Montana Obamacare

2017 Obamacare Rates for Missoula County

Montana 2017 Obamacare Rates for Missoula County

 
Missoula, MT

Providers for Zip Code 59801

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Obamacare Providers, Plans and 2017 Rates for Missoula County

The health insurance rates listed below are for calendar year 2017.

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Missoula County, Montana.

Currently, there are 26 plans offered in Missoula County.

Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

 

The table below shows premiums for the following scenarios:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Missoula County

 

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Missoula, MT area accept this insurance coverage as within the plan's "network".

‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Missoula County here.

Montana Health Cooperative

Local: 1-406-447-9510 | Toll Free: 1-855-488-0622

TTY: 1-855-488-0622

Plan: (PPO) Connected Care Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,750 : Family: $11,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $454.94
$516.36
$581.41
$812.52
$1234.70		 $909.88
$1032.72
$1162.82
$1625.04
$2469.40		 $1198.77
$1321.61
$1451.71
$1913.93		 $1487.66
$1610.50
$1740.60
$2202.82		 $1776.55
$1899.39
$2029.49
$2491.71		 $743.83
$805.25
$870.30
$1101.41		 $1032.72
$1094.14
$1159.19
$1390.30		 $1321.61
$1383.03
$1448.08
$1679.19		 $288.89

PacificSource Health Plans

Local: 1-406-442-6589 | Toll Free: 1-877-590-1596

TTY: 1-800-735-2900

Plan: (PPO) SmartHealth Bronze HSA 6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-590-1596 - Provider Directory for This Plan: (PacificSource Health Plans)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $275.00
$312.00
$351.00
$490.00
$745.00		 $550.00
$624.00
$702.00
$980.00
$1490.00		 $724.00
$798.00
$876.00
$1154.00		 $898.00
$972.00
$1050.00
$1328.00		 $1072.00
$1146.00
$1224.00
$1502.00		 $449.00
$486.00
$525.00
$664.00		 $623.00
$660.00
$699.00
$838.00		 $797.00
$834.00
$873.00
$1012.00		 $174.00

Plan: (PPO) SmartHealth Gold 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-590-1596 - Provider Directory for This Plan: (PacificSource Health Plans)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $419.00
$476.00
$536.00
$749.00
$1138.00		 $838.00
$952.00
$1072.00
$1498.00
$2276.00		 $1104.00
$1218.00
$1338.00
$1764.00		 $1370.00
$1484.00
$1604.00
$2030.00		 $1636.00
$1750.00
$1870.00
$2296.00		 $685.00
$742.00
$802.00
$1015.00		 $951.00
$1008.00
$1068.00
$1281.00		 $1217.00
$1274.00
$1334.00
$1547.00		 $266.00

Plan: (PPO) SmartHealth Silver HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-590-1596 - Provider Directory for This Plan: (PacificSource Health Plans)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $334.00
$379.00
$426.00
$596.00
$905.00		 $668.00
$758.00
$852.00
$1192.00
$1810.00		 $880.00
$970.00
$1064.00
$1404.00		 $1092.00
$1182.00
$1276.00
$1616.00		 $1304.00
$1394.00
$1488.00
$1828.00		 $546.00
$591.00
$638.00
$808.00		 $758.00
$803.00
$850.00
$1020.00		 $970.00
$1015.00
$1062.00
$1232.00		 $212.00

Blue Cross and Blue Shield of Montana

Local: 1-855-258-8471 | Toll Free: 1-855-258-8471

TTY: 1-406-444-4212

Plan: (PPO) Blue Preferred Bronze PPO? 006

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $372.79
$423.12
$476.43
$665.81
$1011.76		 $745.58
$846.24
$952.86
$1331.62
$2023.52		 $982.30
$1082.96
$1189.58
$1568.34		 $1219.02
$1319.68
$1426.30
$1805.06		 $1455.74
$1556.40
$1663.02
$2041.78		 $609.51
$659.84
$713.15
$902.53		 $846.23
$896.56
$949.87
$1139.25		 $1082.95
$1133.28
$1186.59
$1375.97		 $236.72

