Gaston County, North Carolina Obamacare 2024 Rates

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Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Gaston County, NC.

The health insurance rates listed below are for calendar year 2024.

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

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 61 Plans and 2024 Rates for Gaston County, North Carolina

Below, you’ll find a summary of the 61 plans for Gaston County, North Carolina and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |



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Blue Cross and Blue Shield of NC

Local: 1-800-324-4973 | Toll Free: 1-800-324-4973

Toc - Plan #1 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Value Gold | 3 Free PCP | $10 Tier 1 Rx | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 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
$459.17
$521.16
$586.82
$820.08
$1,246.19
$810.44
$872.43
$938.09
$1,171.35
$1,161.71
$1,223.70
$1,289.36
$1,522.62
$1,512.98
$1,574.97
$1,640.63
$1,873.89
$351.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.34
$1,042.32
$1,173.64
$1,640.16
$2,492.38
$1,269.61
$1,393.59
$1,524.91
$1,991.43
$1,620.88
$1,744.86
$1,876.18
$2,342.70
$1,972.15
$2,096.13
$2,227.45
$2,693.97
$351.27
Toc - Plan #2 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$464.45
$527.15
$593.57
$829.51
$1,260.52
$819.75
$882.45
$948.87
$1,184.81
$1,175.05
$1,237.75
$1,304.17
$1,540.11
$1,530.35
$1,593.05
$1,659.47
$1,895.41
$355.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$928.90
$1,054.30
$1,187.14
$1,659.02
$2,521.04
$1,284.20
$1,409.60
$1,542.44
$2,014.32
$1,639.50
$1,764.90
$1,897.74
$2,369.62
$1,994.80
$2,120.20
$2,253.04
$2,724.92
$355.30
Toc - Plan #3 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze | $60 PCP | $20 Tier 1 Rx | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$355.16
$403.11
$453.89
$634.32
$963.90
$626.86
$674.81
$725.59
$906.02
$898.56
$946.51
$997.29
$1,177.72
$1,170.26
$1,218.21
$1,268.99
$1,449.42
$271.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$710.32
$806.22
$907.78
$1,268.64
$1,927.80
$982.02
$1,077.92
$1,179.48
$1,540.34
$1,253.72
$1,349.62
$1,451.18
$1,812.04
$1,525.42
$1,621.32
$1,722.88
$2,083.74
$271.70
Toc - Plan #4 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze | HSA Eligible | Integrated | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$336.27
$381.67
$429.75
$600.58
$912.64
$593.52
$638.92
$687.00
$857.83
$850.77
$896.17
$944.25
$1,115.08
$1,108.02
$1,153.42
$1,201.50
$1,372.33
$257.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$672.54
$763.34
$859.50
$1,201.16
$1,825.28
$929.79
$1,020.59
$1,116.75
$1,458.41
$1,187.04
$1,277.84
$1,374.00
$1,715.66
$1,444.29
$1,535.09
$1,631.25
$1,972.91
$257.25
Toc - Plan #5 Blue Cross and Blue Shield of NC
Catastrophic

(POS) Blue Value Catastrophic | 3 PCP $35 | Integrated | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$265.67
$301.54
$339.53
$474.49
$721.03
$468.91
$504.78
$542.77
$677.73
$672.15
$708.02
$746.01
$880.97
$875.39
$911.26
$949.25
$1,084.21
$203.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$531.34
$603.08
$679.06
$948.98
$1,442.06
$734.58
$806.32
$882.30
$1,152.22
$937.82
$1,009.56
$1,085.54
$1,355.46
$1,141.06
$1,212.80
$1,288.78
$1,558.70
$203.24
Toc - Plan #6 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$442.70
$502.46
$565.77
$790.66
$1,201.49
$781.37
$841.13
$904.44
$1,129.33
$1,120.04
$1,179.80
$1,243.11
$1,468.00
$1,458.71
$1,518.47
$1,581.78
$1,806.67
$338.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$885.40
$1,004.92
$1,131.54
$1,581.32
$2,402.98
$1,224.07
$1,343.59
$1,470.21
$1,919.99
$1,562.74
$1,682.26
$1,808.88
$2,258.66
$1,901.41
$2,020.93
$2,147.55
$2,597.33
$338.67
Toc - Plan #7 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Secure | $15 PCP | $15 Tier 1 Rx | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$461.29
$523.56
$589.53
$823.86
$1,251.94
$814.18
$876.45
$942.42
$1,176.75
$1,167.07
$1,229.34
$1,295.31
$1,529.64
$1,519.96
$1,582.23
$1,648.20
$1,882.53
$352.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$922.58
$1,047.12
$1,179.06
$1,647.72
$2,503.88
$1,275.47
$1,400.01
$1,531.95
$2,000.61
$1,628.36
$1,752.90
$1,884.84
$2,353.50
$1,981.25
$2,105.79
$2,237.73
$2,706.39
$352.89
Toc - Plan #8 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$335.26
$380.52
$428.46
$598.77
$909.90
$591.73
$636.99
$684.93
$855.24
$848.20
$893.46
$941.40
$1,111.71
$1,104.67
$1,149.93
$1,197.87
$1,368.18
$256.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$670.52
$761.04
$856.92
$1,197.54
$1,819.80
$926.99
$1,017.51
$1,113.39
$1,454.01
$1,183.46
$1,273.98
$1,369.86
$1,710.48
$1,439.93
$1,530.45
$1,626.33
$1,966.95
$256.47
Toc - Plan #9 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Value Gold Standard | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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
$459.28
$521.28
$586.96
$820.27
$1,246.49
$810.63
$872.63
$938.31
$1,171.62
$1,161.98
$1,223.98
$1,289.66
$1,522.97
$1,513.33
$1,575.33
$1,641.01
$1,874.32
$351.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.56
$1,042.56
$1,173.92
$1,640.54
$2,492.98
$1,269.91
$1,393.91
$1,525.27
$1,991.89
$1,621.26
$1,745.26
$1,876.62
$2,343.24
$1,972.61
$2,096.61
$2,227.97
$2,694.59
$351.35
Toc - Plan #10 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Standard | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$449.33
$509.99
$574.24
$802.50
$1,219.48
$793.07
$853.73
$917.98
$1,146.24
$1,136.81
$1,197.47
$1,261.72
$1,489.98
$1,480.55
$1,541.21
$1,605.46
$1,833.72
$343.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$898.66
$1,019.98
$1,148.48
$1,605.00
$2,438.96
$1,242.40
$1,363.72
$1,492.22
$1,948.74
$1,586.14
$1,707.46
$1,835.96
$2,292.48
$1,929.88
$2,051.20
$2,179.70
$2,636.22
$343.74
Toc - Plan #11 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze Standard | Statewide Doctors

