☰
LegalConsumer.com
/ obamacare Law Lawyers Wage & Hour Unemploy­ment Child Custody Inheritance Obamacare Student Loans Bankruptcy Democracy
Obamacare
justice fist holding scales LegalConsumer.com
NC map pin image/svg+xml Openclipart map pin 2012-05-04T09:31:05 https://openclipart.org/detail/169839/map-pin-by-netalloy netalloy location map pin pointer
Search
GoogleSearch LegalConsumer content. (example "child custody Ann Arbor, MI")

Obamacare Surry County, NC

ADVERTISEMENT

Obamacare 2023 Rates for Surry County

Obamacare > Rates > North Carolina > Surry 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 Surry County, NC.

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, 42 Plans and 2023 Rates for Surry County, North Carolina

Below, you’ll find a summary of the 42 plans for Surry County, North Carolina 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

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

ADVERTISEMENT

ADVERTISEMENT

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
Bronze

(POS) Blue Value Bronze 9100 | Integrated | Statewide Doctors

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

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 		$328.26
$372.58
$419.52
$586.27
$890.90 		$579.38
$623.70
$670.64
$837.39 		$830.50
$874.82
$921.76
$1,088.51 		$1,081.62
$1,125.94
$1,172.88
$1,339.63 		$251.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656.52
$745.16
$839.04
$1,172.54
$1,781.80 		$907.64
$996.28
$1,090.16
$1,423.66 		$1,158.76
$1,247.40
$1,341.28
$1,674.78 		$1,409.88
$1,498.52
$1,592.40
$1,925.90 		$251.12
Toc - Plan #2 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Value Gold 1800 | 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 		$461.09
$523.34
$589.27
$823.51
$1,251.40 		$813.82
$876.07
$942.00
$1,176.24 		$1,166.55
$1,228.80
$1,294.73
$1,528.97 		$1,519.28
$1,581.53
$1,647.46
$1,881.70 		$352.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$922.18
$1,046.68
$1,178.54
$1,647.02
$2,502.80 		$1,274.91
$1,399.41
$1,531.27
$1,999.75 		$1,627.64
$1,752.14
$1,884.00
$2,352.48 		$1,980.37
$2,104.87
$2,236.73
$2,705.21 		$352.73
Toc - Plan #3 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 7500 | 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
$7,500 $15,000 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 		$343.78
$390.19
$439.35
$613.99
$933.02 		$606.77
$653.18
$702.34
$876.98 		$869.76
$916.17
$965.33
$1,139.97 		$1,132.75
$1,179.16
$1,228.32
$1,402.96 		$262.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$687.56
$780.38
$878.70
$1,227.98
$1,866.04 		$950.55
$1,043.37
$1,141.69
$1,490.97 		$1,213.54
$1,306.36
$1,404.68
$1,753.96 		$1,476.53
$1,569.35
$1,667.67
$2,016.95 		$262.99
Toc - Plan #4 Blue Cross and Blue Shield of NC
Catastrophic

(POS) Blue Value Catastrophic 9100 | 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
$9,100 $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 		$240.76
$273.26
$307.69
$430.00
$653.42 		$424.94
$457.44
$491.87
$614.18 		$609.12
$641.62
$676.05
$798.36 		$793.30
$825.80
$860.23
$982.54 		$184.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$481.52
$546.52
$615.38
$860.00
$1,306.84 		$665.70
$730.70
$799.56
$1,044.18 		$849.88
$914.88
$983.74
$1,228.36 		$1,034.06
$1,099.06
$1,167.92
$1,412.54 		$184.18
Toc - Plan #5 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Choice 4000 | 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
$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 		$468.56
$531.82
$598.82
$836.85
$1,271.67 		$827.01
$890.27
$957.27
$1,195.30 		$1,185.46
$1,248.72
$1,315.72
$1,553.75 		$1,543.91
$1,607.17
$1,674.17
$1,912.20 		$358.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$937.12
$1,063.64
$1,197.64
$1,673.70
$2,543.34 		$1,295.57
$1,422.09
$1,556.09
$2,032.15 		$1,654.02
$1,780.54
$1,914.54
$2,390.60 		$2,012.47
$2,138.99
$2,272.99
$2,749.05 		$358.45
Toc - Plan #6 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 5500 | $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
$9,100 $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 		$346.21
$392.95
$442.46
$618.33
$939.61 		$611.06
$657.80
$707.31
$883.18 		$875.91
$922.65
$972.16
$1,148.03 		$1,140.76
$1,187.50
$1,237.01
$1,412.88 		$264.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.42
$785.90
$884.92
$1,236.66
$1,879.22 		$957.27
$1,050.75
$1,149.77
$1,501.51 		$1,222.12
$1,315.60
$1,414.62
$1,766.36 		$1,486.97
$1,580.45
$1,679.47
$2,031.21 		$264.85
Toc - Plan #7 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Total 3500 | 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
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$474.00
$537.99
$605.77
$846.56
$1,286.44 		$836.61
$900.60
$968.38
$1,209.17 		$1,199.22
$1,263.21
$1,330.99
$1,571.78 		$1,561.83
$1,625.82
$1,693.60
$1,934.39 		$362.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$948.00
$1,075.98
$1,211.54
$1,693.12
$2,572.88 		$1,310.61
$1,438.59
$1,574.15
$2,055.73 		$1,673.22
$1,801.20
$1,936.76
$2,418.34 		$2,035.83
$2,163.81
$2,299.37
$2,780.95 		$362.61
Toc - Plan #8 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Simple | $0 Deductible | 3 Free PCP | Statewide Doctors

