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You are viewing information for Cheshire County, NH

Obamacare 2023 Rates for Cheshire County

Obamacare > Rates > New Hampshire > Cheshire 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 Cheshire County, NH.

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, 55 Plans and 2023 Rates for Cheshire County, New Hampshire

Below, you’ll find a summary of the 55 plans for Cheshire County, New Hampshire and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Harvard Pilgrim Health Care

Local: 1-877-907-4742 | Toll Free: 1-877-907-4742 | TTY: 1-800-637-8257
Toc - Plan #1 Harvard Pilgrim Health Care
Gold

(HMO) NH Local Choice HMO Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393.35
$446.46
$502.71
$702.53
$1,067.56 		$694.27
$747.38
$803.63
$1,003.45 		$995.19
$1,048.30
$1,104.55
$1,304.37 		$1,296.11
$1,349.22
$1,405.47
$1,605.29 		$300.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786.70
$892.92
$1,005.42
$1,405.06
$2,135.12 		$1,087.62
$1,193.84
$1,306.34
$1,705.98 		$1,388.54
$1,494.76
$1,607.26
$2,006.90 		$1,689.46
$1,795.68
$1,908.18
$2,307.82 		$300.92
Toc - Plan #2 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 2500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$359.87
$408.45
$459.91
$642.72
$976.67 		$635.17
$683.75
$735.21
$918.02 		$910.47
$959.05
$1,010.51
$1,193.32 		$1,185.77
$1,234.35
$1,285.81
$1,468.62 		$275.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$719.74
$816.90
$919.82
$1,285.44
$1,953.34 		$995.04
$1,092.20
$1,195.12
$1,560.74 		$1,270.34
$1,367.50
$1,470.42
$1,836.04 		$1,545.64
$1,642.80
$1,745.72
$2,111.34 		$275.30
Toc - Plan #3 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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 		$358.82
$407.26
$458.57
$640.85
$973.83 		$633.32
$681.76
$733.07
$915.35 		$907.82
$956.26
$1,007.57
$1,189.85 		$1,182.32
$1,230.76
$1,282.07
$1,464.35 		$274.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$717.64
$814.52
$917.14
$1,281.70
$1,947.66 		$992.14
$1,089.02
$1,191.64
$1,556.20 		$1,266.64
$1,363.52
$1,466.14
$1,830.70 		$1,541.14
$1,638.02
$1,740.64
$2,105.20 		$274.50
Toc - Plan #4 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$357.25
$405.48
$456.56
$638.05
$969.57 		$630.55
$678.78
$729.86
$911.35 		$903.85
$952.08
$1,003.16
$1,184.65 		$1,177.15
$1,225.38
$1,276.46
$1,457.95 		$273.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$714.50
$810.96
$913.12
$1,276.10
$1,939.14 		$987.80
$1,084.26
$1,186.42
$1,549.40 		$1,261.10
$1,357.56
$1,459.72
$1,822.70 		$1,534.40
$1,630.86
$1,733.02
$2,096.00 		$273.30
Toc - Plan #5 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$332.66
$377.56
$425.13
$594.12
$902.83 		$587.14
$632.04
$679.61
$848.60 		$841.62
$886.52
$934.09
$1,103.08 		$1,096.10
$1,141.00
$1,188.57
$1,357.56 		$254.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$665.32
$755.12
$850.26
$1,188.24
$1,805.66 		$919.80
$1,009.60
$1,104.74
$1,442.72 		$1,174.28
$1,264.08
$1,359.22
$1,697.20 		$1,428.76
$1,518.56
$1,613.70
$1,951.68 		$254.48
Toc - Plan #6 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$296.03
$335.99
$378.32
$528.70
$803.42 		$522.49
$562.45
$604.78
$755.16 		$748.95
$788.91
$831.24
$981.62 		$975.41
$1,015.37
$1,057.70
$1,208.08 		$226.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$592.06
$671.98
$756.64
$1,057.40
$1,606.84 		$818.52
$898.44
$983.10
$1,283.86 		$1,044.98
$1,124.90
$1,209.56
$1,510.32 		$1,271.44
$1,351.36
$1,436.02
$1,736.78 		$226.46
Toc - Plan #7 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 7200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$275.62
$312.83
$352.24
$492.26
$748.03 		$486.47
$523.68
$563.09
$703.11 		$697.32
$734.53
$773.94
$913.96 		$908.17
$945.38
$984.79
$1,124.81 		$210.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$551.24
$625.66
$704.48
$984.52
$1,496.06 		$762.09
$836.51
$915.33
$1,195.37 		$972.94
$1,047.36
$1,126.18
$1,406.22 		$1,183.79
$1,258.21
$1,337.03
$1,617.07 		$210.85
Toc - Plan #8 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 8000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$268.29
$304.51
$342.88
$479.17
$728.15 		$473.53
$509.75
$548.12
$684.41 		$678.77
$714.99
$753.36
$889.65 		$884.01
$920.23
$958.60
$1,094.89 		$205.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$536.58
$609.02
$685.76
$958.34
$1,456.30 		$741.82
$814.26
$891.00
$1,163.58 		$947.06
$1,019.50
$1,096.24
$1,368.82 		$1,152.30
$1,224.74
$1,301.48
$1,574.06 		$205.24
Toc - Plan #9 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO HSA Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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 		$355.16
$403.10
$453.89
$634.31
$963.89 		$626.85
$674.79
$725.58
$906.00 		$898.54
$946.48
$997.27
$1,177.69 		$1,170.23
$1,218.17
$1,268.96
$1,449.38 		$271.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$710.32
$806.20
$907.78
$1,268.62
$1,927.78 		$982.01
$1,077.89
$1,179.47
$1,540.31 		$1,253.70
$1,349.58
$1,451.16
$1,812.00 		$1,525.39
$1,621.27
$1,722.85
$2,083.69 		$271.69
Toc - Plan #10 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO HSA Bronze 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$274.05
$311.05
$350.23
$489.45
$743.77 		$483.70
$520.70
$559.88
$699.10 		$693.35
$730.35
$769.53
$908.75 		$903.00
$940.00
$979.18
$1,118.40 		$209.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$548.10
$622.10
$700.46
$978.90
$1,487.54 		$757.75
$831.75
$910.11
$1,188.55 		$967.40
$1,041.40
$1,119.76
$1,398.20 		$1,177.05
$1,251.05
$1,329.41
$1,607.85 		$209.65
Toc - Plan #11 Harvard Pilgrim Health Care
Gold

