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

Obamacare > Rates > Ohio > Stark 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 Stark 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 Massillon, OH area accept this insurance coverage as within the plan's network.

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

Below, you’ll find a summary of the 124 plans for Stark 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?

  • Stark County, OH Obamacare Rates
  • General Info
  • Rates

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AultCare Insurance Company

Local: 1-330-363-6360 | Toll Free: 1-800-344-8858 | TTY: 1-330-363-2393

Toc - Plan #1 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 5750 No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$5,750 $11,500 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
$384,18
$436,04
$490,97
$686,13
$1 042,65
$678,07
$729,93
$784,86
$980,02
$971,96
$1 023,82
$1 078,75
$1 273,91
$1 265,85
$1 317,71
$1 372,64
$1 567,80
$293,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$768,36
$872,08
$981,94
$1 372,26
$2 085,30
$1 062,25
$1 165,97
$1 275,83
$1 666,15
$1 356,14
$1 459,86
$1 569,72
$1 960,04
$1 650,03
$1 753,75
$1 863,61
$2 253,93
$293,89
Toc - Plan #2 AultCare Insurance Company
Silver

(PPO) AultCare Silver 5000 No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$6,000 $12,000 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
$509,81
$578,63
$651,53
$910,51
$1 383,61
$899,81
$968,63
$1 041,53
$1 300,51
$1 289,81
$1 358,63
$1 431,53
$1 690,51
$1 679,81
$1 748,63
$1 821,53
$2 080,51
$390,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 019,62
$1 157,26
$1 303,06
$1 821,02
$2 767,22
$1 409,62
$1 547,26
$1 693,06
$2 211,02
$1 799,62
$1 937,26
$2 083,06
$2 601,02
$2 189,62
$2 327,26
$2 473,06
$2 991,02
$390,00
Toc - Plan #3 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1000 No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 Annual Deductible
$6,600 $13,200 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
$620,67
$704,45
$793,21
$1 108,50
$1 684,48
$1 095,48
$1 179,26
$1 268,02
$1 583,31
$1 570,29
$1 654,07
$1 742,83
$2 058,12
$2 045,10
$2 128,88
$2 217,64
$2 532,93
$474,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 241,34
$1 408,90
$1 586,42
$2 217,00
$3 368,96
$1 716,15
$1 883,71
$2 061,23
$2 691,81
$2 190,96
$2 358,52
$2 536,04
$3 166,62
$2 665,77
$2 833,33
$3 010,85
$3 641,43
$474,81
Toc - Plan #4 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic Select

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
$195,18
$221,52
$249,43
$348,57
$529,69
$344,49
$370,83
$398,74
$497,88
$493,80
$520,14
$548,05
$647,19
$643,11
$669,45
$697,36
$796,50
$149,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$390,36
$443,04
$498,86
$697,14
$1 059,38
$539,67
$592,35
$648,17
$846,45
$688,98
$741,66
$797,48
$995,76
$838,29
$890,97
$946,79
$1 145,07
$149,31
Toc - Plan #5 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 5750 Select

Annual Out of Pocket Expenses
Individual Family
$5,750 $11,500 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
$303,45
$344,41
$387,80
$541,95
$823,55
$535,58
$576,54
$619,93
$774,08
$767,71
$808,67
$852,06
$1 006,21
$999,84
$1 040,80
$1 084,19
$1 238,34
$232,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$606,90
$688,82
$775,60
$1 083,90
$1 647,10
$839,03
$920,95
$1 007,73
$1 316,03
$1 071,16
$1 153,08
$1 239,86
$1 548,16
$1 303,29
$1 385,21
$1 471,99
$1 780,29
$232,13
Toc - Plan #6 AultCare Insurance Company
Silver

