Obamacare 2023 Rates for Howard County

Obamacare > Rates > Nebraska > Howard 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 Howard County, NE.

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, 86 Plans and 2023 Rates for Howard County, Nebraska

Below, you’ll find a summary of the 86 plans for Howard County, Nebraska and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Medica

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

Toc - Plan #1 Medica

Expanded Bronze

(EPO) Medica Insure Bronze Copay ($0 Virtual Care with Designated Providers)

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

$9,100 $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

$474.97
$539.07
$606.99
$848.27
$1,289.03

$838.31
$902.41
$970.33
$1,211.61

$1,201.65
$1,265.75
$1,333.67
$1,574.95

$1,564.99
$1,629.09
$1,697.01
$1,938.29

$363.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$949.94
$1,078.14
$1,213.98
$1,696.54
$2,578.06

$1,313.28
$1,441.48
$1,577.32
$2,059.88

$1,676.62
$1,804.82
$1,940.66
$2,423.22

$2,039.96
$2,168.16
$2,304.00
$2,786.56

$363.34

Toc - Plan #2 Medica

Expanded Bronze

(EPO) Medica Insure Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

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

$9,100 $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

$499.19
$566.57
$637.95
$891.53
$1,354.77

$881.06
$948.44
$1,019.82
$1,273.40

$1,262.93
$1,330.31
$1,401.69
$1,655.27

$1,644.80
$1,712.18
$1,783.56
$2,037.14

$381.87

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$998.38
$1,133.14
$1,275.90
$1,783.06
$2,709.54

$1,380.25
$1,515.01
$1,657.77
$2,164.93

$1,762.12
$1,896.88
$2,039.64
$2,546.80

$2,143.99
$2,278.75
$2,421.51
$2,928.67

$381.87

Toc - Plan #3 Medica

Expanded Bronze

(EPO) Medica Insure Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$556.11
$631.17
$710.70
$993.20
$1,509.26

$981.53
$1,056.59
$1,136.12
$1,418.62

$1,406.95
$1,482.01
$1,561.54
$1,844.04

$1,832.37
$1,907.43
$1,986.96
$2,269.46

$425.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,112.22
$1,262.34
$1,421.40
$1,986.40
$3,018.52

$1,537.64
$1,687.76
$1,846.82
$2,411.82

$1,963.06
$2,113.18
$2,272.24
$2,837.24

$2,388.48
$2,538.60
$2,697.66
$3,262.66

$425.42

Toc - Plan #4 Medica

Catastrophic

(EPO) Medica Insure Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $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

$353.18
$400.85
$451.36
$630.77
$958.52

$623.36
$671.03
$721.54
$900.95

$893.54
$941.21
$991.72
$1,171.13

$1,163.72
$1,211.39
$1,261.90
$1,441.31

$270.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$706.36
$801.70
$902.72
$1,261.54
$1,917.04

$976.54
$1,071.88
$1,172.90
$1,531.72

$1,246.72
$1,342.06
$1,443.08
$1,801.90

$1,516.90
$1,612.24
$1,713.26
$2,072.08

$270.18

Toc - Plan #5 Medica

Gold

(EPO) Medica Insure Gold Share ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

$8,450 $16,900 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

$638.49
$724.68
$815.98
$1,140.33
$1,732.84

$1,126.93
$1,213.12
$1,304.42
$1,628.77

$1,615.37
$1,701.56
$1,792.86
$2,117.21

$2,103.81
$2,190.00
$2,281.30
$2,605.65

$488.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,276.98
$1,449.36
$1,631.96
$2,280.66
$3,465.68

$1,765.42
$1,937.80
$2,120.40
$2,769.10

$2,253.86
$2,426.24
$2,608.84
$3,257.54

$2,742.30
$2,914.68
$3,097.28
$3,745.98

$488.44

Toc - Plan #6 Medica

Silver

(EPO) Medica Insure Silver Share ($0 Virtual Care with Designated Providers)

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

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$660.96
$750.18
$844.70
$1,180.46
$1,793.82

$1,166.59
$1,255.81
$1,350.33
$1,686.09

$1,672.22
$1,761.44
$1,855.96
$2,191.72

$2,177.85
$2,267.07
$2,361.59
$2,697.35

$505.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,321.92
$1,500.36
$1,689.40
$2,360.92
$3,587.64

$1,827.55
$2,005.99
$2,195.03
$2,866.55

$2,333.18
$2,511.62
$2,700.66
$3,372.18

$2,838.81
$3,017.25
$3,206.29
$3,877.81

$505.63

Toc - Plan #7 Medica

Expanded Bronze

(EPO) Medica Insure Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$2,700 $5,400 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

$486.36
$552.01
$621.56
$868.62
$1,319.96

$858.42
$924.07
$993.62
$1,240.68

$1,230.48
$1,296.13
$1,365.68
$1,612.74

$1,602.54
$1,668.19
$1,737.74
$1,984.80

$372.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$972.72
$1,104.02
$1,243.12
$1,737.24
$2,639.92

$1,344.78
$1,476.08
$1,615.18
$2,109.30

$1,716.84
$1,848.14
$1,987.24
$2,481.36

$2,088.90
$2,220.20
$2,359.30
$2,853.42

$372.06

Toc - Plan #8 Medica

Expanded Bronze

(EPO) Medica Insure Bronze Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$7,200 $14,400 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

$483.76
$549.05
$618.23
$863.97
$1,312.89

$853.83
$919.12
$988.30
$1,234.04

$1,223.90
$1,289.19
$1,358.37
$1,604.11

$1,593.97
$1,659.26
$1,728.44
$1,974.18

$370.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$967.52
$1,098.10
$1,236.46
$1,727.94
$2,625.78

$1,337.59
$1,468.17
$1,606.53
$2,098.01

$1,707.66
$1,838.24
$1,976.60
$2,468.08

$2,077.73
$2,208.31
$2,346.67
$2,838.15

$370.07

Toc - Plan #9 Medica

Expanded Bronze

(EPO) Medica Insure Bronze Premier ($0 Virtual Care with Designated Providers)

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

$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

$480.96
$545.87
$614.65
$858.97
$1,305.29

$848.88
$913.79
$982.57
$1,226.89

$1,216.80
$1,281.71
$1,350.49
$1,594.81

$1,584.72
$1,649.63
$1,718.41
$1,962.73

$367.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$961.92
$1,091.74
$1,229.30
$1,717.94
$2,610.58

$1,329.84
$1,459.66
$1,597.22
$2,085.86

$1,697.76
$1,827.58
$1,965.14
$2,453.78

$2,065.68
$2,195.50
$2,333.06
$2,821.70

$367.92

Toc - Plan #10 Medica

Gold

(EPO) Medica Insure Gold Standard ($0 Virtual Care with Designated Providers)

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

$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

$658.62
$747.52
$841.70
$1,176.27
$1,787.46

$1,162.45
$1,251.35
$1,345.53
$1,680.10

$1,666.28
$1,755.18
$1,849.36
$2,183.93

$2,170.11
$2,259.01
$2,353.19
$2,687.76

$503.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,317.24
$1,495.04
$1,683.40
$2,352.54
$3,574.92

$1,821.07
$1,998.87
$2,187.23
$2,856.37

$2,324.90
$2,502.70
$2,691.06
$3,360.20

$2,828.73
$3,006.53
$3,194.89
$3,864.03

$503.83

Toc - Plan #11 Medica

Silver

(EPO) Medica Insure Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$633.28
$718.77
$809.32
$1,131.03
$1,718.70

$1,117.73
$1,203.22
$1,293.77
$1,615.48

$1,602.18
$1,687.67
$1,778.22
$2,099.93

$2,086.63
$2,172.12
$2,262.67
$2,584.38

$484.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,266.56
$1,437.54
$1,618.64
$2,262.06
$3,437.40

$1,751.01
$1,921.99
$2,103.09
$2,746.51

$2,235.46
$2,406.44
$2,587.54
$3,230.96

$2,719.91
$2,890.89
$3,071.99
$3,715.41

$484.45

Toc - Plan #12 Medica

Bronze

(EPO) Medica Insure Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $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