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343.96
$390.39
$439.58
$614.31
$933.51
$607.09
$653.52
$702.71
$877.44
$870.22
$916.65
$965.84
$1,140.57
$1,133.35
$1,179.78
$1,228.97
$1,403.70
$263.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$687.92
$780.78
$879.16
$1,228.62
$1,867.02
$951.05
$1,043.91
$1,142.29
$1,491.75
$1,214.18
$1,307.04
$1,405.42
$1,754.88
$1,477.31
$1,570.17
$1,668.55
$2,018.01
$263.13
Toc - Plan #12 Blue Cross and Blue Shield of NC
Gold

(EPO) Blue Local Gold | 3 Free PCP | $10 Tier 1 Rx | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 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
$462.05
$524.43
$590.50
$825.22
$1,254.00
$815.52
$877.90
$943.97
$1,178.69
$1,168.99
$1,231.37
$1,297.44
$1,532.16
$1,522.46
$1,584.84
$1,650.91
$1,885.63
$353.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$924.10
$1,048.86
$1,181.00
$1,650.44
$2,508.00
$1,277.57
$1,402.33
$1,534.47
$2,003.91
$1,631.04
$1,755.80
$1,887.94
$2,357.38
$1,984.51
$2,109.27
$2,241.41
$2,710.85
$353.47
Toc - Plan #13 Blue Cross and Blue Shield of NC
Gold

(EPO) Blue Local Gold Standard | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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
$462.10
$524.48
$590.56
$825.31
$1,254.14
$815.61
$877.99
$944.07
$1,178.82
$1,169.12
$1,231.50
$1,297.58
$1,532.33
$1,522.63
$1,585.01
$1,651.09
$1,885.84
$353.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$924.20
$1,048.96
$1,181.12
$1,650.62
$2,508.28
$1,277.71
$1,402.47
$1,534.63
$2,004.13
$1,631.22
$1,755.98
$1,888.14
$2,357.64
$1,984.73
$2,109.49
$2,241.65
$2,711.15
$353.51
Toc - Plan #14 Blue Cross and Blue Shield of NC
Silver

(EPO) Blue Local Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$445.44
$505.57
$569.27
$795.56
$1,208.92
$786.20
$846.33
$910.03
$1,136.32
$1,126.96
$1,187.09
$1,250.79
$1,477.08
$1,467.72
$1,527.85
$1,591.55
$1,817.84
$340.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890.88
$1,011.14
$1,138.54
$1,591.12
$2,417.84
$1,231.64
$1,351.90
$1,479.30
$1,931.88
$1,572.40
$1,692.66
$1,820.06
$2,272.64
$1,913.16
$2,033.42
$2,160.82
$2,613.40
$340.76
Toc - Plan #15 Blue Cross and Blue Shield of NC
Silver

(EPO) Blue Local Silver Secure | $15 PCP | $15 Tier 1 Rx | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$464.16
$526.82
$593.20
$828.99
$1,259.73
$819.24
$881.90
$948.28
$1,184.07
$1,174.32
$1,236.98
$1,303.36
$1,539.15
$1,529.40
$1,592.06
$1,658.44
$1,894.23
$355.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$928.32
$1,053.64
$1,186.40
$1,657.98
$2,519.46
$1,283.40
$1,408.72
$1,541.48
$2,013.06
$1,638.48
$1,763.80
$1,896.56
$2,368.14
$1,993.56
$2,118.88
$2,251.64
$2,723.22
$355.08
Toc - Plan #16 Blue Cross and Blue Shield of NC
Silver

