Buffalo County, Nebraska 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 Buffalo County, NE.

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, 64 Plans and 2024 Rates for Buffalo County, Nebraska

Below, you’ll find a summary of the 64 plans for Buffalo County, Nebraska 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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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-833-7352

Toc - Plan #1 Medica
Gold

(EPO) Medica Insure Gold Share

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

Annual Out of Pocket Expenses:

Individual Family
$800 $1,600 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
$692.77
$786.28
$885.34
$1,237.26
$1,880.14
$1,222.73
$1,316.24
$1,415.30
$1,767.22
$1,752.69
$1,846.20
$1,945.26
$2,297.18
$2,282.65
$2,376.16
$2,475.22
$2,827.14
$529.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,385.54
$1,572.56
$1,770.68
$2,474.52
$3,760.28
$1,915.50
$2,102.52
$2,300.64
$3,004.48
$2,445.46
$2,632.48
$2,830.60
$3,534.44
$2,975.42
$3,162.44
$3,360.56
$4,064.40
$529.96
Toc - Plan #2 Medica
Silver

(EPO) Medica Insure Silver Enhanced

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$676.22
$767.50
$864.20
$1,207.72
$1,835.24
$1,193.52
$1,284.80
$1,381.50
$1,725.02
$1,710.82
$1,802.10
$1,898.80
$2,242.32
$2,228.12
$2,319.40
$2,416.10
$2,759.62
$517.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,352.44
$1,535.00
$1,728.40
$2,415.44
$3,670.48
$1,869.74
$2,052.30
$2,245.70
$2,932.74
$2,387.04
$2,569.60
$2,763.00
$3,450.04
$2,904.34
$3,086.90
$3,280.30
$3,967.34
$517.30
Toc - Plan #3 Medica
Gold

(EPO) Medica Insure Gold Standard

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$700.55
$795.11
$895.29
$1,251.16
$1,901.27
$1,236.46
$1,331.02
$1,431.20
$1,787.07
$1,772.37
$1,866.93
$1,967.11
$2,322.98
$2,308.28
$2,402.84
$2,503.02
$2,858.89
$535.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,401.10
$1,590.22
$1,790.58
$2,502.32
$3,802.54
$1,937.01
$2,126.13
$2,326.49
$3,038.23
$2,472.92
$2,662.04
$2,862.40
$3,574.14
$3,008.83
$3,197.95
$3,398.31
$4,110.05
$535.91
Toc - Plan #4 Medica
Silver

(EPO) Medica Insure Silver Standard

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

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$660.20
$749.32
$843.72
$1,179.10
$1,791.76
$1,165.25
$1,254.37
$1,348.77
$1,684.15
$1,670.30
$1,759.42
$1,853.82
$2,189.20
$2,175.35
$2,264.47
$2,358.87
$2,694.25
$505.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,320.40
$1,498.64
$1,687.44
$2,358.20
$3,583.52
$1,825.45
$2,003.69
$2,192.49
$2,863.25
$2,330.50
$2,508.74
$2,697.54
$3,368.30
$2,835.55
$3,013.79
$3,202.59
$3,873.35
$505.05
Toc - Plan #5 Medica
Expanded Bronze

(EPO) Medica Insure Expanded Bronze Standard

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.30
$534.91
$602.30
$841.72
$1,279.07
$831.83
$895.44
$962.83
$1,202.25
$1,192.36
$1,255.97
$1,323.36
$1,562.78
$1,552.89
$1,616.50
$1,683.89
$1,923.31
$360.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$942.60
$1,069.82
$1,204.60
$1,683.44
$2,558.14
$1,303.13
$1,430.35
$1,565.13
$2,043.97
$1,663.66
$1,790.88
$1,925.66
$2,404.50
$2,024.19
$2,151.41
$2,286.19
$2,765.03
$360.53
Toc - Plan #6 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay + Adult Eye Exam

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,450 $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
$386.83
$439.04
$494.35
$690.86
$1,049.82
$682.75
$734.96
$790.27
$986.78
$978.67
$1,030.88
$1,086.19
$1,282.70
$1,274.59
$1,326.80
$1,382.11
$1,578.62
$295.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773.66
$878.08
$988.70
$1,381.72
$2,099.64
$1,069.58
$1,174.00
$1,284.62
$1,677.64
$1,365.50
$1,469.92
$1,580.54
$1,973.56
$1,661.42
$1,765.84
$1,876.46
$2,269.48
$295.92
Toc - Plan #7 Medica
Silver

(EPO) Medica with CHI Health Silver Share

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

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 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
$543.50
$616.86
$694.58
$970.67
$1,475.03
$959.27
$1,032.63
$1,110.35
$1,386.44
$1,375.04
$1,448.40
$1,526.12
$1,802.21
$1,790.81
$1,864.17
$1,941.89
$2,217.98
$415.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,087.00
$1,233.72
$1,389.16
$1,941.34
$2,950.06
$1,502.77
$1,649.49
$1,804.93
$2,357.11
$1,918.54
$2,065.26
$2,220.70
$2,772.88
$2,334.31
$2,481.03
$2,636.47
$3,188.65
$415.77
Toc - Plan #8 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Share Plus + Adult Eye Exam