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$484.78
$550.23
$619.55
$865.82
$1,315.69 		$855.64
$921.09
$990.41
$1,236.68 		$1,226.50
$1,291.95
$1,361.27
$1,607.54 		$1,597.36
$1,662.81
$1,732.13
$1,978.40 		$370.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$969.56
$1,100.46
$1,239.10
$1,731.64
$2,631.38 		$1,340.42
$1,471.32
$1,609.96
$2,102.50 		$1,711.28
$1,842.18
$1,980.82
$2,473.36 		$2,082.14
$2,213.04
$2,351.68
$2,844.22 		$370.86
Toc - Plan #9 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Preferred 3100 | 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
$3,100 $6,200 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 		$448.87
$509.47
$573.66
$801.68
$1,218.23 		$792.26
$852.86
$917.05
$1,145.07 		$1,135.65
$1,196.25
$1,260.44
$1,488.46 		$1,479.04
$1,539.64
$1,603.83
$1,831.85 		$343.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$897.74
$1,018.94
$1,147.32
$1,603.36
$2,436.46 		$1,241.13
$1,362.33
$1,490.71
$1,946.75 		$1,584.52
$1,705.72
$1,834.10
$2,290.14 		$1,927.91
$2,049.11
$2,177.49
$2,633.53 		$343.39
Toc - Plan #10 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Secure 1900 | $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
$1,900 $3,800 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 		$466.68
$529.68
$596.42
$833.49
$1,266.57 		$823.69
$886.69
$953.43
$1,190.50 		$1,180.70
$1,243.70
$1,310.44
$1,547.51 		$1,537.71
$1,600.71
$1,667.45
$1,904.52 		$357.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$933.36
$1,059.36
$1,192.84
$1,666.98
$2,533.14 		$1,290.37
$1,416.37
$1,549.85
$2,023.99 		$1,647.38
$1,773.38
$1,906.86
$2,381.00 		$2,004.39
$2,130.39
$2,263.87
$2,738.01 		$357.01
Toc - Plan #11 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze 7000 | 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
$9,100 $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 		$327.61
$371.84
$418.69
$585.11
$889.13 		$578.23
$622.46
$669.31
$835.73 		$828.85
$873.08
$919.93
$1,086.35 		$1,079.47
$1,123.70
$1,170.55
$1,336.97 		$250.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$655.22
$743.68
$837.38
$1,170.22
$1,778.26 		$905.84
$994.30
$1,088.00
$1,420.84 		$1,156.46
$1,244.92
$1,338.62
$1,671.46 		$1,407.08
$1,495.54
$1,589.24
$1,922.08 		$250.62
Toc - Plan #12 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Value Gold Standard 2000 | Statewide Doctors

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

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 		$459.36
$521.37
$587.06
$820.42
$1,246.70 		$810.77
$872.78
$938.47
$1,171.83 		$1,162.18
$1,224.19
$1,289.88
$1,523.24 		$1,513.59
$1,575.60
$1,641.29
$1,874.65 		$351.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$918.72
$1,042.74
$1,174.12
$1,640.84
$2,493.40 		$1,270.13
$1,394.15
$1,525.53
$1,992.25 		$1,621.54
$1,745.56
$1,876.94
$2,343.66 		$1,972.95
$2,096.97
$2,228.35
$2,695.07 		$351.41
Toc - Plan #13 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Value Silver Standard 5800 | Statewide Doctors