$468.19
$531.39
$598.34
$836.17
$1,270.65

$826.35
$889.55
$956.50
$1,194.33

$1,184.51
$1,247.71
$1,314.66
$1,552.49

$1,542.67
$1,605.87
$1,672.82
$1,910.65

$358.16

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$936.38
$1,062.78
$1,196.68
$1,672.34
$2,541.30

$1,294.54
$1,420.94
$1,554.84
$2,030.50

$1,652.70
$1,779.10
$1,913.00
$2,388.66

$2,010.86
$2,137.26
$2,271.16
$2,746.82

$358.16

Toc - Plan #13 Medica

Gold

(EPO) Medica Insure Gold HSA ($0 Virtual Care after Deductible with Designated Providers)

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

$6,000 $12,000 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

$784.31
$890.18
$1,002.33
$1,400.76
$2,128.58

$1,384.30
$1,490.17
$1,602.32
$2,000.75

$1,984.29
$2,090.16
$2,202.31
$2,600.74

$2,584.28
$2,690.15
$2,802.30
$3,200.73

$599.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,568.62
$1,780.36
$2,004.66
$2,801.52
$4,257.16

$2,168.61
$2,380.35
$2,604.65
$3,401.51

$2,768.60
$2,980.34
$3,204.64
$4,001.50

$3,368.59
$3,580.33
$3,804.63
$4,601.49

$599.99

Toc - Plan #14 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay ($0 Virtual Care with Designated Providers)

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

$9,100 $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

$363.82
$412.92
$464.94
$649.76
$987.37

$642.13
$691.23
$743.25
$928.07

$920.44
$969.54
$1,021.56
$1,206.38

$1,198.75
$1,247.85
$1,299.87
$1,484.69

$278.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$727.64
$825.84
$929.88
$1,299.52
$1,974.74

$1,005.95
$1,104.15
$1,208.19
$1,577.83

$1,284.26
$1,382.46
$1,486.50
$1,856.14

$1,562.57
$1,660.77
$1,764.81
$2,134.45

$278.31

Toc - Plan #15 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

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

$9,100 $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

$382.37
$433.98
$488.66
$682.89
$1,037.72

$674.87
$726.48
$781.16
$975.39

$967.37
$1,018.98
$1,073.66
$1,267.89

$1,259.87
$1,311.48
$1,366.16
$1,560.39

$292.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$764.74
$867.96
$977.32
$1,365.78
$2,075.44

$1,057.24
$1,160.46
$1,269.82
$1,658.28

$1,349.74
$1,452.96
$1,562.32
$1,950.78

$1,642.24
$1,745.46
$1,854.82
$2,243.28

$292.50

Toc - Plan #16 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$425.97
$483.47
$544.38
$760.77
$1,156.06

$751.83
$809.33
$870.24
$1,086.63

$1,077.69
$1,135.19
$1,196.10
$1,412.49

$1,403.55
$1,461.05
$1,521.96
$1,738.35

$325.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$851.94
$966.94
$1,088.76
$1,521.54
$2,312.12

$1,177.80
$1,292.80
$1,414.62
$1,847.40

$1,503.66
$1,618.66
$1,740.48
$2,173.26

$1,829.52
$1,944.52
$2,066.34
$2,499.12

$325.86

Toc - Plan #17 Medica

Catastrophic

(EPO) Medica with CHI Health Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $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

$270.53
$307.04
$345.73
$483.16
$734.20

$477.48
$513.99
$552.68
$690.11

$684.43
$720.94
$759.63
$897.06

$891.38
$927.89
$966.58
$1,104.01

$206.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$541.06
$614.08
$691.46
$966.32
$1,468.40

$748.01
$821.03
$898.41
$1,173.27

$954.96
$1,027.98
$1,105.36
$1,380.22

$1,161.91
$1,234.93
$1,312.31
$1,587.17

$206.95

Toc - Plan #18 Medica

Silver

(EPO) Medica with CHI Health Silver Share ($0 Virtual Care with Designated Providers)

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

$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

$506.28
$574.62
$647.02
$904.21
$1,374.03

$893.58
$961.92
$1,034.32
$1,291.51

$1,280.88
$1,349.22
$1,421.62
$1,678.81

$1,668.18
$1,736.52
$1,808.92
$2,066.11

$387.30

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,012.56
$1,149.24
$1,294.04
$1,808.42
$2,748.06

$1,399.86
$1,536.54
$1,681.34
$2,195.72

$1,787.16
$1,923.84
$2,068.64
$2,583.02

$2,174.46
$2,311.14
$2,455.94
$2,970.32

$387.30

Toc - Plan #19 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$2,700 $5,400 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

$372.54
$422.83
$476.10
$665.35
$1,011.06

$657.53
$707.82
$761.09
$950.34

$942.52
$992.81
$1,046.08
$1,235.33

$1,227.51
$1,277.80
$1,331.07
$1,520.32

$284.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$745.08
$845.66
$952.20
$1,330.70
$2,022.12

$1,030.07
$1,130.65
$1,237.19
$1,615.69

$1,315.06
$1,415.64
$1,522.18
$1,900.68

$1,600.05
$1,700.63
$1,807.17
$2,185.67

$284.99

Toc - Plan #20 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$7,200 $14,400 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

$370.55
$420.56
$473.55
$661.78
$1,005.64

$654.01
$704.02
$757.01
$945.24

$937.47
$987.48
$1,040.47
$1,228.70

$1,220.93
$1,270.94
$1,323.93
$1,512.16

$283.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$741.10
$841.12
$947.10
$1,323.56
$2,011.28

$1,024.56
$1,124.58
$1,230.56
$1,607.02

$1,308.02
$1,408.04
$1,514.02
$1,890.48

$1,591.48
$1,691.50
$1,797.48
$2,173.94

$283.46

Toc - Plan #21 Medica

Gold

(EPO) Medica with CHI Health Gold Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

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

$8,450 $16,900 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

$508.33
$576.94
$649.63
$907.86
$1,379.58

$897.19
$965.80
$1,038.49
$1,296.72

$1,286.05
$1,354.66
$1,427.35
$1,685.58

$1,674.91
$1,743.52
$1,816.21
$2,074.44

$388.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,016.66
$1,153.88
$1,299.26
$1,815.72
$2,759.16

$1,405.52
$1,542.74
$1,688.12
$2,204.58

$1,794.38
$1,931.60
$2,076.98
$2,593.44

$2,183.24
$2,320.46
$2,465.84
$2,982.30

$388.86

Toc - Plan #22 Medica

Expanded Bronze

(EPO) Medica with CHI Health Bronze Premier ($0 Virtual Care with Designated Providers)

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

$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

$368.40
$418.13
$470.81
$657.95
$999.82

$650.22
$699.95
$752.63
$939.77

$932.04
$981.77
$1,034.45
$1,221.59

$1,213.86
$1,263.59
$1,316.27
$1,503.41

$281.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$736.80
$836.26
$941.62
$1,315.90
$1,999.64

$1,018.62
$1,118.08
$1,223.44
$1,597.72

$1,300.44
$1,399.90
$1,505.26
$1,879.54

$1,582.26
$1,681.72
$1,787.08
$2,161.36

$281.82

Toc - Plan #23 Medica

Silver

(EPO) Medica with CHI Health Silver Enhanced ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,100 $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

$521.90
$592.34
$666.97
$932.09
$1,416.40

$921.14
$991.58
$1,066.21
$1,331.33

$1,320.38
$1,390.82
$1,465.45
$1,730.57

$1,719.62
$1,790.06
$1,864.69
$2,129.81

$399.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,043.80
$1,184.68
$1,333.94
$1,864.18
$2,832.80

$1,443.04
$1,583.92
$1,733.18
$2,263.42

$1,842.28
$1,983.16
$2,132.42
$2,662.66

$2,241.52
$2,382.40
$2,531.66
$3,061.90

$399.24

Toc - Plan #24 Medica

Gold

(EPO) Medica with CHI Health Gold Standard ($0 Virtual Care with Designated Providers)

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

$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

$504.49
$572.58
$644.72
$901.00
$1,369.15

$890.42
$958.51
$1,030.65
$1,286.93

$1,276.35
$1,344.44
$1,416.58
$1,672.86

$1,662.28
$1,730.37
$1,802.51
$2,058.79

$385.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,008.98
$1,145.16
$1,289.44
$1,802.00
$2,738.30