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

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$395.87
$449.30
$505.91
$707.01
$1,074.37
$698.71
$752.14
$808.75
$1,009.85
$1,001.55
$1,054.98
$1,111.59
$1,312.69
$1,304.39
$1,357.82
$1,414.43
$1,615.53
$302.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.74
$898.60
$1,011.82
$1,414.02
$2,148.74
$1,094.58
$1,201.44
$1,314.66
$1,716.86
$1,397.42
$1,504.28
$1,617.50
$2,019.70
$1,700.26
$1,807.12
$1,920.34
$2,322.54
$302.84
Toc - Plan #9 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay $0 PCP Office Visits + Adult Eye Exam

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,450 $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
$399.24
$453.13
$510.21
$713.02
$1,083.51
$704.65
$758.54
$815.62
$1,018.43
$1,010.06
$1,063.95
$1,121.03
$1,323.84
$1,315.47
$1,369.36
$1,426.44
$1,629.25
$305.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798.48
$906.26
$1,020.42
$1,426.04
$2,167.02
$1,103.89
$1,211.67
$1,325.83
$1,731.45
$1,409.30
$1,517.08
$1,631.24
$2,036.86
$1,714.71
$1,822.49
$1,936.65
$2,342.27
$305.41
Toc - Plan #10 Medica
Gold

(EPO) Medica with CHI Health Gold Copay $0 PCP Office Visits

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$550.14
$624.40
$703.07
$982.53
$1,493.05
$970.99
$1,045.25
$1,123.92
$1,403.38
$1,391.84
$1,466.10
$1,544.77
$1,824.23
$1,812.69
$1,886.95
$1,965.62
$2,245.08
$420.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,100.28
$1,248.80
$1,406.14
$1,965.06
$2,986.10
$1,521.13
$1,669.65
$1,826.99
$2,385.91
$1,941.98
$2,090.50
$2,247.84
$2,806.76
$2,362.83
$2,511.35
$2,668.69
$3,227.61
$420.85
Toc - Plan #11 Medica
Silver

(EPO) Medica with CHI Health Silver Copay $0 PCP Office Visits

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

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$519.14
$589.21
$663.45
$927.16
$1,408.91
$916.27
$986.34
$1,060.58
$1,324.29
$1,313.40
$1,383.47
$1,457.71
$1,721.42
$1,710.53
$1,780.60
$1,854.84
$2,118.55
$397.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,038.28
$1,178.42
$1,326.90
$1,854.32
$2,817.82
$1,435.41
$1,575.55
$1,724.03
$2,251.45
$1,832.54
$1,972.68
$2,121.16
$2,648.58
$2,229.67
$2,369.81
$2,518.29
$3,045.71
$397.13
Toc - Plan #12 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Premier

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

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$413.69
$469.53
$528.69
$738.84
$1,122.73
$730.16
$786.00
$845.16
$1,055.31
$1,046.63
$1,102.47
$1,161.63
$1,371.78
$1,363.10
$1,418.94
$1,478.10
$1,688.25
$316.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827.38
$939.06
$1,057.38
$1,477.68
$2,245.46
$1,143.85
$1,255.53
$1,373.85
$1,794.15
$1,460.32
$1,572.00
$1,690.32
$2,110.62
$1,776.79
$1,888.47
$2,006.79
$2,427.09
$316.47
Toc - Plan #13 Medica
Silver

(EPO) Medica with CHI Health Silver Enhanced

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$544.96
$618.52
$696.45
$973.29
$1,479.00
$961.85
$1,035.41
$1,113.34
$1,390.18
$1,378.74
$1,452.30
$1,530.23
$1,807.07
$1,795.63
$1,869.19
$1,947.12
$2,223.96
$416.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,089.92
$1,237.04
$1,392.90
$1,946.58
$2,958.00
$1,506.81
$1,653.93
$1,809.79
$2,363.47
$1,923.70
$2,070.82
$2,226.68
$2,780.36
$2,340.59
$2,487.71
$2,643.57
$3,197.25
$416.89
Toc - Plan #14 Medica
Gold

(EPO) Medica with CHI Health Gold Standard

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$564.57
$640.77
$721.51
$1,008.30
$1,532.21
$996.46
$1,072.66
$1,153.40
$1,440.19
$1,428.35
$1,504.55
$1,585.29
$1,872.08
$1,860.24
$1,936.44
$2,017.18
$2,303.97
$431.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,129.14
$1,281.54
$1,443.02
$2,016.60
$3,064.42
$1,561.03
$1,713.43
$1,874.91
$2,448.49
$1,992.92
$2,145.32
$2,306.80
$2,880.38
$2,424.81
$2,577.21
$2,738.69
$3,312.27
$431.89
Toc - Plan #15 Medica
Silver

(EPO) Medica with CHI Health Silver Standard

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

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$532.05
$603.87
$679.95
$950.23
$1,443.96
$939.06
$1,010.88
$1,086.96
$1,357.24
$1,346.07
$1,417.89
$1,493.97
$1,764.25
$1,753.08
$1,824.90
$1,900.98
$2,171.26
$407.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,064.10
$1,207.74
$1,359.90
$1,900.46
$2,887.92
$1,471.11
$1,614.75
$1,766.91
$2,307.47
$1,878.12
$2,021.76
$2,173.92
$2,714.48
$2,285.13
$2,428.77
$2,580.93
$3,121.49
$407.01
Toc - Plan #16 Medica
Expanded Bronze

(EPO) Medica with CHI Health Expanded Bronze Standard

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$379.82
$431.08
$485.39
$678.33
$1,030.79
$670.37
$721.63
$775.94
$968.88
$960.92
$1,012.18
$1,066.49
$1,259.43
$1,251.47
$1,302.73
$1,357.04
$1,549.98
$290.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$759.64
$862.16
$970.78
$1,356.66
$2,061.58
$1,050.19
$1,152.71
$1,261.33
$1,647.21
$1,340.74
$1,443.26
$1,551.88
$1,937.76
$1,631.29
$1,733.81
$1,842.43
$2,228.31
$290.55

