Obamacare 2022 Rates and Health Insurance Providers for Erie County , Ohio
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Obamacare 2022 Rates and Health Insurance Providers for Erie County , Ohio

Obamacare > Rates > Ohio > Erie County

Obamacare Rates and Providers for Other Years

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

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 Erie County, OH.

The health insurance rates listed below are for calendar year 2022.

For detailed information on available 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

The table below shows premiums for the following profiles at various ages:

  • Individuals
  • Couples
  • Couples with 1, 2, or 3 children
  • Individuals with 1, 2, or 3 children
  • A child alone

Each plan links to the insurance provider's website. You can find the following:

  • Summary of plan benefits and costs
  • Plan brochure
  • Provider Directory where you can find out which doctors and hospitals in the Sandusky, OH area accept this insurance coverage as within the plan's network.

Obamacare Providers, Plans and 2022 Rates for Erie County, Ohio

Below, you’ll find a summary of the 70 plans for Erie County, Ohio 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

You may also be interested in:

How To Sign Up for Obamacare in Ohio

For 2022 health plans, Ohio open enrollment has ended. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period. For example, if you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a 60-day special enrollment period that will allow you to sign up for a new health insurance plan. (See What Happens If I Missed the Enrollment Deadline for 2022?)

To get covered, you can go directly to the online health insurance marketplace for Ohio. If you need personalized help, you can reach out to an enrollment assistant. Most enrollment helpers are working remotely during the COVID crisis.

Where's the Ohio Health Care Exchange?

You can find the health insurance exchange for Ohio at Healthcare.gov. This is where you can learn about the various health insurance options available to you under the Affordable Care Act. If you see a plan you like, you'll be guided through the enrollment process online.

more...  

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

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Ohio in 2021, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of October 2021, 12 states have not expanded their programs.

Ohio Has Expanded Medicaid

Because Ohio did decide to expand its Medicaid program, residents can qualify for Medicaid more easily today than in years past.

more...  

Get Help Finding a Health Insurance Plan in Ohio

Get Help From Ohio's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Healthcare.gov, the health insurance marketplace for Ohio.

Help by phone: 800-318-2596 (TTY: 855-889-4325)

In-person help: Go to Find Local Help, where you can enter your city and state or zip code to find an application assister, insurance agent, or health insurance broker in your area.

Get Help From a Licensed Insurance Broker

To directly connect with a Ohio insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Ohio?

  • Erie County, OH Obamacare Rates
  • General Info
  • Rates
Erie County, OH Obamacare Guide
Obamacare Basics for Ohio - (Basics)
Obamacare Rates for Erie County - (Rates)
Obamacare Enrollment - (How to Enroll)
Obamacare Financial Assistance - (Financial Help)
Obamacare for Different Life Situations - (Life Situations)
Using Your Obamacare Health Insurance Plan - (Using Your Plan)
Obamacare News - (News)

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Anthem Blue Cross and Blue Shield

Local: 1-855-748-1808 | Toll Free: 1-855-748-1808

Toc - Plan #1 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372,01
$422,23
$475,43
$664,41
$1 009,64 		$656,60
$706,82
$760,02
$949,00 		$941,19
$991,41
$1 044,61
$1 233,59 		$1 225,78
$1 276,00
$1 329,20
$1 518,18 		$284,59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$744,02
$844,46
$950,86
$1 328,82
$2 019,28 		$1 028,61
$1 129,05
$1 235,45
$1 613,41 		$1 313,20
$1 413,64
$1 520,04
$1 898,00 		$1 597,79
$1 698,23
$1 804,63
$2 182,59 		$284,59
Toc - Plan #2 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X HMO 8550

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352,60
$400,20
$450,62
$629,74
$956,96 		$622,34
$669,94
$720,36
$899,48 		$892,08
$939,68
$990,10
$1 169,22 		$1 161,82
$1 209,42
$1 259,84
$1 438,96 		$269,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705,20
$800,40
$901,24
$1 259,48
$1 913,92 		$974,94
$1 070,14
$1 170,98
$1 529,22 		$1 244,68
$1 339,88
$1 440,72
$1 798,96 		$1 514,42
$1 609,62
$1 710,46
$2 068,70 		$269,74
Toc - Plan #3 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 4000 Online Plus

Annual Out of Pocket Expenses
Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$494,28
$561,01
$631,69
$882,78
$1 341,48 		$872,40
$939,13
$1 009,81
$1 260,90 		$1 250,52
$1 317,25
$1 387,93
$1 639,02 		$1 628,64
$1 695,37
$1 766,05
$2 017,14 		$378,12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$988,56
$1 122,02
$1 263,38
$1 765,56
$2 682,96 		$1 366,68
$1 500,14
$1 641,50
$2 143,68 		$1 744,80
$1 878,26
$2 019,62
$2 521,80 		$2 122,92
$2 256,38
$2 397,74
$2 899,92 		$378,12
Toc - Plan #4 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X HMO 2500

Annual Out of Pocket Expenses
Individual Family
$2,500 $7,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$542,55
$615,79
$693,38
$968,99
$1 472,48 		$957,60
$1 030,84
$1 108,43
$1 384,04 		$1 372,65
$1 445,89
$1 523,48
$1 799,09 		$1 787,70
$1 860,94
$1 938,53
$2 214,14 		$415,05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 085,10
$1 231,58
$1 386,76
$1 937,98
$2 944,96 		$1 500,15
$1 646,63
$1 801,81
$2 353,03 		$1 915,20
$2 061,68
$2 216,86
$2 768,08 		$2 330,25
$2 476,73
$2 631,91
$3 183,13 		$415,05
Toc - Plan #5 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6850 0 for HSA

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$377,79
$428,79
$482,82
$674,73
$1 025,32 		$666,80
$717,80
$771,83
$963,74 		$955,81
$1 006,81
$1 060,84
$1 252,75 		$1 244,82
$1 295,82
$1 349,85
$1 541,76 		$289,01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$755,58
$857,58
$965,64
$1 349,46
$2 050,64 		$1 044,59
$1 146,59
$1 254,65
$1 638,47 		$1 333,60
$1 435,60
$1 543,66
$1 927,48 		$1 622,61
$1 724,61
$1 832,67
$2 216,49 		$289,01
Toc - Plan #6 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 3200 10 for HSA