(EPO) Blue Local Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$467.36
$530.45
$597.29
$834.70
$1,268.42
$824.89
$887.98
$954.82
$1,192.23
$1,182.42
$1,245.51
$1,312.35
$1,549.76
$1,539.95
$1,603.04
$1,669.88
$1,907.29
$357.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$934.72
$1,060.90
$1,194.58
$1,669.40
$2,536.84
$1,292.25
$1,418.43
$1,552.11
$2,026.93
$1,649.78
$1,775.96
$1,909.64
$2,384.46
$2,007.31
$2,133.49
$2,267.17
$2,741.99
$357.53
Toc - Plan #17 Blue Cross and Blue Shield of NC
Expanded Bronze

(EPO) Blue Local Bronze | $60 PCP | $20 Tier 1 Rx | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$357.40
$405.65
$456.76
$638.32
$969.98
$630.81
$679.06
$730.17
$911.73
$904.22
$952.47
$1,003.58
$1,185.14
$1,177.63
$1,225.88
$1,276.99
$1,458.55
$273.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$714.80
$811.30
$913.52
$1,276.64
$1,939.96
$988.21
$1,084.71
$1,186.93
$1,550.05
$1,261.62
$1,358.12
$1,460.34
$1,823.46
$1,535.03
$1,631.53
$1,733.75
$2,096.87
$273.41
Toc - Plan #18 Blue Cross and Blue Shield of NC
Silver

(EPO) Blue Local Silver Standard | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$452.14
$513.18
$577.83
$807.52
$1,227.11
$798.03
$859.07
$923.72
$1,153.41
$1,143.92
$1,204.96
$1,269.61
$1,499.30
$1,489.81
$1,550.85
$1,615.50
$1,845.19
$345.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$904.28
$1,026.36
$1,155.66
$1,615.04
$2,454.22
$1,250.17
$1,372.25
$1,501.55
$1,960.93
$1,596.06
$1,718.14
$1,847.44
$2,306.82
$1,941.95
$2,064.03
$2,193.33
$2,652.71
$345.89
Toc - Plan #19 Blue Cross and Blue Shield of NC
Expanded Bronze

(EPO) Blue Local Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$337.38
$382.93
$431.17
$602.56
$915.65
$595.48
$641.03
$689.27
$860.66
$853.58
$899.13
$947.37
$1,118.76
$1,111.68
$1,157.23
$1,205.47
$1,376.86
$258.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$674.76
$765.86
$862.34
$1,205.12
$1,831.30
$932.86
$1,023.96
$1,120.44
$1,463.22
$1,190.96
$1,282.06
$1,378.54
$1,721.32
$1,449.06
$1,540.16
$1,636.64
$1,979.42
$258.10
Toc - Plan #20 Blue Cross and Blue Shield of NC
Expanded Bronze

(EPO) Blue Local Bronze Standard | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346.15
$392.88
$442.38
$618.22
$939.45
$610.95
$657.68
$707.18
$883.02
$875.75
$922.48
$971.98
$1,147.82
$1,140.55
$1,187.28
$1,236.78
$1,412.62
$264.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692.30
$785.76
$884.76
$1,236.44
$1,878.90
$957.10
$1,050.56
$1,149.56
$1,501.24
$1,221.90
$1,315.36
$1,414.36
$1,766.04
$1,486.70
$1,580.16
$1,679.16
$2,030.84
$264.80
Toc - Plan #21 Blue Cross and Blue Shield of NC
Expanded Bronze

(EPO) Blue Local Bronze | HSA Eligible | Integrated | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$338.41
$384.10
$432.49
$604.40
$918.44
$597.29
$642.98
$691.37
$863.28
$856.17
$901.86
$950.25
$1,122.16
$1,115.05
$1,160.74
$1,209.13
$1,381.04
$258.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$676.82
$768.20
$864.98
$1,208.80
$1,836.88
$935.70
$1,027.08
$1,123.86
$1,467.68
$1,194.58
$1,285.96
$1,382.74
$1,726.56
$1,453.46
$1,544.84
$1,641.62
$1,985.44
$258.88
Toc - Plan #22 Blue Cross and Blue Shield of NC
Catastrophic

(EPO) Blue Local Catastrophic | 3 PCP $35 | Integrated | with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$267.30
$303.39
$341.61
$477.40
$725.45
$471.78
$507.87
$546.09
$681.88
$676.26
$712.35
$750.57
$886.36
$880.74
$916.83
$955.05
$1,090.84
$204.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$534.60
$606.78
$683.22
$954.80
$1,450.90
$739.08
$811.26
$887.70
$1,159.28
$943.56
$1,015.74
$1,092.18
$1,363.76
$1,148.04
$1,220.22
$1,296.66
$1,568.24
$204.48

ADVERTISEMENT

WellCare of North Carolina

Local: 1-833-925-2861 | Toll Free: 1-833-925-2861 | TTY: 1-833-925-2861

Toc - Plan #23 WellCare of North Carolina
Expanded Bronze

(PPO) WellCare Secure Health Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$761.20
$863.96
$972.81
$1,359.49
$2,065.88
$1,343.51
$1,446.27
$1,555.12
$1,941.80
$1,925.82
$2,028.58
$2,137.43
$2,524.11
$2,508.13
$2,610.89
$2,719.74
$3,106.42
$582.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,522.40
$1,727.92
$1,945.62
$2,718.98
$4,131.76
$2,104.71
$2,310.23
$2,527.93
$3,301.29
$2,687.02
$2,892.54
$3,110.24
$3,883.60
$3,269.33
$3,474.85
$3,692.55
$4,465.91
$582.31
Toc - Plan #24 WellCare of North Carolina
Silver