ADVERTISEMENT

Ambetter from Nebraska Total Care

Local: 1-833-890-0329 | Toll Free: 1-833-890-0329 | TTY: 1-833-890-0329

Toc - Plan #17 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$371.92
$422.12
$475.30
$664.23
$1,009.36
$656.43
$706.63
$759.81
$948.74
$940.94
$991.14
$1,044.32
$1,233.25
$1,225.45
$1,275.65
$1,328.83
$1,517.76
$284.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.84
$844.24
$950.60
$1,328.46
$2,018.72
$1,028.35
$1,128.75
$1,235.11
$1,612.97
$1,312.86
$1,413.26
$1,519.62
$1,897.48
$1,597.37
$1,697.77
$1,804.13
$2,181.99
$284.51
Toc - Plan #18 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$363.71
$412.79
$464.80
$649.56
$987.07
$641.94
$691.02
$743.03
$927.79
$920.17
$969.25
$1,021.26
$1,206.02
$1,198.40
$1,247.48
$1,299.49
$1,484.25
$278.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727.42
$825.58
$929.60
$1,299.12
$1,974.14
$1,005.65
$1,103.81
$1,207.83
$1,577.35
$1,283.88
$1,382.04
$1,486.06
$1,855.58
$1,562.11
$1,660.27
$1,764.29
$2,133.81
$278.23
Toc - Plan #19 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$410.48
$465.89
$524.59
$733.11
$1,114.03
$724.49
$779.90
$838.60
$1,047.12
$1,038.50
$1,093.91
$1,152.61
$1,361.13
$1,352.51
$1,407.92
$1,466.62
$1,675.14
$314.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820.96
$931.78
$1,049.18
$1,466.22
$2,228.06
$1,134.97
$1,245.79
$1,363.19
$1,780.23
$1,448.98
$1,559.80
$1,677.20
$2,094.24
$1,762.99
$1,873.81
$1,991.21
$2,408.25
$314.01
Toc - Plan #20 Ambetter from Nebraska Total Care
Silver

(HMO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$469.83
$533.25
$600.43
$839.10
$1,275.09
$829.24
$892.66
$959.84
$1,198.51
$1,188.65
$1,252.07
$1,319.25
$1,557.92
$1,548.06
$1,611.48
$1,678.66
$1,917.33
$359.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$939.66
$1,066.50
$1,200.86
$1,678.20
$2,550.18
$1,299.07
$1,425.91
$1,560.27
$2,037.61
$1,658.48
$1,785.32
$1,919.68
$2,397.02
$2,017.89
$2,144.73
$2,279.09
$2,756.43
$359.41
Toc - Plan #21 Ambetter from Nebraska Total Care
Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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
$475.23
$539.37
$607.33
$848.74
$1,289.74
$838.77
$902.91
$970.87
$1,212.28
$1,202.31
$1,266.45
$1,334.41
$1,575.82
$1,565.85
$1,629.99
$1,697.95
$1,939.36
$363.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$950.46
$1,078.74
$1,214.66
$1,697.48
$2,579.48
$1,314.00
$1,442.28
$1,578.20
$2,061.02
$1,677.54
$1,805.82
$1,941.74
$2,424.56
$2,041.08
$2,169.36
$2,305.28
$2,788.10
$363.54
Toc - Plan #22 Ambetter from Nebraska Total Care
Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 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
$518.97
$589.02
$663.23
$926.86
$1,408.45
$915.97
$986.02
$1,060.23
$1,323.86
$1,312.97
$1,383.02
$1,457.23
$1,720.86
$1,709.97
$1,780.02
$1,854.23
$2,117.86
$397.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,037.94
$1,178.04
$1,326.46
$1,853.72
$2,816.90
$1,434.94
$1,575.04
$1,723.46
$2,250.72
$1,831.94
$1,972.04
$2,120.46
$2,647.72
$2,228.94
$2,369.04
$2,517.46
$3,044.72
$397.00
Toc - Plan #23 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$357.49
$405.74
$456.86
$638.46
$970.20
$630.96
$679.21
$730.33
$911.93
$904.43
$952.68
$1,003.80
$1,185.40
$1,177.90
$1,226.15
$1,277.27
$1,458.87
$273.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$714.98
$811.48
$913.72
$1,276.92
$1,940.40
$988.45
$1,084.95
$1,187.19
$1,550.39
$1,261.92
$1,358.42
$1,460.66
$1,823.86
$1,535.39
$1,631.89
$1,734.13
$2,097.33
$273.47
Toc - Plan #24 Ambetter from Nebraska Total Care
Silver

(HMO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$453.72
$514.96
$579.84
$810.33
$1,231.38
$800.81
$862.05
$926.93
$1,157.42
$1,147.90
$1,209.14
$1,274.02
$1,504.51
$1,494.99
$1,556.23
$1,621.11
$1,851.60
$347.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$907.44
$1,029.92
$1,159.68
$1,620.66
$2,462.76
$1,254.53
$1,377.01
$1,506.77
$1,967.75
$1,601.62
$1,724.10
$1,853.86
$2,314.84
$1,948.71
$2,071.19
$2,200.95
$2,661.93
$347.09
Toc - Plan #25 Ambetter from Nebraska Total Care
Gold

