Ohio

Obamacare 2018 Rates

Obamacare 2018 Rates and Health Insurance Providers for Medina County,Medina,OH


The health insurance rates listed below are for calendar year 2018.

2018 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

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

Obamacare Providers, Plans and 2018 Rates for Medina County

Medina County is in “Rating Area 11” of Ohio.

Currently, there are 48 plans offered in Rating Area 11.

Below, you’ll find a summary of plans and rates for each of these providers. This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must either

  • contact a licensed health insurance agent (by contacting one of the advertisers you see on this website)
  • complete an application at HealthCare.gov, or
  • contact the provider directly.

The table below shows premiums for the following scenarios for:

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

Each scenario is covered for age

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

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

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

2018 Obamacare Rates Providers, Plans for Medina County

Oscar Insurance Corporation of Ohio

Local: | Toll Free:

Bronze

Plan: (EPO) Classic Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$259.45
$294.48
$331.58
$463.38
$704.15
$518.90
$588.96
$663.16
$926.76
$1,408.30
$717.38
$787.44
$861.64
$1,125.24
$915.86
$985.92
$1,060.12
$1,323.72
$1,114.34
$1,184.40
$1,258.60
$1,522.20
$457.93
$492.96
$530.06
$661.86
$656.41
$691.44
$728.54
$860.34
$854.89
$889.92
$927.02
$1,058.82
$198.48

Medical Health Insuring Corp. of Ohio

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Bronze

Plan: (HMO) Market HMO 5250 HSA - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $5,250 : Family: $10,500
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$261.94
$297.30
$334.76
$467.83
$710.91
$523.88
$594.60
$669.52
$935.66
$1,421.82
$724.26
$794.98
$869.90
$1,136.04
$924.64
$995.36
$1,070.28
$1,336.42
$1,125.02
$1,195.74
$1,270.66
$1,536.80
$462.32
$497.68
$535.14
$668.21
$662.70
$698.06
$735.52
$868.59
$863.08
$898.44
$935.90
$1,068.97
$200.38

Bronze

Plan: (HMO) Market HMO 6400 HSA - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$248.04
$281.53
$317.00
$443.01
$673.19
$496.08
$563.06
$634.00
$886.02
$1,346.38
$685.83
$752.81
$823.75
$1,075.77
$875.58
$942.56
$1,013.50
$1,265.52
$1,065.33
$1,132.31
$1,203.25
$1,455.27
$437.79
$471.28
$506.75
$632.76
$627.54
$661.03
$696.50
$822.51
$817.29
$850.78
$886.25
$1,012.26
$189.75

Bronze

Plan: (HMO) Market HMO 7350 - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$231.79
$263.08
$296.22
$413.97
$629.07
$463.58
$526.16
$592.44
$827.94
$1,258.14
$640.90
$703.48
$769.76
$1,005.26
$818.22
$880.80
$947.08
$1,182.58
$995.54
$1,058.12
$1,124.40
$1,359.90
$409.11
$440.40
$473.54
$591.29
$586.43
$617.72
$650.86
$768.61
$763.75
$795.04
$828.18
$945.93
$177.32

Catastrophic

Plan: (HMO) Market HMO Young Adult Essentials - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Catastrophic 21
30
40
50
60
$186.95
$212.19
$238.92
$333.89
$507.38
$373.90
$424.38
$477.84
$667.78
$1,014.76
$516.92
$567.40
$620.86
$810.80
$659.94
$710.42
$763.88
$953.82
$802.96
$853.44
$906.90
$1,096.84
$329.97
$355.21
$381.94
$476.91
$472.99
$498.23
$524.96
$619.93
$616.01
$641.25
$667.98
$762.95
$143.02

Buckeye Community Health Plan

Local: 1-877-687-1189 | Toll Free: 1-877-687-1189

TTY: 1-877-941-9236

Gold

Plan: (HMO) Ambetter Secure Care 1 (2018) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$365.78
$415.15
$467.45
$653.26
$992.69
$731.56
$830.30
$934.90
$1,306.52
$1,985.38
$1,011.37
$1,110.11
$1,214.71
$1,586.33
$1,291.18
$1,389.92
$1,494.52
$1,866.14
$1,570.99
$1,669.73
$1,774.33
$2,145.95
$645.59
$694.96
$747.26
$933.07
$925.40
$974.77
$1,027.07
$1,212.88
$1,205.21
$1,254.58
$1,306.88
$1,492.69
$279.81