(PPO) AultCare Silver 5000 Select

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$6,000 $12,000 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
$401,73
$455,96
$513,40
$717,48
$1 090,28
$709,05
$763,28
$820,72
$1 024,80
$1 016,37
$1 070,60
$1 128,04
$1 332,12
$1 323,69
$1 377,92
$1 435,36
$1 639,44
$307,32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$803,46
$911,92
$1 026,80
$1 434,96
$2 180,56
$1 110,78
$1 219,24
$1 334,12
$1 742,28
$1 418,10
$1 526,56
$1 641,44
$2 049,60
$1 725,42
$1 833,88
$1 948,76
$2 356,92
$307,32
Toc - Plan #7 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1000 Select

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 Annual Deductible
$6,600 $13,200 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
$489,96
$556,10
$626,16
$875,06
$1 329,74
$864,78
$930,92
$1 000,98
$1 249,88
$1 239,60
$1 305,74
$1 375,80
$1 624,70
$1 614,42
$1 680,56
$1 750,62
$1 999,52
$374,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$979,92
$1 112,20
$1 252,32
$1 750,12
$2 659,48
$1 354,74
$1 487,02
$1 627,14
$2 124,94
$1 729,56
$1 861,84
$2 001,96
$2 499,76
$2 104,38
$2 236,66
$2 376,78
$2 874,58
$374,82
Toc - Plan #8 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic

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
$249,82
$283,54
$319,27
$446,18
$678,01
$440,93
$474,65
$510,38
$637,29
$632,04
$665,76
$701,49
$828,40
$823,15
$856,87
$892,60
$1 019,51
$191,11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$499,64
$567,08
$638,54
$892,36
$1 356,02
$690,75
$758,19
$829,65
$1 083,47
$881,86
$949,30
$1 020,76
$1 274,58
$1 072,97
$1 140,41
$1 211,87
$1 465,69
$191,11
Toc - Plan #9 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 5750

Annual Out of Pocket Expenses
Individual Family
$5,750 $11,500 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
$388,41
$440,84
$496,39
$693,70
$1 054,14
$685,54
$737,97
$793,52
$990,83
$982,67
$1 035,10
$1 090,65
$1 287,96
$1 279,80
$1 332,23
$1 387,78
$1 585,09
$297,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$776,82
$881,68
$992,78
$1 387,40
$2 108,28
$1 073,95
$1 178,81
$1 289,91
$1 684,53
$1 371,08
$1 475,94
$1 587,04
$1 981,66
$1 668,21
$1 773,07
$1 884,17
$2 278,79
$297,13
Toc - Plan #10 AultCare Insurance Company
Silver

(PPO) AultCare Silver 5000

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$6,000 $12,000 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
$514,21
$583,62
$657,16
$918,37
$1 395,56
$907,58
$976,99
$1 050,53
$1 311,74
$1 300,95
$1 370,36
$1 443,90
$1 705,11
$1 694,32
$1 763,73
$1 837,27
$2 098,48
$393,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 028,42
$1 167,24
$1 314,32
$1 836,74
$2 791,12
$1 421,79
$1 560,61
$1 707,69
$2 230,11
$1 815,16
$1 953,98
$2 101,06
$2 623,48
$2 208,53
$2 347,35
$2 494,43
$3 016,85
$393,37
Toc - Plan #11 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1000

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 Annual Deductible
$6,600 $13,200 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
$627,15
$711,81
$801,49
$1 120,08
$1 702,07
$1 106,92
$1 191,58
$1 281,26
$1 599,85
$1 586,69
$1 671,35
$1 761,03
$2 079,62
$2 066,46
$2 151,12
$2 240,80
$2 559,39
$479,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 254,30
$1 423,62
$1 602,98
$2 240,16
$3 404,14
$1 734,07
$1 903,39
$2 082,75
$2 719,93
$2 213,84
$2 383,16
$2 562,52
$3 199,70
$2 693,61
$2 862,93
$3 042,29
$3 679,47
$479,77
Toc - Plan #12 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic No Pediatric Dental