Annual Out of Pocket Expenses
Individual Family
$3,200 $6,400 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$497,72
$564,91
$636,09
$888,93
$1 350,81 		$878,48
$945,67
$1 016,85
$1 269,69 		$1 259,24
$1 326,43
$1 397,61
$1 650,45 		$1 640,00
$1 707,19
$1 778,37
$2 031,21 		$380,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$995,44
$1 129,82
$1 272,18
$1 777,86
$2 701,62 		$1 376,20
$1 510,58
$1 652,94
$2 158,62 		$1 756,96
$1 891,34
$2 033,70
$2 539,38 		$2 137,72
$2 272,10
$2 414,46
$2 920,14 		$380,76
Toc - Plan #7 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 3500

Annual Out of Pocket Expenses
Individual Family
$3,500 $7,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$508,27
$576,89
$649,57
$907,77
$1 379,44 		$897,10
$965,72
$1 038,40
$1 296,60 		$1 285,93
$1 354,55
$1 427,23
$1 685,43 		$1 674,76
$1 743,38
$1 816,06
$2 074,26 		$388,83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 016,54
$1 153,78
$1 299,14
$1 815,54
$2 758,88 		$1 405,37
$1 542,61
$1 687,97
$2 204,37 		$1 794,20
$1 931,44
$2 076,80
$2 593,20 		$2 183,03
$2 320,27
$2 465,63
$2 982,03 		$388,83
Toc - Plan #8 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000 20 for HSA

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$376,70
$427,55
$481,42
$672,79
$1 022,36 		$664,88
$715,73
$769,60
$960,97 		$953,06
$1 003,91
$1 057,78
$1 249,15 		$1 241,24
$1 292,09
$1 345,96
$1 537,33 		$288,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$753,40
$855,10
$962,84
$1 345,58
$2 044,72 		$1 041,58
$1 143,28
$1 251,02
$1 633,76 		$1 329,76
$1 431,46
$1 539,20
$1 921,94 		$1 617,94
$1 719,64
$1 827,38
$2 210,12 		$288,18
Toc - Plan #9 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 6100 0 for HSA

Annual Out of Pocket Expenses
Individual Family
$6,100 $12,200 Annual Deductible
$6,100 $12,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$461,26
$523,53
$589,49
$823,81
$1 251,86 		$814,12
$876,39
$942,35
$1 176,67 		$1 166,98
$1 229,25
$1 295,21
$1 529,53 		$1 519,84
$1 582,11
$1 648,07
$1 882,39 		$352,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$922,52
$1 047,06
$1 178,98
$1 647,62
$2 503,72 		$1 275,38
$1 399,92
$1 531,84
$2 000,48 		$1 628,24
$1 752,78
$1 884,70
$2 353,34 		$1 981,10
$2 105,64
$2 237,56
$2 706,20 		$352,86
Toc - Plan #10 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 4500

Annual Out of Pocket Expenses
Individual Family
$4,500 $9,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$492,91
$559,45
$629,94
$880,34
$1 337,76 		$869,99
$936,53
$1 007,02
$1 257,42 		$1 247,07
$1 313,61
$1 384,10
$1 634,50 		$1 624,15
$1 690,69
$1 761,18
$2 011,58 		$377,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$985,82
$1 118,90
$1 259,88
$1 760,68
$2 675,52 		$1 362,90
$1 495,98
$1 636,96
$2 137,76 		$1 739,98
$1 873,06
$2 014,04
$2 514,84 		$2 117,06
$2 250,14
$2 391,12
$2 891,92 		$377,08
Toc - Plan #11 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 3000

Annual Out of Pocket Expenses
Individual Family
$3,000 $6,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$512,15
$581,29
$654,53
$914,70
$1 389,98 		$903,94
$973,08
$1 046,32
$1 306,49 		$1 295,73
$1 364,87
$1 438,11
$1 698,28 		$1 687,52
$1 756,66
$1 829,90
$2 090,07 		$391,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 024,30
$1 162,58
$1 309,06
$1 829,40
$2 779,96 		$1 416,09
$1 554,37
$1 700,85
$2 221,19 		$1 807,88
$1 946,16
$2 092,64
$2 612,98 		$2 199,67
$2 337,95
$2 484,43
$3 004,77 		$391,79
Toc - Plan #12 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 5000

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$470,19
$533,67
$600,90
$839,76
$1 276,10 		$829,89
$893,37
$960,60
$1 199,46 		$1 189,59
$1 253,07
$1 320,30
$1 559,16 		$1 549,29
$1 612,77
$1 680,00
$1 918,86 		$359,70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$940,38
$1 067,34
$1 201,80
$1 679,52
$2 552,20 		$1 300,08
$1 427,04
$1 561,50
$2 039,22 		$1 659,78
$1 786,74
$1 921,20
$2 398,92 		$2 019,48
$2 146,44
$2 280,90
$2 758,62 		$359,70
Toc - Plan #13 Anthem Blue Cross and Blue Shield
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 8550

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$282,51
$320,65
$361,05
$504,56
$766,73 		$498,63
$536,77
$577,17
$720,68 		$714,75
$752,89
$793,29
$936,80 		$930,87
$969,01
$1 009,41
$1 152,92 		$216,12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$565,02
$641,30
$722,10
$1 009,12
$1 533,46 		$781,14
$857,42
$938,22
$1 225,24 		$997,26
$1 073,54
$1 154,34
$1 441,36 		$1 213,38
$1 289,66
$1 370,46
$1 657,48 		$216,12
Toc - Plan #14 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 2600