$1,394.91
$1,531.09
$1,675.37
$2,187.93

$1,780.84
$1,917.02
$2,061.30
$2,573.86

$2,166.77
$2,302.95
$2,447.23
$2,959.79

$385.93

Toc - Plan #25 Medica

Silver

(EPO) Medica with CHI Health Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$485.08
$550.56
$619.92
$866.34
$1,316.49

$856.16
$921.64
$991.00
$1,237.42

$1,227.24
$1,292.72
$1,362.08
$1,608.50

$1,598.32
$1,663.80
$1,733.16
$1,979.58

$371.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$970.16
$1,101.12
$1,239.84
$1,732.68
$2,632.98

$1,341.24
$1,472.20
$1,610.92
$2,103.76

$1,712.32
$1,843.28
$1,982.00
$2,474.84

$2,083.40
$2,214.36
$2,353.08
$2,845.92

$371.08

Toc - Plan #26 Medica

Bronze

(EPO) Medica with CHI Health Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $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

$358.63
$407.03
$458.31
$640.49
$973.29

$632.97
$681.37
$732.65
$914.83

$907.31
$955.71
$1,006.99
$1,189.17

$1,181.65
$1,230.05
$1,281.33
$1,463.51

$274.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$717.26
$814.06
$916.62
$1,280.98
$1,946.58

$991.60
$1,088.40
$1,190.96
$1,555.32

$1,265.94
$1,362.74
$1,465.30
$1,829.66

$1,540.28
$1,637.08
$1,739.64
$2,104.00

$274.34

Ambetter from Nebraska Total Care

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

Toc - Plan #27 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

$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

$360.93
$409.65
$461.26
$644.61
$979.54

$637.04
$685.76
$737.37
$920.72

$913.15
$961.87
$1,013.48
$1,196.83

$1,189.26
$1,237.98
$1,289.59
$1,472.94

$276.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$721.86
$819.30
$922.52
$1,289.22
$1,959.08

$997.97
$1,095.41
$1,198.63
$1,565.33

$1,274.08
$1,371.52
$1,474.74
$1,841.44

$1,550.19
$1,647.63
$1,750.85
$2,117.55

$276.11

Toc - Plan #28 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

$8,300 $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

$352.22
$399.75
$450.12
$629.04
$955.89

$621.66
$669.19
$719.56
$898.48

$891.10
$938.63
$989.00
$1,167.92

$1,160.54
$1,208.07
$1,258.44
$1,437.36

$269.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$704.44
$799.50
$900.24
$1,258.08
$1,911.78

$973.88
$1,068.94
$1,169.68
$1,527.52

$1,243.32
$1,338.38
$1,439.12
$1,796.96

$1,512.76
$1,607.82
$1,708.56
$2,066.40

$269.44

Toc - Plan #29 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

$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

$394.81
$448.10
$504.56
$705.11
$1,071.49

$696.83
$750.12
$806.58
$1,007.13

$998.85
$1,052.14
$1,108.60
$1,309.15

$1,300.87
$1,354.16
$1,410.62
$1,611.17

$302.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$789.62
$896.20
$1,009.12
$1,410.22
$2,142.98

$1,091.64
$1,198.22
$1,311.14
$1,712.24

$1,393.66
$1,500.24
$1,613.16
$2,014.26

$1,695.68
$1,802.26
$1,915.18
$2,316.28

$302.02

Toc - Plan #30 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

$427.24
$484.90
$546.00
$763.03
$1,159.49

$754.07
$811.73
$872.83
$1,089.86

$1,080.90
$1,138.56
$1,199.66
$1,416.69

$1,407.73
$1,465.39
$1,526.49
$1,743.52

$326.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$854.48
$969.80
$1,092.00
$1,526.06
$2,318.98

$1,181.31
$1,296.63
$1,418.83
$1,852.89

$1,508.14
$1,623.46
$1,745.66
$2,179.72

$1,834.97
$1,950.29
$2,072.49
$2,506.55

$326.83

Toc - Plan #31 Ambetter from Nebraska Total Care

Silver

(HMO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$423.22
$480.34
$540.86
$755.86
$1,148.60

$746.98
$804.10
$864.62
$1,079.62

$1,070.74
$1,127.86
$1,188.38
$1,403.38

$1,394.50
$1,451.62
$1,512.14
$1,727.14

$323.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$846.44
$960.68
$1,081.72
$1,511.72
$2,297.20

$1,170.20
$1,284.44
$1,405.48
$1,835.48

$1,493.96
$1,608.20
$1,729.24
$2,159.24

$1,817.72
$1,931.96
$2,053.00
$2,483.00

$323.76

Toc - Plan #32 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

$463.72
$526.31
$592.62
$828.19
$1,258.52

$818.46
$881.05
$947.36
$1,182.93

$1,173.20
$1,235.79
$1,302.10
$1,537.67

$1,527.94
$1,590.53
$1,656.84
$1,892.41

$354.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$927.44
$1,052.62
$1,185.24
$1,656.38
$2,517.04

$1,282.18
$1,407.36
$1,539.98
$2,011.12

$1,636.92
$1,762.10
$1,894.72
$2,365.86

$1,991.66
$2,116.84
$2,249.46
$2,720.60

$354.74

Toc - Plan #33 Ambetter from Nebraska Total Care

Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

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

$314.96
$357.47
$402.51
$562.50
$854.78

$555.90
$598.41
$643.45
$803.44

$796.84
$839.35
$884.39
$1,044.38

$1,037.78
$1,080.29
$1,125.33
$1,285.32

$240.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$629.92
$714.94
$805.02
$1,125.00
$1,709.56

$870.86
$955.88
$1,045.96
$1,365.94

$1,111.80
$1,196.82
$1,286.90
$1,606.88

$1,352.74
$1,437.76
$1,527.84
$1,847.82

$240.94

Toc - Plan #34 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

$5,000 $10,000 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

$510.55
$579.46
$652.47
$911.82
$1,385.60

$901.11
$970.02
$1,043.03
$1,302.38

$1,291.67
$1,360.58
$1,433.59
$1,692.94

$1,682.23
$1,751.14
$1,824.15
$2,083.50

$390.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,021.10
$1,158.92
$1,304.94
$1,823.64
$2,771.20

$1,411.66
$1,549.48
$1,695.50
$2,214.20

$1,802.22
$1,940.04
$2,086.06
$2,604.76

$2,192.78
$2,330.60
$2,476.62
$2,995.32

$390.56

Toc - Plan #35 Ambetter from Nebraska Total Care

Expanded Bronze

(HMO) CMS 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

$9,000 $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

$345.04
$391.61
$440.95
$616.22
$936.41

$608.99
$655.56
$704.90
$880.17

$872.94
$919.51
$968.85
$1,144.12

$1,136.89
$1,183.46
$1,232.80
$1,408.07

$263.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$690.08
$783.22
$881.90
$1,232.44
$1,872.82

$954.03
$1,047.17
$1,145.85
$1,496.39

$1,217.98
$1,311.12
$1,409.80
$1,760.34

$1,481.93
$1,575.07
$1,673.75
$2,024.29

$263.95

Toc - Plan #36 Ambetter from Nebraska Total Care

Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

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

$417.41
$473.75
$533.44
$745.48
$1,132.83

$736.72
$793.06
$852.75
$1,064.79

$1,056.03
$1,112.37
$1,172.06
$1,384.10

$1,375.34
$1,431.68
$1,491.37
$1,703.41

$319.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$834.82
$947.50
$1,066.88
$1,490.96
$2,265.66

$1,154.13
$1,266.81
$1,386.19
$1,810.27

$1,473.44
$1,586.12
$1,705.50
$2,129.58

$1,792.75
$1,905.43
$2,024.81
$2,448.89

$319.31

Toc - Plan #37 Ambetter from Nebraska Total Care

Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

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

$439.41
$498.72
$561.56
$784.77
$1,192.54

$775.55
$834.86
$897.70
$1,120.91

$1,111.69
$1,171.00
$1,233.84
$1,457.05

$1,447.83
$1,507.14
$1,569.98
$1,793.19

$336.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$878.82
$997.44
$1,123.12
$1,569.54
$2,385.08