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
$247,16
$280,52
$315,86
$441,42
$670,78
$436,23
$469,59
$504,93
$630,49
$625,30
$658,66
$694,00
$819,56
$814,37
$847,73
$883,07
$1 008,63
$189,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$494,32
$561,04
$631,72
$882,84
$1 341,56
$683,39
$750,11
$820,79
$1 071,91
$872,46
$939,18
$1 009,86
$1 260,98
$1 061,53
$1 128,25
$1 198,93
$1 450,05
$189,07
Toc - Plan #13 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1000 Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 Annual Deductible
$6,600 $13,200 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
$484,90
$550,35
$619,69
$866,02
$1 316,00
$855,84
$921,29
$990,63
$1 236,96
$1 226,78
$1 292,23
$1 361,57
$1 607,90
$1 597,72
$1 663,17
$1 732,51
$1 978,84
$370,94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$969,80
$1 100,70
$1 239,38
$1 732,04
$2 632,00
$1 340,74
$1 471,64
$1 610,32
$2 102,98
$1 711,68
$1 842,58
$1 981,26
$2 473,92
$2 082,62
$2 213,52
$2 352,20
$2 844,86
$370,94
Toc - Plan #14 AultCare Insurance Company
Silver

(PPO) AultCare Silver 5000 Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$6,000 $12,000 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
$398,29
$452,05
$509,01
$711,34
$1 080,95
$702,98
$756,74
$813,70
$1 016,03
$1 007,67
$1 061,43
$1 118,39
$1 320,72
$1 312,36
$1 366,12
$1 423,08
$1 625,41
$304,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796,58
$904,10
$1 018,02
$1 422,68
$2 161,90
$1 101,27
$1 208,79
$1 322,71
$1 727,37
$1 405,96
$1 513,48
$1 627,40
$2 032,06
$1 710,65
$1 818,17
$1 932,09
$2 336,75
$304,69
Toc - Plan #15 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 5750 Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$5,750 $11,500 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
$300,14
$340,65
$383,57
$536,04
$814,57
$529,74
$570,25
$613,17
$765,64
$759,34
$799,85
$842,77
$995,24
$988,94
$1 029,45
$1 072,37
$1 224,84
$229,60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600,28
$681,30
$767,14
$1 072,08
$1 629,14
$829,88
$910,90
$996,74
$1 301,68
$1 059,48
$1 140,50
$1 226,34
$1 531,28
$1 289,08
$1 370,10
$1 455,94
$1 760,88
$229,60
Toc - Plan #16 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic Select No Pediatric Dental

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
$193,09
$219,16
$246,77
$344,86
$524,04
$340,80
$366,87
$394,48
$492,57
$488,51
$514,58
$542,19
$640,28
$636,22
$662,29
$689,90
$787,99
$147,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$386,18
$438,32
$493,54
$689,72
$1 048,08
$533,89
$586,03
$641,25
$837,43
$681,60
$733,74
$788,96
$985,14
$829,31
$881,45
$936,67
$1 132,85
$147,71
Toc - Plan #17 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850

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
$443,58
$503,45
$566,89
$792,22
$1 203,85
$782,91
$842,78
$906,22
$1 131,55
$1 122,24
$1 182,11
$1 245,55
$1 470,88
$1 461,57
$1 521,44
$1 584,88
$1 810,21
$339,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$887,16
$1 006,90
$1 133,78
$1 584,44
$2 407,70
$1 226,49
$1 346,23
$1 473,11
$1 923,77
$1 565,82
$1 685,56
$1 812,44
$2 263,10
$1 905,15
$2 024,89
$2 151,77
$2 602,43
$339,33
Toc - Plan #18 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850 Select

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
$346,55
$393,32
$442,88
$618,92
$940,51
$611,65
$658,42
$707,98
$884,02
$876,75
$923,52
$973,08
$1 149,12
$1 141,85
$1 188,62
$1 238,18
$1 414,22
$265,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$693,10
$786,64
$885,76
$1 237,84
$1 881,02
$958,20
$1 051,74
$1 150,86
$1 502,94
$1 223,30
$1 316,84
$1 415,96
$1 768,04
$1 488,40
$1 581,94
$1 681,06
$2 033,14
$265,10
Toc - Plan #19 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850 No Pediatric Dental