(HMO) NH Local HMO Gold 2000 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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 		$383.94
$435.77
$490.67
$685.71
$1,042.00 		$677.65
$729.48
$784.38
$979.42 		$971.36
$1,023.19
$1,078.09
$1,273.13 		$1,265.07
$1,316.90
$1,371.80
$1,566.84 		$293.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767.88
$871.54
$981.34
$1,371.42
$2,084.00 		$1,061.59
$1,165.25
$1,275.05
$1,665.13 		$1,355.30
$1,458.96
$1,568.76
$1,958.84 		$1,649.01
$1,752.67
$1,862.47
$2,252.55 		$293.71
Toc - Plan #12 Harvard Pilgrim Health Care
Silver

(HMO) NH Local HMO Silver 5800 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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 		$330.04
$374.59
$421.79
$589.45
$895.73 		$582.52
$627.07
$674.27
$841.93 		$835.00
$879.55
$926.75
$1,094.41 		$1,087.48
$1,132.03
$1,179.23
$1,346.89 		$252.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$660.08
$749.18
$843.58
$1,178.90
$1,791.46 		$912.56
$1,001.66
$1,096.06
$1,431.38 		$1,165.04
$1,254.14
$1,348.54
$1,683.86 		$1,417.52
$1,506.62
$1,601.02
$1,936.34 		$252.48
Toc - Plan #13 Harvard Pilgrim Health Care
Bronze

