
$445.83
$623.04
$946.77
$615.72
$662.81
$712.70
$889.91
$882.59
$929.68
$979.57
$1,156.78
$1,149.46
$1,196.55
$1,246.44
$1,423.65
$266.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697.70
$791.88
$891.66
$1,246.08
$1,893.54
$964.57
$1,058.75
$1,158.53
$1,512.95
$1,231.44
$1,325.62
$1,425.40
$1,779.82
$1,498.31
$1,592.49
$1,692.27
$2,046.69
$266.87
Toc - Plan #34 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$344.95
$391.52
$440.85
$616.08
$936.20
$608.84
$655.41
$704.74
$879.97
$872.73
$919.30
$968.63
$1,143.86
$1,136.62
$1,183.19
$1,232.52
$1,407.75
$263.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$689.90
$783.04
$881.70
$1,232.16
$1,872.40
$953.79
$1,046.93
$1,145.59
$1,496.05
$1,217.68
$1,310.82
$1,409.48
$1,759.94
$1,481.57
$1,574.71
$1,673.37
$2,023.83
$263.89
Toc - Plan #35 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$359.57
$408.12
$459.54
$642.20
$975.88
$634.64
$683.19
$734.61
$917.27
$909.71
$958.26
$1,009.68
$1,192.34
$1,184.78
$1,233.33
$1,284.75
$1,467.41
$275.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719.14
$816.24
$919.08
$1,284.40
$1,951.76
$994.21
$1,091.31
$1,194.15
$1,559.47
$1,269.28
$1,366.38
$1,469.22
$1,834.54
$1,544.35
$1,641.45
$1,744.29
$2,109.61
$275.07
Toc - Plan #36 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage $0 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

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
$353.61
$401.34
$451.91
$631.54
$959.68
$624.12
$671.85
$722.42
$902.05
$894.63
$942.36
$992.93
$1,172.56
$1,165.14
$1,212.87
$1,263.44
$1,443.07
$270.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$707.22
$802.68
$903.82
$1,263.08
$1,919.36
$977.73
$1,073.19
$1,174.33
$1,533.59
$1,248.24
$1,343.70
$1,444.84
$1,804.10
$1,518.75
$1,614.21
$1,715.35
$2,074.61
$270.51
Toc - Plan #37 UnitedHealthcare
Silver

(EPO) UHC Silver Value HSA $5,400 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

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
$351.60
$399.07
$449.35
$627.96
$954.24
$620.57
$668.04
$718.32
$896.93
$889.54
$937.01
$987.29
$1,165.90
$1,158.51
$1,205.98
$1,256.26
$1,434.87
$268.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703.20
$798.14
$898.70
$1,255.92
$1,908.48
$972.17
$1,067.11
$1,167.67
$1,524.89
$1,241.14
$1,336.08
$1,436.64
$1,793.86
$1,510.11
$1,605.05
$1,705.61
$2,062.83
$268.97
Toc - Plan #38 UnitedHealthcare
Silver

(EPO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$350.64
$397.98
$448.12
$626.25
$951.65
$618.88
$666.22
$716.36
$894.49
$887.12
$934.46
$984.60
$1,162.73
$1,155.36
$1,202.70
$1,252.84
$1,430.97
$268.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701.28
$795.96
$896.24
$1,252.50
$1,903.30
$969.52
$1,064.20
$1,164.48
$1,520.74
$1,237.76
$1,332.44
$1,432.72
$1,788.98
$1,506.00
$1,600.68
$1,700.96
$2,057.22
$268.24
Toc - Plan #39 UnitedHealthcare
Gold

(EPO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$384.77
$436.71
$491.73
$687.19
$1,044.26
$679.12
$731.06
$786.08
$981.54
$973.47
$1,025.41
$1,080.43
$1,275.89
$1,267.82
$1,319.76
$1,374.78
$1,570.24
$294.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$769.54
$873.42
$983.46
$1,374.38
$2,088.52
$1,063.89
$1,167.77
$1,277.81
$1,668.73
$1,358.24
$1,462.12
$1,572.16
$1,963.08
$1,652.59
$1,756.47
$1,866.51
$2,257.43
$294.35
Toc - Plan #40 UnitedHealthcare
Bronze