$1,214.96
$1,333.58
$1,459.26
$1,905.68

$1,551.10
$1,669.72
$1,795.40
$2,241.82

$1,887.24
$2,005.86
$2,131.54
$2,577.96

$336.14

Toc - Plan #38 Ambetter from Nebraska Total Care

Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

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

$329.53
$374.01
$421.13
$588.52
$894.32

$581.61
$626.09
$673.21
$840.60

$833.69
$878.17
$925.29
$1,092.68

$1,085.77
$1,130.25
$1,177.37
$1,344.76

$252.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$659.06
$748.02
$842.26
$1,177.04
$1,788.64

$911.14
$1,000.10
$1,094.34
$1,429.12

$1,163.22
$1,252.18
$1,346.42
$1,681.20

$1,415.30
$1,504.26
$1,598.50
$1,933.28

$252.08

Toc - Plan #39 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

$419.72
$476.37
$536.39
$749.60
$1,139.09

$740.80
$797.45
$857.47
$1,070.68

$1,061.88
$1,118.53
$1,178.55
$1,391.76

$1,382.96
$1,439.61
$1,499.63
$1,712.84

$321.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$839.44
$952.74
$1,072.78
$1,499.20
$2,278.18

$1,160.52
$1,273.82
$1,393.86
$1,820.28

$1,481.60
$1,594.90
$1,714.94
$2,141.36

$1,802.68
$1,915.98
$2,036.02
$2,462.44

$321.08

Toc - Plan #40 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

$6,100 $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

$421.73
$478.65
$538.95
$753.18
$1,144.54

$744.34
$801.26
$861.56
$1,075.79

$1,066.95
$1,123.87
$1,184.17
$1,398.40

$1,389.56
$1,446.48
$1,506.78
$1,721.01

$322.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$843.46
$957.30
$1,077.90
$1,506.36
$2,289.08

$1,166.07
$1,279.91
$1,400.51
$1,828.97

$1,488.68
$1,602.52
$1,723.12
$2,151.58

$1,811.29
$1,925.13
$2,045.73
$2,474.19

$322.61

Toc - Plan #41 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

$444.58
$504.59
$568.16
$794.01
$1,206.57

$784.68
$844.69
$908.26
$1,134.11

$1,124.78
$1,184.79
$1,248.36
$1,474.21

$1,464.88
$1,524.89
$1,588.46
$1,814.31

$340.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$889.16
$1,009.18
$1,136.32
$1,588.02
$2,413.14

$1,229.26
$1,349.28
$1,476.42
$1,928.12

$1,569.36
$1,689.38
$1,816.52
$2,268.22

$1,909.46
$2,029.48
$2,156.62
$2,608.32

$340.10

Toc - Plan #42 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

$439.07
$498.33
$561.12
$784.16
$1,191.61

$774.95
$834.21
$897.00
$1,120.04

$1,110.83
$1,170.09
$1,232.88
$1,455.92

$1,446.71
$1,505.97
$1,568.76
$1,791.80

$335.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$878.14
$996.66
$1,122.24
$1,568.32
$2,383.22

$1,214.02
$1,332.54
$1,458.12
$1,904.20

$1,549.90
$1,668.42
$1,794.00
$2,240.08

$1,885.78
$2,004.30
$2,129.88
$2,575.96

$335.88

Toc - Plan #43 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

$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

$375.75
$426.46
$480.19
$671.07
$1,019.75

$663.19
$713.90
$767.63
$958.51

$950.63
$1,001.34
$1,055.07
$1,245.95

$1,238.07
$1,288.78
$1,342.51
$1,533.39

$287.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$751.50
$852.92
$960.38
$1,342.14
$2,039.50

$1,038.94
$1,140.36
$1,247.82
$1,629.58

$1,326.38
$1,427.80
$1,535.26
$1,917.02

$1,613.82
$1,715.24
$1,822.70
$2,204.46

$287.44

Toc - Plan #44 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

$8,300 $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

$366.67
$416.16
$468.60
$654.86
$995.12

$647.17
$696.66
$749.10
$935.36

$927.67
$977.16
$1,029.60
$1,215.86

$1,208.17
$1,257.66
$1,310.10
$1,496.36

$280.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$733.34
$832.32
$937.20
$1,309.72
$1,990.24

$1,013.84
$1,112.82
$1,217.70
$1,590.22

$1,294.34
$1,393.32
$1,498.20
$1,870.72

$1,574.84
$1,673.82
$1,778.70
$2,151.22

$280.50

Toc - Plan #45 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

$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

$411.02
$466.49
$525.27
$734.06
$1,115.47

$725.44
$780.91
$839.69
$1,048.48

$1,039.86
$1,095.33
$1,154.11
$1,362.90

$1,354.28
$1,409.75
$1,468.53
$1,677.32

$314.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$822.04
$932.98
$1,050.54
$1,468.12
$2,230.94

$1,136.46
$1,247.40
$1,364.96
$1,782.54

$1,450.88
$1,561.82
$1,679.38
$2,096.96

$1,765.30
$1,876.24
$1,993.80
$2,411.38

$314.42

Toc - Plan #46 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

$444.77
$504.81
$568.41
$794.35
$1,207.09

$785.01
$845.05
$908.65
$1,134.59

$1,125.25
$1,185.29
$1,248.89
$1,474.83

$1,465.49
$1,525.53
$1,589.13
$1,815.07

$340.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$889.54
$1,009.62
$1,136.82
$1,588.70
$2,414.18

$1,229.78
$1,349.86
$1,477.06
$1,928.94

$1,570.02
$1,690.10
$1,817.30
$2,269.18

$1,910.26
$2,030.34
$2,157.54
$2,609.42

$340.24

Toc - Plan #47 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

$482.76
$547.92
$616.95
$862.19
$1,310.17

$852.06
$917.22
$986.25
$1,231.49

$1,221.36
$1,286.52
$1,355.55
$1,600.79

$1,590.66
$1,655.82
$1,724.85
$1,970.09

$369.30

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$965.52
$1,095.84
$1,233.90
$1,724.38
$2,620.34

$1,334.82
$1,465.14
$1,603.20
$2,093.68

$1,704.12
$1,834.44
$1,972.50
$2,462.98

$2,073.42
$2,203.74
$2,341.80
$2,832.28

$369.30

Toc - Plan #48 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

$5,000 $10,000 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

$531.50
$603.24
$679.25
$949.25
$1,442.47

$938.09
$1,009.83
$1,085.84
$1,355.84

$1,344.68
$1,416.42
$1,492.43
$1,762.43

$1,751.27
$1,823.01
$1,899.02
$2,169.02

$406.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,063.00
$1,206.48
$1,358.50
$1,898.50
$2,884.94

$1,469.59
$1,613.07
$1,765.09
$2,305.09

$1,876.18
$2,019.66
$2,171.68
$2,711.68

$2,282.77
$2,426.25
$2,578.27
$3,118.27

$406.59

Toc - Plan #49 Ambetter from Nebraska Total Care

Silver

(HMO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$440.59
$500.06
$563.07
$786.88
$1,195.74

$777.64
$837.11
$900.12
$1,123.93

$1,114.69
$1,174.16
$1,237.17
$1,460.98

$1,451.74
$1,511.21
$1,574.22
$1,798.03

$337.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$881.18
$1,000.12
$1,126.14
$1,573.76
$2,391.48

$1,218.23
$1,337.17
$1,463.19
$1,910.81

$1,555.28
$1,674.22
$1,800.24
$2,247.86

$1,892.33
$2,011.27
$2,137.29
$2,584.91

$337.05

Toc - Plan #50 Ambetter from Nebraska Total Care

Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$8,600 $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

$343.06
$389.36
$438.41
$612.68
$931.03

$605.49
$651.79
$700.84
$875.11

$867.92
$914.22
$963.27
$1,137.54

$1,130.35
$1,176.65
$1,225.70
$1,399.97

$262.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$686.12
$778.72
$876.82
$1,225.36
$1,862.06

$948.55
$1,041.15
$1,139.25
$1,487.79

$1,210.98
$1,303.58
$1,401.68
$1,750.22

$1,473.41
$1,566.01
$1,664.11
$2,012.65

$262.43

Toc - Plan #51 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

$436.95
$495.92
$558.40
$780.37
$1,185.84

$771.21
$830.18
$892.66
$1,114.63

$1,105.47
$1,164.44
$1,226.92
$1,448.89

$1,439.73
$1,498.70
$1,561.18
$1,783.15

$334.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$873.90
$991.84
$1,116.80
$1,560.74
$2,371.68