(HMO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$457.17
$518.88
$584.25
$816.49
$1,240.73
$806.90
$868.61
$933.98
$1,166.22
$1,156.63
$1,218.34
$1,283.71
$1,515.95
$1,506.36
$1,568.07
$1,633.44
$1,865.68
$349.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$914.34
$1,037.76
$1,168.50
$1,632.98
$2,481.46
$1,264.07
$1,387.49
$1,518.23
$1,982.71
$1,613.80
$1,737.22
$1,867.96
$2,332.44
$1,963.53
$2,086.95
$2,217.69
$2,682.17
$349.73
Toc - Plan #26 Ambetter from Nebraska Total Care
Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$459.08
$521.04
$586.69
$819.89
$1,245.91
$810.27
$872.23
$937.88
$1,171.08
$1,161.46
$1,223.42
$1,289.07
$1,522.27
$1,512.65
$1,574.61
$1,640.26
$1,873.46
$351.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.16
$1,042.08
$1,173.38
$1,639.78
$2,491.82
$1,269.35
$1,393.27
$1,524.57
$1,990.97
$1,620.54
$1,744.46
$1,875.76
$2,342.16
$1,971.73
$2,095.65
$2,226.95
$2,693.35
$351.19
Toc - Plan #27 Ambetter from Nebraska Total Care
Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$463.21
$525.73
$591.96
$827.27
$1,257.11
$817.55
$880.07
$946.30
$1,181.61
$1,171.89
$1,234.41
$1,300.64
$1,535.95
$1,526.23
$1,588.75
$1,654.98
$1,890.29
$354.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$926.42
$1,051.46
$1,183.92
$1,654.54
$2,514.22
$1,280.76
$1,405.80
$1,538.26
$2,008.88
$1,635.10
$1,760.14
$1,892.60
$2,363.22
$1,989.44
$2,114.48
$2,246.94
$2,717.56
$354.34
Toc - Plan #28 Ambetter from Nebraska Total Care
Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$455.86
$517.38
$582.57
$814.14
$1,237.16
$804.58
$866.10
$931.29
$1,162.86
$1,153.30
$1,214.82
$1,280.01
$1,511.58
$1,502.02
$1,563.54
$1,628.73
$1,860.30
$348.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.72
$1,034.76
$1,165.14
$1,628.28
$2,474.32
$1,260.44
$1,383.48
$1,513.86
$1,977.00
$1,609.16
$1,732.20
$1,862.58
$2,325.72
$1,957.88
$2,080.92
$2,211.30
$2,674.44
$348.72
Toc - Plan #29 Ambetter from Nebraska Total Care
Gold

(HMO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$448.87
$509.45
$573.64
$801.66
$1,218.20
$792.25
$852.83
$917.02
$1,145.04
$1,135.63
$1,196.21
$1,260.40
$1,488.42
$1,479.01
$1,539.59
$1,603.78
$1,831.80
$343.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$897.74
$1,018.90
$1,147.28
$1,603.32
$2,436.40
$1,241.12
$1,362.28
$1,490.66
$1,946.70
$1,584.50
$1,705.66
$1,834.04
$2,290.08
$1,927.88
$2,049.04
$2,177.42
$2,633.46
$343.38
Toc - Plan #30 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$386.41
$438.56
$493.82
$690.11
$1,048.69
$682.01
$734.16
$789.42
$985.71
$977.61
$1,029.76
$1,085.02
$1,281.31
$1,273.21
$1,325.36
$1,380.62
$1,576.91
$295.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772.82
$877.12
$987.64
$1,380.22
$2,097.38
$1,068.42
$1,172.72
$1,283.24
$1,675.82
$1,364.02
$1,468.32
$1,578.84
$1,971.42
$1,659.62
$1,763.92
$1,874.44
$2,267.02
$295.60
Toc - Plan #31 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$377.88
$428.88
$482.91
$674.87
$1,025.53
$666.95
$717.95
$771.98
$963.94
$956.02
$1,007.02
$1,061.05
$1,253.01
$1,245.09
$1,296.09
$1,350.12
$1,542.08
$289.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755.76
$857.76
$965.82
$1,349.74
$2,051.06
$1,044.83
$1,146.83
$1,254.89
$1,638.81
$1,333.90
$1,435.90
$1,543.96
$1,927.88
$1,622.97
$1,724.97
$1,833.03
$2,216.95
$289.07
Toc - Plan #32 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$426.48
$484.04
$545.03
$761.67
$1,157.43
$752.73
$810.29
$871.28
$1,087.92
$1,078.98
$1,136.54
$1,197.53
$1,414.17
$1,405.23
$1,462.79
$1,523.78
$1,740.42
$326.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$852.96
$968.08
$1,090.06
$1,523.34
$2,314.86
$1,179.21
$1,294.33
$1,416.31
$1,849.59
$1,505.46
$1,620.58
$1,742.56
$2,175.84
$1,831.71
$1,946.83
$2,068.81
$2,502.09
$326.25
Toc - Plan #33 Ambetter from Nebraska Total Care
Silver