(PPO) WellCare Secure Health Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 Annual Deductible
$8,100 $16,200 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
$988.79
$1,122.26
$1,263.66
$1,765.96
$2,683.54
$1,745.21
$1,878.68
$2,020.08
$2,522.38
$2,501.63
$2,635.10
$2,776.50
$3,278.80
$3,258.05
$3,391.52
$3,532.92
$4,035.22
$756.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,977.58
$2,244.52
$2,527.32
$3,531.92
$5,367.08
$2,734.00
$3,000.94
$3,283.74
$4,288.34
$3,490.42
$3,757.36
$4,040.16
$5,044.76
$4,246.84
$4,513.78
$4,796.58
$5,801.18
$756.42
Toc - Plan #25 WellCare of North Carolina
Gold

(PPO) WellCare Secure Health Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

Annual Out of Pocket Expenses:

Individual Family
$1,850 $3,700 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
$1,033.09
$1,172.54
$1,320.27
$1,845.07
$2,803.77
$1,823.39
$1,962.84
$2,110.57
$2,635.37
$2,613.69
$2,753.14
$2,900.87
$3,425.67
$3,403.99
$3,543.44
$3,691.17
$4,215.97
$790.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,066.18
$2,345.08
$2,640.54
$3,690.14
$5,607.54
$2,856.48
$3,135.38
$3,430.84
$4,480.44
$3,646.78
$3,925.68
$4,221.14
$5,270.74
$4,437.08
$4,715.98
$5,011.44
$6,061.04
$790.30
Toc - Plan #26 WellCare of North Carolina
Expanded Bronze

(PPO) Standard Expanded Bronze WellCare

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$755.11
$857.04
$965.02
$1,348.61
$2,049.34
$1,332.76
$1,434.69
$1,542.67
$1,926.26
$1,910.41
$2,012.34
$2,120.32
$2,503.91
$2,488.06
$2,589.99
$2,697.97
$3,081.56
$577.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,510.22
$1,714.08
$1,930.04
$2,697.22
$4,098.68
$2,087.87
$2,291.73
$2,507.69
$3,274.87
$2,665.52
$2,869.38
$3,085.34
$3,852.52
$3,243.17
$3,447.03
$3,662.99
$4,430.17
$577.65
Toc - Plan #27 WellCare of North Carolina
Silver

(PPO) Standard Silver WellCare

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$967.22
$1,097.78
$1,236.09
$1,727.44
$2,625.01
$1,707.14
$1,837.70
$1,976.01
$2,467.36
$2,447.06
$2,577.62
$2,715.93
$3,207.28
$3,186.98
$3,317.54
$3,455.85
$3,947.20
$739.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,934.44
$2,195.56
$2,472.18
$3,454.88
$5,250.02
$2,674.36
$2,935.48
$3,212.10
$4,194.80
$3,414.28
$3,675.40
$3,952.02
$4,934.72
$4,154.20
$4,415.32
$4,691.94
$5,674.64
$739.92
Toc - Plan #28 WellCare of North Carolina
Gold

(PPO) Standard Gold WellCare

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-925-2861

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
$1,003.59
$1,139.06
$1,282.57
$1,792.39
$2,723.71
$1,771.33
$1,906.80
$2,050.31
$2,560.13
$2,539.07
$2,674.54
$2,818.05
$3,327.87
$3,306.81
$3,442.28
$3,585.79
$4,095.61
$767.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,007.18
$2,278.12
$2,565.14
$3,584.78
$5,447.42
$2,774.92
$3,045.86
$3,332.88
$4,352.52
$3,542.66
$3,813.60
$4,100.62
$5,120.26
$4,310.40
$4,581.34
$4,868.36
$5,888.00
$767.74

ADVERTISEMENT

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #29 Aetna CVS Health
Expanded Bronze

(HMO) Bronze 2 HSA: Aetna network of doctors & hospitals + MinuteClinic + Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 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
$295.60
$335.50
$377.77
$527.94
$802.25
$521.73
$561.63
$603.90
$754.07
$747.86
$787.76
$830.03
$980.20
$973.99
$1,013.89
$1,056.16
$1,206.33
$226.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$591.20
$671.00
$755.54
$1,055.88
$1,604.50
$817.33
$897.13
$981.67
$1,282.01
$1,043.46
$1,123.26
$1,207.80
$1,508.14
$1,269.59
$1,349.39
$1,433.93
$1,734.27
$226.13
Toc - Plan #30 Aetna CVS Health
Silver

(HMO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,845 $17,690 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
$405.63
$460.39
$518.40
$724.46
$1,100.88
$715.94
$770.70
$828.71
$1,034.77
$1,026.25
$1,081.01
$1,139.02
$1,345.08
$1,336.56
$1,391.32
$1,449.33
$1,655.39
$310.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811.26
$920.78
$1,036.80
$1,448.92
$2,201.76
$1,121.57
$1,231.09
$1,347.11
$1,759.23
$1,431.88
$1,541.40
$1,657.42
$2,069.54
$1,742.19
$1,851.71
$1,967.73
$2,379.85
$310.31
Toc - Plan #31 Aetna CVS Health
Silver