(HMO) NH Local HMO Bronze 9100 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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 		$264.63
$300.36
$338.20
$472.63
$718.21 		$467.07
$502.80
$540.64
$675.07 		$669.51
$705.24
$743.08
$877.51 		$871.95
$907.68
$945.52
$1,079.95 		$202.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$529.26
$600.72
$676.40
$945.26
$1,436.42 		$731.70
$803.16
$878.84
$1,147.70 		$934.14
$1,005.60
$1,081.28
$1,350.14 		$1,136.58
$1,208.04
$1,283.72
$1,552.58 		$202.44
Toc - Plan #14 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local HMO Bronze 7500 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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 		$281.90
$319.95
$360.27
$503.47
$765.07 		$497.55
$535.60
$575.92
$719.12 		$713.20
$751.25
$791.57
$934.77 		$928.85
$966.90
$1,007.22
$1,150.42 		$215.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$563.80
$639.90
$720.54
$1,006.94
$1,530.14 		$779.45
$855.55
$936.19
$1,222.59 		$995.10
$1,071.20
$1,151.84
$1,438.24 		$1,210.75
$1,286.85
$1,367.49
$1,653.89 		$215.65

ADVERTISEMENT

Ambetter from NH Healthy Families

Local: 1-844-265-1278 | Toll Free: 1-844-265-1278 | TTY: 1-855-742-0123
Toc - Plan #15 Ambetter from NH Healthy Families
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$307.88
$349.43
$393.46
$549.86
$835.56 		$543.40
$584.95
$628.98
$785.38 		$778.92
$820.47
$864.50
$1,020.90 		$1,014.44
$1,055.99
$1,100.02
$1,256.42 		$235.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$615.76
$698.86
$786.92
$1,099.72
$1,671.12 		$851.28
$934.38
$1,022.44
$1,335.24 		$1,086.80
$1,169.90
$1,257.96
$1,570.76 		$1,322.32
$1,405.42
$1,493.48
$1,806.28 		$235.52
Toc - Plan #16 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$239.60
$271.94
$306.20
$427.92
$650.26 		$422.89
$455.23
$489.49
$611.21 		$606.18
$638.52
$672.78
$794.50 		$789.47
$821.81
$856.07
$977.79 		$183.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$479.20
$543.88
$612.40
$855.84
$1,300.52 		$662.49
$727.17
$795.69
$1,039.13 		$845.78
$910.46
$978.98
$1,222.42 		$1,029.07
$1,093.75
$1,162.27
$1,405.71 		$183.29
Toc - Plan #17 Ambetter from NH Healthy Families
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$279.03
$316.69
$356.59
$498.33
$757.26 		$492.48
$530.14
$570.04
$711.78 		$705.93
$743.59
$783.49
$925.23 		$919.38
$957.04
$996.94
$1,138.68 		$213.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$558.06
$633.38
$713.18
$996.66
$1,514.52 		$771.51
$846.83
$926.63
$1,210.11 		$984.96
$1,060.28
$1,140.08
$1,423.56 		$1,198.41
$1,273.73
$1,353.53
$1,637.01 		$213.45
Toc - Plan #18 Ambetter from NH Healthy Families
Silver