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

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 		$464.75
$527.49
$593.95
$830.04
$1,261.33 		$820.28
$883.02
$949.48
$1,185.57 		$1,175.81
$1,238.55
$1,305.01
$1,541.10 		$1,531.34
$1,594.08
$1,660.54
$1,896.63 		$355.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$929.50
$1,054.98
$1,187.90
$1,660.08
$2,522.66 		$1,285.03
$1,410.51
$1,543.43
$2,015.61 		$1,640.56
$1,766.04
$1,898.96
$2,371.14 		$1,996.09
$2,121.57
$2,254.49
$2,726.67 		$355.53
Toc - Plan #14 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Value Bronze Standard 7500 | 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
$9,000 $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 		$328.02
$372.30
$419.21
$585.84
$890.25 		$578.96
$623.24
$670.15
$836.78 		$829.90
$874.18
$921.09
$1,087.72 		$1,080.84
$1,125.12
$1,172.03
$1,338.66 		$250.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656.04
$744.60
$838.42
$1,171.68
$1,780.50 		$906.98
$995.54
$1,089.36
$1,422.62 		$1,157.92
$1,246.48
$1,340.30
$1,673.56 		$1,408.86
$1,497.42
$1,591.24
$1,924.50 		$250.94

ADVERTISEMENT

AmeriHealth Caritas Next

Local: 1-984-245-3613 | Toll Free: 1-833-613-2262 | TTY: 1-844-214-2471
Toc - Plan #15 AmeriHealth Caritas Next
Bronze

(HMO) AmeriHealth Caritas Next Bronze + Free Telemedicine + Free Preventive Care + Healthy Rewards

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-613-2262

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 		$227.77
$258.51
$291.08
$406.79
$618.15 		$402.01
$432.75
$465.32
$581.03 		$576.25
$606.99
$639.56
$755.27 		$750.49
$781.23
$813.80
$929.51 		$174.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$455.54
$517.02
$582.16
$813.58
$1,236.30 		$629.78
$691.26
$756.40
$987.82 		$804.02
$865.50
$930.64
$1,162.06 		$978.26
$1,039.74
$1,104.88
$1,336.30 		$174.24
Toc - Plan #16 AmeriHealth Caritas Next
Expanded Bronze

(HMO) AmeriHealth Caritas Next Expanded Bronze + Free Telemedicine + Free Preventive Care + Healthy Rewards

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-613-2262

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 		$256.45
$291.07
$327.74
$458.02
$696.00 		$452.64
$487.26
$523.93
$654.21 		$648.83
$683.45
$720.12
$850.40 		$845.02
$879.64
$916.31
$1,046.59 		$196.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$512.90
$582.14
$655.48
$916.04
$1,392.00 		$709.09
$778.33
$851.67
$1,112.23 		$905.28
$974.52
$1,047.86
$1,308.42 		$1,101.47
$1,170.71
$1,244.05
$1,504.61 		$196.19
Toc - Plan #17 AmeriHealth Caritas Next
Silver

(HMO) AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-613-2262

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 		$349.44
$396.62
$446.59
$624.10
$948.38 		$616.76
$663.94
$713.91
$891.42 		$884.08
$931.26
$981.23
$1,158.74 		$1,151.40
$1,198.58
$1,248.55
$1,426.06 		$267.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698.88
$793.24
$893.18
$1,248.20
$1,896.76 		$966.20
$1,060.56
$1,160.50
$1,515.52 		$1,233.52
$1,327.88
$1,427.82
$1,782.84 		$1,500.84
$1,595.20
$1,695.14
$2,050.16 		$267.32
Toc - Plan #18 AmeriHealth Caritas Next
Gold

(HMO) AmeriHealth Caritas Next Gold + Free Telemedicine + Free Preventive Care + Healthy Rewards

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-613-2262

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 		$428.94
$486.85
$548.18
$766.08
$1,164.13 		$757.08
$814.99
$876.32
$1,094.22 		$1,085.22
$1,143.13
$1,204.46
$1,422.36 		$1,413.36
$1,471.27
$1,532.60
$1,750.50 		$328.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857.88
$973.70
$1,096.36
$1,532.16
$2,328.26 		$1,186.02
$1,301.84
$1,424.50
$1,860.30 		$1,514.16
$1,629.98
$1,752.64
$2,188.44 		$1,842.30
$1,958.12
$2,080.78
$2,516.58 		$328.14