(HMO) Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.25
$466.76
$525.57
$734.48
$1,116.11
$725.85
$781.36
$840.17
$1,049.08
$1,040.45
$1,095.96
$1,154.77
$1,363.68
$1,355.05
$1,410.56
$1,469.37
$1,678.28
$314.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822.50
$933.52
$1,051.14
$1,468.96
$2,232.22
$1,137.10
$1,248.12
$1,365.74
$1,783.56
$1,451.70
$1,562.72
$1,680.34
$2,098.16
$1,766.30
$1,877.32
$1,994.94
$2,412.76
$314.60
Toc - Plan #32 Aetna CVS Health
Expanded Bronze

(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$300.87
$341.49
$384.51
$537.35
$816.56
$531.04
$571.66
$614.68
$767.52
$761.21
$801.83
$844.85
$997.69
$991.38
$1,032.00
$1,075.02
$1,227.86
$230.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$601.74
$682.98
$769.02
$1,074.70
$1,633.12
$831.91
$913.15
$999.19
$1,304.87
$1,062.08
$1,143.32
$1,229.36
$1,535.04
$1,292.25
$1,373.49
$1,459.53
$1,765.21
$230.17
Toc - Plan #33 Aetna CVS Health
Gold

(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

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
$406.29
$461.14
$519.24
$725.63
$1,102.67
$717.10
$771.95
$830.05
$1,036.44
$1,027.91
$1,082.76
$1,140.86
$1,347.25
$1,338.72
$1,393.57
$1,451.67
$1,658.06
$310.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812.58
$922.28
$1,038.48
$1,451.26
$2,205.34
$1,123.39
$1,233.09
$1,349.29
$1,762.07
$1,434.20
$1,543.90
$1,660.10
$2,072.88
$1,745.01
$1,854.71
$1,970.91
$2,383.69
$310.81
Toc - Plan #34 Aetna CVS Health
Silver

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$397.03
$450.62
$507.40
$709.09
$1,077.52
$700.76
$754.35
$811.13
$1,012.82
$1,004.49
$1,058.08
$1,114.86
$1,316.55
$1,308.22
$1,361.81
$1,418.59
$1,620.28
$303.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$794.06
$901.24
$1,014.80
$1,418.18
$2,155.04
$1,097.79
$1,204.97
$1,318.53
$1,721.91
$1,401.52
$1,508.70
$1,622.26
$2,025.64
$1,705.25
$1,812.43
$1,925.99
$2,329.37
$303.73
Toc - Plan #35 Aetna CVS Health
Expanded Bronze

(HMO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$333.32
$378.32
$425.98
$595.31
$904.63
$588.31
$633.31
$680.97
$850.30
$843.30
$888.30
$935.96
$1,105.29
$1,098.29
$1,143.29
$1,190.95
$1,360.28
$254.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$666.64
$756.64
$851.96
$1,190.62
$1,809.26
$921.63
$1,011.63
$1,106.95
$1,445.61
$1,176.62
$1,266.62
$1,361.94
$1,700.60
$1,431.61
$1,521.61
$1,616.93
$1,955.59
$254.99
Toc - Plan #36 Aetna CVS Health
Gold

(HMO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,195 $18,390 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
$406.96
$461.90
$520.10
$726.83
$1,104.49
$718.29
$773.23
$831.43
$1,038.16
$1,029.62
$1,084.56
$1,142.76
$1,349.49
$1,340.95
$1,395.89
$1,454.09
$1,660.82
$311.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$813.92
$923.80
$1,040.20
$1,453.66
$2,208.98
$1,125.25
$1,235.13
$1,351.53
$1,764.99
$1,436.58
$1,546.46
$1,662.86
$2,076.32
$1,747.91
$1,857.79
$1,974.19
$2,387.65
$311.33
Toc - Plan #37 Aetna CVS Health
Gold

(HMO) Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$410.63
$466.06
$524.78
$733.37
$1,114.43
$724.76
$780.19
$838.91
$1,047.50
$1,038.89
$1,094.32
$1,153.04
$1,361.63
$1,353.02
$1,408.45
$1,467.17
$1,675.76
$314.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$821.26
$932.12
$1,049.56
$1,466.74
$2,228.86
$1,135.39
$1,246.25
$1,363.69
$1,780.87
$1,449.52
$1,560.38
$1,677.82
$2,095.00
$1,763.65
$1,874.51
$1,991.95
$2,409.13
$314.13
Toc - Plan #38 Aetna CVS Health
Silver

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,395 $16,790 Annual Deductible
$8,885 $17,770 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
$397.18
$450.80
$507.60
$709.36
$1,077.94
$701.03
$754.65
$811.45
$1,013.21
$1,004.88
$1,058.50
$1,115.30
$1,317.06
$1,308.73
$1,362.35
$1,419.15
$1,620.91
$303.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$794.36
$901.60
$1,015.20
$1,418.72
$2,155.88
$1,098.21
$1,205.45
$1,319.05
$1,722.57
$1,402.06
$1,509.30
$1,622.90
$2,026.42
$1,705.91
$1,813.15
$1,926.75
$2,330.27
$303.85
Toc - Plan #39 Aetna CVS Health
Silver