$1,208.16
$1,326.10
$1,451.06
$1,895.00

$1,542.42
$1,660.36
$1,785.32
$2,229.26

$1,876.68
$1,994.62
$2,119.58
$2,563.52

$334.26

Toc - Plan #52 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

$6,100 $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

$439.04
$498.30
$561.08
$784.10
$1,191.52

$774.90
$834.16
$896.94
$1,119.96

$1,110.76
$1,170.02
$1,232.80
$1,455.82

$1,446.62
$1,505.88
$1,568.66
$1,791.68

$335.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$878.08
$996.60
$1,122.16
$1,568.20
$2,383.04

$1,213.94
$1,332.46
$1,458.02
$1,904.06

$1,549.80
$1,668.32
$1,793.88
$2,239.92

$1,885.66
$2,004.18
$2,129.74
$2,575.78

$335.86

Toc - Plan #53 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

$462.83
$525.30
$591.49
$826.60
$1,256.10

$816.89
$879.36
$945.55
$1,180.66

$1,170.95
$1,233.42
$1,299.61
$1,534.72

$1,525.01
$1,587.48
$1,653.67
$1,888.78

$354.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$925.66
$1,050.60
$1,182.98
$1,653.20
$2,512.20

$1,279.72
$1,404.66
$1,537.04
$2,007.26

$1,633.78
$1,758.72
$1,891.10
$2,361.32

$1,987.84
$2,112.78
$2,245.16
$2,715.38

$354.06

Toc - Plan #54 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

$457.09
$518.79
$584.15
$816.35
$1,240.53

$806.76
$868.46
$933.82
$1,166.02

$1,156.43
$1,218.13
$1,283.49
$1,515.69

$1,506.10
$1,567.80
$1,633.16
$1,865.36

$349.67

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.18
$1,037.58
$1,168.30
$1,632.70
$2,481.06

$1,263.85
$1,387.25
$1,517.97
$1,982.37

$1,613.52
$1,736.92
$1,867.64
$2,332.04

$1,963.19
$2,086.59
$2,217.31
$2,681.71

$349.67

Toc - Plan #55 Ambetter from Nebraska Total Care

Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 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

$348.03
$395.00
$444.77
$621.56
$944.52

$614.26
$661.23
$711.00
$887.79

$880.49
$927.46
$977.23
$1,154.02

$1,146.72
$1,193.69
$1,243.46
$1,420.25

$266.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$696.06
$790.00
$889.54
$1,243.12
$1,889.04

$962.29
$1,056.23
$1,155.77
$1,509.35

$1,228.52
$1,322.46
$1,422.00
$1,775.58

$1,494.75
$1,588.69
$1,688.23
$2,041.81

$266.23

Toc - Plan #56 Ambetter from Nebraska Total Care

Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$5,700 $11,400 Annual Deductible

$7,400 $14,800 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

$417.84
$474.24
$533.98
$746.24
$1,133.99

$737.48
$793.88
$853.62
$1,065.88

$1,057.12
$1,113.52
$1,173.26
$1,385.52

$1,376.76
$1,433.16
$1,492.90
$1,705.16

$319.64

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$835.68
$948.48
$1,067.96
$1,492.48
$2,267.98

$1,155.32
$1,268.12
$1,387.60
$1,812.12

$1,474.96
$1,587.76
$1,707.24
$2,131.76

$1,794.60
$1,907.40
$2,026.88
$2,451.40

$319.64

Toc - Plan #57 Ambetter from Nebraska Total Care

Gold

(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-890-0329

Annual Out of Pocket Expenses:

Individual Family

$950 $1,900 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

$456.63
$518.26
$583.56
$815.52
$1,239.27

$805.94
$867.57
$932.87
$1,164.83

$1,155.25
$1,216.88
$1,282.18
$1,514.14

$1,504.56
$1,566.19
$1,631.49
$1,863.45

$349.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$913.26
$1,036.52
$1,167.12
$1,631.04
$2,478.54

$1,262.57
$1,385.83
$1,516.43
$1,980.35

$1,611.88
$1,735.14
$1,865.74
$2,329.66

$1,961.19
$2,084.45
$2,215.05
$2,678.97

$349.31

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 #58 Blue Cross and Blue Shield of Nebraska

Expanded Bronze

(EPO) Nebraska HeartlandBlue Bronze HSA 6000 NB

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

$7,450 $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

$486.62
$552.31
$621.90
$869.10
$1,320.68

$858.88
$924.57
$994.16
$1,241.36

$1,231.14
$1,296.83
$1,366.42
$1,613.62

$1,603.40
$1,669.09
$1,738.68
$1,985.88

$372.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$973.24
$1,104.62
$1,243.80
$1,738.20
$2,641.36

$1,345.50
$1,476.88
$1,616.06
$2,110.46

$1,717.76
$1,849.14
$1,988.32
$2,482.72

$2,090.02
$2,221.40
$2,360.58
$2,854.98

$372.26

Toc - Plan #59 Blue Cross and Blue Shield of Nebraska

Bronze

(EPO) Nebraska HeartlandBlue Bronze 0% Coinsurance 9100 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

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

$443.44
$503.31
$566.72
$791.99
$1,203.50

$782.67
$842.54
$905.95
$1,131.22

$1,121.90
$1,181.77
$1,245.18
$1,470.45

$1,461.13
$1,521.00
$1,584.41
$1,809.68

$339.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$886.88
$1,006.62
$1,133.44
$1,583.98
$2,407.00

$1,226.11
$1,345.85
$1,472.67
$1,923.21

$1,565.34
$1,685.08
$1,811.90
$2,262.44

$1,904.57
$2,024.31
$2,151.13
$2,601.67

$339.23

Toc - Plan #60 Blue Cross and Blue Shield of Nebraska

Expanded Bronze

(EPO) Nebraska HeartlandBlue Bronze $0 PCP Visit 8100 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family

$8,100 $16,200 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

$468.50
$531.75
$598.74
$836.74
$1,271.50

$826.90
$890.15
$957.14
$1,195.14

$1,185.30
$1,248.55
$1,315.54
$1,553.54

$1,543.70
$1,606.95
$1,673.94
$1,911.94

$358.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$937.00
$1,063.50
$1,197.48
$1,673.48
$2,543.00

$1,295.40
$1,421.90
$1,555.88
$2,031.88

$1,653.80
$1,780.30
$1,914.28
$2,390.28

$2,012.20
$2,138.70
$2,272.68
$2,748.68

$358.40

Toc - Plan #61 Blue Cross and Blue Shield of Nebraska

Expanded Bronze

(EPO) Nebraska HeartlandBlue Bronze $0 Mental Health Visit 7750 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

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

$461.24
$523.51
$589.46
$823.77
$1,251.80

$814.09
$876.36
$942.31
$1,176.62

$1,166.94
$1,229.21
$1,295.16
$1,529.47

$1,519.79
$1,582.06
$1,648.01
$1,882.32

$352.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$922.48
$1,047.02
$1,178.92
$1,647.54
$2,503.60

$1,275.33
$1,399.87
$1,531.77
$2,000.39

$1,628.18
$1,752.72
$1,884.62
$2,353.24

$1,981.03
$2,105.57
$2,237.47
$2,706.09

$352.85

Toc - Plan #62 Blue Cross and Blue Shield of Nebraska

Bronze

(EPO) Nebraska HeartlandBlue Bronze Standard Deductible 9100 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

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

$443.44
$503.31
$566.72
$791.99
$1,203.50

$782.67
$842.54
$905.95
$1,131.22

$1,121.90
$1,181.77
$1,245.18
$1,470.45

$1,461.13
$1,521.00
$1,584.41
$1,809.68

$339.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$886.88
$1,006.62
$1,133.44
$1,583.98
$2,407.00

$1,226.11
$1,345.85
$1,472.67
$1,923.21

$1,565.34
$1,685.08
$1,811.90
$2,262.44

$1,904.57
$2,024.31
$2,151.13
$2,601.67

$339.23

Toc - Plan #63 Blue Cross and Blue Shield of Nebraska

Expanded Bronze

(EPO) Nebraska HeartlandBlue Bronze Standard Copay 7500 NB

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

$9,000 $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

$454.56
$515.92
$580.92
$811.84
$1,233.67

$802.30
$863.66
$928.66
$1,159.58

$1,150.04
$1,211.40
$1,276.40
$1,507.32

$1,497.78
$1,559.14
$1,624.14
$1,855.06

$347.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$909.12
$1,031.84
$1,161.84
$1,623.68
$2,467.34