ADVERTISEMENT

WellCare of North Carolina

Local: 1-833-705-2175 | Toll Free: 1-833-705-2175

Toc - Plan #19 WellCare of North Carolina
Expanded Bronze

(PPO) WellCare Secure Health Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 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 		$584.50
$663.40
$746.98
$1,043.90
$1,586.31 		$1,031.64
$1,110.54
$1,194.12
$1,491.04 		$1,478.78
$1,557.68
$1,641.26
$1,938.18 		$1,925.92
$2,004.82
$2,088.40
$2,385.32 		$447.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,169.00
$1,326.80
$1,493.96
$2,087.80
$3,172.62 		$1,616.14
$1,773.94
$1,941.10
$2,534.94 		$2,063.28
$2,221.08
$2,388.24
$2,982.08 		$2,510.42
$2,668.22
$2,835.38
$3,429.22 		$447.14
Toc - Plan #20 WellCare of North Carolina
Silver

(PPO) WellCare Secure Health Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

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 		$749.84
$851.06
$958.28
$1,339.19
$2,035.04 		$1,323.46
$1,424.68
$1,531.90
$1,912.81 		$1,897.08
$1,998.30
$2,105.52
$2,486.43 		$2,470.70
$2,571.92
$2,679.14
$3,060.05 		$573.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,499.68
$1,702.12
$1,916.56
$2,678.38
$4,070.08 		$2,073.30
$2,275.74
$2,490.18
$3,252.00 		$2,646.92
$2,849.36
$3,063.80
$3,825.62 		$3,220.54
$3,422.98
$3,637.42
$4,399.24 		$573.62
Toc - Plan #21 WellCare of North Carolina
Gold

(PPO) WellCare Secure Health Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

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 		$775.86
$880.59
$991.53
$1,385.66
$2,105.65 		$1,369.38
$1,474.11
$1,585.05
$1,979.18 		$1,962.90
$2,067.63
$2,178.57
$2,572.70 		$2,556.42
$2,661.15
$2,772.09
$3,166.22 		$593.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,551.72
$1,761.18
$1,983.06
$2,771.32
$4,211.30 		$2,145.24
$2,354.70
$2,576.58
$3,364.84 		$2,738.76
$2,948.22
$3,170.10
$3,958.36 		$3,332.28
$3,541.74
$3,763.62
$4,551.88 		$593.52
Toc - Plan #22 WellCare of North Carolina
Expanded Bronze

(PPO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

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 		$585.48
$664.50
$748.23
$1,045.64
$1,588.96 		$1,033.36
$1,112.38
$1,196.11
$1,493.52 		$1,481.24
$1,560.26
$1,643.99
$1,941.40 		$1,929.12
$2,008.14
$2,091.87
$2,389.28 		$447.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,170.96
$1,329.00
$1,496.46
$2,091.28
$3,177.92 		$1,618.84
$1,776.88
$1,944.34
$2,539.16 		$2,066.72
$2,224.76
$2,392.22
$2,987.04 		$2,514.60
$2,672.64
$2,840.10
$3,434.92 		$447.88
Toc - Plan #23 WellCare of North Carolina
Silver

(PPO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

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 		$740.77
$840.76
$946.69
$1,322.99
$2,010.41 		$1,307.45
$1,407.44
$1,513.37
$1,889.67 		$1,874.13
$1,974.12
$2,080.05
$2,456.35 		$2,440.81
$2,540.80
$2,646.73
$3,023.03 		$566.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,481.54
$1,681.52
$1,893.38
$2,645.98
$4,020.82 		$2,048.22
$2,248.20
$2,460.06
$3,212.66 		$2,614.90
$2,814.88
$3,026.74
$3,779.34 		$3,181.58
$3,381.56
$3,593.42
$4,346.02 		$566.68
Toc - Plan #24 WellCare of North Carolina
Gold