(HMO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,445 $16,890 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
$405.67
$460.44
$518.45
$724.52
$1,100.98
$716.01
$770.78
$828.79
$1,034.86
$1,026.35
$1,081.12
$1,139.13
$1,345.20
$1,336.69
$1,391.46
$1,449.47
$1,655.54
$310.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811.34
$920.88
$1,036.90
$1,449.04
$2,201.96
$1,121.68
$1,231.22
$1,347.24
$1,759.38
$1,432.02
$1,541.56
$1,657.58
$2,069.72
$1,742.36
$1,851.90
$1,967.92
$2,380.06
$310.34

ADVERTISEMENT

Ambetter of North Carolina

Local: 1-833-863-1310 | Toll Free: 1-833-863-1310 | TTY: 1-833-863-1310

Toc - Plan #40 Ambetter of North Carolina
Expanded Bronze

(HMO) Choice Bronze HSA with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$345.93
$392.62
$442.09
$617.82
$938.84
$610.56
$657.25
$706.72
$882.45
$875.19
$921.88
$971.35
$1,147.08
$1,139.82
$1,186.51
$1,235.98
$1,411.71
$264.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$691.86
$785.24
$884.18
$1,235.64
$1,877.68
$956.49
$1,049.87
$1,148.81
$1,500.27
$1,221.12
$1,314.50
$1,413.44
$1,764.90
$1,485.75
$1,579.13
$1,678.07
$2,029.53
$264.63
Toc - Plan #41 Ambetter of North Carolina
Expanded Bronze

(HMO) Everyday Bronze with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$339.27
$385.06
$433.57
$605.91
$920.74
$598.80
$644.59
$693.10
$865.44
$858.33
$904.12
$952.63
$1,124.97
$1,117.86
$1,163.65
$1,212.16
$1,384.50
$259.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.54
$770.12
$867.14
$1,211.82
$1,841.48
$938.07
$1,029.65
$1,126.67
$1,471.35
$1,197.60
$1,289.18
$1,386.20
$1,730.88
$1,457.13
$1,548.71
$1,645.73
$1,990.41
$259.53
Toc - Plan #42 Ambetter of North Carolina
Expanded Bronze

(HMO) Elite Bronze with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.37
$439.65
$495.04
$691.82
$1,051.29
$683.70
$735.98
$791.37
$988.15
$980.03
$1,032.31
$1,087.70
$1,284.48
$1,276.36
$1,328.64
$1,384.03
$1,580.81
$296.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774.74
$879.30
$990.08
$1,383.64
$2,102.58
$1,071.07
$1,175.63
$1,286.41
$1,679.97
$1,367.40
$1,471.96
$1,582.74
$1,976.30
$1,663.73
$1,768.29
$1,879.07
$2,272.63
$296.33
Toc - Plan #43 Ambetter of North Carolina
Silver

(HMO) Complete Silver with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$434.67
$493.34
$555.50
$776.30
$1,179.67
$767.18
$825.85
$888.01
$1,108.81
$1,099.69
$1,158.36
$1,220.52
$1,441.32
$1,432.20
$1,490.87
$1,553.03
$1,773.83
$332.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.34
$986.68
$1,111.00
$1,552.60
$2,359.34
$1,201.85
$1,319.19
$1,443.51
$1,885.11
$1,534.36
$1,651.70
$1,776.02
$2,217.62
$1,866.87
$1,984.21
$2,108.53
$2,550.13
$332.51
Toc - Plan #44 Ambetter of North Carolina
Silver

(HMO) Everyday Silver with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$430.64
$488.77
$550.35
$769.11
$1,168.74
$760.08
$818.21
$879.79
$1,098.55
$1,089.52
$1,147.65
$1,209.23
$1,427.99
$1,418.96
$1,477.09
$1,538.67
$1,757.43
$329.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$861.28
$977.54
$1,100.70
$1,538.22
$2,337.48
$1,190.72
$1,306.98
$1,430.14
$1,867.66
$1,520.16
$1,636.42
$1,759.58
$2,197.10
$1,849.60
$1,965.86
$2,089.02
$2,526.54
$329.44
Toc - Plan #45 Ambetter of North Carolina
Silver

(HMO) Clear Silver with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$422.22
$479.20
$539.58
$754.06
$1,145.86
$745.21
$802.19
$862.57
$1,077.05
$1,068.20
$1,125.18
$1,185.56
$1,400.04
$1,391.19
$1,448.17
$1,508.55
$1,723.03
$322.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.44
$958.40
$1,079.16
$1,508.12
$2,291.72
$1,167.43
$1,281.39
$1,402.15
$1,831.11
$1,490.42
$1,604.38
$1,725.14
$2,154.10
$1,813.41
$1,927.37
$2,048.13
$2,477.09
$322.99
Toc - Plan #46 Ambetter of North Carolina
Silver

(HMO) Focused Silver with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$427.88
$485.63
$546.81
$764.17
$1,161.23
$755.20
$812.95
$874.13
$1,091.49
$1,082.52
$1,140.27
$1,201.45
$1,418.81
$1,409.84
$1,467.59
$1,528.77
$1,746.13
$327.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$855.76
$971.26
$1,093.62
$1,528.34
$2,322.46
$1,183.08
$1,298.58
$1,420.94
$1,855.66
$1,510.40
$1,625.90
$1,748.26
$2,182.98
$1,837.72
$1,953.22
$2,075.58
$2,510.30
$327.32
Toc - Plan #47 Ambetter of North Carolina
Gold

