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Providers for Zip Code 03894

Obamacare 2017 Marketplace Rates For Carroll County, New Hampshire

Wednesday, December 7th, 2016

Click for Wolfeboro, New Hampshire Forecast

Obamacare Providers, Plans and 2017 Rates for Carroll County

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

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

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

Currently, there are 29 plans offered in Carroll County.

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

 

The table below shows premiums for the following scenarios:

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

Each scenario is covered for age

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

 

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

 

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

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

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

Harvard Pilgrim Health Care of NE

Local: 1-877-907-4742 | Toll Free: 1-877-907-4742

TTY: 1-800-637-8257

Plan: (HMO) New Hampshire Network Gold 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care of NE)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$371.94
$422.15
$475.34
$664.28
$1009.44
$743.88
$844.30
$950.68
$1328.56
$2018.88
$980.06
$1080.48
$1186.86
$1564.74
$1216.24
$1316.66
$1423.04
$1800.92
$1452.42
$1552.84
$1659.22
$2037.10
$608.12
$658.33
$711.52
$900.46
$844.30
$894.51
$947.70
$1136.64
$1080.48
$1130.69
$1183.88
$1372.82
$236.18

Plan: (HMO) New Hampshire Network Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care of NE)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$316.62
$359.36
$404.64
$565.48
$859.31
$633.24
$718.72
$809.28
$1130.96
$1718.62
$834.29
$919.77
$1010.33
$1332.01
$1035.34
$1120.82
$1211.38
$1533.06
$1236.39
$1321.87
$1412.43
$1734.11
$517.67
$560.41
$605.69
$766.53
$718.72
$761.46
$806.74
$967.58
$919.77
$962.51
$1007.79
$1168.63
$201.05

Matthew Thornton Hlth Plan(Anthem BCBS)

Local: 1-855-748-1804 | Toll Free: 1-855-748-1804

Plan: (HMO) Anthem Bronze Pathway X Enhanced HMO 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $6,050 : Family: $12,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$220.11
$249.82
$281.30
$393.12
$597.38
$440.22
$499.64
$562.60
$786.24
$1194.76
$579.99
$639.41
$702.37
$926.01
$719.76
$779.18
$842.14
$1065.78
$859.53
$918.95
$981.91
$1205.55
$359.88
$389.59
$421.07
$532.89
$499.65
$529.36
$560.84
$672.66
$639.42
$669.13
$700.61
$812.43
$139.77

Harvard Pilgrim Health Care of NE

Local: 1-877-907-4742 | Toll Free: 1-877-907-4742

TTY: 1-800-637-8257

Plan: (HMO) New Hampshire Network Bronze HSA 5100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-907-4742 - Provider Directory for This Plan: (Harvard Pilgrim Health Care of NE)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$236.58
$268.52
$302.35
$422.54
$642.08
$473.16
$537.04
$604.70
$845.08
$1284.16
$623.39
$687.27
$754.93
$995.31
$773.62
$837.50
$905.16
$1145.54
$923.85
$987.73
$1055.39
$1295.77
$386.81
$418.75
$452.58
$572.77
$537.04
$568.98
$602.81
$723.00
$687.27
$719.21
$753.04
$873.23
$150.23

Minuteman Health, Inc

Local: 1-857-265-3201 | Toll Free: 1-855-644-1776

Plan: (HMO) MyDoc HMO Platinum

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$303.95
$344.98
$388.44
$542.85
$824.91
$607.90
$689.96
$776.88
$1085.70
$1649.82
$800.91
$882.97
$969.89
$1278.71
$993.92
$1075.98
$1162.90
$1471.72
$1186.93
$1268.99
$1355.91
$1664.73
$496.96
$537.99
$581.45
$735.86
$689.97
$731.00
$774.46
$928.87
$882.98
$924.01
$967.47
$1121.88
$193.01

Plan: (HMO) MyDoc HMO Gold Basic 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$270.33
$306.83
$345.48
$482.81
$733.68
$540.66
$613.66
$690.96
$965.62
$1467.36
$712.32
$785.32
$862.62
$1137.28
$883.98
$956.98
$1034.28
$1308.94
$1055.64
$1128.64
$1205.94
$1480.60
$441.99
$478.49
$517.14
$654.47
$613.65
$650.15
$688.80
$826.13
$785.31
$821.81
$860.46
$997.79
$171.66