(PPO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-705-2175

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 		$754.41
$856.25
$964.13
$1,347.36
$2,047.45 		$1,331.53
$1,433.37
$1,541.25
$1,924.48 		$1,908.65
$2,010.49
$2,118.37
$2,501.60 		$2,485.77
$2,587.61
$2,695.49
$3,078.72 		$577.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,508.82
$1,712.50
$1,928.26
$2,694.72
$4,094.90 		$2,085.94
$2,289.62
$2,505.38
$3,271.84 		$2,663.06
$2,866.74
$3,082.50
$3,848.96 		$3,240.18
$3,443.86
$3,659.62
$4,426.08 		$577.12

ADVERTISEMENT

UnitedHealthcare

Local: 1-800-980-5357 | Toll Free: 1-800-980-5357 | TTY: 1-800-980-5357
Toc - Plan #25 UnitedHealthcare
Gold

(HMO) UHC Gold Value ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$1,900 $3,800 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 		$559.65
$635.21
$715.24
$999.54
$1,518.90 		$987.79
$1,063.35
$1,143.38
$1,427.68 		$1,415.93
$1,491.49
$1,571.52
$1,855.82 		$1,844.07
$1,919.63
$1,999.66
$2,283.96 		$428.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,119.30
$1,270.42
$1,430.48
$1,999.08
$3,037.80 		$1,547.44
$1,698.56
$1,858.62
$2,427.22 		$1,975.58
$2,126.70
$2,286.76
$2,855.36 		$2,403.72
$2,554.84
$2,714.90
$3,283.50 		$428.14
Toc - Plan #26 UnitedHealthcare
Silver

(HMO) UHC Silver Value $3,000 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$552.52
$627.11
$706.12
$986.80
$1,499.53 		$975.20
$1,049.79
$1,128.80
$1,409.48 		$1,397.88
$1,472.47
$1,551.48
$1,832.16 		$1,820.56
$1,895.15
$1,974.16
$2,254.84 		$422.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,105.04
$1,254.22
$1,412.24
$1,973.60
$2,999.06 		$1,527.72
$1,676.90
$1,834.92
$2,396.28 		$1,950.40
$2,099.58
$2,257.60
$2,818.96 		$2,373.08
$2,522.26
$2,680.28
$3,241.64 		$422.68
Toc - Plan #27 UnitedHealthcare
Silver

(HMO) UHC Silver Value $3,350 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$3,350 $6,700 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 		$551.63
$626.10
$704.98
$985.21
$1,497.12 		$973.63
$1,048.10
$1,126.98
$1,407.21 		$1,395.63
$1,470.10
$1,548.98
$1,829.21 		$1,817.63
$1,892.10
$1,970.98
$2,251.21 		$422.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,103.26
$1,252.20
$1,409.96
$1,970.42
$2,994.24 		$1,525.26
$1,674.20
$1,831.96
$2,392.42 		$1,947.26
$2,096.20
$2,253.96
$2,814.42 		$2,369.26
$2,518.20
$2,675.96
$3,236.42 		$422.00
Toc - Plan #28 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value $7,500 Indiv Ded Saver ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$389.75
$442.37
$498.11
$696.10
$1,057.79 		$687.91
$740.53
$796.27
$994.26 		$986.07
$1,038.69
$1,094.43
$1,292.42 		$1,284.23
$1,336.85
$1,392.59
$1,590.58 		$298.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$779.50
$884.74
$996.22
$1,392.20
$2,115.58 		$1,077.66
$1,182.90
$1,294.38
$1,690.36 		$1,375.82
$1,481.06
$1,592.54
$1,988.52 		$1,673.98
$1,779.22
$1,890.70
$2,286.68 		$298.16
Toc - Plan #29 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$7,000 $14,000 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 		$581.30
$659.78
$742.91
$1,038.21
$1,577.66 		$1,026.00
$1,104.48
$1,187.61
$1,482.91 		$1,470.70
$1,549.18
$1,632.31
$1,927.61 		$1,915.40
$1,993.88
$2,077.01
$2,372.31 		$444.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,162.60
$1,319.56
$1,485.82
$2,076.42
$3,155.32 		$1,607.30
$1,764.26
$1,930.52
$2,521.12 		$2,052.00
$2,208.96
$2,375.22
$2,965.82 		$2,496.70
$2,653.66
$2,819.92
$3,410.52 		$444.70
Toc - Plan #30 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$7,000 $14,000 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 		$602.92
$684.32
$770.53
$1,076.82
$1,636.33 		$1,064.15
$1,145.55
$1,231.76
$1,538.05 		$1,525.38
$1,606.78
$1,692.99
$1,999.28 		$1,986.61
$2,068.01
$2,154.22
$2,460.51 		$461.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,205.84
$1,368.64
$1,541.06
$2,153.64
$3,272.66 		$1,667.07
$1,829.87
$2,002.29
$2,614.87 		$2,128.30
$2,291.10
$2,463.52
$3,076.10 		$2,589.53
$2,752.33
$2,924.75
$3,537.33 		$461.23
Toc - Plan #31 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value HSA (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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 		$414.52
$470.48
$529.75
$740.33
$1,125.00 		$731.63
$787.59
$846.86
$1,057.44 		$1,048.74
$1,104.70
$1,163.97
$1,374.55 		$1,365.85
$1,421.81
$1,481.08
$1,691.66 		$317.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$829.04
$940.96
$1,059.50
$1,480.66
$2,250.00 		$1,146.15
$1,258.07
$1,376.61
$1,797.77 		$1,463.26
$1,575.18
$1,693.72
$2,114.88 		$1,780.37
$1,892.29
$2,010.83
$2,431.99 		$317.11
Toc - Plan #32 UnitedHealthcare
Silver