Plan: (PPO) Blue Preferred Security PPO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $288.32
$327.24
$368.47
$514.93
$782.49		 $576.64
$654.48
$736.94
$1029.86
$1564.98		 $759.72
$837.56
$920.02
$1212.94		 $942.80
$1020.64
$1103.10
$1396.02		 $1125.88
$1203.72
$1286.18
$1579.10		 $471.40
$510.32
$551.55
$698.01		 $654.48
$693.40
$734.63
$881.09		 $837.56
$876.48
$917.71
$1064.17		 $183.08

Plan: (PPO) Blue Preferred Silver PPO? 101 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $438.41
$497.59
$560.28
$783.00
$1189.84		 $876.82
$995.18
$1120.56
$1566.00
$2379.68		 $1155.21
$1273.57
$1398.95
$1844.39		 $1433.60
$1551.96
$1677.34
$2122.78		 $1711.99
$1830.35
$1955.73
$2401.17		 $716.80
$775.98
$838.67
$1061.39		 $995.19
$1054.37
$1117.06
$1339.78		 $1273.58
$1332.76
$1395.45
$1618.17		 $278.39

Montana Health Cooperative

Local: 1-406-447-9510 | Toll Free: 1-855-488-0622

TTY: 1-855-488-0622

Plan: (PPO) Access Care Bronze Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $288.00
$326.88
$368.06
$514.36
$781.62		 $576.00
$653.76
$736.12
$1028.72
$1563.24		 $758.88
$836.64
$919.00
$1211.60		 $941.76
$1019.52
$1101.88
$1394.48		 $1124.64
$1202.40
$1284.76
$1577.36		 $470.88
$509.76
$550.94
$697.24		 $653.76
$692.64
$733.82
$880.12		 $836.64
$875.52
$916.70
$1063.00		 $182.88
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Blue Cross and Blue Shield of Montana

Local: 1-855-258-8471 | Toll Free: 1-855-258-8471

TTY: 1-406-444-4212

Plan: (PPO) Blue Preferred Bronze PPO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $364.65
$413.87
$466.02
$651.26
$989.65		 $729.30
$827.74
$932.04
$1302.52
$1979.30		 $960.85
$1059.29
$1163.59
$1534.07		 $1192.40
$1290.84
$1395.14
$1765.62		 $1423.95
$1522.39
$1626.69
$1997.17		 $596.20
$645.42
$697.57
$882.81		 $827.75
$876.97
$929.12
$1114.36		 $1059.30
$1108.52
$1160.67
$1345.91		 $231.55

Plan: (PPO) Blue Preferred Bronze PPO? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $373.81
$424.28
$477.73
$667.63
$1014.52		 $747.62
$848.56
$955.46
$1335.26
$2029.04		 $984.99
$1085.93
$1192.83
$1572.63		 $1222.36
$1323.30
$1430.20
$1810.00		 $1459.73
$1560.67
$1667.57
$2047.37		 $611.18
$661.65
$715.10
$905.00		 $848.55
$899.02
$952.47
$1142.37		 $1085.92
$1136.39
$1189.84
$1379.74		 $237.37

Plan: (PPO) Blue Preferred Gold PPO? 104

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $3,350 : Family: $6,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $524.07
$594.82
$669.76
$935.99
$1422.32		 $1048.14
$1189.64
$1339.52
$1871.98
$2844.64		 $1380.92
$1522.42
$1672.30
$2204.76		 $1713.70
$1855.20
$2005.08
$2537.54		 $2046.48
$2187.98
$2337.86
$2870.32		 $856.85
$927.60
$1002.54
$1268.77		 $1189.63
$1260.38
$1335.32
$1601.55		 $1522.41
$1593.16
$1668.10
$1934.33		 $332.78

Plan: (PPO) Blue Preferred Silver PPO? 105

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $441.15
$500.71
$563.79
$787.90
$1197.29		 $882.30
$1001.42
$1127.58
$1575.80
$2394.58		 $1162.43
$1281.55
$1407.71
$1855.93		 $1442.56
$1561.68
$1687.84
$2136.06		 $1722.69
$1841.81
$1967.97
$2416.19		 $721.28
$780.84
$843.92
$1068.03		 $1001.41
$1060.97
$1124.05
$1348.16		 $1281.54
$1341.10
$1404.18
$1628.29		 $280.13