(EPO) UHC Bronze Essential ($3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$288.69
$327.67
$368.95
$515.61
$783.51
$509.54
$548.52
$589.80
$736.46
$730.39
$769.37
$810.65
$957.31
$951.24
$990.22
$1,031.50
$1,178.16
$220.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$577.38
$655.34
$737.90
$1,031.22
$1,567.02
$798.23
$876.19
$958.75
$1,252.07
$1,019.08
$1,097.04
$1,179.60
$1,472.92
$1,239.93
$1,317.89
$1,400.45
$1,693.77
$220.85
Toc - Plan #41 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$300.63
$341.22
$384.21
$536.93
$815.92
$530.62
$571.21
$614.20
$766.92
$760.61
$801.20
$844.19
$996.91
$990.60
$1,031.19
$1,074.18
$1,226.90
$229.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$601.26
$682.44
$768.42
$1,073.86
$1,631.84
$831.25
$912.43
$998.41
$1,303.85
$1,061.24
$1,142.42
$1,228.40
$1,533.84
$1,291.23
$1,372.41
$1,458.39
$1,763.83
$229.99
Toc - Plan #42 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value HSA $6,700 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$299.26
$339.66
$382.45
$534.47
$812.18
$528.19
$568.59
$611.38
$763.40
$757.12
$797.52
$840.31
$992.33
$986.05
$1,026.45
$1,069.24
$1,221.26
$228.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$598.52
$679.32
$764.90
$1,068.94
$1,624.36
$827.45
$908.25
$993.83
$1,297.87
$1,056.38
$1,137.18
$1,222.76
$1,526.80
$1,285.31
$1,366.11
$1,451.69
$1,755.73
$228.93
Toc - Plan #43 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 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
$302.63
$343.48
$386.75
$540.49
$821.32
$534.14
$574.99
$618.26
$772.00
$765.65
$806.50
$849.77
$1,003.51
$997.16
$1,038.01
$1,081.28
$1,235.02
$231.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$605.26
$686.96
$773.50
$1,080.98
$1,642.64
$836.77
$918.47
$1,005.01
$1,312.49
$1,068.28
$1,149.98
$1,236.52
$1,544.00
$1,299.79
$1,381.49
$1,468.03
$1,775.51
$231.51
Toc - Plan #44 UnitedHealthcare
Bronze

(EPO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$281.07
$319.01
$359.20
$501.98
$762.81
$496.09
$534.03
$574.22
$717.00
$711.11
$749.05
$789.24
$932.02
$926.13
$964.07
$1,004.26
$1,147.04
$215.02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$562.14
$638.02
$718.40
$1,003.96
$1,525.62
$777.16
$853.04
$933.42
$1,218.98
$992.18
$1,068.06
$1,148.44
$1,434.00
$1,207.20
$1,283.08
$1,363.46
$1,649.02
$215.02