Silver

Plan: (HMO) Ambetter Balanced Care 1 (2018)

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$313.00
$355.24
$400.00
$559.00
$849.45
$626.00
$710.48
$800.00
$1,118.00
$1,698.90
$865.44
$949.92
$1,039.44
$1,357.44
$1,104.88
$1,189.36
$1,278.88
$1,596.88
$1,344.32
$1,428.80
$1,518.32
$1,836.32
$552.44
$594.68
$639.44
$798.44
$791.88
$834.12
$878.88
$1,037.88
$1,031.32
$1,073.56
$1,118.32
$1,277.32
$239.44

Silver

Plan: (HMO) Ambetter Balanced Care 2 (2018)

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$306.86
$348.28
$392.16
$548.04
$832.79
$613.72
$696.56
$784.32
$1,096.08
$1,665.58
$848.46
$931.30
$1,019.06
$1,330.82
$1,083.20
$1,166.04
$1,253.80
$1,565.56
$1,317.94
$1,400.78
$1,488.54
$1,800.30
$541.60
$583.02
$626.90
$782.78
$776.34
$817.76
$861.64
$1,017.52
$1,011.08
$1,052.50
$1,096.38
$1,252.26
$234.74

Silver

Plan: (HMO) Ambetter Balanced Care 10 (2018)

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$328.95
$373.35
$420.39
$587.50
$892.76
$657.90
$746.70
$840.78
$1,175.00
$1,785.52
$909.54
$998.34
$1,092.42
$1,426.64
$1,161.18
$1,249.98
$1,344.06
$1,678.28
$1,412.82
$1,501.62
$1,595.70
$1,929.92
$580.59
$624.99
$672.03
$839.14
$832.23
$876.63
$923.67
$1,090.78
$1,083.87
$1,128.27
$1,175.31
$1,342.42
$251.64

Silver

Plan: (HMO) Ambetter Balanced Care 12 (2018)

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$336.32
$381.71
$429.80
$600.65
$912.74
$672.64
$763.42
$859.60
$1,201.30
$1,825.48
$929.92
$1,020.70
$1,116.88
$1,458.58
$1,187.20
$1,277.98
$1,374.16
$1,715.86
$1,444.48
$1,535.26
$1,631.44
$1,973.14
$593.60
$638.99
$687.08
$857.93
$850.88
$896.27
$944.36
$1,115.21
$1,108.16
$1,153.55
$1,201.64
$1,372.49
$257.28

Silver

Plan: (HMO) Ambetter Balanced Care 5 (2018)

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$287.22
$325.99
$367.06
$512.96
$779.50
$574.44
$651.98
$734.12
$1,025.92
$1,559.00
$794.16
$871.70
$953.84
$1,245.64
$1,013.88
$1,091.42
$1,173.56
$1,465.36
$1,233.60
$1,311.14
$1,393.28
$1,685.08
$506.94
$545.71
$586.78
$732.68
$726.66
$765.43
$806.50
$952.40
$946.38
$985.15
$1,026.22
$1,172.12
$219.72

Silver

Plan: (HMO) Ambetter Balanced Care 1 (2018) + Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$317.01
$359.79
$405.13
$566.16
$860.34
$634.02
$719.58
$810.26
$1,132.32
$1,720.68
$876.52
$962.08
$1,052.76
$1,374.82
$1,119.02
$1,204.58
$1,295.26
$1,617.32
$1,361.52
$1,447.08
$1,537.76
$1,859.82
$559.51
$602.29
$647.63
$808.66
$802.01
$844.79
$890.13
$1,051.16
$1,044.51
$1,087.29
$1,132.63
$1,293.66
$242.50

Silver

Plan: (HMO) Ambetter Balanced Care 2 (2018) + Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$310.79
$352.74
$397.18
$555.06
$843.47
$621.58
$705.48
$794.36
$1,110.12
$1,686.94
$859.33
$943.23
$1,032.11
$1,347.87
$1,097.08
$1,180.98
$1,269.86
$1,585.62
$1,334.83
$1,418.73
$1,507.61
$1,823.37
$548.54
$590.49
$634.93
$792.81
$786.29
$828.24
$872.68
$1,030.56
$1,024.04
$1,065.99
$1,110.43
$1,268.31
$237.75