Plan: (PPO) Blue Cross Blue Shield Premier? 101, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $1,650 : Family: $3,300
Out of Pocket Maximum per year: Individual: $3,350 : Family: $6,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $521.29
$591.67
$666.21
$931.03
$1414.79		 $1042.58
$1183.34
$1332.42
$1862.06
$2829.58		 $1373.60
$1514.36
$1663.44
$2193.08		 $1704.62
$1845.38
$1994.46
$2524.10		 $2035.64
$2176.40
$2325.48
$2855.12		 $852.31
$922.69
$997.23
$1262.05		 $1183.33
$1253.71
$1328.25
$1593.07		 $1514.35
$1584.73
$1659.27
$1924.09		 $331.02

Plan: (PPO) Blue Cross Blue Shield Solution? 102, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $3,350 : Family: $6,700
Out of Pocket Maximum per year: Individual: $5,600 : Family: $11,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $442.21
$501.91
$565.14
$789.78
$1200.15		 $884.42
$1003.82
$1130.28
$1579.56
$2400.30		 $1165.22
$1284.62
$1411.08
$1860.36		 $1446.02
$1565.42
$1691.88
$2141.16		 $1726.82
$1846.22
$1972.68
$2421.96		 $723.01
$782.71
$845.94
$1070.58		 $1003.81
$1063.51
$1126.74
$1351.38		 $1284.61
$1344.31
$1407.54
$1632.18		 $280.80

Plan: (PPO) Blue Cross Blue Shield Basic? 103, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $6,100 : Family: $12,200
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $348.08
$395.07
$444.85
$621.67
$944.69		 $696.16
$790.14
$889.70
$1243.34
$1889.38		 $917.19
$1011.17
$1110.73
$1464.37		 $1138.22
$1232.20
$1331.76
$1685.40		 $1359.25
$1453.23
$1552.79
$1906.43		 $569.11
$616.10
$665.88
$842.70		 $790.14
$837.13
$886.91
$1063.73		 $1011.17
$1058.16
$1107.94
$1284.76		 $221.03

Plan: (HMO) Blue Focus Bronze POS? 104 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $305.36
$346.59
$390.25
$545.38
$828.75		 $610.72
$693.18
$780.50
$1090.76
$1657.50		 $804.62
$887.08
$974.40
$1284.66		 $998.52
$1080.98
$1168.30
$1478.56		 $1192.42
$1274.88
$1362.20
$1672.46		 $499.26
$540.49
$584.15
$739.28		 $693.16
$734.39
$778.05
$933.18		 $887.06
$928.29
$971.95
$1127.08		 $193.90

Plan: (HMO) Blue Focus Silver POS? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $379.68
$430.94
$485.24
$678.12
$1030.46		 $759.36
$861.88
$970.48
$1356.24
$2060.92		 $1000.46
$1102.98
$1211.58
$1597.34		 $1241.56
$1344.08
$1452.68
$1838.44		 $1482.66
$1585.18
$1693.78
$2079.54		 $620.78
$672.04
$726.34
$919.22		 $861.88
$913.14
$967.44
$1160.32		 $1102.98
$1154.24
$1208.54
$1401.42		 $241.10

Plan: (HMO) Blue Focus Silver POS? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $3,850 : Family: $7,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $378.38
$429.46
$483.57
$675.79
$1026.92		 $756.76
$858.92
$967.14
$1351.58
$2053.84		 $997.03
$1099.19
$1207.41
$1591.85		 $1237.30
$1339.46
$1447.68
$1832.12		 $1477.57
$1579.73
$1687.95
$2072.39		 $618.65
$669.73
$723.84
$916.06		 $858.92
$910.00
$964.11
$1156.33		 $1099.19
$1150.27
$1204.38
$1396.60		 $240.27

Plan: (HMO) Blue Focus Gold POS? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-258-8471 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Montana)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $5,250 : Family: $10,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $464.49
$527.20
$593.62
$829.59
$1260.64		 $928.98
$1054.40
$1187.24
$1659.18
$2521.28		 $1223.93
$1349.35
$1482.19
$1954.13		 $1518.88
$1644.30
$1777.14
$2249.08		 $1813.83
$1939.25
$2072.09
$2544.03		 $759.44
$822.15
$888.57
$1124.54		 $1054.39
$1117.10
$1183.52
$1419.49		 $1349.34
$1412.05
$1478.47
$1714.44		 $294.95
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Montana Health Cooperative