ADVERTISEMENT

Ambetter from Home State Health

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

Toc - Plan #45 Ambetter from Home State Health
Bronze

(EPO) Clear Bronze

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

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 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
$307.19
$348.65
$392.58
$548.63
$833.70
$542.19
$583.65
$627.58
$783.63
$777.19
$818.65
$862.58
$1,018.63
$1,012.19
$1,053.65
$1,097.58
$1,253.63
$235.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$614.38
$697.30
$785.16
$1,097.26
$1,667.40
$849.38
$932.30
$1,020.16
$1,332.26
$1,084.38
$1,167.30
$1,255.16
$1,567.26
$1,319.38
$1,402.30
$1,490.16
$1,802.26
$235.00
Toc - Plan #46 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
$7,750 $15,500 Annual Deductible
$7,750 $15,500 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
$355.80
$403.82
$454.69
$635.43
$965.60
$627.98
$676.00
$726.87
$907.61
$900.16
$948.18
$999.05
$1,179.79
$1,172.34
$1,220.36
$1,271.23
$1,451.97
$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
$909.38
$1,270.86
$1,931.20
$983.78
$1,079.82
$1,181.56
$1,543.04
$1,255.96
$1,352.00
$1,453.74
$1,815.22
$1,528.14
$1,624.18
$1,725.92
$2,087.40
$272.18
Toc - Plan #47 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
$8,500 $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
$354.48
$402.32
$453.01
$633.08
$962.03
$625.65
$673.49
$724.18
$904.25
$896.82
$944.66
$995.35
$1,175.42
$1,167.99
$1,215.83
$1,266.52
$1,446.59
$271.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$708.96
$804.64
$906.02
$1,266.16
$1,924.06
$980.13
$1,075.81
$1,177.19
$1,537.33
$1,251.30
$1,346.98
$1,448.36
$1,808.50
$1,522.47
$1,618.15
$1,719.53
$2,079.67
$271.17
Toc - Plan #48 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
$440.76
$500.25
$563.27
$787.17
$1,196.19
$777.93
$837.42
$900.44
$1,124.34
$1,115.10
$1,174.59
$1,237.61
$1,461.51
$1,452.27
$1,511.76
$1,574.78
$1,798.68
$337.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.52
$1,000.50
$1,126.54
$1,574.34
$2,392.38
$1,218.69
$1,337.67
$1,463.71
$1,911.51
$1,555.86
$1,674.84
$1,800.88
$2,248.68
$1,893.03
$2,012.01
$2,138.05
$2,585.85
$337.17
Toc - Plan #49 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
$8,300 $16,600 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
$332.63
$377.53
$425.09
$594.07
$902.74
$587.09
$631.99
$679.55
$848.53
$841.55
$886.45
$934.01
$1,102.99
$1,096.01
$1,140.91
$1,188.47
$1,357.45
$254.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$665.26
$755.06
$850.18
$1,188.14
$1,805.48
$919.72
$1,009.52
$1,104.64
$1,442.60
$1,174.18
$1,263.98
$1,359.10
$1,697.06
$1,428.64
$1,518.44
$1,613.56
$1,951.52
$254.46
Toc - Plan #50 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
$6,900 $13,800 Annual Deductible
$6,900 $13,800 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
$337.65
$383.22
$431.50
$603.03
$916.36
$595.94
$641.51
$689.79
$861.32
$854.23
$899.80
$948.08
$1,119.61
$1,112.52
$1,158.09
$1,206.37
$1,377.90
$258.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$675.30
$766.44
$863.00
$1,206.06
$1,832.72
$933.59
$1,024.73
$1,121.29
$1,464.35
$1,191.88
$1,283.02
$1,379.58
$1,722.64
$1,450.17
$1,541.31
$1,637.87
$1,980.93
$258.29
Toc - Plan #51 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
$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
$372.55
$422.84
$476.11
$665.36
$1,011.08
$657.55
$707.84
$761.11
$950.36
$942.55
$992.84
$1,046.11
$1,235.36
$1,227.55
$1,277.84
$1,331.11
$1,520.36
$285.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$745.10
$845.68
$952.22
$1,330.72
$2,022.16
$1,030.10
$1,130.68
$1,237.22
$1,615.72
$1,315.10
$1,415.68
$1,522.22
$1,900.72
$1,600.10
$1,700.68
$1,807.22
$2,185.72
$285.00
Toc - Plan #52 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
$343.02
$389.32
$438.37
$612.62
$930.94
$605.42
$651.72
$700.77
$875.02
$867.82
$914.12
$963.17
$1,137.42
$1,130.22
$1,176.52
$1,225.57
$1,399.82
$262.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$686.04
$778.64
$876.74
$1,225.24
$1,861.88
$948.44
$1,041.04
$1,139.14
$1,487.64
$1,210.84
$1,303.44
$1,401.54
$1,750.04
$1,473.24
$1,565.84
$1,663.94
$2,012.44
$262.40
Toc - Plan #53 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
$6,100 $12,200 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
$349.46
$396.63
$446.60
$624.12
$948.41
$616.79
$663.96
$713.93
$891.45
$884.12
$931.29
$981.26
$1,158.78
$1,151.45
$1,198.62
$1,248.59
$1,426.11
$267.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$698.92
$793.26
$893.20
$1,248.24
$1,896.82
$966.25
$1,060.59
$1,160.53
$1,515.57
$1,233.58
$1,327.92
$1,427.86
$1,782.90
$1,500.91
$1,595.25
$1,695.19
$2,050.23
$267.33
Toc - Plan #54 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
$422.15
$479.13
$539.49
$753.94
$1,145.69
$745.09
$802.07
$862.43
$1,076.88
$1,068.03
$1,125.01
$1,185.37
$1,399.82
$1,390.97
$1,447.95
$1,508.31
$1,722.76
$322.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.30
$958.26
$1,078.98
$1,507.88
$2,291.38
$1,167.24
$1,281.20
$1,401.92
$1,830.82
$1,490.18
$1,604.14
$1,724.86
$2,153.76
$1,813.12
$1,927.08
$2,047.80
$2,476.70
$322.94
Toc - Plan #55 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
$415.89
$472.02
$531.49
$742.76
$1,128.69
$734.04
$790.17
$849.64
$1,060.91
$1,052.19
$1,108.32
$1,167.79
$1,379.06
$1,370.34
$1,426.47
$1,485.94
$1,697.21
$318.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$831.78
$944.04
$1,062.98
$1,485.52
$2,257.38
$1,149.93
$1,262.19
$1,381.13
$1,803.67
$1,468.08
$1,580.34
$1,699.28
$2,121.82
$1,786.23
$1,898.49
$2,017.43
$2,439.97
$318.15
Toc - Plan #56 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
$5,300 $10,600 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
$482.42
$547.53
$616.52
$861.58
$1,309.26
$851.46
$916.57
$985.56
$1,230.62
$1,220.50
$1,285.61
$1,354.60
$1,599.66
$1,589.54
$1,654.65
$1,723.64
$1,968.70
$369.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$964.84
$1,095.06
$1,233.04
$1,723.16
$2,618.52
$1,333.88
$1,464.10
$1,602.08
$2,092.20
$1,702.92
$1,833.14
$1,971.12
$2,461.24
$2,071.96
$2,202.18
$2,340.16
$2,830.28
$369.04
Toc - Plan #57 Ambetter from Home State Health
Bronze