(HMO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$488.14
$554.02
$623.82
$871.79
$1,324.77
$861.56
$927.44
$997.24
$1,245.21
$1,234.98
$1,300.86
$1,370.66
$1,618.63
$1,608.40
$1,674.28
$1,744.08
$1,992.05
$373.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$976.28
$1,108.04
$1,247.64
$1,743.58
$2,649.54
$1,349.70
$1,481.46
$1,621.06
$2,117.00
$1,723.12
$1,854.88
$1,994.48
$2,490.42
$2,096.54
$2,228.30
$2,367.90
$2,863.84
$373.42
Toc - Plan #34 Ambetter from Nebraska Total Care
Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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
$493.75
$560.39
$630.99
$881.81
$1,340.00
$871.46
$938.10
$1,008.70
$1,259.52
$1,249.17
$1,315.81
$1,386.41
$1,637.23
$1,626.88
$1,693.52
$1,764.12
$2,014.94
$377.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$987.50
$1,120.78
$1,261.98
$1,763.62
$2,680.00
$1,365.21
$1,498.49
$1,639.69
$2,141.33
$1,742.92
$1,876.20
$2,017.40
$2,519.04
$2,120.63
$2,253.91
$2,395.11
$2,896.75
$377.71
Toc - Plan #35 Ambetter from Nebraska Total Care
Expanded Bronze

(HMO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$371.42
$421.55
$474.66
$663.34
$1,008.00
$655.55
$705.68
$758.79
$947.47
$939.68
$989.81
$1,042.92
$1,231.60
$1,223.81
$1,273.94
$1,327.05
$1,515.73
$284.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742.84
$843.10
$949.32
$1,326.68
$2,016.00
$1,026.97
$1,127.23
$1,233.45
$1,610.81
$1,311.10
$1,411.36
$1,517.58
$1,894.94
$1,595.23
$1,695.49
$1,801.71
$2,179.07
$284.13
Toc - Plan #36 Ambetter from Nebraska Total Care
Silver

(HMO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$471.40
$535.03
$602.44
$841.90
$1,279.36
$832.01
$895.64
$963.05
$1,202.51
$1,192.62
$1,256.25
$1,323.66
$1,563.12
$1,553.23
$1,616.86
$1,684.27
$1,923.73
$360.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$942.80
$1,070.06
$1,204.88
$1,683.80
$2,558.72
$1,303.41
$1,430.67
$1,565.49
$2,044.41
$1,664.02
$1,791.28
$1,926.10
$2,405.02
$2,024.63
$2,151.89
$2,286.71
$2,765.63
$360.61
Toc - Plan #37 Ambetter from Nebraska Total Care
Gold

(HMO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$474.98
$539.10
$607.02
$848.30
$1,289.08
$838.34
$902.46
$970.38
$1,211.66
$1,201.70
$1,265.82
$1,333.74
$1,575.02
$1,565.06
$1,629.18
$1,697.10
$1,938.38
$363.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$949.96
$1,078.20
$1,214.04
$1,696.60
$2,578.16
$1,313.32
$1,441.56
$1,577.40
$2,059.96
$1,676.68
$1,804.92
$1,940.76
$2,423.32
$2,040.04
$2,168.28
$2,304.12
$2,786.68
$363.36
Toc - Plan #38 Ambetter from Nebraska Total Care
Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$539.19
$611.97
$689.07
$962.97
$1,463.33
$951.66
$1,024.44
$1,101.54
$1,375.44
$1,364.13
$1,436.91
$1,514.01
$1,787.91
$1,776.60
$1,849.38
$1,926.48
$2,200.38
$412.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,078.38
$1,223.94
$1,378.14
$1,925.94
$2,926.66
$1,490.85
$1,636.41
$1,790.61
$2,338.41
$1,903.32
$2,048.88
$2,203.08
$2,750.88
$2,315.79
$2,461.35
$2,615.55
$3,163.35
$412.47
Toc - Plan #39 Ambetter from Nebraska Total Care
Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$476.96
$541.34
$609.55
$851.84
$1,294.45
$841.83
$906.21
$974.42
$1,216.71
$1,206.70
$1,271.08
$1,339.29
$1,581.58
$1,571.57
$1,635.95
$1,704.16
$1,946.45
$364.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$953.92
$1,082.68
$1,219.10
$1,703.68
$2,588.90
$1,318.79
$1,447.55
$1,583.97
$2,068.55
$1,683.66
$1,812.42
$1,948.84
$2,433.42
$2,048.53
$2,177.29
$2,313.71
$2,798.29
$364.87
Toc - Plan #40 Ambetter from Nebraska Total Care
Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$481.25
$546.21
$615.03
$859.50
$1,306.09
$849.40
$914.36
$983.18
$1,227.65
$1,217.55
$1,282.51
$1,351.33
$1,595.80
$1,585.70
$1,650.66
$1,719.48
$1,963.95
$368.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$962.50
$1,092.42
$1,230.06
$1,719.00
$2,612.18
$1,330.65
$1,460.57
$1,598.21
$2,087.15
$1,698.80
$1,828.72
$1,966.36
$2,455.30
$2,066.95
$2,196.87
$2,334.51
$2,823.45
$368.15
Toc - Plan #41 Ambetter from Nebraska Total Care
Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$473.62
$537.54
$605.27
$845.86
$1,285.37
$835.93
$899.85
$967.58
$1,208.17
$1,198.24
$1,262.16
$1,329.89
$1,570.48
$1,560.55
$1,624.47
$1,692.20
$1,932.79
$362.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$947.24
$1,075.08
$1,210.54
$1,691.72
$2,570.74
$1,309.55
$1,437.39
$1,572.85
$2,054.03
$1,671.86
$1,799.70
$1,935.16
$2,416.34
$2,034.17
$2,162.01
$2,297.47
$2,778.65
$362.31
Toc - Plan #42 Ambetter from Nebraska Total Care
Gold