Silver

Plan: (HMO) Ambetter Balanced Care 10 (2018) + Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$333.17
$378.14
$425.78
$595.02
$904.20
$666.34
$756.28
$851.56
$1,190.04
$1,808.40
$921.21
$1,011.15
$1,106.43
$1,444.91
$1,176.08
$1,266.02
$1,361.30
$1,699.78
$1,430.95
$1,520.89
$1,616.17
$1,954.65
$588.04
$633.01
$680.65
$849.89
$842.91
$887.88
$935.52
$1,104.76
$1,097.78
$1,142.75
$1,190.39
$1,359.63
$254.87

Silver

Plan: (HMO) Ambetter Balanced Care 1 (2018) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$328.74
$373.10
$420.11
$587.10
$892.16
$657.48
$746.20
$840.22
$1,174.20
$1,784.32
$908.96
$997.68
$1,091.70
$1,425.68
$1,160.44
$1,249.16
$1,343.18
$1,677.16
$1,411.92
$1,500.64
$1,594.66
$1,928.64
$580.22
$624.58
$671.59
$838.58
$831.70
$876.06
$923.07
$1,090.06
$1,083.18
$1,127.54
$1,174.55
$1,341.54
$251.48

Silver

Plan: (HMO) Ambetter Balanced Care 2 (2018) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$322.29
$365.79
$411.87
$575.59
$874.67
$644.58
$731.58
$823.74
$1,151.18
$1,749.34
$891.12
$978.12
$1,070.28
$1,397.72
$1,137.66
$1,224.66
$1,316.82
$1,644.26
$1,384.20
$1,471.20
$1,563.36
$1,890.80
$568.83
$612.33
$658.41
$822.13
$815.37
$858.87
$904.95
$1,068.67
$1,061.91
$1,105.41
$1,151.49
$1,315.21
$246.54

Silver

Plan: (HMO) Ambetter Balanced Care 10 (2018) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Buckeye Community Health Plan)
Customer Service Phone: 1-877-687-1189

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$345.49
$392.12
$441.53
$617.04
$937.64
$690.98
$784.24
$883.06
$1,234.08
$1,875.28
$955.28
$1,048.54
$1,147.36
$1,498.38
$1,219.58
$1,312.84
$1,411.66
$1,762.68
$1,483.88
$1,577.14
$1,675.96
$2,026.98
$609.79
$656.42
$705.83
$881.34
$874.09
$920.72
$970.13
$1,145.64
$1,138.39
$1,185.02
$1,234.43
$1,409.94
$264.30
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Oscar Insurance Corporation of Ohio

Local: | Toll Free:

Catastrophic

Plan: (EPO) Simple Secure

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Catastrophic 21
30
40
50
60
$212.54
$241.24
$271.63
$379.60
$576.84
$425.08
$482.48
$543.26
$759.20
$1,153.68
$587.68
$645.08
$705.86
$921.80
$750.28
$807.68
$868.46
$1,084.40
$912.88
$970.28
$1,031.06
$1,247.00
$375.14
$403.84
$434.23
$542.20
$537.74
$566.44
$596.83
$704.80
$700.34
$729.04
$759.43
$867.40
$162.60

Silver

Plan: (EPO) Classic Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$331.11
$375.81
$423.16
$591.36
$898.63
$662.22
$751.62
$846.32
$1,182.72
$1,797.26
$915.52
$1,004.92
$1,099.62
$1,436.02
$1,168.82
$1,258.22
$1,352.92
$1,689.32
$1,422.12
$1,511.52
$1,606.22
$1,942.62
$584.41
$629.11
$676.46
$844.66
$837.71
$882.41
$929.76
$1,097.96
$1,091.01
$1,135.71
$1,183.06
$1,351.26
$253.30

Gold

Plan: (EPO) Classic Gold

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$388.87
$441.37
$496.98
$694.52
$1,055.40
$777.74
$882.74
$993.96
$1,389.04
$2,110.80
$1,075.23
$1,180.23
$1,291.45
$1,686.53
$1,372.72
$1,477.72
$1,588.94
$1,984.02
$1,670.21
$1,775.21
$1,886.43
$2,281.51
$686.36
$738.86
$794.47
$992.01
$983.85
$1,036.35
$1,091.96
$1,289.50
$1,281.34
$1,333.84
$1,389.45
$1,586.99
$297.49