(EPO) Elite Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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 		$288.96
$327.96
$369.28
$516.07
$784.22 		$510.01
$549.01
$590.33
$737.12 		$731.06
$770.06
$811.38
$958.17 		$952.11
$991.11
$1,032.43
$1,179.22 		$221.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$577.92
$655.92
$738.56
$1,032.14
$1,568.44 		$798.97
$876.97
$959.61
$1,253.19 		$1,020.02
$1,098.02
$1,180.66
$1,474.24 		$1,241.07
$1,319.07
$1,401.71
$1,695.29 		$221.05
Toc - Plan #19 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$262.96
$298.45
$336.05
$469.63
$713.64 		$464.12
$499.61
$537.21
$670.79 		$665.28
$700.77
$738.37
$871.95 		$866.44
$901.93
$939.53
$1,073.11 		$201.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$525.92
$596.90
$672.10
$939.26
$1,427.28 		$727.08
$798.06
$873.26
$1,140.42 		$928.24
$999.22
$1,074.42
$1,341.58 		$1,129.40
$1,200.38
$1,275.58
$1,542.74 		$201.16
Toc - Plan #20 Ambetter from NH Healthy Families
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$275.01
$312.13
$351.45
$491.15
$746.36 		$485.39
$522.51
$561.83
$701.53 		$695.77
$732.89
$772.21
$911.91 		$906.15
$943.27
$982.59
$1,122.29 		$210.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$550.02
$624.26
$702.90
$982.30
$1,492.72 		$760.40
$834.64
$913.28
$1,192.68 		$970.78
$1,045.02
$1,123.66
$1,403.06 		$1,181.16
$1,255.40
$1,334.04
$1,613.44 		$210.38
Toc - Plan #21 Ambetter from NH Healthy Families
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$295.21
$335.06
$377.27
$527.23
$801.18 		$521.04
$560.89
$603.10
$753.06 		$746.87
$786.72
$828.93
$978.89 		$972.70
$1,012.55
$1,054.76
$1,204.72 		$225.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$590.42
$670.12
$754.54
$1,054.46
$1,602.36 		$816.25
$895.95
$980.37
$1,280.29 		$1,042.08
$1,121.78
$1,206.20
$1,506.12 		$1,267.91
$1,347.61
$1,432.03
$1,731.95 		$225.83
Toc - Plan #22 Ambetter from NH Healthy Families
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$271.16
$307.76
$346.53
$484.28
$735.91 		$478.59
$515.19
$553.96
$691.71 		$686.02
$722.62
$761.39
$899.14 		$893.45
$930.05
$968.82
$1,106.57 		$207.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$542.32
$615.52
$693.06
$968.56
$1,471.82 		$749.75
$822.95
$900.49
$1,175.99 		$957.18
$1,030.38
$1,107.92
$1,383.42 		$1,164.61
$1,237.81
$1,315.35
$1,590.85 		$207.43
Toc - Plan #23 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$230.23
$261.30
$294.22
$411.17
$624.82 		$406.35
$437.42
$470.34
$587.29 		$582.47
$613.54
$646.46
$763.41 		$758.59
$789.66
$822.58
$939.53 		$176.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$460.46
$522.60
$588.44
$822.34
$1,249.64 		$636.58
$698.72
$764.56
$998.46 		$812.70
$874.84
$940.68
$1,174.58 		$988.82
$1,050.96
$1,116.80
$1,350.70 		$176.12
Toc - Plan #24 Ambetter from NH Healthy Families
Silver

(EPO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$272.81
$309.63
$348.64
$487.22
$740.37 		$481.50
$518.32
$557.33
$695.91 		$690.19
$727.01
$766.02
$904.60 		$898.88
$935.70
$974.71
$1,113.29 		$208.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$545.62
$619.26
$697.28
$974.44
$1,480.74 		$754.31
$827.95
$905.97
$1,183.13 		$963.00
$1,036.64
$1,114.66
$1,391.82 		$1,171.69
$1,245.33
$1,323.35
$1,600.51 		$208.69
Toc - Plan #25 Ambetter from NH Healthy Families
Gold

(EPO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$293.09
$332.65
$374.56
$523.45
$795.43 		$517.30
$556.86
$598.77
$747.66 		$741.51
$781.07
$822.98
$971.87 		$965.72
$1,005.28
$1,047.19
$1,196.08 		$224.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$586.18
$665.30
$749.12
$1,046.90
$1,590.86 		$810.39
$889.51
$973.33
$1,271.11 		$1,034.60
$1,113.72
$1,197.54
$1,495.32 		$1,258.81
$1,337.93
$1,421.75
$1,719.53 		$224.21
Toc - Plan #26 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$253.27
$287.46
$323.67
$452.33
$687.36 		$447.02
$481.21
$517.42
$646.08 		$640.77
$674.96
$711.17
$839.83 		$834.52
$868.71
$904.92
$1,033.58 		$193.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$506.54
$574.92
$647.34
$904.66
$1,374.72 		$700.29
$768.67
$841.09
$1,098.41 		$894.04
$962.42
$1,034.84
$1,292.16 		$1,087.79
$1,156.17
$1,228.59
$1,485.91 		$193.75
Toc - Plan #27 Ambetter from NH Healthy Families
Silver