Annual Out of Pocket Expenses
Individual Family
$2,600 $5,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$524,88
$595,74
$670,80
$937,44
$1 424,52 		$926,41
$997,27
$1 072,33
$1 338,97 		$1 327,94
$1 398,80
$1 473,86
$1 740,50 		$1 729,47
$1 800,33
$1 875,39
$2 142,03 		$401,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 049,76
$1 191,48
$1 341,60
$1 874,88
$2 849,04 		$1 451,29
$1 593,01
$1 743,13
$2 276,41 		$1 852,82
$1 994,54
$2 144,66
$2 677,94 		$2 254,35
$2 396,07
$2 546,19
$3 079,47 		$401,53
Toc - Plan #15 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 6900 25

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$458,19
$520,05
$585,57
$818,33
$1 243,53 		$808,71
$870,57
$936,09
$1 168,85 		$1 159,23
$1 221,09
$1 286,61
$1 519,37 		$1 509,75
$1 571,61
$1 637,13
$1 869,89 		$350,52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$916,38
$1 040,10
$1 171,14
$1 636,66
$2 487,06 		$1 266,90
$1 390,62
$1 521,66
$1 987,18 		$1 617,42
$1 741,14
$1 872,18
$2 337,70 		$1 967,94
$2 091,66
$2 222,70
$2 688,22 		$350,52
Toc - Plan #16 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5500 Online Plus

Annual Out of Pocket Expenses
Individual Family
$5,500 $11,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$383,89
$435,72
$490,61
$685,63
$1 041,88 		$677,57
$729,40
$784,29
$979,31 		$971,25
$1 023,08
$1 077,97
$1 272,99 		$1 264,93
$1 316,76
$1 371,65
$1 566,67 		$293,68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767,78
$871,44
$981,22
$1 371,26
$2 083,76 		$1 061,46
$1 165,12
$1 274,90
$1 664,94 		$1 355,14
$1 458,80
$1 568,58
$1 958,62 		$1 648,82
$1 752,48
$1 862,26
$2 252,30 		$293,68
Toc - Plan #17 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364,21
$413,38
$465,46
$650,48
$988,47 		$642,83
$692,00
$744,08
$929,10 		$921,45
$970,62
$1 022,70
$1 207,72 		$1 200,07
$1 249,24
$1 301,32
$1 486,34 		$278,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728,42
$826,76
$930,92
$1 300,96
$1 976,94 		$1 007,04
$1 105,38
$1 209,54
$1 579,58 		$1 285,66
$1 384,00
$1 488,16
$1 858,20 		$1 564,28
$1 662,62
$1 766,78
$2 136,82 		$278,62

ADVERTISEMENT

Ambetter from Buckeye Health

Local: 1-877-687-1189 | Toll Free: 1-877-687-1189 | TTY: 1-877-941-9236
Toc - Plan #18 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 11 (2021)

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:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$249,70
$283,40
$319,11
$445,95
$677,67 		$440,72
$474,42
$510,13
$636,97 		$631,74
$665,44
$701,15
$827,99 		$822,76
$856,46
$892,17
$1 019,01 		$191,02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$499,40
$566,80
$638,22
$891,90
$1 355,34 		$690,42
$757,82
$829,24
$1 082,92 		$881,44
$948,84
$1 020,26
$1 273,94 		$1 072,46
$1 139,86
$1 211,28
$1 464,96 		$191,02
Toc - Plan #19 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 12 (2021)

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:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$245,16
$278,24
$313,30
$437,84
$665,33 		$432,70
$465,78
$500,84
$625,38 		$620,24
$653,32
$688,38
$812,92 		$807,78
$840,86
$875,92
$1 000,46 		$187,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$490,32
$556,48
$626,60
$875,68
$1 330,66 		$677,86
$744,02
$814,14
$1 063,22 		$865,40
$931,56
$1 001,68
$1 250,76 		$1 052,94
$1 119,10
$1 189,22
$1 438,30 		$187,54
Toc - Plan #20 Ambetter from Buckeye Health
Gold

(HMO) Ambetter Secure Care 5 (2021)

Annual Out of Pocket Expenses
Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287,78
$326,62
$367,77
$513,96
$781,01 		$507,92
$546,76
$587,91
$734,10 		$728,06
$766,90
$808,05
$954,24 		$948,20
$987,04
$1 028,19
$1 174,38 		$220,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$575,56
$653,24
$735,54
$1 027,92
$1 562,02 		$795,70
$873,38
$955,68
$1 248,06 		$1 015,84
$1 093,52
$1 175,82
$1 468,20 		$1 235,98
$1 313,66
$1 395,96
$1 688,34 		$220,14
Toc - Plan #21 Ambetter from Buckeye Health
Bronze

(HMO) Ambetter Essential Care 1 (2021)

Annual Out of Pocket Expenses
Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$189,10
$214,62
$241,66
$337,72
$513,20 		$333,76
$359,28
$386,32
$482,38 		$478,42
$503,94
$530,98
$627,04 		$623,08
$648,60
$675,64
$771,70 		$144,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$378,20
$429,24
$483,32
$675,44
$1 026,40 		$522,86
$573,90
$627,98
$820,10 		$667,52
$718,56
$772,64
$964,76 		$812,18
$863,22
$917,30
$1 109,42 		$144,66
Toc - Plan #22 Ambetter from Buckeye Health
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$204,68
$232,30
$261,57
$365,55
$555,48 		$361,26
$388,88
$418,15
$522,13 		$517,84
$545,46
$574,73
$678,71 		$674,42
$702,04
$731,31
$835,29 		$156,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$409,36
$464,60
$523,14
$731,10
$1 110,96 		$565,94
$621,18
$679,72
$887,68 		$722,52
$777,76
$836,30
$1 044,26 		$879,10
$934,34
$992,88
$1 200,84 		$156,58
Toc - Plan #23 Ambetter from Buckeye Health
Expanded Bronze

(HMO) Ambetter Essential Care 10 (2021)

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$194,65
$220,91
$248,74
$347,62
$528,24 		$343,55
$369,81
$397,64
$496,52 		$492,45
$518,71
$546,54
$645,42 		$641,35
$667,61
$695,44
$794,32 		$148,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$389,30
$441,82
$497,48
$695,24
$1 056,48 		$538,20
$590,72
$646,38
$844,14 		$687,10
$739,62
$795,28
$993,04 		$836,00
$888,52
$944,18
$1 141,94 		$148,90
Toc - Plan #24 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 24 (2021)