Plan: (HMO) MyDoc HMO Bronze Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$178.26
$202.32
$227.81
$318.36
$483.79
$356.52
$404.64
$455.62
$636.72
$967.58
$469.71
$517.83
$568.81
$749.91
$582.90
$631.02
$682.00
$863.10
$696.09
$744.21
$795.19
$976.29
$291.45
$315.51
$341.00
$431.55
$404.64
$428.70
$454.19
$544.74
$517.83
$541.89
$567.38
$657.93
$113.19

Plan: (HMO) MyDoc HMO Silver Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$207.00
$234.95
$264.55
$369.71
$561.80
$414.00
$469.90
$529.10
$739.42
$1123.60
$545.45
$601.35
$660.55
$870.87
$676.90
$732.80
$792.00
$1002.32
$808.35
$864.25
$923.45
$1133.77
$338.45
$366.40
$396.00
$501.16
$469.90
$497.85
$527.45
$632.61
$601.35
$629.30
$658.90
$764.06
$131.45

Plan: (HMO) MyDoc HMO Silver Care

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$209.75
$238.06
$268.06
$374.61
$569.25
$419.50
$476.12
$536.12
$749.22
$1138.50
$552.69
$609.31
$669.31
$882.41
$685.88
$742.50
$802.50
$1015.60
$819.07
$875.69
$935.69
$1148.79
$342.94
$371.25
$401.25
$507.80
$476.13
$504.44
$534.44
$640.99
$609.32
$637.63
$667.63
$774.18
$133.19

Plan: (HMO) MyDoc HMO Bronze Basic 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$177.26
$201.19
$226.53
$316.58
$481.08
$354.52
$402.38
$453.06
$633.16
$962.16
$467.08
$514.94
$565.62
$745.72
$579.64
$627.50
$678.18
$858.28
$692.20
$740.06
$790.74
$970.84
$289.82
$313.75
$339.09
$429.14
$402.38
$426.31
$451.65
$541.70
$514.94
$538.87
$564.21
$654.26
$112.56

Plan: (HMO) MyDoc HMO Bronze 6300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$172.50
$195.78
$220.45
$308.08
$468.16
$345.00
$391.56
$440.90
$616.16
$936.32
$454.54
$501.10
$550.44
$725.70
$564.08
$610.64
$659.98
$835.24
$673.62
$720.18
$769.52
$944.78
$282.04
$305.32
$329.99
$417.62
$391.58
$414.86
$439.53
$527.16
$501.12
$524.40
$549.07
$636.70
$109.54

Plan: (HMO) MyDoc HMO Simple Care

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$114.96
$130.48
$146.92
$205.31
$311.99
$229.92
$260.96
$293.84
$410.62
$623.98
$302.92
$333.96
$366.84
$483.62
$375.92
$406.96
$439.84
$556.62
$448.92
$479.96
$512.84
$629.62
$187.96
$203.48
$219.92
$278.31
$260.96
$276.48
$292.92
$351.31
$333.96
$349.48
$365.92
$424.31
$73.00

Plan: (HMO) MyDoc HMO Platinum Extra Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$326.51
$370.58
$417.28
$583.14
$886.14
$653.02
$741.16
$834.56
$1166.28
$1772.28
$860.35
$948.49
$1041.89
$1373.61
$1067.68
$1155.82
$1249.22
$1580.94
$1275.01
$1363.15
$1456.55
$1788.27
$533.84
$577.91
$624.61
$790.47
$741.17
$785.24
$831.94
$997.80
$948.50
$992.57
$1039.27
$1205.13
$207.33

Plan: (HMO) MyDoc HMO Silver Assistance A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$208.86
$237.06
$266.92
$373.03
$566.85
$417.72
$474.12
$533.84
$746.06
$1133.70
$550.35
$606.75
$666.47
$878.69
$682.98
$739.38
$799.10
$1011.32
$815.61
$872.01
$931.73
$1143.95
$341.49
$369.69
$399.55
$505.66
$474.12
$502.32
$532.18
$638.29
$606.75
$634.95
$664.81
$770.92
$132.63

Plan: (HMO) MyDoc HMO Bronze HSA 5800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-644-1776 - Provider Directory for This Plan: (Minuteman Health, Inc)