(EPO) CMS Standard Bronze

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

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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
$292.86
$332.38
$374.26
$523.02
$794.79
$516.89
$556.41
$598.29
$747.05
$740.92
$780.44
$822.32
$971.08
$964.95
$1,004.47
$1,046.35
$1,195.11
$224.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$585.72
$664.76
$748.52
$1,046.04
$1,589.58
$809.75
$888.79
$972.55
$1,270.07
$1,033.78
$1,112.82
$1,196.58
$1,494.10
$1,257.81
$1,336.85
$1,420.61
$1,718.13
$224.03
Toc - Plan #58 Ambetter from Home State Health
Expanded Bronze

(EPO) CMS 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
$9,000 $18,000 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
$322.17
$365.66
$411.72
$575.38
$874.35
$568.63
$612.12
$658.18
$821.84
$815.09
$858.58
$904.64
$1,068.30
$1,061.55
$1,105.04
$1,151.10
$1,314.76
$246.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$644.34
$731.32
$823.44
$1,150.76
$1,748.70
$890.80
$977.78
$1,069.90
$1,397.22
$1,137.26
$1,224.24
$1,316.36
$1,643.68
$1,383.72
$1,470.70
$1,562.82
$1,890.14
$246.46
Toc - Plan #59 Ambetter from Home State Health
Silver

(EPO) CMS Standard Silver

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

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$342.38
$388.59
$437.55
$611.48
$929.20
$604.29
$650.50
$699.46
$873.39
$866.20
$912.41
$961.37
$1,135.30
$1,128.11
$1,174.32
$1,223.28
$1,397.21
$261.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$684.76
$777.18
$875.10
$1,222.96
$1,858.40
$946.67
$1,039.09
$1,137.01
$1,484.87
$1,208.58
$1,301.00
$1,398.92
$1,746.78
$1,470.49
$1,562.91
$1,660.83
$2,008.69
$261.91
Toc - Plan #60 Ambetter from Home State Health
Gold