(HMO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-890-0329

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
$466.36
$529.30
$595.99
$832.90
$1,265.67
$823.12
$886.06
$952.75
$1,189.66
$1,179.88
$1,242.82
$1,309.51
$1,546.42
$1,536.64
$1,599.58
$1,666.27
$1,903.18
$356.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$932.72
$1,058.60
$1,191.98
$1,665.80
$2,531.34
$1,289.48
$1,415.36
$1,548.74
$2,022.56
$1,646.24
$1,772.12
$1,905.50
$2,379.32
$2,003.00
$2,128.88
$2,262.26
$2,736.08
$356.76

ADVERTISEMENT

Blue Cross and Blue Shield of Nebraska

Local: 1-888-592-8960 | Toll Free: 1-888-592-8960 | TTY: 1-800-821-4791

Toc - Plan #43 Blue Cross and Blue Shield of Nebraska
Bronze

(EPO) HeartlandBlue Bronze 0% Coinsurance After Deductible 9450 NEtwork Blue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

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
$459.74
$521.81
$587.55
$821.10
$1,247.74
$811.44
$873.51
$939.25
$1,172.80
$1,163.14
$1,225.21
$1,290.95
$1,524.50
$1,514.84
$1,576.91
$1,642.65
$1,876.20
$351.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$919.48
$1,043.62
$1,175.10
$1,642.20
$2,495.48
$1,271.18
$1,395.32
$1,526.80
$1,993.90
$1,622.88
$1,747.02
$1,878.50
$2,345.60
$1,974.58
$2,098.72
$2,230.20
$2,697.30
$351.70
Toc - Plan #44 Blue Cross and Blue Shield of Nebraska
Silver

(EPO) HeartlandBlue Silver $0 PCP Visit 5000 NEtwork Blue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,950 $17,900 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
$613.52
$696.35
$784.08
$1,095.75
$1,665.10
$1,082.87
$1,165.70
$1,253.43
$1,565.10
$1,552.22
$1,635.05
$1,722.78
$2,034.45
$2,021.57
$2,104.40
$2,192.13
$2,503.80
$469.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,227.04
$1,392.70
$1,568.16
$2,191.50
$3,330.20
$1,696.39
$1,862.05
$2,037.51
$2,660.85
$2,165.74
$2,331.40
$2,506.86
$3,130.20
$2,635.09
$2,800.75
$2,976.21
$3,599.55
$469.35
Toc - Plan #45 Blue Cross and Blue Shield of Nebraska
Silver

(EPO) HeartlandBlue Silver $0 Mental Health Visit 6000 NEtwork Blue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,900 $15,800 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
$616.91
$700.20
$788.41
$1,101.81
$1,674.30
$1,088.85
$1,172.14
$1,260.35
$1,573.75
$1,560.79
$1,644.08
$1,732.29
$2,045.69
$2,032.73
$2,116.02
$2,204.23
$2,517.63
$471.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,233.82
$1,400.40
$1,576.82
$2,203.62
$3,348.60
$1,705.76
$1,872.34
$2,048.76
$2,675.56
$2,177.70
$2,344.28
$2,520.70
$3,147.50
$2,649.64
$2,816.22
$2,992.64
$3,619.44
$471.94
Toc - Plan #46 Blue Cross and Blue Shield of Nebraska
Gold

(EPO) HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$641.57
$728.18
$819.92
$1,145.84
$1,741.21
$1,132.37
$1,218.98
$1,310.72
$1,636.64
$1,623.17
$1,709.78
$1,801.52
$2,127.44
$2,113.97
$2,200.58
$2,292.32
$2,618.24
$490.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,283.14
$1,456.36
$1,639.84
$2,291.68
$3,482.42
$1,773.94
$1,947.16
$2,130.64
$2,782.48
$2,264.74
$2,437.96
$2,621.44
$3,273.28
$2,755.54
$2,928.76
$3,112.24
$3,764.08
$490.80
Toc - Plan #47 Blue Cross and Blue Shield of Nebraska
Gold

(EPO) HeartlandBlue Gold $0 Deductible NEtwork Blue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$648.94
$736.55
$829.35
$1,159.01
$1,761.23
$1,145.38
$1,232.99
$1,325.79
$1,655.45
$1,641.82
$1,729.43
$1,822.23
$2,151.89
$2,138.26
$2,225.87
$2,318.67
$2,648.33
$496.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,297.88
$1,473.10
$1,658.70
$2,318.02
$3,522.46
$1,794.32
$1,969.54
$2,155.14
$2,814.46
$2,290.76
$2,465.98
$2,651.58
$3,310.90
$2,787.20
$2,962.42
$3,148.02
$3,807.34
$496.44
Toc - Plan #48 Blue Cross and Blue Shield of Nebraska
Expanded Bronze

(EPO) HeartlandBlue Bronze HSA 6500 Blueprint Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,050 $16,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398.09
$451.83
$508.76
$710.98
$1,080.41
$702.63
$756.37
$813.30
$1,015.52
$1,007.17
$1,060.91
$1,117.84
$1,320.06
$1,311.71
$1,365.45
$1,422.38
$1,624.60
$304.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796.18
$903.66
$1,017.52
$1,421.96
$2,160.82
$1,100.72
$1,208.20
$1,322.06
$1,726.50
$1,405.26
$1,512.74
$1,626.60
$2,031.04
$1,709.80
$1,817.28
$1,931.14
$2,335.58
$304.54
Toc - Plan #49 Blue Cross and Blue Shield of Nebraska
Expanded Bronze