Bronze

Plan: (EPO) Simple Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$251.71
$285.69
$321.69
$449.56
$683.15
$503.42
$571.38
$643.38
$899.12
$1,366.30
$695.98
$763.94
$835.94
$1,091.68
$888.54
$956.50
$1,028.50
$1,284.24
$1,081.10
$1,149.06
$1,221.06
$1,476.80
$444.27
$478.25
$514.25
$642.12
$636.83
$670.81
$706.81
$834.68
$829.39
$863.37
$899.37
$1,027.24
$192.56

Silver

Plan: (EPO) Simple Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

Deductible: Individual: $7,000 : Family: $14,000
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$353.12
$400.79
$451.28
$630.67
$958.36
$706.24
$801.58
$902.56
$1,261.34
$1,916.72
$976.37
$1,071.71
$1,172.69
$1,531.47
$1,246.50
$1,341.84
$1,442.82
$1,801.60
$1,516.63
$1,611.97
$1,712.95
$2,071.73
$623.25
$670.92
$721.41
$900.80
$893.38
$941.05
$991.54
$1,170.93
$1,163.51
$1,211.18
$1,261.67
$1,441.06
$270.13

Bronze

Plan: (EPO) Saver Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$263.54
$299.12
$336.81
$470.68
$715.25
$527.08
$598.24
$673.62
$941.36
$1,430.50
$728.69
$799.85
$875.23
$1,142.97
$930.30
$1,001.46
$1,076.84
$1,344.58
$1,131.91
$1,203.07
$1,278.45
$1,546.19
$465.15
$500.73
$538.42
$672.29
$666.76
$702.34
$740.03
$873.90
$868.37
$903.95
$941.64
$1,075.51
$201.61

Silver

Plan: (EPO) Saver Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Oscar Insurance Corporation of Ohio)
Customer Service Phone:

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$335.52
$380.81
$428.79
$599.24
$910.60
$671.04
$761.62
$857.58
$1,198.48
$1,821.20
$927.71
$1,018.29
$1,114.25
$1,455.15
$1,184.38
$1,274.96
$1,370.92
$1,711.82
$1,441.05
$1,531.63
$1,627.59
$1,968.49
$592.19
$637.48
$685.46
$855.91
$848.86
$894.15
$942.13
$1,112.58
$1,105.53
$1,150.82
$1,198.80
$1,369.25
$256.67

Summa Insurance Company, Inc.

Local: 1-330-996-8675 | Toll Free: 1-888-996-8675

TTY: 1-800-750-0750

Silver

Plan: (PPO) SummaCare Silver 3500 with SCConnect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$338.83
$384.56
$433.01
$605.14
$919.56
$677.66
$769.12
$866.02
$1,210.28
$1,839.12
$936.86
$1,028.32
$1,125.22
$1,469.48
$1,196.06
$1,287.52
$1,384.42
$1,728.68
$1,455.26
$1,546.72
$1,643.62
$1,987.88
$598.03
$643.76
$692.21
$864.34
$857.23
$902.96
$951.41
$1,123.54
$1,116.43
$1,162.16
$1,210.61
$1,382.74
$259.20

Silver

Plan: (PPO) SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$324.14
$367.88
$414.23
$578.89
$879.68
$648.28
$735.76
$828.46
$1,157.78
$1,759.36
$896.24
$983.72
$1,076.42
$1,405.74
$1,144.20
$1,231.68
$1,324.38
$1,653.70
$1,392.16
$1,479.64
$1,572.34
$1,901.66
$572.10
$615.84
$662.19
$826.85
$820.06
$863.80
$910.15
$1,074.81
$1,068.02
$1,111.76
$1,158.11
$1,322.77
$247.96

Gold

Plan: (PPO) SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$368.22
$417.92
$470.58
$657.63
$999.33
$736.44
$835.84
$941.16
$1,315.26
$1,998.66
$1,018.12
$1,117.52
$1,222.84
$1,596.94
$1,299.80
$1,399.20
$1,504.52
$1,878.62
$1,581.48
$1,680.88
$1,786.20
$2,160.30
$649.90
$699.60
$752.26
$939.31
$931.58
$981.28
$1,033.94
$1,220.99
$1,213.26
$1,262.96
$1,315.62
$1,502.67
$281.68