(HMO) UHC Silver Value $4,000 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$551.98
$626.50
$705.43
$985.84
$1,498.08 		$974.25
$1,048.77
$1,127.70
$1,408.11 		$1,396.52
$1,471.04
$1,549.97
$1,830.38 		$1,818.79
$1,893.31
$1,972.24
$2,252.65 		$422.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,103.96
$1,253.00
$1,410.86
$1,971.68
$2,996.16 		$1,526.23
$1,675.27
$1,833.13
$2,393.95 		$1,948.50
$2,097.54
$2,255.40
$2,816.22 		$2,370.77
$2,519.81
$2,677.67
$3,238.49 		$422.27
Toc - Plan #33 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value $7,500 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$394.53
$447.80
$504.21
$704.64
$1,070.76 		$696.35
$749.62
$806.03
$1,006.46 		$998.17
$1,051.44
$1,107.85
$1,308.28 		$1,299.99
$1,353.26
$1,409.67
$1,610.10 		$301.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789.06
$895.60
$1,008.42
$1,409.28
$2,141.52 		$1,090.88
$1,197.42
$1,310.24
$1,711.10 		$1,392.70
$1,499.24
$1,612.06
$2,012.92 		$1,694.52
$1,801.06
$1,913.88
$2,314.74 		$301.82
Toc - Plan #34 UnitedHealthcare
Gold

(HMO) UHC Gold Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$569.65
$646.55
$728.01
$1,017.40
$1,546.03 		$1,005.43
$1,082.33
$1,163.79
$1,453.18 		$1,441.21
$1,518.11
$1,599.57
$1,888.96 		$1,876.99
$1,953.89
$2,035.35
$2,324.74 		$435.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,139.30
$1,293.10
$1,456.02
$2,034.80
$3,092.06 		$1,575.08
$1,728.88
$1,891.80
$2,470.58 		$2,010.86
$2,164.66
$2,327.58
$2,906.36 		$2,446.64
$2,600.44
$2,763.36
$3,342.14 		$435.78
Toc - Plan #35 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage $0 Medical Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$560.25
$635.88
$715.99
$1,000.60
$1,520.51 		$988.84
$1,064.47
$1,144.58
$1,429.19 		$1,417.43
$1,493.06
$1,573.17
$1,857.78 		$1,846.02
$1,921.65
$2,001.76
$2,286.37 		$428.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,120.50
$1,271.76
$1,431.98
$2,001.20
$3,041.02 		$1,549.09
$1,700.35
$1,860.57
$2,429.79 		$1,977.68
$2,128.94
$2,289.16
$2,858.38 		$2,406.27
$2,557.53
$2,717.75
$3,286.97 		$428.59
Toc - Plan #36 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage $2,000 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$547.03
$620.87
$699.10
$976.99
$1,484.63 		$965.50
$1,039.34
$1,117.57
$1,395.46 		$1,383.97
$1,457.81
$1,536.04
$1,813.93 		$1,802.44
$1,876.28
$1,954.51
$2,232.40 		$418.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,094.06
$1,241.74
$1,398.20
$1,953.98
$2,969.26 		$1,512.53
$1,660.21
$1,816.67
$2,372.45 		$1,931.00
$2,078.68
$2,235.14
$2,790.92 		$2,349.47
$2,497.15
$2,653.61
$3,209.39 		$418.47
Toc - Plan #37 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$576.75
$654.62
$737.09
$1,030.08
$1,565.31 		$1,017.97
$1,095.84
$1,178.31
$1,471.30 		$1,459.19
$1,537.06
$1,619.53
$1,912.52 		$1,900.41
$1,978.28
$2,060.75
$2,353.74 		$441.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,153.50
$1,309.24
$1,474.18
$2,060.16
$3,130.62 		$1,594.72
$1,750.46
$1,915.40
$2,501.38 		$2,035.94
$2,191.68
$2,356.62
$2,942.60 		$2,477.16
$2,632.90
$2,797.84
$3,383.82 		$441.22
Toc - Plan #38 UnitedHealthcare
Silver