Deductible: Individual: $5,800 : Family: $11,600
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$173.27
$196.66
$221.44
$309.47
$470.26
$346.54
$393.32
$442.88
$618.94
$940.52
$456.57
$503.35
$552.91
$728.97
$566.60
$613.38
$662.94
$839.00
$676.63
$723.41
$772.97
$949.03
$283.30
$306.69
$331.47
$419.50
$393.33
$416.72
$441.50
$529.53
$503.36
$526.75
$551.53
$639.56
$110.03
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Celtic Insurance Company

Local: 1-844-265-1278 | Toll Free: 1-844-265-1278

TTY: 1-855-742-0123

Plan: (EPO) Ambetter Secure Care 1 (2017) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-265-1278 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$331.61
$376.37
$423.79
$592.24
$899.97
$663.22
$752.74
$847.58
$1184.48
$1799.94
$873.79
$963.31
$1058.15
$1395.05
$1084.36
$1173.88
$1268.72
$1605.62
$1294.93
$1384.45
$1479.29
$1816.19
$542.18
$586.94
$634.36
$802.81
$752.75
$797.51
$844.93
$1013.38
$963.32
$1008.08
$1055.50
$1223.95
$210.57

Plan: (EPO) Ambetter Balanced Care 8 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-265-1278 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$320.71
$363.99
$409.85
$572.77
$870.38
$641.42
$727.98
$819.70
$1145.54
$1740.76
$845.06
$931.62
$1023.34
$1349.18
$1048.70
$1135.26
$1226.98
$1552.82
$1252.34
$1338.90
$1430.62
$1756.46
$524.35
$567.63
$613.49
$776.41
$727.99
$771.27
$817.13
$980.05
$931.63
$974.91
$1020.77
$1183.69
$203.64
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Matthew Thornton Hlth Plan(Anthem BCBS)

Local: 1-855-748-1804 | Toll Free: 1-855-748-1804

Plan: (HMO) Anthem Bronze Pathway X Enhanced HMO 25 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $5,150 : Family: $10,300
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$226.49
$257.07
$289.45
$404.51
$614.69
$452.98
$514.14
$578.90
$809.02
$1229.38
$596.80
$657.96
$722.72
$952.84
$740.62
$801.78
$866.54
$1096.66
$884.44
$945.60
$1010.36
$1240.48
$370.31
$400.89
$433.27
$548.33
$514.13
$544.71
$577.09
$692.15
$657.95
$688.53
$720.91
$835.97
$143.82

Plan: (HMO) Anthem Bronze Pathway X Enhanced HMO 5400 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $5,400 : Family: $10,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$220.58
$250.36
$281.90
$393.96
$598.65
$441.16
$500.72
$563.80
$787.92
$1197.30
$581.23
$640.79
$703.87
$927.99
$721.30
$780.86
$843.94
$1068.06
$861.37
$920.93
$984.01
$1208.13
$360.65
$390.43
$421.97
$534.03
$500.72
$530.50
$562.04
$674.10
$640.79
$670.57
$702.11
$814.17
$140.07

Plan: (HMO) Anthem Bronze Pathway X Enhanced HMO 5750 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$222.87
$252.96
$284.83
$398.05
$604.87
$445.74
$505.92
$569.66
$796.10
$1209.74
$587.26
$647.44
$711.18
$937.62
$728.78
$788.96
$852.70
$1079.14
$870.30
$930.48
$994.22
$1220.66
$364.39
$394.48
$426.35
$539.57
$505.91
$536.00
$567.87
$681.09
$647.43
$677.52
$709.39
$822.61
$141.52

Plan: (HMO) Anthem Silver Pathway X Enhanced HMO 10 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$263.52
$299.10
$336.78
$470.65
$715.19
$527.04
$598.20
$673.56
$941.30
$1430.38
$694.38
$765.54
$840.90
$1108.64
$861.72
$932.88
$1008.24
$1275.98
$1029.06
$1100.22
$1175.58
$1443.32
$430.86
$466.44
$504.12
$637.99
$598.20
$633.78
$671.46
$805.33
$765.54
$801.12
$838.80
$972.67
$167.34