Silver

Plan: (PPO) SummaCare Silver 5000 40 with SCConnect Network

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$296.65
$336.69
$379.10
$529.80
$805.08
$593.30
$673.38
$758.20
$1,059.60
$1,610.16
$820.23
$900.31
$985.13
$1,286.53
$1,047.16
$1,127.24
$1,212.06
$1,513.46
$1,274.09
$1,354.17
$1,438.99
$1,740.39
$523.58
$563.62
$606.03
$756.73
$750.51
$790.55
$832.96
$983.66
$977.44
$1,017.48
$1,059.89
$1,210.59
$226.93

Catastrophic

Plan: (PPO) SummaCare Value with SCConnect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Catastrophic 21
30
40
50
60
$206.02
$233.83
$263.29
$367.94
$559.12
$412.04
$467.66
$526.58
$735.88
$1,118.24
$569.64
$625.26
$684.18
$893.48
$727.24
$782.86
$841.78
$1,051.08
$884.84
$940.46
$999.38
$1,208.68
$363.62
$391.43
$420.89
$525.54
$521.22
$549.03
$578.49
$683.14
$678.82
$706.63
$736.09
$840.74
$157.60

Bronze

Plan: (PPO) SummaCare Bronze 5000 HSA with SCConnect Network

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Customer Service Phone: 1-888-996-8675

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$272.16
$308.89
$347.80
$486.05
$738.60
$544.32
$617.78
$695.60
$972.10
$1,477.20
$752.51
$825.97
$903.79
$1,180.29
$960.70
$1,034.16
$1,111.98
$1,388.48
$1,168.89
$1,242.35
$1,320.17
$1,596.67
$480.35
$517.08
$555.99
$694.24
$688.54
$725.27
$764.18
$902.43
$896.73
$933.46
$972.37
$1,110.62
$208.19
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CareSource

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502

TTY: 1-800-750-0750

Bronze

Plan: (HMO) CareSource HSA Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$212.29
$240.95
$271.30
$379.15
$576.15
$424.58
$481.90
$542.60
$758.30
$1,152.30
$586.98
$644.30
$705.00
$920.70
$749.38
$806.70
$867.40
$1,083.10
$911.78
$969.10
$1,029.80
$1,245.50
$374.69
$403.35
$433.70
$541.55
$537.09
$565.75
$596.10
$703.95
$699.49
$728.15
$758.50
$866.35
$162.40

Silver

Plan: (HMO) CareSource Low Premium Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $6,150 : Family: $12,300
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$255.12
$289.56
$326.04
$455.64
$692.40
$510.24
$579.12
$652.08
$911.28
$1,384.80
$705.41
$774.29
$847.25
$1,106.45
$900.58
$969.46
$1,042.42
$1,301.62
$1,095.75
$1,164.63
$1,237.59
$1,496.79
$450.29
$484.73
$521.21
$650.81
$645.46
$679.90
$716.38
$845.98
$840.63
$875.07
$911.55
$1,041.15
$195.17

Gold

Plan: (HMO) CareSource Gold

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$307.67
$349.20
$393.19
$549.49
$835.00
$615.34
$698.40
$786.38
$1,098.98
$1,670.00
$850.70
$933.76
$1,021.74
$1,334.34
$1,086.06
$1,169.12
$1,257.10
$1,569.70
$1,321.42
$1,404.48
$1,492.46
$1,805.06
$543.03
$584.56
$628.55
$784.85
$778.39
$819.92
$863.91
$1,020.21
$1,013.75
$1,055.28
$1,099.27
$1,255.57
$235.36

Silver

Plan: (HMO) CareSource Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $3,900 : Family: $7,800
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$267.54
$303.66
$341.91
$477.82
$726.10
$535.08
$607.32
$683.82
$955.64
$1,452.20
$739.75
$811.99
$888.49
$1,160.31
$944.42
$1,016.66
$1,093.16
$1,364.98
$1,149.09
$1,221.33
$1,297.83
$1,569.65
$472.21
$508.33
$546.58
$682.49
$676.88
$713.00
$751.25
$887.16
$881.55
$917.67
$955.92
$1,091.83
$204.67