(EPO) Elite Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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 		$305.45
$346.67
$390.35
$545.52
$828.96 		$539.11
$580.33
$624.01
$779.18 		$772.77
$813.99
$857.67
$1,012.84 		$1,006.43
$1,047.65
$1,091.33
$1,246.50 		$233.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$610.90
$693.34
$780.70
$1,091.04
$1,657.92 		$844.56
$927.00
$1,014.36
$1,324.70 		$1,078.22
$1,160.66
$1,248.02
$1,558.36 		$1,311.88
$1,394.32
$1,481.68
$1,792.02 		$233.66
Toc - Plan #28 Ambetter from NH Healthy Families
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$325.45
$369.37
$415.91
$581.23
$883.24 		$574.41
$618.33
$664.87
$830.19 		$823.37
$867.29
$913.83
$1,079.15 		$1,072.33
$1,116.25
$1,162.79
$1,328.11 		$248.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$650.90
$738.74
$831.82
$1,162.46
$1,766.48 		$899.86
$987.70
$1,080.78
$1,411.42 		$1,148.82
$1,236.66
$1,329.74
$1,660.38 		$1,397.78
$1,485.62
$1,578.70
$1,909.34 		$248.96
Toc - Plan #29 Ambetter from NH Healthy Families
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$294.95
$334.76
$376.93
$526.76
$800.47 		$520.58
$560.39
$602.56
$752.39 		$746.21
$786.02
$828.19
$978.02 		$971.84
$1,011.65
$1,053.82
$1,203.65 		$225.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$589.90
$669.52
$753.86
$1,053.52
$1,600.94 		$815.53
$895.15
$979.49
$1,279.15 		$1,041.16
$1,120.78
$1,205.12
$1,504.78 		$1,266.79
$1,346.41
$1,430.75
$1,730.41 		$225.63
Toc - Plan #30 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$277.96
$315.47
$355.22
$496.42
$754.36 		$490.59
$528.10
$567.85
$709.05 		$703.22
$740.73
$780.48
$921.68 		$915.85
$953.36
$993.11
$1,134.31 		$212.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$555.92
$630.94
$710.44
$992.84
$1,508.72 		$768.55
$843.57
$923.07
$1,205.47 		$981.18
$1,056.20
$1,135.70
$1,418.10 		$1,193.81
$1,268.83
$1,348.33
$1,630.73 		$212.63
Toc - Plan #31 Ambetter from NH Healthy Families
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$312.06
$354.17
$398.80
$557.32
$846.89 		$550.78
$592.89
$637.52
$796.04 		$789.50
$831.61
$876.24
$1,034.76 		$1,028.22
$1,070.33
$1,114.96
$1,273.48 		$238.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$624.12
$708.34
$797.60
$1,114.64
$1,693.78 		$862.84
$947.06
$1,036.32
$1,353.36 		$1,101.56
$1,185.78
$1,275.04
$1,592.08 		$1,340.28
$1,424.50
$1,513.76
$1,830.80 		$238.72
Toc - Plan #32 Ambetter from NH Healthy Families
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$286.63
$325.32
$366.30
$511.91
$777.89 		$505.90
$544.59
$585.57
$731.18 		$725.17
$763.86
$804.84
$950.45 		$944.44
$983.13
$1,024.11
$1,169.72 		$219.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$573.26
$650.64
$732.60
$1,023.82
$1,555.78 		$792.53
$869.91
$951.87
$1,243.09 		$1,011.80
$1,089.18
$1,171.14
$1,462.36 		$1,231.07
$1,308.45
$1,390.41
$1,681.63 		$219.27
Toc - Plan #33 Ambetter from NH Healthy Families
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$290.70
$329.94
$371.51
$519.18
$788.94 		$513.08
$552.32
$593.89
$741.56 		$735.46
$774.70
$816.27
$963.94 		$957.84
$997.08
$1,038.65
$1,186.32 		$222.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$581.40
$659.88
$743.02
$1,038.36
$1,577.88 		$803.78
$882.26
$965.40
$1,260.74 		$1,026.16
$1,104.64
$1,187.78
$1,483.12 		$1,248.54
$1,327.02
$1,410.16
$1,705.50 		$222.38
Toc - Plan #34 Ambetter from NH Healthy Families
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$230.15
$261.20
$294.11
$411.02
$624.59 		$406.20
$437.25
$470.16
$587.07 		$582.25
$613.30
$646.21
$763.12 		$758.30
$789.35
$822.26
$939.17 		$176.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$460.30
$522.40
$588.22
$822.04
$1,249.18 		$636.35
$698.45
$764.27
$998.09 		$812.40
$874.50
$940.32
$1,174.14 		$988.45
$1,050.55
$1,116.37
$1,350.19 		$176.05
Toc - Plan #35 Ambetter from NH Healthy Families
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$270.35
$306.84
$345.50
$482.83
$733.71 		$477.16
$513.65
$552.31
$689.64 		$683.97
$720.46
$759.12
$896.45 		$890.78
$927.27
$965.93
$1,103.26 		$206.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$540.70
$613.68
$691.00
$965.66
$1,467.42 		$747.51
$820.49
$897.81
$1,172.47 		$954.32
$1,027.30
$1,104.62
$1,379.28 		$1,161.13
$1,234.11
$1,311.43
$1,586.09 		$206.81
Toc - Plan #36 Ambetter from NH Healthy Families
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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 		$300.74
$341.33
$384.33
$537.10
$816.18 		$530.80
$571.39
$614.39
$767.16 		$760.86
$801.45
$844.45
$997.22 		$990.92
$1,031.51
$1,074.51
$1,227.28 		$230.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$601.48
$682.66
$768.66
$1,074.20
$1,632.36 		$831.54
$912.72
$998.72
$1,304.26 		$1,061.60
$1,142.78
$1,228.78
$1,534.32 		$1,291.66
$1,372.84
$1,458.84
$1,764.38 		$230.06