Annual Out of Pocket Expenses
Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$253,80
$288,05
$324,34
$453,27
$688,78 		$447,95
$482,20
$518,49
$647,42 		$642,10
$676,35
$712,64
$841,57 		$836,25
$870,50
$906,79
$1 035,72 		$194,15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$507,60
$576,10
$648,68
$906,54
$1 377,56 		$701,75
$770,25
$842,83
$1 100,69 		$895,90
$964,40
$1 036,98
$1 294,84 		$1 090,05
$1 158,55
$1 231,13
$1 488,99 		$194,15
Toc - Plan #25 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 29 (2021)

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$243,04
$275,83
$310,59
$434,04
$659,57 		$428,96
$461,75
$496,51
$619,96 		$614,88
$647,67
$682,43
$805,88 		$800,80
$833,59
$868,35
$991,80 		$185,92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$486,08
$551,66
$621,18
$868,08
$1 319,14 		$672,00
$737,58
$807,10
$1 054,00 		$857,92
$923,50
$993,02
$1 239,92 		$1 043,84
$1 109,42
$1 178,94
$1 425,84 		$185,92
Toc - Plan #26 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 26 (2021)

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$256,17
$290,74
$327,37
$457,50
$695,22 		$452,13
$486,70
$523,33
$653,46 		$648,09
$682,66
$719,29
$849,42 		$844,05
$878,62
$915,25
$1 045,38 		$195,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$512,34
$581,48
$654,74
$915,00
$1 390,44 		$708,30
$777,44
$850,70
$1 110,96 		$904,26
$973,40
$1 046,66
$1 306,92 		$1 100,22
$1 169,36
$1 242,62
$1 502,88 		$195,96
Toc - Plan #27 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 28 (2021)

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$265,48
$301,31
$339,28
$474,14
$720,50 		$468,57
$504,40
$542,37
$677,23 		$671,66
$707,49
$745,46
$880,32 		$874,75
$910,58
$948,55
$1 083,41 		$203,09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$530,96
$602,62
$678,56
$948,28
$1 441,00 		$734,05
$805,71
$881,65
$1 151,37 		$937,14
$1 008,80
$1 084,74
$1 354,46 		$1 140,23
$1 211,89
$1 287,83
$1 557,55 		$203,09
Toc - Plan #28 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

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:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$256,99
$291,67
$328,42
$458,97
$697,45 		$453,58
$488,26
$525,01
$655,56 		$650,17
$684,85
$721,60
$852,15 		$846,76
$881,44
$918,19
$1 048,74 		$196,59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$513,98
$583,34
$656,84
$917,94
$1 394,90 		$710,57
$779,93
$853,43
$1 114,53 		$907,16
$976,52
$1 050,02
$1 311,12 		$1 103,75
$1 173,11
$1 246,61
$1 507,71 		$196,59
Toc - Plan #29 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

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:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$261,76
$297,08
$334,51
$467,48
$710,38 		$462,00
$497,32
$534,75
$667,72 		$662,24
$697,56
$734,99
$867,96 		$862,48
$897,80
$935,23
$1 068,20 		$200,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$523,52
$594,16
$669,02
$934,96
$1 420,76 		$723,76
$794,40
$869,26
$1 135,20 		$924,00
$994,64
$1 069,50
$1 335,44 		$1 124,24
$1 194,88
$1 269,74
$1 535,68 		$200,24
Toc - Plan #30 Ambetter from Buckeye Health
Gold

(HMO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$301,67
$342,39
$385,52
$538,77
$818,71 		$532,44
$573,16
$616,29
$769,54 		$763,21
$803,93
$847,06
$1 000,31 		$993,98
$1 034,70
$1 077,83
$1 231,08 		$230,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603,34
$684,78
$771,04
$1 077,54
$1 637,42 		$834,11
$915,55
$1 001,81
$1 308,31 		$1 064,88
$1 146,32
$1 232,58
$1 539,08 		$1 295,65
$1 377,09
$1 463,35
$1 769,85 		$230,77
Toc - Plan #31 Ambetter from Buckeye Health
Bronze

(HMO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$198,23
$224,98
$253,32
$354,02
$537,97 		$349,87
$376,62
$404,96
$505,66 		$501,51
$528,26
$556,60
$657,30 		$653,15
$679,90
$708,24
$808,94 		$151,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$396,46
$449,96
$506,64
$708,04
$1 075,94 		$548,10
$601,60
$658,28
$859,68 		$699,74
$753,24
$809,92
$1 011,32 		$851,38
$904,88
$961,56
$1 162,96 		$151,64
Toc - Plan #32 Ambetter from Buckeye Health
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$214,56
$243,52
$274,20
$383,19
$582,30 		$378,69
$407,65
$438,33
$547,32 		$542,82
$571,78
$602,46
$711,45 		$706,95
$735,91
$766,59
$875,58 		$164,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$429,12
$487,04
$548,40
$766,38
$1 164,60 		$593,25
$651,17
$712,53
$930,51 		$757,38
$815,30
$876,66
$1 094,64 		$921,51
$979,43
$1 040,79
$1 258,77 		$164,13
Toc - Plan #33 Ambetter from Buckeye Health
Expanded Bronze