(EPO) HeartlandBlue Bronze Standard Copay 7500 Blueprint Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

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
$391.60
$444.46
$500.46
$699.39
$1,062.80
$691.17
$744.03
$800.03
$998.96
$990.74
$1,043.60
$1,099.60
$1,298.53
$1,290.31
$1,343.17
$1,399.17
$1,598.10
$299.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$783.20
$888.92
$1,000.92
$1,398.78
$2,125.60
$1,082.77
$1,188.49
$1,300.49
$1,698.35
$1,382.34
$1,488.06
$1,600.06
$1,997.92
$1,681.91
$1,787.63
$1,899.63
$2,297.49
$299.57
Toc - Plan #50 Blue Cross and Blue Shield of Nebraska
Silver

(EPO) HeartlandBlue Silver Standard 5900 Blueprint Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

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
$496.35
$563.36
$634.34
$886.49
$1,347.10
$876.06
$943.07
$1,014.05
$1,266.20
$1,255.77
$1,322.78
$1,393.76
$1,645.91
$1,635.48
$1,702.49
$1,773.47
$2,025.62
$379.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$992.70
$1,126.72
$1,268.68
$1,772.98
$2,694.20
$1,372.41
$1,506.43
$1,648.39
$2,152.69
$1,752.12
$1,886.14
$2,028.10
$2,532.40
$2,131.83
$2,265.85
$2,407.81
$2,912.11
$379.71
Toc - Plan #51 Blue Cross and Blue Shield of Nebraska
Gold

(EPO) HeartlandBlue Gold Standard 1500 Blueprint Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8960

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
$520.90
$591.23
$665.72
$930.34
$1,413.74
$919.39
$989.72
$1,064.21
$1,328.83
$1,317.88
$1,388.21
$1,462.70
$1,727.32
$1,716.37
$1,786.70
$1,861.19
$2,125.81
$398.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,041.80
$1,182.46
$1,331.44
$1,860.68
$2,827.48
$1,440.29
$1,580.95
$1,729.93
$2,259.17
$1,838.78
$1,979.44
$2,128.42
$2,657.66
$2,237.27
$2,377.93
$2,526.91
$3,056.15
$398.49

ADVERTISEMENT

Oscar Insurance Company

Local: 1-855-672-2755 | Toll Free: 

Toc - Plan #52 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 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
$472.74
$536.55
$604.15
$844.29
$1,282.98
$834.38
$898.19
$965.79
$1,205.93
$1,196.02
$1,259.83
$1,327.43
$1,567.57
$1,557.66
$1,621.47
$1,689.07
$1,929.21
$361.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$945.48
$1,073.10
$1,208.30
$1,688.58
$2,565.96
$1,307.12
$1,434.74
$1,569.94
$2,050.22
$1,668.76
$1,796.38
$1,931.58
$2,411.86
$2,030.40
$2,158.02
$2,293.22
$2,773.50
$361.64
Toc - Plan #53 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite + PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$522.39
$592.90
$667.60
$932.97
$1,417.73
$922.01
$992.52
$1,067.22
$1,332.59
$1,321.63
$1,392.14
$1,466.84
$1,732.21
$1,721.25
$1,791.76
$1,866.46
$2,131.83
$399.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,044.78
$1,185.80
$1,335.20
$1,865.94
$2,835.46
$1,444.40
$1,585.42
$1,734.82
$2,265.56
$1,844.02
$1,985.04
$2,134.44
$2,665.18
$2,243.64
$2,384.66
$2,534.06
$3,064.80
$399.62
Toc - Plan #54 Oscar Insurance Company
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,650 $17,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$593.42
$673.52
$758.38
$1,059.83
$1,610.51
$1,047.38
$1,127.48
$1,212.34
$1,513.79
$1,501.34
$1,581.44
$1,666.30
$1,967.75
$1,955.30
$2,035.40
$2,120.26
$2,421.71
$453.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,186.84
$1,347.04
$1,516.76
$2,119.66
$3,221.02
$1,640.80
$1,801.00
$1,970.72
$2,573.62
$2,094.76
$2,254.96
$2,424.68
$3,027.58
$2,548.72
$2,708.92
$2,878.64
$3,481.54
$453.96
Toc - Plan #55 Oscar Insurance Company
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$374.37
$424.90
$478.43
$668.60
$1,016.01
$660.75
$711.28
$764.81
$954.98
$947.13
$997.66
$1,051.19
$1,241.36
$1,233.51
$1,284.04
$1,337.57
$1,527.74
$286.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$748.74
$849.80
$956.86
$1,337.20
$2,032.02
$1,035.12
$1,136.18
$1,243.24
$1,623.58
$1,321.50
$1,422.56
$1,529.62
$1,909.96
$1,607.88
$1,708.94
$1,816.00
$2,196.34
$286.38
Toc - Plan #56 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$494.50
$561.25
$631.96
$883.16
$1,342.05
$872.79
$939.54
$1,010.25
$1,261.45
$1,251.08
$1,317.83
$1,388.54
$1,639.74
$1,629.37
$1,696.12
$1,766.83
$2,018.03
$378.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$989.00
$1,122.50
$1,263.92
$1,766.32
$2,684.10
$1,367.29
$1,500.79
$1,642.21
$2,144.61
$1,745.58
$1,879.08
$2,020.50
$2,522.90
$2,123.87
$2,257.37
$2,398.79
$2,901.19
$378.29
Toc - Plan #57 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$502.96
$570.85
$642.77
$898.27
$1,365.00
$887.72
$955.61
$1,027.53
$1,283.03
$1,272.48
$1,340.37
$1,412.29
$1,667.79
$1,657.24
$1,725.13
$1,797.05
$2,052.55
$384.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,005.92
$1,141.70
$1,285.54
$1,796.54
$2,730.00
$1,390.68
$1,526.46
$1,670.30
$2,181.30
$1,775.44
$1,911.22
$2,055.06
$2,566.06
$2,160.20
$2,295.98
$2,439.82
$2,950.82
$384.76
Toc - Plan #58 Oscar Insurance Company
Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$578.13
$656.16
$738.84
$1,032.52
$1,569.01
$1,020.39
$1,098.42
$1,181.10
$1,474.78
$1,462.65
$1,540.68
$1,623.36
$1,917.04
$1,904.91
$1,982.94
$2,065.62
$2,359.30
$442.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,156.26
$1,312.32
$1,477.68
$2,065.04
$3,138.02
$1,598.52
$1,754.58
$1,919.94
$2,507.30
$2,040.78
$2,196.84
$2,362.20
$2,949.56
$2,483.04
$2,639.10
$2,804.46
$3,391.82
$442.26
Toc - Plan #59 Oscar Insurance Company
Silver