Plan: (HMO) Anthem Silver Pathway X Enhanced HMO 4000 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$262.24
$297.64
$335.14
$468.36
$711.72
$524.48
$595.28
$670.28
$936.72
$1423.44
$691.00
$761.80
$836.80
$1103.24
$857.52
$928.32
$1003.32
$1269.76
$1024.04
$1094.84
$1169.84
$1436.28
$428.76
$464.16
$501.66
$634.88
$595.28
$630.68
$668.18
$801.40
$761.80
$797.20
$834.70
$967.92
$166.52

Plan: (HMO) Anthem Gold Pathway X Enhanced HMO 1000 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$339.45
$385.28
$433.82
$606.26
$921.27
$678.90
$770.56
$867.64
$1212.52
$1842.54
$894.45
$986.11
$1083.19
$1428.07
$1110.00
$1201.66
$1298.74
$1643.62
$1325.55
$1417.21
$1514.29
$1859.17
$555.00
$600.83
$649.37
$821.81
$770.55
$816.38
$864.92
$1037.36
$986.10
$1031.93
$1080.47
$1252.91
$215.55

Plan: (HMO) Anthem Catastrophic Pathway X Enhanced HMO 7150 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$174.11
$197.61
$222.51
$310.96
$472.53
$348.22
$395.22
$445.02
$621.92
$945.06
$458.78
$505.78
$555.58
$732.48
$569.34
$616.34
$666.14
$843.04
$679.90
$726.90
$776.70
$953.60
$284.67
$308.17
$333.07
$421.52
$395.23
$418.73
$443.63
$532.08
$505.79
$529.29
$554.19
$642.64
$110.56

Plan: (HMO) Anthem Silver Pathway X Enhanced HMO 4200 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $4,200 : Family: $8,400
Out of Pocket Maximum per year: Individual: $5,900 : Family: $11,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$263.04
$298.55
$336.17
$469.79
$713.89
$526.08
$597.10
$672.34
$939.58
$1427.78
$693.11
$764.13
$839.37
$1106.61
$860.14
$931.16
$1006.40
$1273.64
$1027.17
$1098.19
$1173.43
$1440.67
$430.07
$465.58
$503.20
$636.82
$597.10
$632.61
$670.23
$803.85
$764.13
$799.64
$837.26
$970.88
$167.03

Plan: (HMO) Anthem Bronze Pathway X Enhanced HMO 6350 40

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$213.96
$242.84
$273.44
$382.13
$580.69
$427.92
$485.68
$546.88
$764.26
$1161.38
$563.78
$621.54
$682.74
$900.12
$699.64
$757.40
$818.60
$1035.98
$835.50
$893.26
$954.46
$1171.84
$349.82
$378.70
$409.30
$517.99
$485.68
$514.56
$545.16
$653.85
$621.54
$650.42
$681.02
$789.71
$135.86

Plan: (HMO) Anthem Silver Pathway X Enhanced HMO 5300 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $5,300 : Family: $10,600
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$246.74
$280.05
$315.33
$440.68
$669.65
$493.48
$560.10
$630.66
$881.36
$1339.30
$650.16
$716.78
$787.34
$1038.04
$806.84
$873.46
$944.02
$1194.72
$963.52
$1030.14
$1100.70
$1351.40
$403.42
$436.73
$472.01
$597.36
$560.10
$593.41
$628.69
$754.04
$716.78
$750.09
$785.37
$910.72
$156.68

Plan: (HMO) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$266.92
$302.95
$341.12
$476.72
$724.42
$533.84
$605.90
$682.24
$953.44
$1448.84
$703.33
$775.39
$851.73
$1122.93
$872.82
$944.88
$1021.22
$1292.42
$1042.31
$1114.37
$1190.71
$1461.91
$436.41
$472.44
$510.61
$646.21
$605.90
$641.93
$680.10
$815.70
$775.39
$811.42
$849.59
$985.19
$169.49

Plan: (HMO) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1804 - Provider Directory for This Plan: (Matthew Thornton Hlth Plan(Anthem BCBS))

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$343.60
$389.99
$439.12
$613.67
$932.53
$687.20
$779.98
$878.24
$1227.34
$1865.06
$905.39
$998.17
$1096.43
$1445.53
$1123.58
$1216.36
$1314.62
$1663.72
$1341.77
$1434.55
$1532.81
$1881.91
$561.79
$608.18
$657.31
$831.86
$779.98
$826.37
$875.50
$1050.05
$998.17
$1044.56
$1093.69
$1268.24
$218.19