(HMO) Complete Gold with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$453.00
$514.14
$578.92
$809.03
$1,229.40
$799.53
$860.67
$925.45
$1,155.56
$1,146.06
$1,207.20
$1,271.98
$1,502.09
$1,492.59
$1,553.73
$1,618.51
$1,848.62
$346.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$906.00
$1,028.28
$1,157.84
$1,618.06
$2,458.80
$1,252.53
$1,374.81
$1,504.37
$1,964.59
$1,599.06
$1,721.34
$1,850.90
$2,311.12
$1,945.59
$2,067.87
$2,197.43
$2,657.65
$346.53
Toc - Plan #48 Ambetter of North Carolina
Expanded Bronze

(HMO) Standard Expanded Bronze with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$333.31
$378.30
$425.96
$595.28
$904.58
$588.29
$633.28
$680.94
$850.26
$843.27
$888.26
$935.92
$1,105.24
$1,098.25
$1,143.24
$1,190.90
$1,360.22
$254.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$666.62
$756.60
$851.92
$1,190.56
$1,809.16
$921.60
$1,011.58
$1,106.90
$1,445.54
$1,176.58
$1,266.56
$1,361.88
$1,700.52
$1,431.56
$1,521.54
$1,616.86
$1,955.50
$254.98
Toc - Plan #49 Ambetter of North Carolina
Silver

(HMO) Standard Silver with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$419.36
$475.97
$535.93
$748.97
$1,138.13
$740.17
$796.78
$856.74
$1,069.78
$1,060.98
$1,117.59
$1,177.55
$1,390.59
$1,381.79
$1,438.40
$1,498.36
$1,711.40
$320.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838.72
$951.94
$1,071.86
$1,497.94
$2,276.26
$1,159.53
$1,272.75
$1,392.67
$1,818.75
$1,480.34
$1,593.56
$1,713.48
$2,139.56
$1,801.15
$1,914.37
$2,034.29
$2,460.37
$320.81
Toc - Plan #50 Ambetter of North Carolina
Gold

(HMO) Standard Gold with Atrium Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$434.80
$493.48
$555.66
$776.53
$1,180.01
$767.41
$826.09
$888.27
$1,109.14
$1,100.02
$1,158.70
$1,220.88
$1,441.75
$1,432.63
$1,491.31
$1,553.49
$1,774.36
$332.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.60
$986.96
$1,111.32
$1,553.06
$2,360.02
$1,202.21
$1,319.57
$1,443.93
$1,885.67
$1,534.82
$1,652.18
$1,776.54
$2,218.28
$1,867.43
$1,984.79
$2,109.15
$2,550.89
$332.61
Toc - Plan #51 Ambetter of North Carolina
Expanded Bronze

(HMO) Choice Bronze HSA with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$359.62
$408.16
$459.59
$642.27
$975.99
$634.72
$683.26
$734.69
$917.37
$909.82
$958.36
$1,009.79
$1,192.47
$1,184.92
$1,233.46
$1,284.89
$1,467.57
$275.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719.24
$816.32
$919.18
$1,284.54
$1,951.98
$994.34
$1,091.42
$1,194.28
$1,559.64
$1,269.44
$1,366.52
$1,469.38
$1,834.74
$1,544.54
$1,641.62
$1,744.48
$2,109.84
$275.10
Toc - Plan #52 Ambetter of North Carolina
Expanded Bronze

(HMO) Everyday Bronze with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352.69
$400.29
$450.73
$629.89
$957.18
$622.49
$670.09
$720.53
$899.69
$892.29
$939.89
$990.33
$1,169.49
$1,162.09
$1,209.69
$1,260.13
$1,439.29
$269.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705.38
$800.58
$901.46
$1,259.78
$1,914.36
$975.18
$1,070.38
$1,171.26
$1,529.58
$1,244.98
$1,340.18
$1,441.06
$1,799.38
$1,514.78
$1,609.98
$1,710.86
$2,069.18
$269.80
Toc - Plan #53 Ambetter of North Carolina
Expanded Bronze

(HMO) Elite Bronze with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$402.70
$457.05
$514.63
$719.20
$1,092.89
$710.75
$765.10
$822.68
$1,027.25
$1,018.80
$1,073.15
$1,130.73
$1,335.30
$1,326.85
$1,381.20
$1,438.78
$1,643.35
$308.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$805.40
$914.10
$1,029.26
$1,438.40
$2,185.78
$1,113.45
$1,222.15
$1,337.31
$1,746.45
$1,421.50
$1,530.20
$1,645.36
$2,054.50
$1,729.55
$1,838.25
$1,953.41
$2,362.55
$308.05
Toc - Plan #54 Ambetter of North Carolina
Silver