Local: 1-406-447-9510 | Toll Free: 1-855-488-0622

TTY: 1-855-488-0622

Plan: (PPO) Access Care Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $525.59
$596.54
$671.70
$938.70
$1426.45		 $1051.18
$1193.08
$1343.40
$1877.40
$2852.90		 $1384.93
$1526.83
$1677.15
$2211.15		 $1718.68
$1860.58
$2010.90
$2544.90		 $2052.43
$2194.33
$2344.65
$2878.65		 $859.34
$930.29
$1005.45
$1272.45		 $1193.09
$1264.04
$1339.20
$1606.20		 $1526.84
$1597.79
$1672.95
$1939.95		 $333.75

Plan: (PPO) Access Care Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $375.07
$425.70
$479.34
$669.87
$1017.93		 $750.14
$851.40
$958.68
$1339.74
$2035.86		 $988.31
$1089.57
$1196.85
$1577.91		 $1226.48
$1327.74
$1435.02
$1816.08		 $1464.65
$1565.91
$1673.19
$2054.25		 $613.24
$663.87
$717.51
$908.04		 $851.41
$902.04
$955.68
$1146.21		 $1089.58
$1140.21
$1193.85
$1384.38		 $238.17

Plan: (PPO) Access Care Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $5,250 : Family: $10,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $284.45
$322.85
$363.52
$508.02
$771.99		 $568.90
$645.70
$727.04
$1016.04
$1543.98		 $749.52
$826.32
$907.66
$1196.66		 $930.14
$1006.94
$1088.28
$1377.28		 $1110.76
$1187.56
$1268.90
$1557.90		 $465.07
$503.47
$544.14
$688.64		 $645.69
$684.09
$724.76
$869.26		 $826.31
$864.71
$905.38
$1049.88		 $180.62

Plan: (PPO) Connected Care Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $2,150 : Family: $4,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $314.86
$357.36
$402.39
$562.34
$854.52		 $629.72
$714.72
$804.78
$1124.68
$1709.04		 $829.65
$914.65
$1004.71
$1324.61		 $1029.58
$1114.58
$1204.64
$1524.54		 $1229.51
$1314.51
$1404.57
$1724.47		 $514.79
$557.29
$602.32
$762.27		 $714.72
$757.22
$802.25
$962.20		 $914.65
$957.15
$1002.18
$1162.13		 $199.93

Plan: (PPO) Connected Care Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $5,550 : Family: $11,100
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $249.84
$283.57
$319.30
$446.22
$678.07		 $499.68
$567.14
$638.60
$892.44
$1356.14		 $658.33
$725.79
$797.25
$1051.09		 $816.98
$884.44
$955.90
$1209.74		 $975.63
$1043.09
$1114.55
$1368.39		 $408.49
$442.22
$477.95
$604.87		 $567.14
$600.87
$636.60
$763.52		 $725.79
$759.52
$795.25
$922.17		 $158.65

Plan: (PPO) Connected Care Bronze Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $253.58
$287.81
$324.07
$452.89
$688.21		 $507.16
$575.62
$648.14
$905.78
$1376.42		 $668.18
$736.64
$809.16
$1066.80		 $829.20
$897.66
$970.18
$1227.82		 $990.22
$1058.68
$1131.20
$1388.84		 $414.60
$448.83
$485.09
$613.91		 $575.62
$609.85
$646.11
$774.93		 $736.64
$770.87
$807.13
$935.95		 $161.02

Plan: (PPO) Access Care Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-488-0622 - Provider Directory for This Plan: (Montana Health Cooperative)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $192.37
$218.34
$245.85
$343.58
$522.10		 $384.74
$436.68
$491.70
$687.16
$1044.20		 $506.90
$558.84
$613.86
$809.32		 $629.06
$681.00
$736.02
$931.48		 $751.22
$803.16
$858.18
$1053.64		 $314.53
$340.50
$368.01
$465.74		 $436.69
$462.66
$490.17
$587.90		 $558.85
$584.82
$612.33
$710.06		 $122.16