(HMO) Ambetter Essential Care 10 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$204,04
$231,57
$260,75
$364,40
$553,74 		$360,12
$387,65
$416,83
$520,48 		$516,20
$543,73
$572,91
$676,56 		$672,28
$699,81
$728,99
$832,64 		$156,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$408,08
$463,14
$521,50
$728,80
$1 107,48 		$564,16
$619,22
$677,58
$884,88 		$720,24
$775,30
$833,66
$1 040,96 		$876,32
$931,38
$989,74
$1 197,04 		$156,08
Toc - Plan #34 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 24 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$266,05
$301,95
$340,00
$475,14
$722,03 		$469,57
$505,47
$543,52
$678,66 		$673,09
$708,99
$747,04
$882,18 		$876,61
$912,51
$950,56
$1 085,70 		$203,52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$532,10
$603,90
$680,00
$950,28
$1 444,06 		$735,62
$807,42
$883,52
$1 153,80 		$939,14
$1 010,94
$1 087,04
$1 357,32 		$1 142,66
$1 214,46
$1 290,56
$1 560,84 		$203,52
Toc - Plan #35 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$268,53
$304,78
$343,17
$479,58
$728,77 		$473,95
$510,20
$548,59
$685,00 		$679,37
$715,62
$754,01
$890,42 		$884,79
$921,04
$959,43
$1 095,84 		$205,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$537,06
$609,56
$686,34
$959,16
$1 457,54 		$742,48
$814,98
$891,76
$1 164,58 		$947,90
$1 020,40
$1 097,18
$1 370,00 		$1 153,32
$1 225,82
$1 302,60
$1 575,42 		$205,42
Toc - Plan #36 Ambetter from Buckeye Health
Silver

(HMO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$278,30
$315,86
$355,65
$497,02
$755,27 		$491,19
$528,75
$568,54
$709,91 		$704,08
$741,64
$781,43
$922,80 		$916,97
$954,53
$994,32
$1 135,69 		$212,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$556,60
$631,72
$711,30
$994,04
$1 510,54 		$769,49
$844,61
$924,19
$1 206,93 		$982,38
$1 057,50
$1 137,08
$1 419,82 		$1 195,27
$1 270,39
$1 349,97
$1 632,71 		$212,89

ADVERTISEMENT

Molina Healthcare

Local: 1-888-296-7677 | Toll Free: 1-888-296-7677

Toc - Plan #37 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Annual Out of Pocket Expenses
Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326,90
$371,03
$417,78
$583,85
$887,21 		$576,98
$621,11
$667,86
$833,93 		$827,06
$871,19
$917,94
$1 084,01 		$1 077,14
$1 121,27
$1 168,02
$1 334,09 		$250,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$653,80
$742,06
$835,56
$1 167,70
$1 774,42 		$903,88
$992,14
$1 085,64
$1 417,78 		$1 153,96
$1 242,22
$1 335,72
$1 667,86 		$1 404,04
$1 492,30
$1 585,80
$1 917,94 		$250,08
Toc - Plan #38 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 250

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$279,43
$317,16
$357,12
$499,07
$758,38 		$493,20
$530,93
$570,89
$712,84 		$706,97
$744,70
$784,66
$926,61 		$920,74
$958,47
$998,43
$1 140,38 		$213,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$558,86
$634,32
$714,24
$998,14
$1 516,76 		$772,63
$848,09
$928,01
$1 211,91 		$986,40
$1 061,86
$1 141,78
$1 425,68 		$1 200,17
$1 275,63
$1 355,55
$1 639,45 		$213,77
Toc - Plan #39 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 1

Annual Out of Pocket Expenses
Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$227,74
$258,48
$291,05
$406,74
$618,08 		$401,96
$432,70
$465,27
$580,96 		$576,18
$606,92
$639,49
$755,18 		$750,40
$781,14
$813,71
$929,40 		$174,22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$455,48
$516,96
$582,10
$813,48
$1 236,16 		$629,70
$691,18
$756,32
$987,70 		$803,92
$865,40
$930,54
$1 161,92 		$978,14
$1 039,62
$1 104,76
$1 336,14 		$174,22
Toc - Plan #40 Molina Healthcare
Silver

(HMO) Constant Care Silver 4 250

Annual Out of Pocket Expenses
Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$276,80
$314,17
$353,76
$494,37
$751,25 		$488,56
$525,93
$565,52
$706,13 		$700,32
$737,69
$777,28
$917,89 		$912,08
$949,45
$989,04
$1 129,65 		$211,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$553,60
$628,34
$707,52
$988,74
$1 502,50 		$765,36
$840,10
$919,28
$1 200,50 		$977,12
$1 051,86
$1 131,04
$1 412,26 		$1 188,88
$1 263,62
$1 342,80
$1 624,02 		$211,76
Toc - Plan #41 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 4

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$238,53
$270,73
$304,84
$426,01
$647,36 		$421,00
$453,20
$487,31
$608,48 		$603,47
$635,67
$669,78
$790,95 		$785,94
$818,14
$852,25
$973,42 		$182,47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$477,06
$541,46
$609,68
$852,02
$1 294,72 		$659,53
$723,93
$792,15
$1 034,49 		$842,00
$906,40
$974,62
$1 216,96 		$1 024,47
$1 088,87
$1 157,09
$1 399,43 		$182,47
Toc - Plan #42 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 5

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$231,93
$263,24
$296,41
$414,23
$629,46 		$409,36
$440,67
$473,84
$591,66 		$586,79
$618,10
$651,27
$769,09 		$764,22
$795,53
$828,70
$946,52 		$177,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$463,86
$526,48
$592,82
$828,46
$1 258,92 		$641,29
$703,91
$770,25
$1 005,89 		$818,72
$881,34
$947,68
$1 183,32 		$996,15
$1 058,77
$1 125,11
$1 360,75 		$177,43
Toc - Plan #43 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 +Vision

Annual Out of Pocket Expenses
Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$329,78
$374,30
$421,45
$588,98
$895,01 		$582,06
$626,58
$673,73
$841,26 		$834,34
$878,86
$926,01
$1 093,54 		$1 086,62
$1 131,14
$1 178,29
$1 345,82 		$252,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$659,56
$748,60
$842,90
$1 177,96
$1 790,02 		$911,84
$1 000,88
$1 095,18
$1 430,24 		$1 164,12
$1 253,16
$1 347,46
$1 682,52 		$1 416,40
$1 505,44
$1 599,74
$1 934,80 		$252,28
Toc - Plan #44 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 250 +Vision