$1,256.86
$1,379.58
$1,509.58
$1,971.42

$1,604.60
$1,727.32
$1,857.32
$2,319.16

$1,952.34
$2,075.06
$2,205.06
$2,666.90

$347.74

Toc - Plan #64 Blue Cross and Blue Shield of Nebraska

Silver

(EPO) Nebraska HeartlandBlue Silver $0 Deductible 9100 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,100 $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

$645.12
$732.21
$824.46
$1,152.18
$1,750.85

$1,138.63
$1,225.72
$1,317.97
$1,645.69

$1,632.14
$1,719.23
$1,811.48
$2,139.20

$2,125.65
$2,212.74
$2,304.99
$2,632.71

$493.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,290.24
$1,464.42
$1,648.92
$2,304.36
$3,501.70

$1,783.75
$1,957.93
$2,142.43
$2,797.87

$2,277.26
$2,451.44
$2,635.94
$3,291.38

$2,770.77
$2,944.95
$3,129.45
$3,784.89

$493.51

Toc - Plan #65 Blue Cross and Blue Shield of Nebraska

Silver

(EPO) Nebraska HeartlandBlue Silver $0 PCP Visit 5000 NB

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

$579.84
$658.12
$741.04
$1,035.60
$1,573.69

$1,023.42
$1,101.70
$1,184.62
$1,479.18

$1,467.00
$1,545.28
$1,628.20
$1,922.76

$1,910.58
$1,988.86
$2,071.78
$2,366.34

$443.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,159.68
$1,316.24
$1,482.08
$2,071.20
$3,147.38

$1,603.26
$1,759.82
$1,925.66
$2,514.78

$2,046.84
$2,203.40
$2,369.24
$2,958.36

$2,490.42
$2,646.98
$2,812.82
$3,401.94

$443.58

Toc - Plan #66 Blue Cross and Blue Shield of Nebraska

Silver

(EPO) Nebraska HeartlandBlue Silver $0 Mental Health Visit 6000 NB

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

$585.37
$664.39
$748.10
$1,045.46
$1,588.68

$1,033.17
$1,112.19
$1,195.90
$1,493.26

$1,480.97
$1,559.99
$1,643.70
$1,941.06

$1,928.77
$2,007.79
$2,091.50
$2,388.86

$447.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,170.74
$1,328.78
$1,496.20
$2,090.92
$3,177.36

$1,618.54
$1,776.58
$1,944.00
$2,538.72

$2,066.34
$2,224.38
$2,391.80
$2,986.52

$2,514.14
$2,672.18
$2,839.60
$3,434.32

$447.80

Toc - Plan #67 Blue Cross and Blue Shield of Nebraska

Silver

(EPO) Nebraska HeartlandBlue Silver Standard 5800 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

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

$579.78
$658.05
$740.95
$1,035.48
$1,573.51

$1,023.31
$1,101.58
$1,184.48
$1,479.01

$1,466.84
$1,545.11
$1,628.01
$1,922.54

$1,910.37
$1,988.64
$2,071.54
$2,366.07

$443.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,159.56
$1,316.10
$1,481.90
$2,070.96
$3,147.02

$1,603.09
$1,759.63
$1,925.43
$2,514.49

$2,046.62
$2,203.16
$2,368.96
$2,958.02

$2,490.15
$2,646.69
$2,812.49
$3,401.55

$443.53

Toc - Plan #68 Blue Cross and Blue Shield of Nebraska

Gold

(EPO) Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB

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

$622.82
$706.90
$795.97
$1,112.36
$1,690.34

$1,099.28
$1,183.36
$1,272.43
$1,588.82

$1,575.74
$1,659.82
$1,748.89
$2,065.28

$2,052.20
$2,136.28
$2,225.35
$2,541.74

$476.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,245.64
$1,413.80
$1,591.94
$2,224.72
$3,380.68

$1,722.10
$1,890.26
$2,068.40
$2,701.18

$2,198.56
$2,366.72
$2,544.86
$3,177.64

$2,675.02
$2,843.18
$3,021.32
$3,654.10

$476.46

Toc - Plan #69 Blue Cross and Blue Shield of Nebraska

Gold

(EPO) Nebraska HeartlandBlue Gold $0 Deductible NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,100 $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

$676.53
$767.87
$864.61
$1,208.29
$1,836.11

$1,194.08
$1,285.42
$1,382.16
$1,725.84

$1,711.63
$1,802.97
$1,899.71
$2,243.39

$2,229.18
$2,320.52
$2,417.26
$2,760.94

$517.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,353.06
$1,535.74
$1,729.22
$2,416.58
$3,672.22

$1,870.61
$2,053.29
$2,246.77
$2,934.13

$2,388.16
$2,570.84
$2,764.32
$3,451.68

$2,905.71
$3,088.39
$3,281.87
$3,969.23

$517.55

Toc - Plan #70 Blue Cross and Blue Shield of Nebraska

Gold

(EPO) Nebraska HeartlandBlue Gold Standard 2000 NB

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8960

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

$615.43
$698.52
$786.52
$1,099.17
$1,670.29

$1,086.24
$1,169.33
$1,257.33
$1,569.98

$1,557.05
$1,640.14
$1,728.14
$2,040.79

$2,027.86
$2,110.95
$2,198.95
$2,511.60

$470.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,230.86
$1,397.04
$1,573.04
$2,198.34
$3,340.58

$1,701.67
$1,867.85
$2,043.85
$2,669.15

$2,172.48
$2,338.66
$2,514.66
$3,139.96

$2,643.29
$2,809.47
$2,985.47
$3,610.77

$470.81

Oscar Insurance Company

Local: | Toll Free:

Toc - Plan #71 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

$498.76
$566.08
$637.40
$890.77
$1,353.61

$880.30
$947.62
$1,018.94
$1,272.31

$1,261.84
$1,329.16
$1,400.48
$1,653.85

$1,643.38
$1,710.70
$1,782.02
$2,035.39

$381.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$997.52
$1,132.16
$1,274.80
$1,781.54
$2,707.22

$1,379.06
$1,513.70
$1,656.34
$2,163.08

$1,760.60
$1,895.24
$2,037.88
$2,544.62

$2,142.14
$2,276.78
$2,419.42
$2,926.16

$381.54

Toc - Plan #72 Oscar Insurance Company

Expanded Bronze

(EPO) Bronze Elite- $0 Ded+PCP Saver

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

$590.27
$669.95
$754.35
$1,054.21
$1,601.97

$1,041.82
$1,121.50
$1,205.90
$1,505.76

$1,493.37
$1,573.05
$1,657.45
$1,957.31

$1,944.92
$2,024.60
$2,109.00
$2,408.86

$451.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,180.54
$1,339.90
$1,508.70
$2,108.42
$3,203.94

$1,632.09
$1,791.45
$1,960.25
$2,559.97

$2,083.64
$2,243.00
$2,411.80
$3,011.52

$2,535.19
$2,694.55
$2,863.35
$3,463.07

$451.55

Toc - Plan #73 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

$645.88
$733.06
$825.42
$1,153.52
$1,752.89

$1,139.97
$1,227.15
$1,319.51
$1,647.61

$1,634.06
$1,721.24
$1,813.60
$2,141.70

$2,128.15
$2,215.33
$2,307.69
$2,635.79

$494.09

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,291.76
$1,466.12
$1,650.84
$2,307.04
$3,505.78

$1,785.85
$1,960.21
$2,144.93
$2,801.13

$2,279.94
$2,454.30
$2,639.02
$3,295.22

$2,774.03
$2,948.39
$3,133.11
$3,789.31

$494.09

Toc - Plan #74 Oscar Insurance Company

Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

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

$431.44
$489.67
$551.37
$770.53
$1,170.90

$761.48
$819.71
$881.41
$1,100.57

$1,091.52
$1,149.75
$1,211.45
$1,430.61

$1,421.56
$1,479.79
$1,541.49
$1,760.65

$330.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$862.88
$979.34
$1,102.74
$1,541.06
$2,341.80