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
$438,86
$498,10
$560,86
$783,80
$1 191,06
$774,59
$833,83
$896,59
$1 119,53
$1 110,32
$1 169,56
$1 232,32
$1 455,26
$1 446,05
$1 505,29
$1 568,05
$1 790,99
$335,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$877,72
$996,20
$1 121,72
$1 567,60
$2 382,12
$1 213,45
$1 331,93
$1 457,45
$1 903,33
$1 549,18
$1 667,66
$1 793,18
$2 239,06
$1 884,91
$2 003,39
$2 128,91
$2 574,79
$335,73
Toc - Plan #20 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850 Select No Pediatric Dental

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
$342,86
$389,14
$438,17
$612,34
$930,52
$605,15
$651,43
$700,46
$874,63
$867,44
$913,72
$962,75
$1 136,92
$1 129,73
$1 176,01
$1 225,04
$1 399,21
$262,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685,72
$778,28
$876,34
$1 224,68
$1 861,04
$948,01
$1 040,57
$1 138,63
$1 486,97
$1 210,30
$1 302,86
$1 400,92
$1 749,26
$1 472,59
$1 565,15
$1 663,21
$2 011,55
$262,29
Toc - Plan #21 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 6850

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
$389,95
$442,58
$498,34
$696,43
$1 058,30
$688,26
$740,89
$796,65
$994,74
$986,57
$1 039,20
$1 094,96
$1 293,05
$1 284,88
$1 337,51
$1 393,27
$1 591,36
$298,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$779,90
$885,16
$996,68
$1 392,86
$2 116,60
$1 078,21
$1 183,47
$1 294,99
$1 691,17
$1 376,52
$1 481,78
$1 593,30
$1 989,48
$1 674,83
$1 780,09
$1 891,61
$2 287,79
$298,31
Toc - Plan #22 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 6850 Select

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
$304,65
$345,77
$389,33
$544,09
$826,80
$537,70
$578,82
$622,38
$777,14
$770,75
$811,87
$855,43
$1 010,19
$1 003,80
$1 044,92
$1 088,48
$1 243,24
$233,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$609,30
$691,54
$778,66
$1 088,18
$1 653,60
$842,35
$924,59
$1 011,71
$1 321,23
$1 075,40
$1 157,64
$1 244,76
$1 554,28
$1 308,45
$1 390,69
$1 477,81
$1 787,33
$233,05
Toc - Plan #23 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 6850 No Pediatric Dental

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
$385,73
$437,79
$492,95
$688,90
$1 046,84
$680,81
$732,87
$788,03
$983,98
$975,89
$1 027,95
$1 083,11
$1 279,06
$1 270,97
$1 323,03
$1 378,19
$1 574,14
$295,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$771,46
$875,58
$985,90
$1 377,80
$2 093,68
$1 066,54
$1 170,66
$1 280,98
$1 672,88
$1 361,62
$1 465,74
$1 576,06
$1 967,96
$1 656,70
$1 760,82
$1 871,14
$2 263,04
$295,08
Toc - Plan #24 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 6850 Select No Pediatric Dental

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
$301,35
$342,03
$385,12
$538,20
$817,85
$531,88
$572,56
$615,65
$768,73
$762,41
$803,09
$846,18
$999,26
$992,94
$1 033,62
$1 076,71
$1 229,79
$230,53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$602,70
$684,06
$770,24
$1 076,40
$1 635,70
$833,23
$914,59
$1 000,77
$1 306,93
$1 063,76
$1 145,12
$1 231,30
$1 537,46
$1 294,29
$1 375,65
$1 461,83
$1 767,99
$230,53
Toc - Plan #25 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze Standard Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$6,650 $13,300 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
$290,60
$329,83
$371,38
$519,01
$788,68
$512,91
$552,14
$593,69
$741,32
$735,22
$774,45
$816,00
$963,63
$957,53
$996,76
$1 038,31
$1 185,94
$222,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$581,20
$659,66
$742,76
$1 038,02
$1 577,36
$803,51
$881,97
$965,07
$1 260,33
$1 025,82
$1 104,28
$1 187,38
$1 482,64
$1 248,13
$1 326,59
$1 409,69
$1 704,95
$222,31
Toc - Plan #26 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8250