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$282,31
$320,42
$360,79
$504,20
$766,18 		$498,27
$536,38
$576,75
$720,16 		$714,23
$752,34
$792,71
$936,12 		$930,19
$968,30
$1 008,67
$1 152,08 		$215,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$564,62
$640,84
$721,58
$1 008,40
$1 532,36 		$780,58
$856,80
$937,54
$1 224,36 		$996,54
$1 072,76
$1 153,50
$1 440,32 		$1 212,50
$1 288,72
$1 369,46
$1 656,28 		$215,96
Toc - Plan #45 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 1 +Vision

Annual Out of Pocket Expenses
Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$230,61
$261,74
$294,72
$411,87
$625,88 		$407,03
$438,16
$471,14
$588,29 		$583,45
$614,58
$647,56
$764,71 		$759,87
$791,00
$823,98
$941,13 		$176,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$461,22
$523,48
$589,44
$823,74
$1 251,76 		$637,64
$699,90
$765,86
$1 000,16 		$814,06
$876,32
$942,28
$1 176,58 		$990,48
$1 052,74
$1 118,70
$1 353,00 		$176,42
Toc - Plan #46 Molina Healthcare
Silver

(HMO) Constant Care Silver 2 250

Annual Out of Pocket Expenses
Individual Family
$5,200 $10,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$278,83
$316,48
$356,35
$498,00
$756,76 		$492,14
$529,79
$569,66
$711,31 		$705,45
$743,10
$782,97
$924,62 		$918,76
$956,41
$996,28
$1 137,93 		$213,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557,66
$632,96
$712,70
$996,00
$1 513,52 		$770,97
$846,27
$926,01
$1 209,31 		$984,28
$1 059,58
$1 139,32
$1 422,62 		$1 197,59
$1 272,89
$1 352,63
$1 635,93 		$213,31
Toc - Plan #47 Molina Healthcare
Bronze

(HMO) Core Care Bronze 2

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$225,73
$256,20
$288,48
$403,15
$612,63 		$398,41
$428,88
$461,16
$575,83 		$571,09
$601,56
$633,84
$748,51 		$743,77
$774,24
$806,52
$921,19 		$172,68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$451,46
$512,40
$576,96
$806,30
$1 225,26 		$624,14
$685,08
$749,64
$978,98 		$796,82
$857,76
$922,32
$1 151,66 		$969,50
$1 030,44
$1 095,00
$1 324,34 		$172,68

ADVERTISEMENT

Paramount

Local: 1-419-887-2525 | Toll Free: 1-800-462-3589 | TTY: 1-888-740-5670
Toc - Plan #48 Paramount
Silver

(HMO) Paramount Silver 5

Annual Out of Pocket Expenses
Individual Family
$4,000 $8,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$552,46
$627,04
$706,04
$986,69
$1 499,38 		$975,09
$1 049,67
$1 128,67
$1 409,32 		$1 397,72
$1 472,30
$1 551,30
$1 831,95 		$1 820,35
$1 894,93
$1 973,93
$2 254,58 		$422,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 104,92
$1 254,08
$1 412,08
$1 973,38
$2 998,76 		$1 527,55
$1 676,71
$1 834,71
$2 396,01 		$1 950,18
$2 099,34
$2 257,34
$2 818,64 		$2 372,81
$2 521,97
$2 679,97
$3 241,27 		$422,63
Toc - Plan #49 Paramount
Silver

(HMO) Paramount Silver 6

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$526,30
$597,36
$672,62
$939,98
$1 428,40 		$928,92
$999,98
$1 075,24
$1 342,60 		$1 331,54
$1 402,60
$1 477,86
$1 745,22 		$1 734,16
$1 805,22
$1 880,48
$2 147,84 		$402,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 052,60
$1 194,72
$1 345,24
$1 879,96
$2 856,80 		$1 455,22
$1 597,34
$1 747,86
$2 282,58 		$1 857,84
$1 999,96
$2 150,48
$2 685,20 		$2 260,46
$2 402,58
$2 553,10
$3 087,82 		$402,62
Toc - Plan #50 Paramount
Gold

(HMO) Paramount Gold 3

Annual Out of Pocket Expenses
Individual Family
$2,500 $5,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$585,63
$664,69
$748,43
$1 045,93
$1 589,40 		$1 033,63
$1 112,69
$1 196,43
$1 493,93 		$1 481,63
$1 560,69
$1 644,43
$1 941,93 		$1 929,63
$2 008,69
$2 092,43
$2 389,93 		$448,00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 171,26
$1 329,38
$1 496,86
$2 091,86
$3 178,80 		$1 619,26
$1 777,38
$1 944,86
$2 539,86 		$2 067,26
$2 225,38
$2 392,86
$2 987,86 		$2 515,26
$2 673,38
$2 840,86
$3 435,86 		$448,00

ADVERTISEMENT

CareSource

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502 | TTY: 1-800-750-0750
Toc - Plan #51 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Annual Out of Pocket Expenses
Individual Family
$5,400 $10,800 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$310,62
$352,55
$396,97
$554,76
$843,01 		$548,24
$590,17
$634,59
$792,38 		$785,86
$827,79
$872,21
$1 030,00 		$1 023,48
$1 065,41
$1 109,83
$1 267,62 		$237,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$621,24
$705,10
$793,94
$1 109,52
$1 686,02 		$858,86
$942,72
$1 031,56
$1 347,14 		$1 096,48
$1 180,34
$1 269,18
$1 584,76 		$1 334,10
$1 417,96
$1 506,80
$1 822,38 		$237,62
Toc - Plan #52 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$394,96
$448,28
$504,76
$705,40
$1 071,92 		$697,10
$750,42
$806,90
$1 007,54 		$999,24
$1 052,56
$1 109,04
$1 309,68 		$1 301,38
$1 354,70
$1 411,18
$1 611,82 		$302,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789,92
$896,56
$1 009,52
$1 410,80
$2 143,84 		$1 092,06
$1 198,70
$1 311,66
$1 712,94 		$1 394,20
$1 500,84
$1 613,80
$2 015,08 		$1 696,34
$1 802,98
$1 915,94
$2 317,22 		$302,14
Toc - Plan #53 CareSource
Gold