$1,192.92
$1,309.38
$1,432.78
$1,871.10

$1,522.96
$1,639.42
$1,762.82
$2,201.14

$1,853.00
$1,969.46
$2,092.86
$2,531.18

$330.04

Toc - Plan #75 Oscar Insurance Company

Expanded Bronze

(EPO) Bronze Simple- HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,200 $10,400 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

$529.85
$601.37
$677.14
$946.30
$1,437.99

$935.18
$1,006.70
$1,082.47
$1,351.63

$1,340.51
$1,412.03
$1,487.80
$1,756.96

$1,745.84
$1,817.36
$1,893.13
$2,162.29

$405.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,059.70
$1,202.74
$1,354.28
$1,892.60
$2,875.98

$1,465.03
$1,608.07
$1,759.61
$2,297.93

$1,870.36
$2,013.40
$2,164.94
$2,703.26

$2,275.69
$2,418.73
$2,570.27
$3,108.59

$405.33

Toc - Plan #76 Oscar Insurance Company

Silver

(EPO) Silver Simple- Specialist Saver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$636.43
$722.34
$813.35
$1,136.65
$1,727.25

$1,123.29
$1,209.20
$1,300.21
$1,623.51

$1,610.15
$1,696.06
$1,787.07
$2,110.37

$2,097.01
$2,182.92
$2,273.93
$2,597.23

$486.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,272.86
$1,444.68
$1,626.70
$2,273.30
$3,454.50

$1,759.72
$1,931.54
$2,113.56
$2,760.16

$2,246.58
$2,418.40
$2,600.42
$3,247.02

$2,733.44
$2,905.26
$3,087.28
$3,733.88

$486.86

Toc - Plan #77 Oscar Insurance Company

Expanded Bronze

(EPO) Bronze Classic- $0 PCP

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

$528.63
$599.98
$675.58
$944.11
$1,434.67

$933.02
$1,004.37
$1,079.97
$1,348.50

$1,337.41
$1,408.76
$1,484.36
$1,752.89

$1,741.80
$1,813.15
$1,888.75
$2,157.28

$404.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,057.26
$1,199.96
$1,351.16
$1,888.22
$2,869.34

$1,461.65
$1,604.35
$1,755.55
$2,292.61

$1,866.04
$2,008.74
$2,159.94
$2,697.00

$2,270.43
$2,413.13
$2,564.33
$3,101.39

$404.39

Toc - Plan #78 Oscar Insurance Company

Expanded Bronze

(EPO) Bronze Classic- $4700 Ded

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

$539.31
$612.11
$689.23
$963.19
$1,463.66

$951.87
$1,024.67
$1,101.79
$1,375.75

$1,364.43
$1,437.23
$1,514.35
$1,788.31

$1,776.99
$1,849.79
$1,926.91
$2,200.87

$412.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,078.62
$1,224.22
$1,378.46
$1,926.38
$2,927.32

$1,491.18
$1,636.78
$1,791.02
$2,338.94

$1,903.74
$2,049.34
$2,203.58
$2,751.50

$2,316.30
$2,461.90
$2,616.14
$3,164.06

$412.56

Toc - Plan #79 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

$621.16
$705.00
$793.83
$1,109.37
$1,685.80

$1,096.34
$1,180.18
$1,269.01
$1,584.55

$1,571.52
$1,655.36
$1,744.19
$2,059.73

$2,046.70
$2,130.54
$2,219.37
$2,534.91

$475.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,242.32
$1,410.00
$1,587.66
$2,218.74
$3,371.60

$1,717.50
$1,885.18
$2,062.84
$2,693.92

$2,192.68
$2,360.36
$2,538.02
$3,169.10

$2,667.86
$2,835.54
$3,013.20
$3,644.28

$475.18

Toc - Plan #80 Oscar Insurance Company

Silver

(EPO) Silver Elite- $0 Ded

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

$649.20
$736.83
$829.66
$1,159.45
$1,761.90

$1,145.83
$1,233.46
$1,326.29
$1,656.08

$1,642.46
$1,730.09
$1,822.92
$2,152.71

$2,139.09
$2,226.72
$2,319.55
$2,649.34

$496.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,298.40
$1,473.66
$1,659.32
$2,318.90
$3,523.80

$1,795.03
$1,970.29
$2,155.95
$2,815.53

$2,291.66
$2,466.92
$2,652.58
$3,312.16

$2,788.29
$2,963.55
$3,149.21
$3,808.79

$496.63

Toc - Plan #81 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

$655.63
$744.13
$837.89
$1,170.94
$1,779.36

$1,157.18
$1,245.68
$1,339.44
$1,672.49

$1,658.73
$1,747.23
$1,840.99
$2,174.04

$2,160.28
$2,248.78
$2,342.54
$2,675.59

$501.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,311.26
$1,488.26
$1,675.78
$2,341.88
$3,558.72

$1,812.81
$1,989.81
$2,177.33
$2,843.43

$2,314.36
$2,491.36
$2,678.88
$3,344.98

$2,815.91
$2,992.91
$3,180.43
$3,846.53

$501.55

Toc - Plan #82 Oscar Insurance Company

Silver

(EPO) Silver Simple- For 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

$638.75
$724.97
$816.31
$1,140.79
$1,733.53

$1,127.38
$1,213.60
$1,304.94
$1,629.42

$1,616.01
$1,702.23
$1,793.57
$2,118.05

$2,104.64
$2,190.86
$2,282.20
$2,606.68

$488.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,277.50
$1,449.94
$1,632.62
$2,281.58
$3,467.06

$1,766.13
$1,938.57
$2,121.25
$2,770.21

$2,254.76
$2,427.20
$2,609.88
$3,258.84

$2,743.39
$2,915.83
$3,098.51
$3,747.47

$488.63

Toc - Plan #83 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

$9,000 $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

$526.50
$597.57
$672.85
$940.31
$1,428.89

$929.26
$1,000.33
$1,075.61
$1,343.07

$1,332.02
$1,403.09
$1,478.37
$1,745.83

$1,734.78
$1,805.85
$1,881.13
$2,148.59

$402.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,053.00
$1,195.14
$1,345.70
$1,880.62
$2,857.78

$1,455.76
$1,597.90
$1,748.46
$2,283.38

$1,858.52
$2,000.66
$2,151.22
$2,686.14

$2,261.28
$2,403.42
$2,553.98
$3,088.90

$402.76

Toc - Plan #84 Oscar Insurance Company

Bronze

(EPO) Bronze Simple- Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

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

$476.10
$540.36
$608.44
$850.29
$1,292.10

$840.31
$904.57
$972.65
$1,214.50

$1,204.52
$1,268.78
$1,336.86
$1,578.71

$1,568.73
$1,632.99
$1,701.07
$1,942.92

$364.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$952.20
$1,080.72
$1,216.88
$1,700.58
$2,584.20

$1,316.41
$1,444.93
$1,581.09
$2,064.79

$1,680.62
$1,809.14
$1,945.30
$2,429.00

$2,044.83
$2,173.35
$2,309.51
$2,793.21

$364.21

Toc - Plan #85 Oscar Insurance Company

Silver

(EPO) Silver Classic- Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,800 $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

$627.36
$712.04
$801.75
$1,120.44
$1,702.62

$1,107.28
$1,191.96
$1,281.67
$1,600.36

$1,587.20
$1,671.88
$1,761.59
$2,080.28

$2,067.12
$2,151.80
$2,241.51
$2,560.20

$479.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,254.72
$1,424.08
$1,603.50
$2,240.88
$3,405.24

$1,734.64
$1,904.00
$2,083.42
$2,720.80

$2,214.56
$2,383.92
$2,563.34
$3,200.72

$2,694.48
$2,863.84
$3,043.26
$3,680.64

$479.92

Toc - Plan #86 Oscar Insurance Company

Gold

(EPO) Gold Classic- Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

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

$605.30
$687.01
$773.56
$1,081.05
$1,642.76

$1,068.35
$1,150.06
$1,236.61
$1,544.10

$1,531.40
$1,613.11
$1,699.66
$2,007.15

$1,994.45
$2,076.16
$2,162.71
$2,470.20

$463.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,210.60
$1,374.02
$1,547.12
$2,162.10
$3,285.52

$1,673.65
$1,837.07
$2,010.17
$2,625.15

$2,136.70
$2,300.12
$2,473.22
$3,088.20

$2,599.75
$2,763.17
$2,936.27
$3,551.25

$463.05

‡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 Howard County here.