Annual Out of Pocket Expenses
Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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
$323,19
$366,81
$413,03
$577,20
$877,12
$570,42
$614,04
$660,26
$824,43
$817,65
$861,27
$907,49
$1 071,66
$1 064,88
$1 108,50
$1 154,72
$1 318,89
$247,23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$646,38
$733,62
$826,06
$1 154,40
$1 754,24
$893,61
$980,85
$1 073,29
$1 401,63
$1 140,84
$1 228,08
$1 320,52
$1 648,86
$1 388,07
$1 475,31
$1 567,75
$1 896,09
$247,23
Toc - Plan #27 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8250 Select

Annual Out of Pocket Expenses
Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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
$252,49
$286,57
$322,68
$450,94
$685,25
$445,64
$479,72
$515,83
$644,09
$638,79
$672,87
$708,98
$837,24
$831,94
$866,02
$902,13
$1 030,39
$193,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$504,98
$573,14
$645,36
$901,88
$1 370,50
$698,13
$766,29
$838,51
$1 095,03
$891,28
$959,44
$1 031,66
$1 288,18
$1 084,43
$1 152,59
$1 224,81
$1 481,33
$193,15
Toc - Plan #28 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8250 No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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
$319,57
$362,71
$408,41
$570,75
$867,30
$564,04
$607,18
$652,88
$815,22
$808,51
$851,65
$897,35
$1 059,69
$1 052,98
$1 096,12
$1 141,82
$1 304,16
$244,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$639,14
$725,42
$816,82
$1 141,50
$1 734,60
$883,61
$969,89
$1 061,29
$1 385,97
$1 128,08
$1 214,36
$1 305,76
$1 630,44
$1 372,55
$1 458,83
$1 550,23
$1 874,91
$244,47
Toc - Plan #29 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8250 Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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
$249,67
$283,37
$319,07
$445,90
$677,58
$440,66
$474,36
$510,06
$636,89
$631,65
$665,35
$701,05
$827,88
$822,64
$856,34
$892,04
$1 018,87
$190,99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$499,34
$566,74
$638,14
$891,80
$1 355,16
$690,33
$757,73
$829,13
$1 082,79
$881,32
$948,72
$1 020,12
$1 273,78
$1 072,31
$1 139,71
$1 211,11
$1 464,77
$190,99
Toc - Plan #30 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 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
$314,57
$357,04
$402,02
$561,82
$853,74
$555,22
$597,69
$642,67
$802,47
$795,87
$838,34
$883,32
$1 043,12
$1 036,52
$1 078,99
$1 123,97
$1 283,77
$240,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$629,14
$714,08
$804,04
$1 123,64
$1 707,48
$869,79
$954,73
$1 044,69
$1 364,29
$1 110,44
$1 195,38
$1 285,34
$1 604,94
$1 351,09
$1 436,03
$1 525,99
$1 845,59
$240,65
Toc - Plan #31 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8550 Select

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
$245,76
$278,93
$314,08
$438,92
$666,98
$433,76
$466,93
$502,08
$626,92
$621,76
$654,93
$690,08
$814,92
$809,76
$842,93
$878,08
$1 002,92
$188,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$491,52
$557,86
$628,16
$877,84
$1 333,96
$679,52
$745,86
$816,16
$1 065,84
$867,52
$933,86
$1 004,16
$1 253,84
$1 055,52
$1 121,86
$1 192,16
$1 441,84
$188,00
Toc - Plan #32 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8550 No Pediatric Dental