(HMO) Complete Silver with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$451.87
$512.86
$577.48
$807.02
$1,226.35
$797.54
$858.53
$923.15
$1,152.69
$1,143.21
$1,204.20
$1,268.82
$1,498.36
$1,488.88
$1,549.87
$1,614.49
$1,844.03
$345.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$903.74
$1,025.72
$1,154.96
$1,614.04
$2,452.70
$1,249.41
$1,371.39
$1,500.63
$1,959.71
$1,595.08
$1,717.06
$1,846.30
$2,305.38
$1,940.75
$2,062.73
$2,191.97
$2,651.05
$345.67
Toc - Plan #55 Ambetter of North Carolina
Silver

(HMO) Everyday Silver with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$447.68
$508.11
$572.13
$799.55
$1,214.99
$790.15
$850.58
$914.60
$1,142.02
$1,132.62
$1,193.05
$1,257.07
$1,484.49
$1,475.09
$1,535.52
$1,599.54
$1,826.96
$342.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.36
$1,016.22
$1,144.26
$1,599.10
$2,429.98
$1,237.83
$1,358.69
$1,486.73
$1,941.57
$1,580.30
$1,701.16
$1,829.20
$2,284.04
$1,922.77
$2,043.63
$2,171.67
$2,626.51
$342.47
Toc - Plan #56 Ambetter of North Carolina
Silver

(HMO) Clear Silver with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$438.92
$498.17
$560.93
$783.90
$1,191.21
$774.69
$833.94
$896.70
$1,119.67
$1,110.46
$1,169.71
$1,232.47
$1,455.44
$1,446.23
$1,505.48
$1,568.24
$1,791.21
$335.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$877.84
$996.34
$1,121.86
$1,567.80
$2,382.42
$1,213.61
$1,332.11
$1,457.63
$1,903.57
$1,549.38
$1,667.88
$1,793.40
$2,239.34
$1,885.15
$2,003.65
$2,129.17
$2,575.11
$335.77
Toc - Plan #57 Ambetter of North Carolina
Silver

(HMO) Focused Silver with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$444.81
$504.85
$568.45
$794.41
$1,207.18
$785.08
$845.12
$908.72
$1,134.68
$1,125.35
$1,185.39
$1,248.99
$1,474.95
$1,465.62
$1,525.66
$1,589.26
$1,815.22
$340.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$889.62
$1,009.70
$1,136.90
$1,588.82
$2,414.36
$1,229.89
$1,349.97
$1,477.17
$1,929.09
$1,570.16
$1,690.24
$1,817.44
$2,269.36
$1,910.43
$2,030.51
$2,157.71
$2,609.63
$340.27
Toc - Plan #58 Ambetter of North Carolina
Gold

(HMO) Complete Gold with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$470.92
$534.48
$601.82
$841.05
$1,278.05
$831.17
$894.73
$962.07
$1,201.30
$1,191.42
$1,254.98
$1,322.32
$1,561.55
$1,551.67
$1,615.23
$1,682.57
$1,921.80
$360.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$941.84
$1,068.96
$1,203.64
$1,682.10
$2,556.10
$1,302.09
$1,429.21
$1,563.89
$2,042.35
$1,662.34
$1,789.46
$1,924.14
$2,402.60
$2,022.59
$2,149.71
$2,284.39
$2,762.85
$360.25
Toc - Plan #59 Ambetter of North Carolina
Expanded Bronze

(HMO) Standard Expanded Bronze with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346.50
$393.27
$442.82
$618.83
$940.38
$611.57
$658.34
$707.89
$883.90
$876.64
$923.41
$972.96
$1,148.97
$1,141.71
$1,188.48
$1,238.03
$1,414.04
$265.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$693.00
$786.54
$885.64
$1,237.66
$1,880.76
$958.07
$1,051.61
$1,150.71
$1,502.73
$1,223.14
$1,316.68
$1,415.78
$1,767.80
$1,488.21
$1,581.75
$1,680.85
$2,032.87
$265.07
Toc - Plan #60 Ambetter of North Carolina
Silver

(HMO) Standard Silver with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.96
$494.80
$557.14
$778.60
$1,183.16
$769.46
$828.30
$890.64
$1,112.10
$1,102.96
$1,161.80
$1,224.14
$1,445.60
$1,436.46
$1,495.30
$1,557.64
$1,779.10
$333.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.92
$989.60
$1,114.28
$1,557.20
$2,366.32
$1,205.42
$1,323.10
$1,447.78
$1,890.70
$1,538.92
$1,656.60
$1,781.28
$2,224.20
$1,872.42
$1,990.10
$2,114.78
$2,557.70
$333.50
Toc - Plan #61 Ambetter of North Carolina
Gold

(HMO) Standard Gold with Atrium Health + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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
$452.00
$513.01
$577.64
$807.26
$1,226.70
$797.77
$858.78
$923.41
$1,153.03
$1,143.54
$1,204.55
$1,269.18
$1,498.80
$1,489.31
$1,550.32
$1,614.95
$1,844.57
$345.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$904.00
$1,026.02
$1,155.28
$1,614.52
$2,453.40
$1,249.77
$1,371.79
$1,501.05
$1,960.29
$1,595.54
$1,717.56
$1,846.82
$2,306.06
$1,941.31
$2,063.33
$2,192.59
$2,651.83
$345.77

‡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 Gaston County here.

Gaston County is in “Rating Area 5” of North Carolina.

Currently, there are 61 plans offered in Rating Area 5.

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2024 Obamacare Plans for Gaston County, NC

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