Bronze

Plan: (HMO) CareSource Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $7,250 : Family: $14,500
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$195.08
$221.41
$249.31
$348.41
$529.44
$390.16
$442.82
$498.62
$696.82
$1,058.88
$539.40
$592.06
$647.86
$846.06
$688.64
$741.30
$797.10
$995.30
$837.88
$890.54
$946.34
$1,144.54
$344.32
$370.65
$398.55
$497.65
$493.56
$519.89
$547.79
$646.89
$642.80
$669.13
$697.03
$796.13
$149.24

Silver

Plan: (HMO) CareSource Low Premium Silver Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $6,150 : Family: $12,300
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$267.65
$303.78
$342.06
$478.02
$726.40
$535.30
$607.56
$684.12
$956.04
$1,452.80
$740.05
$812.31
$888.87
$1,160.79
$944.80
$1,017.06
$1,093.62
$1,365.54
$1,149.55
$1,221.81
$1,298.37
$1,570.29
$472.40
$508.53
$546.81
$682.77
$677.15
$713.28
$751.56
$887.52
$881.90
$918.03
$956.31
$1,092.27
$204.75

Gold

Plan: (HMO) CareSource Gold Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$320.20
$363.42
$409.21
$571.86
$869.00
$640.40
$726.84
$818.42
$1,143.72
$1,738.00
$885.35
$971.79
$1,063.37
$1,388.67
$1,130.30
$1,216.74
$1,308.32
$1,633.62
$1,375.25
$1,461.69
$1,553.27
$1,878.57
$565.15
$608.37
$654.16
$816.81
$810.10
$853.32
$899.11
$1,061.76
$1,055.05
$1,098.27
$1,144.06
$1,306.71
$244.95

Silver

Plan: (HMO) CareSource Silver Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $3,900 : Family: $7,800
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$280.07
$317.88
$357.93
$500.20
$760.10
$560.14
$635.76
$715.86
$1,000.40
$1,520.20
$774.39
$850.01
$930.11
$1,214.65
$988.64
$1,064.26
$1,144.36
$1,428.90
$1,202.89
$1,278.51
$1,358.61
$1,643.15
$494.32
$532.13
$572.18
$714.45
$708.57
$746.38
$786.43
$928.70
$922.82
$960.63
$1,000.68
$1,142.95
$214.25

Bronze

Plan: (HMO) CareSource Bronze Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $7,250 : Family: $14,500
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Bronze 21
30
40
50
60
$207.61
$235.64
$265.32
$370.79
$563.45
$415.22
$471.28
$530.64
$741.58
$1,126.90
$574.04
$630.10
$689.46
$900.40
$732.86
$788.92
$848.28
$1,059.22
$891.68
$947.74
$1,007.10
$1,218.04
$366.43
$394.46
$424.14
$529.61
$525.25
$553.28
$582.96
$688.43
$684.07
$712.10
$741.78
$847.25
$158.82

Silver

Plan: (HMO) CareSource Federal Simple Choice Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$277.87
$315.38
$355.11
$496.27
$754.13
$555.74
$630.76
$710.22
$992.54
$1,508.26
$768.31
$843.33
$922.79
$1,205.11
$980.88
$1,055.90
$1,135.36
$1,417.68
$1,193.45
$1,268.47
$1,347.93
$1,630.25
$490.44
$527.95
$567.68
$708.84
$703.01
$740.52
$780.25
$921.41
$915.58
$953.09
$992.82
$1,133.98
$212.57

Expanded Bronze

Plan: (HMO) CareSource Federal Simple Choice Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Expanded Bronze 21
30
40
50
60
$221.56
$251.47
$283.15
$395.71
$601.31
$443.12
$502.94
$566.30
$791.42
$1,202.62
$612.61
$672.43
$735.79
$960.91
$782.10
$841.92
$905.28
$1,130.40
$951.59
$1,011.41
$1,074.77
$1,299.89
$391.05
$420.96
$452.64
$565.20
$560.54
$590.45
$622.13
$734.69
$730.03
$759.94
$791.62
$904.18
$169.49

Silver

Plan: (HMO) CareSource Federal Simple Choice Silver Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$290.40
$329.60
$371.12
$518.64
$788.13
$580.80
$659.20
$742.24
$1,037.28
$1,576.26
$802.95
$881.35
$964.39
$1,259.43
$1,025.10
$1,103.50
$1,186.54
$1,481.58
$1,247.25
$1,325.65
$1,408.69
$1,703.73
$512.55
$551.75
$593.27
$740.79
$734.70
$773.90
$815.42
$962.94
$956.85
$996.05
$1,037.57
$1,185.09
$222.15