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
$311,11
$353,11
$397,60
$555,64
$844,35
$549,11
$591,11
$635,60
$793,64
$787,11
$829,11
$873,60
$1 031,64
$1 025,11
$1 067,11
$1 111,60
$1 269,64
$238,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$622,22
$706,22
$795,20
$1 111,28
$1 688,70
$860,22
$944,22
$1 033,20
$1 349,28
$1 098,22
$1 182,22
$1 271,20
$1 587,28
$1 336,22
$1 420,22
$1 509,20
$1 825,28
$238,00
Toc - Plan #33 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8550 Select No Pediatric Dental

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
$243,06
$275,87
$310,62
$434,09
$659,65
$429,00
$461,81
$496,56
$620,03
$614,94
$647,75
$682,50
$805,97
$800,88
$833,69
$868,44
$991,91
$185,94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$486,12
$551,74
$621,24
$868,18
$1 319,30
$672,06
$737,68
$807,18
$1 054,12
$858,00
$923,62
$993,12
$1 240,06
$1 043,94
$1 109,56
$1 179,06
$1 426,00
$185,94
Toc - Plan #34 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7000

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$327,31
$371,49
$418,30
$584,57
$888,31
$577,70
$621,88
$668,69
$834,96
$828,09
$872,27
$919,08
$1 085,35
$1 078,48
$1 122,66
$1 169,47
$1 335,74
$250,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654,62
$742,98
$836,60
$1 169,14
$1 776,62
$905,01
$993,37
$1 086,99
$1 419,53
$1 155,40
$1 243,76
$1 337,38
$1 669,92
$1 405,79
$1 494,15
$1 587,77
$1 920,31
$250,39
Toc - Plan #35 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7000 Select

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$255,71
$290,23
$326,79
$456,69
$693,99
$451,33
$485,85
$522,41
$652,31
$646,95
$681,47
$718,03
$847,93
$842,57
$877,09
$913,65
$1 043,55
$195,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$511,42
$580,46
$653,58
$913,38
$1 387,98
$707,04
$776,08
$849,20
$1 109,00
$902,66
$971,70
$1 044,82
$1 304,62
$1 098,28
$1 167,32
$1 240,44
$1 500,24
$195,62
Toc - Plan #36 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7000 No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$324,02
$367,75
$414,09
$578,69
$879,37
$571,89
$615,62
$661,96
$826,56
$819,76
$863,49
$909,83
$1 074,43
$1 067,63
$1 111,36
$1 157,70
$1 322,30
$247,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$648,04
$735,50
$828,18
$1 157,38
$1 758,74
$895,91
$983,37
$1 076,05
$1 405,25
$1 143,78
$1 231,24
$1 323,92
$1 653,12
$1 391,65
$1 479,11
$1 571,79
$1 900,99
$247,87
Toc - Plan #37 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7000 Select No Pediatric Dental

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$253,14
$287,31
$323,51
$452,10
$687,01
$446,79
$480,96
$517,16
$645,75
$640,44
$674,61
$710,81
$839,40
$834,09
$868,26
$904,46
$1 033,05
$193,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$506,28
$574,62
$647,02
$904,20
$1 374,02
$699,93
$768,27
$840,67
$1 097,85
$893,58
$961,92
$1 034,32
$1 291,50
$1 087,23
$1 155,57
$1 227,97
$1 485,15
$193,65