(EPO) CMS Standard Gold

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

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$416.17
$472.34
$531.85
$743.27
$1,129.46
$734.53
$790.70
$850.21
$1,061.63
$1,052.89
$1,109.06
$1,168.57
$1,379.99
$1,371.25
$1,427.42
$1,486.93
$1,698.35
$318.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$832.34
$944.68
$1,063.70
$1,486.54
$2,258.92
$1,150.70
$1,263.04
$1,382.06
$1,804.90
$1,469.06
$1,581.40
$1,700.42
$2,123.26
$1,787.42
$1,899.76
$2,018.78
$2,441.62
$318.36
Toc - Plan #61 Ambetter from Home State Health
Expanded Bronze

(EPO) Clear Bronze + Vision + Adult Dental

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

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 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
$317.20
$360.01
$405.36
$566.49
$860.84
$559.85
$602.66
$648.01
$809.14
$802.50
$845.31
$890.66
$1,051.79
$1,045.15
$1,087.96
$1,133.31
$1,294.44
$242.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$634.40
$720.02
$810.72
$1,132.98
$1,721.68
$877.05
$962.67
$1,053.37
$1,375.63
$1,119.70
$1,205.32
$1,296.02
$1,618.28
$1,362.35
$1,447.97
$1,538.67
$1,860.93
$242.65
Toc - Plan #62 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
$8,300 $16,600 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
$343.46
$389.82
$438.93
$613.41
$932.13
$606.20
$652.56
$701.67
$876.15
$868.94
$915.30
$964.41
$1,138.89
$1,131.68
$1,178.04
$1,227.15
$1,401.63
$262.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$686.92
$779.64
$877.86
$1,226.82
$1,864.26
$949.66
$1,042.38
$1,140.60
$1,489.56
$1,212.40
$1,305.12
$1,403.34
$1,752.30
$1,475.14
$1,567.86
$1,666.08
$2,015.04
$262.74
Toc - Plan #63 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
$455.11
$516.53
$581.61
$812.80
$1,235.13
$803.26
$864.68
$929.76
$1,160.95
$1,151.41
$1,212.83
$1,277.91
$1,509.10
$1,499.56
$1,560.98
$1,626.06
$1,857.25
$348.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$910.22
$1,033.06
$1,163.22
$1,625.60
$2,470.26
$1,258.37
$1,381.21
$1,511.37
$1,973.75
$1,606.52
$1,729.36
$1,859.52
$2,321.90
$1,954.67
$2,077.51
$2,207.67
$2,670.05
$348.15
Toc - Plan #64 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
$8,500 $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
$366.02
$415.42
$467.76
$653.69
$993.35
$646.02
$695.42
$747.76
$933.69
$926.02
$975.42
$1,027.76
$1,213.69
$1,206.02
$1,255.42
$1,307.76
$1,493.69
$280.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$732.04
$830.84
$935.52
$1,307.38
$1,986.70
$1,012.04
$1,110.84
$1,215.52
$1,587.38
$1,292.04
$1,390.84
$1,495.52
$1,867.38
$1,572.04
$1,670.84
$1,775.52
$2,147.38
$280.00
Toc - Plan #65 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
$7,750 $15,500 Annual Deductible
$7,750 $15,500 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
$367.38
$416.96
$469.50
$656.12
$997.04
$648.42
$698.00
$750.54
$937.16
$929.46
$979.04
$1,031.58
$1,218.20
$1,210.50
$1,260.08
$1,312.62
$1,499.24
$281.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$734.76
$833.92
$939.00
$1,312.24
$1,994.08
$1,015.80
$1,114.96
$1,220.04
$1,593.28
$1,296.84
$1,396.00
$1,501.08
$1,874.32
$1,577.88
$1,677.04
$1,782.12
$2,155.36
$281.04
Toc - Plan #66 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
$6,900 $13,800 Annual Deductible
$6,900 $13,800 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
$348.64
$395.70
$445.55
$622.66
$946.19
$615.34
$662.40
$712.25
$889.36
$882.04
$929.10
$978.95
$1,156.06
$1,148.74
$1,195.80
$1,245.65