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

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

Toc - Plan #37 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 35% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$215.55
$244.65
$275.47
$384.97
$585.00 		$380.45
$409.55
$440.37
$549.87 		$545.35
$574.45
$605.27
$714.77 		$710.25
$739.35
$770.17
$879.67 		$164.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$431.10
$489.30
$550.94
$769.94
$1,170.00 		$596.00
$654.20
$715.84
$934.84 		$760.90
$819.10
$880.74
$1,099.74 		$925.80
$984.00
$1,045.64
$1,264.64 		$164.90
Toc - Plan #38 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 6000/20% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$216.22
$245.41
$276.33
$386.17
$586.82 		$381.63
$410.82
$441.74
$551.58 		$547.04
$576.23
$607.15
$716.99 		$712.45
$741.64
$772.56
$882.40 		$165.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$432.44
$490.82
$552.66
$772.34
$1,173.64 		$597.85
$656.23
$718.07
$937.75 		$763.26
$821.64
$883.48
$1,103.16 		$928.67
$987.05
$1,048.89
$1,268.57 		$165.41
Toc - Plan #39 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 15% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$264.59
$300.31
$338.15
$472.56
$718.10 		$467.00
$502.72
$540.56
$674.97 		$669.41
$705.13
$742.97
$877.38 		$871.82
$907.54
$945.38
$1,079.79 		$202.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$529.18
$600.62
$676.30
$945.12
$1,436.20 		$731.59
$803.03
$878.71
$1,147.53 		$934.00
$1,005.44
$1,081.12
$1,349.94 		$1,136.41
$1,207.85
$1,283.53
$1,552.35 		$202.41
Toc - Plan #40 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 4000/0% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$272.72
$309.54
$348.54
$487.08
$740.16 		$481.35
$518.17
$557.17
$695.71 		$689.98
$726.80
$765.80
$904.34 		$898.61
$935.43
$974.43
$1,112.97 		$208.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$545.44
$619.08
$697.08
$974.16
$1,480.32 		$754.07
$827.71
$905.71
$1,182.79 		$962.70
$1,036.34
$1,114.34
$1,391.42 		$1,171.33
$1,244.97
$1,322.97
$1,600.05 		$208.63
Toc - Plan #41 Anthem Blue Cross and Blue Shield
Catastrophic