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

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

Toc - Plan #38 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
$254,86
$289,27
$325,71
$455,18
$691,69
$449,83
$484,24
$520,68
$650,15
$644,80
$679,21
$715,65
$845,12
$839,77
$874,18
$910,62
$1 040,09
$194,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$509,72
$578,54
$651,42
$910,36
$1 383,38
$704,69
$773,51
$846,39
$1 105,33
$899,66
$968,48
$1 041,36
$1 300,30
$1 094,63
$1 163,45
$1 236,33
$1 495,27
$194,97
Toc - Plan #39 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
$241,56
$274,17
$308,71
$431,43
$655,59
$426,35
$458,96
$493,50
$616,22
$611,14
$643,75
$678,29
$801,01
$795,93
$828,54
$863,08
$985,80
$184,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$483,12
$548,34
$617,42
$862,86
$1 311,18
$667,91
$733,13
$802,21
$1 047,65
$852,70
$917,92
$987,00
$1 232,44
$1 037,49
$1 102,71
$1 171,79
$1 417,23
$184,79
Toc - Plan #40 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
$338,63
$384,35
$432,77
$604,79
$919,04
$597,68
$643,40
$691,82
$863,84
$856,73
$902,45
$950,87
$1 122,89
$1 115,78
$1 161,50
$1 209,92
$1 381,94
$259,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$677,26
$768,70
$865,54
$1 209,58
$1 838,08
$936,31
$1 027,75
$1 124,59
$1 468,63
$1 195,36
$1 286,80
$1 383,64
$1 727,68
$1 454,41
$1 545,85
$1 642,69
$1 986,73
$259,05
Toc - Plan #41 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
$371,69
$421,87
$475,02
$663,84
$1 008,77
$656,03
$706,21
$759,36
$948,18
$940,37
$990,55
$1 043,70
$1 232,52
$1 224,71
$1 274,89
$1 328,04
$1 516,86
$284,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743,38
$843,74
$950,04
$1 327,68
$2 017,54
$1 027,72
$1 128,08
$1 234,38
$1 612,02
$1 312,06
$1 412,42
$1 518,72
$1 896,36
$1 596,40
$1 696,76
$1 803,06
$2 180,70
$284,34
Toc - Plan #42 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
$258,82
$293,76
$330,77
$462,25
$702,44
$456,82
$491,76
$528,77
$660,25
$654,82
$689,76
$726,77
$858,25
$852,82
$887,76
$924,77
$1 056,25
$198,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$517,64
$587,52
$661,54
$924,50
$1 404,88
$715,64
$785,52
$859,54
$1 122,50
$913,64
$983,52
$1 057,54
$1 320,50
$1 111,64
$1 181,52
$1 255,54
$1 518,50
$198,00
Toc - Plan #43 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
$340,98
$387,01
$435,77
$608,99
$925,42
$601,83
$647,86
$696,62
$869,84
$862,68
$908,71
$957,47
$1 130,69
$1 123,53
$1 169,56
$1 218,32
$1 391,54
$260,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681,96
$774,02
$871,54
$1 217,98
$1 850,84
$942,81
$1 034,87
$1 132,39
$1 478,83
$1 203,66
$1 295,72
$1 393,24
$1 739,68
$1 464,51
$1 556,57
$1 654,09
$2 000,53
$260,85
Toc - Plan #44 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
$348,21
$395,22
$445,01
$621,90
$945,04
$614,59
$661,60
$711,39
$888,28
$880,97
$927,98
$977,77
$1 154,66
$1 147,35
$1 194,36
$1 244,15
$1 421,04
$266,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$696,42
$790,44
$890,02
$1 243,80
$1 890,08
$962,80
$1 056,82
$1 156,40
$1 510,18
$1 229,18
$1 323,20
$1 422,78
$1 776,56
$1 495,56
$1 589,58
$1 689,16
$2 042,94
$266,38
Toc - Plan #45 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
$258,07
$292,91
$329,81
$460,91
$700,40
$455,49
$490,33
$527,23
$658,33
$652,91
$687,75
$724,65
$855,75
$850,33
$885,17
$922,07
$1 053,17
$197,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$516,14
$585,82
$659,62
$921,82
$1 400,80
$713,56
$783,24
$857,04
$1 119,24
$910,98
$980,66
$1 054,46
$1 316,66
$1 108,40
$1 178,08
$1 251,88
$1 514,08
$197,42