Expanded Bronze

Plan: (HMO) CareSource Federal Simple Choice Bronze Dental and Vision

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (CareSource)
Customer Service Phone: 1-800-479-9502

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Expanded Bronze 21
30
40
50
60
$234.10
$265.70
$299.18
$418.10
$635.34
$468.20
$531.40
$598.36
$836.20
$1,270.68
$647.29
$710.49
$777.45
$1,015.29
$826.38
$889.58
$956.54
$1,194.38
$1,005.47
$1,068.67
$1,135.63
$1,373.47
$413.19
$444.79
$478.27
$597.19
$592.28
$623.88
$657.36
$776.28
$771.37
$802.97
$836.45
$955.37
$179.09
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Medical Health Insuring Corp. of Ohio

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Gold

Plan: (HMO) Market HMO 2000/25 - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Gold 21
30
40
50
60
$422.93
$480.03
$540.51
$755.36
$1,147.84
$845.86
$960.06
$1,081.02
$1,510.72
$2,295.68
$1,169.40
$1,283.60
$1,404.56
$1,834.26
$1,492.94
$1,607.14
$1,728.10
$2,157.80
$1,816.48
$1,930.68
$2,051.64
$2,481.34
$746.47
$803.57
$864.05
$1,078.90
$1,070.01
$1,127.11
$1,187.59
$1,402.44
$1,393.55
$1,450.65
$1,511.13
$1,725.98
$323.54

Silver

Plan: (HMO) Market HMO 2000/30 - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$381.24
$432.71
$487.23
$680.90
$1,034.69
$762.48
$865.42
$974.46
$1,361.80
$2,069.38
$1,054.13
$1,157.07
$1,266.11
$1,653.45
$1,345.78
$1,448.72
$1,557.76
$1,945.10
$1,637.43
$1,740.37
$1,849.41
$2,236.75
$672.89
$724.36
$778.88
$972.55
$964.54
$1,016.01
$1,070.53
$1,264.20
$1,256.19
$1,307.66
$1,362.18
$1,555.85
$291.65

Silver

Plan: (HMO) Market HMO 2400 - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $2,400 : Family: $4,800
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$391.21
$444.02
$499.96
$698.69
$1,061.73
$782.42
$888.04
$999.92
$1,397.38
$2,123.46
$1,081.69
$1,187.31
$1,299.19
$1,696.65
$1,380.96
$1,486.58
$1,598.46
$1,995.92
$1,680.23
$1,785.85
$1,897.73
$2,295.19
$690.48
$743.29
$799.23
$997.96
$989.75
$1,042.56
$1,098.50
$1,297.23
$1,289.02
$1,341.83
$1,397.77
$1,596.50
$299.27

Silver

Plan: (HMO) Market HMO 3500 - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$362.10
$410.99
$462.77
$646.71
$982.74
$724.20
$821.98
$925.54
$1,293.42
$1,965.48
$1,001.21
$1,098.99
$1,202.55
$1,570.43
$1,278.22
$1,376.00
$1,479.56
$1,847.44
$1,555.23
$1,653.01
$1,756.57
$2,124.45
$639.11
$688.00
$739.78
$923.72
$916.12
$965.01
$1,016.79
$1,200.73
$1,193.13
$1,242.02
$1,293.80
$1,477.74
$277.01

Silver

Plan: (HMO) Market HMO 4000 HSA - NE Ohio

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)
Customer Service Phone: 1-888-308-0357

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
0-14
Silver 21
30
40
50
60
$380.46
$431.82
$486.22
$679.49
$1,032.56
$760.92
$863.64
$972.44
$1,358.98
$2,065.12
$1,051.97
$1,154.69
$1,263.49
$1,650.03
$1,343.02
$1,445.74
$1,554.54
$1,941.08
$1,634.07
$1,736.79
$1,845.59
$2,232.13
$671.51
$722.87
$777.27
$970.54
$962.56
$1,013.92
$1,068.32
$1,261.59
$1,253.61
$1,304.97
$1,359.37
$1,552.64
$291.05

‡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 Medina County here.

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