$1,422.76
$266.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697.28
$791.40
$891.10
$1,245.32
$1,892.38
$963.98
$1,058.10
$1,157.80
$1,512.02
$1,230.68
$1,324.80
$1,424.50
$1,778.72
$1,497.38
$1,591.50
$1,691.20
$2,045.42
$266.70
Toc - Plan #67 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
$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
$384.68
$436.60
$491.61
$687.02
$1,044.00
$678.95
$730.87
$785.88
$981.29
$973.22
$1,025.14
$1,080.15
$1,275.56
$1,267.49
$1,319.41
$1,374.42
$1,569.83
$294.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$769.36
$873.20
$983.22
$1,374.04
$2,088.00
$1,063.63
$1,167.47
$1,277.49
$1,668.31
$1,357.90
$1,461.74
$1,571.76
$1,962.58
$1,652.17
$1,756.01
$1,866.03
$2,256.85
$294.27
Toc - Plan #68 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
$6,100 $12,200 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
$360.84
$409.54
$461.14
$644.44
$979.29
$636.87
$685.57
$737.17
$920.47
$912.90
$961.60
$1,013.20
$1,196.50
$1,188.93
$1,237.63
$1,289.23
$1,472.53
$276.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721.68
$819.08
$922.28
$1,288.88
$1,958.58
$997.71
$1,095.11
$1,198.31
$1,564.91
$1,273.74
$1,371.14
$1,474.34
$1,840.94
$1,549.77
$1,647.17
$1,750.37
$2,116.97
$276.03
Toc - Plan #69 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
$435.89
$494.73
$557.06
$778.49
$1,182.98
$769.34
$828.18
$890.51
$1,111.94
$1,102.79
$1,161.63
$1,223.96
$1,445.39
$1,436.24
$1,495.08
$1,557.41
$1,778.84
$333.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.78
$989.46
$1,114.12
$1,556.98
$2,365.96
$1,205.23
$1,322.91
$1,447.57
$1,890.43
$1,538.68
$1,656.36
$1,781.02
$2,223.88
$1,872.13
$1,989.81
$2,114.47
$2,557.33
$333.45
Toc - Plan #70 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
$354.19
$401.99
$452.64
$632.56
$961.24
$625.14
$672.94
$723.59
$903.51
$896.09
$943.89
$994.54
$1,174.46
$1,167.04
$1,214.84
$1,265.49
$1,445.41
$270.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$708.38
$803.98
$905.28
$1,265.12
$1,922.48
$979.33
$1,074.93
$1,176.23
$1,536.07
$1,250.28
$1,345.88
$1,447.18
$1,807.02
$1,521.23
$1,616.83
$1,718.13
$2,077.97
$270.95
Toc - Plan #71 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
$429.43
$487.39
$548.79
$766.94
$1,165.44
$757.93
$815.89
$877.29
$1,095.44
$1,086.43
$1,144.39
$1,205.79
$1,423.94
$1,414.93
$1,472.89
$1,534.29
$1,752.44
$328.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$858.86
$974.78
$1,097.58
$1,533.88
$2,330.88
$1,187.36
$1,303.28
$1,426.08
$1,862.38
$1,515.86
$1,631.78
$1,754.58
$2,190.88
$1,844.36
$1,960.28
$2,083.08
$2,519.38
$328.50
Toc - Plan #72 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
$5,300 $10,600 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
$498.12
$565.36
$636.59
$889.63
$1,351.88
$879.18
$946.42
$1,017.65
$1,270.69
$1,260.24
$1,327.48
$1,398.71
$1,651.75
$1,641.30
$1,708.54
$1,779.77
$2,032.81
$381.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$996.24
$1,130.72
$1,273.18
$1,779.26
$2,703.76
$1,377.30
$1,511.78
$1,654.24
$2,160.32
$1,758.36
$1,892.84
$2,035.30
$2,541.38
$2,139.42
$2,273.90
$2,416.36
$2,922.44
$381.06

‡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 Saint Genevieve County here.

Saint Genevieve County is in “Rating Area 6” of Missouri.

Currently, there are 72 plans offered in Rating Area 6.

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2023 Obamacare Plans for Saint Genevieve County, MO

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