(HMO) Anthem Catastrophic Pathway X Enhanced HMO 9100/0%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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 		$157.10
$178.31
$200.77
$280.58
$426.37 		$277.28
$298.49
$320.95
$400.76 		$397.46
$418.67
$441.13
$520.94 		$517.64
$538.85
$561.31
$641.12 		$120.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$314.20
$356.62
$401.54
$561.16
$852.74 		$434.38
$476.80
$521.72
$681.34 		$554.56
$596.98
$641.90
$801.52 		$674.74
$717.16
$762.08
$921.70 		$120.18
Toc - Plan #42 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 3700/0% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$3,700 $7,400 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 		$273.22
$310.10
$349.18
$487.97
$741.52 		$482.23
$519.11
$558.19
$696.98 		$691.24
$728.12
$767.20
$905.99 		$900.25
$937.13
$976.21
$1,115.00 		$209.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$546.44
$620.20
$698.36
$975.94
$1,483.04 		$755.45
$829.21
$907.37
$1,184.95 		$964.46
$1,038.22
$1,116.38
$1,393.96 		$1,173.47
$1,247.23
$1,325.39
$1,602.97 		$209.01
Toc - Plan #43 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 6500/40% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$212.90
$241.64
$272.09
$380.24
$577.81 		$375.77
$404.51
$434.96
$543.11 		$538.64
$567.38
$597.83
$705.98 		$701.51
$730.25
$760.70
$868.85 		$162.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$425.80
$483.28
$544.18
$760.48
$1,155.62 		$588.67
$646.15
$707.05
$923.35 		$751.54
$809.02
$869.92
$1,086.22 		$914.41
$971.89
$1,032.79
$1,249.09 		$162.87
Toc - Plan #44 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 5900/30% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$252.59
$286.69
$322.81
$451.13
$685.53 		$445.82
$479.92
$516.04
$644.36 		$639.05
$673.15
$709.27
$837.59 		$832.28
$866.38
$902.50
$1,030.82 		$193.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$505.18
$573.38
$645.62
$902.26
$1,371.06 		$698.41
$766.61
$838.85
$1,095.49 		$891.64
$959.84
$1,032.08
$1,288.72 		$1,084.87
$1,153.07
$1,225.31
$1,481.95 		$193.23
Toc - Plan #45 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced HMO 1500/20% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$1,500 $4,500 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 		$285.29
$323.80
$364.60
$509.53
$774.28 		$503.54
$542.05
$582.85
$727.78 		$721.79
$760.30
$801.10
$946.03 		$940.04
$978.55
$1,019.35
$1,164.28 		$218.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$570.58
$647.60
$729.20
$1,019.06
$1,548.56 		$788.83
$865.85
$947.45
$1,237.31 		$1,007.08
$1,084.10
$1,165.70
$1,455.56 		$1,225.33
$1,302.35
$1,383.95
$1,673.81 		$218.25
Toc - Plan #46 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 5500/25% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$217.85
$247.26
$278.41
$389.08
$591.24 		$384.51
$413.92
$445.07
$555.74 		$551.17
$580.58
$611.73
$722.40 		$717.83
$747.24
$778.39
$889.06 		$166.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$435.70
$494.52
$556.82
$778.16
$1,182.48 		$602.36
$661.18
$723.48
$944.82 		$769.02
$827.84
$890.14
$1,111.48 		$935.68
$994.50
$1,056.80
$1,278.14 		$166.66
Toc - Plan #47 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 5500/20% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$254.06
$288.36
$324.69
$453.75
$689.52 		$448.42
$482.72
$519.05
$648.11 		$642.78
$677.08
$713.41
$842.47 		$837.14
$871.44
$907.77
$1,036.83 		$194.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$508.12
$576.72
$649.38
$907.50
$1,379.04 		$702.48
$771.08
$843.74
$1,101.86 		$896.84
$965.44
$1,038.10
$1,296.22 		$1,091.20
$1,159.80
$1,232.46
$1,490.58 		$194.36
Toc - Plan #48 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 20% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$6,150 $12,300 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 		$252.50
$286.59
$322.70
$450.97
$685.29 		$445.66
$479.75
$515.86
$644.13 		$638.82
$672.91
$709.02
$837.29 		$831.98
$866.07
$902.18
$1,030.45 		$193.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$505.00
$573.18
$645.40
$901.94
$1,370.58 		$698.16
$766.34
$838.56
$1,095.10 		$891.32
$959.50
$1,031.72
$1,288.26 		$1,084.48
$1,152.66
$1,224.88
$1,481.42 		$193.16