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

Currently, there are 86 plans offered in Rating Area 3.

Top

2023 Obamacare Plans for Howard County, NE

Plan Browser: 86 Plans

Medica

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

1. Expanded Bronze Medica Insure Bronze Copay ($0 Virtual Care with Designated Providers)

2. Expanded Bronze Medica Insure Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

3. Expanded Bronze Medica Insure Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

4. Catastrophic Medica Insure Catastrophic ($0 Virtual Care with Designated Providers)

5. Gold Medica Insure Gold Share ($0 Virtual Care with Designated Providers)

6. Silver Medica Insure Silver Share ($0 Virtual Care with Designated Providers)

7. Expanded Bronze Medica Insure Bronze Share Plus ($0 Virtual Care with Designated Providers)

8. Expanded Bronze Medica Insure Bronze Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

9. Expanded Bronze Medica Insure Bronze Premier ($0 Virtual Care with Designated Providers)

10. Gold Medica Insure Gold Standard ($0 Virtual Care with Designated Providers)

11. Silver Medica Insure Silver Standard ($0 Virtual Care with Designated Providers)

12. Bronze Medica Insure Bronze Standard ($0 Virtual Care with Designated Providers)

13. Gold Medica Insure Gold HSA ($0 Virtual Care after Deductible with Designated Providers)

14. Expanded Bronze Medica with CHI Health Bronze Copay ($0 Virtual Care with Designated Providers)

15. Expanded Bronze Medica with CHI Health Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

16. Expanded Bronze Medica with CHI Health Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

17. Catastrophic Medica with CHI Health Catastrophic ($0 Virtual Care with Designated Providers)

18. Silver Medica with CHI Health Silver Share ($0 Virtual Care with Designated Providers)

19. Expanded Bronze Medica with CHI Health Bronze Share Plus ($0 Virtual Care with Designated Providers)

20. Expanded Bronze Medica with CHI Health Bronze Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

21. Gold Medica with CHI Health Gold Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

22. Expanded Bronze Medica with CHI Health Bronze Premier ($0 Virtual Care with Designated Providers)

23. Silver Medica with CHI Health Silver Enhanced ($0 Virtual Care with Designated Providers)

24. Gold Medica with CHI Health Gold Standard ($0 Virtual Care with Designated Providers)

25. Silver Medica with CHI Health Silver Standard ($0 Virtual Care with Designated Providers)

26. Bronze Medica with CHI Health Bronze Standard ($0 Virtual Care with Designated Providers)

Ambetter from Nebraska Total Care

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

27. Expanded Bronze Choice Bronze HSA

28. Expanded Bronze Everyday Bronze

29. Expanded Bronze Elite Bronze

30. Silver Complete Silver

31. Silver Everyday Silver

32. Gold Complete Gold

33. Bronze CMS Standard Bronze

34. Gold Elite Gold

35. Expanded Bronze CMS Standard Expanded Bronze

36. Silver CMS Standard Silver

37. Gold CMS Standard Gold

38. Bronze Clear Bronze

39. Silver Clear Silver

40. Silver Focused Silver

41. Gold Everyday Gold

42. Gold Clear Gold

43. Expanded Bronze Choice Bronze HSA + Vision + Adult Dental

44. Expanded Bronze Everyday Bronze + Vision + Adult Dental

45. Expanded Bronze Elite Bronze + Vision + Adult Dental

46. Silver Complete Silver + Vision + Adult Dental

47. Gold Complete Gold + Vision + Adult Dental

48. Gold Elite Gold + Vision + Adult Dental

49. Silver Everyday Silver + Vision + Adult Dental

50. Bronze Clear Bronze + Vision + Adult Dental

51. Silver Clear Silver + Vision + Adult Dental

52. Silver Focused Silver + Vision + Adult Dental

53. Gold Everyday Gold + Vision + Adult Dental

54. Gold Clear Gold + Vision + Adult Dental

55. Expanded Bronze Ambetter Virtual Access Bronze - Virtual PCP selection required

56. Silver Ambetter Virtual Access Silver - Virtual PCP selection required

57. Gold Ambetter Virtual Access Gold - Virtual PCP selection required

Blue Cross and Blue Shield of Nebraska

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

58. Expanded Bronze Nebraska HeartlandBlue Bronze HSA 6000 NB

59. Bronze Nebraska HeartlandBlue Bronze 0% Coinsurance 9100 NB

60. Expanded Bronze Nebraska HeartlandBlue Bronze $0 PCP Visit 8100 NB

61. Expanded Bronze Nebraska HeartlandBlue Bronze $0 Mental Health Visit 7750 NB

62. Bronze Nebraska HeartlandBlue Bronze Standard Deductible 9100 NB

63. Expanded Bronze Nebraska HeartlandBlue Bronze Standard Copay 7500 NB

64. Silver Nebraska HeartlandBlue Silver $0 Deductible 9100 NB

65. Silver Nebraska HeartlandBlue Silver $0 PCP Visit 5000 NB

66. Silver Nebraska HeartlandBlue Silver $0 Mental Health Visit 6000 NB

67. Silver Nebraska HeartlandBlue Silver Standard 5800 NB

68. Gold Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB

69. Gold Nebraska HeartlandBlue Gold $0 Deductible NB

70. Gold Nebraska HeartlandBlue Gold Standard 2000 NB

Oscar Insurance Company

Local: | Toll Free:

71. Expanded Bronze Bronze Classic

72. Expanded Bronze Bronze Elite- $0 Ded+PCP Saver

73. Silver Silver Classic

74. Catastrophic Secure

75. Expanded Bronze Bronze Simple- HSA

76. Silver Silver Simple- Specialist Saver

77. Expanded Bronze Bronze Classic- $0 PCP

78. Expanded Bronze Bronze Classic- $4700 Ded

79. Silver Silver Simple- PCP Saver

80. Silver Silver Elite- $0 Ded

81. Gold Gold Elite

82. Silver Silver Simple- For Diabetes

83. Expanded Bronze Bronze Classic- Standard

84. Bronze Bronze Simple- Standard

85. Silver Silver Classic- Standard

86. Gold Gold Classic- Standard

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For information on subsidies to make your coverage affordable, you must take one of the following actions:

Obamacare Providers, 86 Plans and 2023 Rates for Howard County, Nebraska

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Using a Broker to Help You Sign Up

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How To Sign Up for Obamacare in Nebraska for 2023

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Nebraska Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

Nebraska Has Expanded Medicaid

Get Help Finding a Health Insurance Plan in Nebraska

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More Information

Medica

(EPO) Medica Insure Bronze Copay ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Catastrophic ($0 Virtual Care with Designated Providers)

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:

(EPO) Medica Insure Gold Share ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $750 $1,500 Annual Deductible $8,450 $16,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Silver Share ($0 Virtual Care with Designated Providers)

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:

(EPO) Medica Insure Bronze Share Plus ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $2,700 $5,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Bronze Copay $0 PCP Office Visits ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $7,200 $14,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Bronze Premier ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica Insure Gold Standard ($0 Virtual Care with Designated Providers)

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:

(EPO) Medica Insure Silver Standard ($0 Virtual Care with Designated Providers)

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:

(EPO) Medica Insure Bronze Standard ($0 Virtual Care with Designated Providers)

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:

(EPO) Medica Insure Gold HSA ($0 Virtual Care after Deductible with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $3,000 $6,000 Annual Deductible $6,000 $12,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica with CHI Health Bronze Copay ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica with CHI Health Bronze Copay + Dental Reimbursement ($0 Virtual Care with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Medica with CHI Health Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

Individual Family

$7,500 $15,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$750 $1,500 Annual Deductible

$8,450 $16,900 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$2,700 $5,400 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,200 $14,400 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$3,000 $6,000 Annual Deductible

$6,000 $12,000 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$2,700 $5,400 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,200 $14,400 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,450 $16,900 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 Maximum Out of Pocket Per Year

Individual Family

$8,300 $16,600 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$6,000 $12,000 Annual Deductible

$8,500 $17,000 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year