(HMO) UHC Silver Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$550.10
$624.36
$703.02
$982.47
$1,492.96 		$970.92
$1,045.18
$1,123.84
$1,403.29 		$1,391.74
$1,466.00
$1,544.66
$1,824.11 		$1,812.56
$1,886.82
$1,965.48
$2,244.93 		$420.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,100.20
$1,248.72
$1,406.04
$1,964.94
$2,985.92 		$1,521.02
$1,669.54
$1,826.86
$2,385.76 		$1,941.84
$2,090.36
$2,247.68
$2,806.58 		$2,362.66
$2,511.18
$2,668.50
$3,227.40 		$420.82
Toc - Plan #39 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential $9,100 Indiv Ded ($3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$376.99
$427.89
$481.80
$673.31
$1,023.16 		$665.39
$716.29
$770.20
$961.71 		$953.79
$1,004.69
$1,058.60
$1,250.11 		$1,242.19
$1,293.09
$1,347.00
$1,538.51 		$288.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$753.98
$855.78
$963.60
$1,346.62
$2,046.32 		$1,042.38
$1,144.18
$1,252.00
$1,635.02 		$1,330.78
$1,432.58
$1,540.40
$1,923.42 		$1,619.18
$1,720.98
$1,828.80
$2,211.82 		$288.40
Toc - Plan #40 UnitedHealthcare
Bronze

(HMO) UHC Bronze Standard $9,100 Indiv Ded (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$375.69
$426.41
$480.13
$670.98
$1,019.62 		$663.09
$713.81
$767.53
$958.38 		$950.49
$1,001.21
$1,054.93
$1,245.78 		$1,237.89
$1,288.61
$1,342.33
$1,533.18 		$287.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$751.38
$852.82
$960.26
$1,341.96
$2,039.24 		$1,038.78
$1,140.22
$1,247.66
$1,629.36 		$1,326.18
$1,427.62
$1,535.06
$1,916.76 		$1,613.58
$1,715.02
$1,822.46
$2,204.16 		$287.40
Toc - Plan #41 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Standard $7,500 Indiv Ded (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

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 		$395.18
$448.53
$505.04
$705.79
$1,072.52 		$697.49
$750.84
$807.35
$1,008.10 		$999.80
$1,053.15
$1,109.66
$1,310.41 		$1,302.11
$1,355.46
$1,411.97
$1,612.72 		$302.31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$790.36
$897.06
$1,010.08
$1,411.58
$2,145.04 		$1,092.67
$1,199.37
$1,312.39
$1,713.89 		$1,394.98
$1,501.68
$1,614.70
$2,016.20 		$1,697.29
$1,803.99
$1,917.01
$2,318.51 		$302.31
Toc - Plan #42 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential $6,350 Indiv Ded ($3 Generic Rx Pref Pharm, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 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 		$384.81
$436.76
$491.79
$687.27
$1,044.37 		$679.19
$731.14
$786.17
$981.65 		$973.57
$1,025.52
$1,080.55
$1,276.03 		$1,267.95
$1,319.90
$1,374.93
$1,570.41 		$294.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$769.62
$873.52
$983.58
$1,374.54
$2,088.74 		$1,064.00
$1,167.90
$1,277.96
$1,668.92 		$1,358.38
$1,462.28
$1,572.34
$1,963.30 		$1,652.76
$1,756.66
$1,866.72
$2,257.68 		$294.38

‡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 Surry County here.

Surry County is in “Rating Area 6” of North Carolina.

Currently, there are 42 plans offered in Rating Area 6.

Top

2023 Obamacare Plans for Surry County, NC

Plan Browser: 42 Plans
scroll down for more