(HMO) CareSource Marketplace Gold

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$532,51
$604,40
$680,54
$951,06
$1 445,23 		$939,88
$1 011,77
$1 087,91
$1 358,43 		$1 347,25
$1 419,14
$1 495,28
$1 765,80 		$1 754,62
$1 826,51
$1 902,65
$2 173,17 		$407,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 065,02
$1 208,80
$1 361,08
$1 902,12
$2 890,46 		$1 472,39
$1 616,17
$1 768,45
$2 309,49 		$1 879,76
$2 023,54
$2 175,82
$2 716,86 		$2 287,13
$2 430,91
$2 583,19
$3 124,23 		$407,37
Toc - Plan #54 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Annual Out of Pocket Expenses
Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$415,66
$471,77
$531,21
$742,37
$1 128,10 		$733,64
$789,75
$849,19
$1 060,35 		$1 051,62
$1 107,73
$1 167,17
$1 378,33 		$1 369,60
$1 425,71
$1 485,15
$1 696,31 		$317,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$831,32
$943,54
$1 062,42
$1 484,74
$2 256,20 		$1 149,30
$1 261,52
$1 380,40
$1 802,72 		$1 467,28
$1 579,50
$1 698,38
$2 120,70 		$1 785,26
$1 897,48
$2 016,36
$2 438,68 		$317,98
Toc - Plan #55 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze

Annual Out of Pocket Expenses
Individual Family
$7,700 $15,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$280,08
$317,89
$357,94
$500,22
$760,13 		$494,34
$532,15
$572,20
$714,48 		$708,60
$746,41
$786,46
$928,74 		$922,86
$960,67
$1 000,72
$1 143,00 		$214,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$560,16
$635,78
$715,88
$1 000,44
$1 520,26 		$774,42
$850,04
$930,14
$1 214,70 		$988,68
$1 064,30
$1 144,40
$1 428,96 		$1 202,94
$1 278,56
$1 358,66
$1 643,22 		$214,26
Toc - Plan #56 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Annual Out of Pocket Expenses
Individual Family
$5,100 $10,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$426,75
$484,36
$545,39
$762,18
$1 158,20 		$753,21
$810,82
$871,85
$1 088,64 		$1 079,67
$1 137,28
$1 198,31
$1 415,10 		$1 406,13
$1 463,74
$1 524,77
$1 741,56 		$326,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$853,50
$968,72
$1 090,78
$1 524,36
$2 316,40 		$1 179,96
$1 295,18
$1 417,24
$1 850,82 		$1 506,42
$1 621,64
$1 743,70
$2 177,28 		$1 832,88
$1 948,10
$2 070,16
$2 503,74 		$326,46
Toc - Plan #57 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$411,49
$467,04
$525,89
$734,92
$1 116,79 		$726,28
$781,83
$840,68
$1 049,71 		$1 041,07
$1 096,62
$1 155,47
$1 364,50 		$1 355,86
$1 411,41
$1 470,26
$1 679,29 		$314,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822,98
$934,08
$1 051,78
$1 469,84
$2 233,58 		$1 137,77
$1 248,87
$1 366,57
$1 784,63 		$1 452,56
$1 563,66
$1 681,36
$2 099,42 		$1 767,35
$1 878,45
$1 996,15
$2 414,21 		$314,79
Toc - Plan #58 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$555,62
$630,63
$710,08
$992,33
$1 507,95 		$980,67
$1 055,68
$1 135,13
$1 417,38 		$1 405,72
$1 480,73
$1 560,18
$1 842,43 		$1 830,77
$1 905,78
$1 985,23
$2 267,48 		$425,05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 111,24
$1 261,26
$1 420,16
$1 984,66
$3 015,90 		$1 536,29
$1 686,31
$1 845,21
$2 409,71 		$1 961,34
$2 111,36
$2 270,26
$2 834,76 		$2 386,39
$2 536,41
$2 695,31
$3 259,81 		$425,05
Toc - Plan #59 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness

Annual Out of Pocket Expenses
Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$433,49
$492,01
$553,99
$774,20
$1 176,48 		$765,11
$823,63
$885,61
$1 105,82 		$1 096,73
$1 155,25
$1 217,23
$1 437,44 		$1 428,35
$1 486,87
$1 548,85
$1 769,06 		$331,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$866,98
$984,02
$1 107,98
$1 548,40
$2 352,96 		$1 198,60
$1 315,64
$1 439,60
$1 880,02 		$1 530,22
$1 647,26
$1 771,22
$2 211,64 		$1 861,84
$1 978,88
$2 102,84
$2 543,26 		$331,62
Toc - Plan #60 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness

Annual Out of Pocket Expenses
Individual Family
$7,700 $15,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$292,74
$332,25
$374,11
$522,82
$794,48 		$516,68
$556,19
$598,05
$746,76 		$740,62
$780,13
$821,99
$970,70 		$964,56
$1 004,07
$1 045,93
$1 194,64 		$223,94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$585,48
$664,50
$748,22
$1 045,64
$1 588,96 		$809,42
$888,44
$972,16
$1 269,58 		$1 033,36
$1 112,38
$1 196,10
$1 493,52 		$1 257,30
$1 336,32
$1 420,04
$1 717,46 		$223,94
Toc - Plan #61 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Annual Out of Pocket Expenses
Individual Family
$5,100 $10,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$445,83
$506,02
$569,77
$796,25
$1 209,98 		$786,89
$847,08
$910,83
$1 137,31 		$1 127,95
$1 188,14
$1 251,89
$1 478,37 		$1 469,01
$1 529,20
$1 592,95
$1 819,43 		$341,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$891,66
$1 012,04
$1 139,54
$1 592,50
$2 419,96 		$1 232,72
$1 353,10
$1 480,60
$1 933,56 		$1 573,78
$1 694,16
$1 821,66
$2 274,62 		$1 914,84
$2 035,22
$2 162,72
$2 615,68 		$341,06

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Toc - Plan #62 MedMutual
Gold