(EPO) Silver Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$604.38
$685.96
$772.38
$1,079.40
$1,640.25
$1,066.72
$1,148.30
$1,234.72
$1,541.74
$1,529.06
$1,610.64
$1,697.06
$2,004.08
$1,991.40
$2,072.98
$2,159.40
$2,466.42
$462.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,208.76
$1,371.92
$1,544.76
$2,158.80
$3,280.50
$1,671.10
$1,834.26
$2,007.10
$2,621.14
$2,133.44
$2,296.60
$2,469.44
$3,083.48
$2,595.78
$2,758.94
$2,931.78
$3,545.82
$462.34
Toc - Plan #60 Oscar Insurance Company
Gold

(EPO) Gold Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$5,500 $11,000 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
$654.02
$742.30
$835.82
$1,168.06
$1,774.97
$1,154.34
$1,242.62
$1,336.14
$1,668.38
$1,654.66
$1,742.94
$1,836.46
$2,168.70
$2,154.98
$2,243.26
$2,336.78
$2,669.02
$500.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,308.04
$1,484.60
$1,671.64
$2,336.12
$3,549.94
$1,808.36
$1,984.92
$2,171.96
$2,836.44
$2,308.68
$2,485.24
$2,672.28
$3,336.76
$2,809.00
$2,985.56
$3,172.60
$3,837.08
$500.32
Toc - Plan #61 Oscar Insurance Company
Silver

(EPO) Silver Simple Diabetes

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,450 $12,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$591.23
$671.03
$755.58
$1,055.91
$1,604.56
$1,043.51
$1,123.31
$1,207.86
$1,508.19
$1,495.79
$1,575.59
$1,660.14
$1,960.47
$1,948.07
$2,027.87
$2,112.42
$2,412.75
$452.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,182.46
$1,342.06
$1,511.16
$2,111.82
$3,209.12
$1,634.74
$1,794.34
$1,963.44
$2,564.10
$2,087.02
$2,246.62
$2,415.72
$3,016.38
$2,539.30
$2,698.90
$2,868.00
$3,468.66
$452.28
Toc - Plan #62 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$483.92
$549.24
$618.44
$864.26
$1,313.33
$854.11
$919.43
$988.63
$1,234.45
$1,224.30
$1,289.62
$1,358.82
$1,604.64
$1,594.49
$1,659.81
$1,729.01
$1,974.83
$370.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$967.84
$1,098.48
$1,236.88
$1,728.52
$2,626.66
$1,338.03
$1,468.67
$1,607.07
$2,098.71
$1,708.22
$1,838.86
$1,977.26
$2,468.90
$2,078.41
$2,209.05
$2,347.45
$2,839.09
$370.19
Toc - Plan #63 Oscar Insurance Company
Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$574.66
$652.22
$734.40
$1,026.32
$1,559.59
$1,014.26
$1,091.82
$1,174.00
$1,465.92
$1,453.86
$1,531.42
$1,613.60
$1,905.52
$1,893.46
$1,971.02
$2,053.20
$2,345.12
$439.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,149.32
$1,304.44
$1,468.80
$2,052.64
$3,119.18
$1,588.92
$1,744.04
$1,908.40
$2,492.24
$2,028.52
$2,183.64
$2,348.00
$2,931.84
$2,468.12
$2,623.24
$2,787.60
$3,371.44
$439.60
Toc - Plan #64 Oscar Insurance Company
Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$590.80
$670.54
$755.02
$1,055.14
$1,603.39
$1,042.75
$1,122.49
$1,206.97
$1,507.09
$1,494.70
$1,574.44
$1,658.92
$1,959.04
$1,946.65
$2,026.39
$2,110.87
$2,410.99
$451.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,181.60
$1,341.08
$1,510.04
$2,110.28
$3,206.78
$1,633.55
$1,793.03
$1,961.99
$2,562.23
$2,085.50
$2,244.98
$2,413.94
$3,014.18
$2,537.45
$2,696.93
$2,865.89
$3,466.13
$451.95

‡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 Buffalo County here.

Buffalo County is in “Rating Area 3” of Nebraska.

Currently, there are 64 plans offered in Rating Area 3.

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2024 Obamacare Plans for Buffalo County, NE

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