Toc - Plan #49 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 4500/10% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$259.94
$295.03
$332.20
$464.25
$705.48 		$458.79
$493.88
$531.05
$663.10 		$657.64
$692.73
$729.90
$861.95 		$856.49
$891.58
$928.75
$1,060.80 		$198.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$519.88
$590.06
$664.40
$928.50
$1,410.96 		$718.73
$788.91
$863.25
$1,127.35 		$917.58
$987.76
$1,062.10
$1,326.20 		$1,116.43
$1,186.61
$1,260.95
$1,525.05 		$198.85
Toc - Plan #50 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced HMO 800/40% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$800 $1,600 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 		$280.76
$318.66
$358.81
$501.44
$761.98 		$495.54
$533.44
$573.59
$716.22 		$710.32
$748.22
$788.37
$931.00 		$925.10
$963.00
$1,003.15
$1,145.78 		$214.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561.52
$637.32
$717.62
$1,002.88
$1,523.96 		$776.30
$852.10
$932.40
$1,217.66 		$991.08
$1,066.88
$1,147.18
$1,432.44 		$1,205.86
$1,281.66
$1,361.96
$1,647.22 		$214.78
Toc - Plan #51 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 3300/35% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$3,300 $6,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$256.08
$290.65
$327.27
$457.36
$695.00 		$451.98
$486.55
$523.17
$653.26 		$647.88
$682.45
$719.07
$849.16 		$843.78
$878.35
$914.97
$1,045.06 		$195.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$512.16
$581.30
$654.54
$914.72
$1,390.00 		$708.06
$777.20
$850.44
$1,110.62 		$903.96
$973.10
$1,046.34
$1,306.52 		$1,099.86
$1,169.00
$1,242.24
$1,502.42 		$195.90
Toc - Plan #52 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 7500/50% ($0 Preferred Virtual Care + $0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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 		$218.47
$247.96
$279.20
$390.19
$592.93 		$385.60
$415.09
$446.33
$557.32 		$552.73
$582.22
$613.46
$724.45 		$719.86
$749.35
$780.59
$891.58 		$167.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$436.94
$495.92
$558.40
$780.38
$1,185.86 		$604.07
$663.05
$725.53
$947.51 		$771.20
$830.18
$892.66
$1,114.64 		$938.33
$997.31
$1,059.79
$1,281.77 		$167.13
Toc - Plan #53 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced HMO 5800/40% ($0 Preferred Virtual Care + $0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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 		$247.99
$281.47
$316.93
$442.91
$673.04 		$437.70
$471.18
$506.64
$632.62 		$627.41
$660.89
$696.35
$822.33 		$817.12
$850.60
$886.06
$1,012.04 		$189.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$495.98
$562.94
$633.86
$885.82
$1,346.08 		$685.69
$752.65
$823.57
$1,075.53 		$875.40
$942.36
$1,013.28
$1,265.24 		$1,065.11
$1,132.07
$1,202.99
$1,454.95 		$189.71
Toc - Plan #54 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced HMO 2000/25% ($0 Preferred Virtual Care + $0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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 		$281.92
$319.98
$360.29
$503.51
$765.13 		$497.59
$535.65
$575.96
$719.18 		$713.26
$751.32
$791.63
$934.85 		$928.93
$966.99
$1,007.30
$1,150.52 		$215.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$563.84
$639.96
$720.58
$1,007.02
$1,530.26 		$779.51
$855.63
$936.25
$1,222.69 		$995.18
$1,071.30
$1,151.92
$1,438.36 		$1,210.85
$1,286.97
$1,367.59
$1,654.03 		$215.67
Toc - Plan #55 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X Enhanced HMO 9100/0% ($0 Preferred Virtual Care+$0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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 		$207.84
$235.90
$265.62
$371.20
$564.08 		$366.84
$394.90
$424.62
$530.20 		$525.84
$553.90
$583.62
$689.20 		$684.84
$712.90
$742.62
$848.20 		$159.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$415.68
$471.80
$531.24
$742.40
$1,128.16 		$574.68
$630.80
$690.24
$901.40 		$733.68
$789.80
$849.24
$1,060.40 		$892.68
$948.80
$1,008.24
$1,219.40 		$159.00

‡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 Cheshire County here.

Cheshire County is in “Rating Area 1” of New Hampshire.

Currently, there are 55 plans offered in Rating Area 1.

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2023 Obamacare Plans for Cheshire County, NH

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