(HMO) Market HMO 2000 - Mercy

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$451,57
$512,54
$577,11
$806,51
$1 225,57 		$797,02
$857,99
$922,56
$1 151,96 		$1 142,47
$1 203,44
$1 268,01
$1 497,41 		$1 487,92
$1 548,89
$1 613,46
$1 842,86 		$345,45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$903,14
$1 025,08
$1 154,22
$1 613,02
$2 451,14 		$1 248,59
$1 370,53
$1 499,67
$1 958,47 		$1 594,04
$1 715,98
$1 845,12
$2 303,92 		$1 939,49
$2 061,43
$2 190,57
$2 649,37 		$345,45
Toc - Plan #63 MedMutual
Silver

(HMO) Market HMO 3000 - Mercy

Annual Out of Pocket Expenses
Individual Family
$3,000 $6,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$345,77
$392,45
$441,90
$617,55
$938,43 		$610,29
$656,97
$706,42
$882,07 		$874,81
$921,49
$970,94
$1 146,59 		$1 139,33
$1 186,01
$1 235,46
$1 411,11 		$264,52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$691,54
$784,90
$883,80
$1 235,10
$1 876,86 		$956,06
$1 049,42
$1 148,32
$1 499,62 		$1 220,58
$1 313,94
$1 412,84
$1 764,14 		$1 485,10
$1 578,46
$1 677,36
$2 028,66 		$264,52
Toc - Plan #64 MedMutual
Silver

(HMO) Market HMO 4000 HSA - Mercy

Annual Out of Pocket Expenses
Individual Family
$4,000 $8,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$344,64
$391,16
$440,45
$615,52
$935,35 		$608,29
$654,81
$704,10
$879,17 		$871,94
$918,46
$967,75
$1 142,82 		$1 135,59
$1 182,11
$1 231,40
$1 406,47 		$263,65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$689,28
$782,32
$880,90
$1 231,04
$1 870,70 		$952,93
$1 045,97
$1 144,55
$1 494,69 		$1 216,58
$1 309,62
$1 408,20
$1 758,34 		$1 480,23
$1 573,27
$1 671,85
$2 021,99 		$263,65
Toc - Plan #65 MedMutual
Silver

(HMO) Market HMO 6500 - Mercy

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$358,25
$406,62
$457,85
$639,84
$972,30 		$632,31
$680,68
$731,91
$913,90 		$906,37
$954,74
$1 005,97
$1 187,96 		$1 180,43
$1 228,80
$1 280,03
$1 462,02 		$274,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$716,50
$813,24
$915,70
$1 279,68
$1 944,60 		$990,56
$1 087,30
$1 189,76
$1 553,74 		$1 264,62
$1 361,36
$1 463,82
$1 827,80 		$1 538,68
$1 635,42
$1 737,88
$2 101,86 		$274,06
Toc - Plan #66 MedMutual
Expanded Bronze

(HMO) Market HMO 5850 HSA - Mercy

Annual Out of Pocket Expenses
Individual Family
$5,850 $11,700 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$284,50
$322,91
$363,60
$508,12
$772,14 		$502,15
$540,56
$581,25
$725,77 		$719,80
$758,21
$798,90
$943,42 		$937,45
$975,86
$1 016,55
$1 161,07 		$217,65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$569,00
$645,82
$727,20
$1 016,24
$1 544,28 		$786,65
$863,47
$944,85
$1 233,89 		$1 004,30
$1 081,12
$1 162,50
$1 451,54 		$1 221,95
$1 298,77
$1 380,15
$1 669,19 		$217,65
Toc - Plan #67 MedMutual
Expanded Bronze

(HMO) Market HMO 7000 HSA - Mercy

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$265,78
$301,66
$339,67
$474,69
$721,33 		$469,10
$504,98
$542,99
$678,01 		$672,42
$708,30
$746,31
$881,33 		$875,74
$911,62
$949,63
$1 084,65 		$203,32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$531,56
$603,32
$679,34
$949,38
$1 442,66 		$734,88
$806,64
$882,66
$1 152,70 		$938,20
$1 009,96
$1 085,98
$1 356,02 		$1 141,52
$1 213,28
$1 289,30
$1 559,34 		$203,32
Toc - Plan #68 MedMutual
Bronze

(HMO) Market HMO 8500 - Mercy

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$255,57
$290,07
$326,62
$456,45
$693,62 		$451,08
$485,58
$522,13
$651,96 		$646,59
$681,09
$717,64
$847,47 		$842,10
$876,60
$913,15
$1 042,98 		$195,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$511,14
$580,14
$653,24
$912,90
$1 387,24 		$706,65
$775,65
$848,75
$1 108,41 		$902,16
$971,16
$1 044,26
$1 303,92 		$1 097,67
$1 166,67
$1 239,77
$1 499,43 		$195,51
Toc - Plan #69 MedMutual
Expanded Bronze

(HMO) Market HMO $0 Deductible - Mercy

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$296,42
$336,43
$378,82
$529,40
$804,48 		$523,18
$563,19
$605,58
$756,16 		$749,94
$789,95
$832,34
$982,92 		$976,70
$1 016,71
$1 059,10
$1 209,68 		$226,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$592,84
$672,86
$757,64
$1 058,80
$1 608,96 		$819,60
$899,62
$984,40
$1 285,56 		$1 046,36
$1 126,38
$1 211,16
$1 512,32 		$1 273,12
$1 353,14
$1 437,92
$1 739,08 		$226,76
Toc - Plan #70 MedMutual
Catastrophic

(HMO) Market HMO Young Adult Essentials - Mercy

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$161,40
$183,19
$206,27
$288,26
$438,03 		$284,87
$306,66
$329,74
$411,73 		$408,34
$430,13
$453,21
$535,20 		$531,81
$553,60
$576,68
$658,67 		$123,47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$322,80
$366,38
$412,54
$576,52
$876,06 		$446,27
$489,85
$536,01
$699,99 		$569,74
$613,32
$659,48
$823,46 		$693,21
$736,79
$782,95
$946,93 		$123,47

‡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 Erie County here.

Erie County is in “Rating Area 6” of Ohio.

Currently, there are 70 plans offered in Rating Area 6.

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2022 Obamacare Rates for Erie County

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