Toc - Plan #46 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
$316,00
$358,66
$403,85
$564,38
$857,62
$557,74
$600,40
$645,59
$806,12
$799,48
$842,14
$887,33
$1 047,86
$1 041,22
$1 083,88
$1 129,07
$1 289,60
$241,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$632,00
$717,32
$807,70
$1 128,76
$1 715,24
$873,74
$959,06
$1 049,44
$1 370,50
$1 115,48
$1 200,80
$1 291,18
$1 612,24
$1 357,22
$1 442,54
$1 532,92
$1 853,98
$241,74
Toc - Plan #47 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
$337,68
$383,27
$431,56
$603,10
$916,46
$596,01
$641,60
$689,89
$861,43
$854,34
$899,93
$948,22
$1 119,76
$1 112,67
$1 158,26
$1 206,55
$1 378,09
$258,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$675,36
$766,54
$863,12
$1 206,20
$1 832,92
$933,69
$1 024,87
$1 121,45
$1 464,53
$1 192,02
$1 283,20
$1 379,78
$1 722,86
$1 450,35
$1 541,53
$1 638,11
$1 981,19
$258,33
Toc - Plan #48 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
$350,87
$398,24
$448,41
$626,65
$952,26
$619,29
$666,66
$716,83
$895,07
$887,71
$935,08
$985,25
$1 163,49
$1 156,13
$1 203,50
$1 253,67
$1 431,91
$268,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701,74
$796,48
$896,82
$1 253,30
$1 904,52
$970,16
$1 064,90
$1 165,24
$1 521,72
$1 238,58
$1 333,32
$1 433,66
$1 790,14
$1 507,00
$1 601,74
$1 702,08
$2 058,56
$268,42
Toc - Plan #49 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
$322,12
$365,61
$411,67
$575,31
$874,23
$568,54
$612,03
$658,09
$821,73
$814,96
$858,45
$904,51
$1 068,15
$1 061,38
$1 104,87
$1 150,93
$1 314,57
$246,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$644,24
$731,22
$823,34
$1 150,62
$1 748,46
$890,66
$977,64
$1 069,76
$1 397,04
$1 137,08
$1 224,06
$1 316,18
$1 643,46
$1 383,50
$1 470,48
$1 562,60
$1 889,88
$246,42
Toc - Plan #50 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
$193,54
$219,67
$247,34
$345,66
$525,27
$341,60
$367,73
$395,40
$493,72
$489,66
$515,79
$543,46
$641,78
$637,72
$663,85
$691,52
$789,84
$148,06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$387,08
$439,34
$494,68
$691,32
$1 050,54
$535,14
$587,40
$642,74
$839,38
$683,20
$735,46
$790,80
$987,44
$831,26
$883,52
$938,86
$1 135,50
$148,06
Toc - Plan #51 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
$359,59
$408,13
$459,56
$642,23
$975,93
$634,68
$683,22
$734,65
$917,32
$909,77
$958,31
$1 009,74
$1 192,41
$1 184,86
$1 233,40
$1 284,83
$1 467,50
$275,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719,18
$816,26
$919,12
$1 284,46
$1 951,86
$994,27
$1 091,35
$1 194,21
$1 559,55
$1 269,36
$1 366,44
$1 469,30
$1 834,64
$1 544,45
$1 641,53
$1 744,39
$2 109,73
$275,09
Toc - Plan #52 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
$313,90
$356,28
$401,16
$560,63
$851,92
$554,03
$596,41
$641,29
$800,76
$794,16
$836,54
$881,42
$1 040,89
$1 034,29
$1 076,67
$1 121,55
$1 281,02
$240,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$627,80
$712,56
$802,32
$1 121,26
$1 703,84
$867,93
$952,69
$1 042,45
$1 361,39
$1 108,06
$1 192,82
$1 282,58
$1 601,52
$1 348,19
$1 432,95
$1 522,71
$1 841,65
$240,13
Toc - Plan #53 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
$263,00
$298,51
$336,11
$469,72
$713,78
$464,20
$499,71
$537,31
$670,92
$665,40
$700,91
$738,51
$872,12
$866,60
$902,11
$939,71
$1 073,32
$201,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$526,00
$597,02
$672,22
$939,44
$1 427,56
$727,20
$798,22
$873,42
$1 140,64
$928,40
$999,42
$1 074,62
$1 341,84
$1 129,60
$1 200,62
$1 275,82
$1 543,04
$201,20
Toc - Plan #54 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
$249,51
$283,19
$318,87
$445,62
$677,17
$440,39
$474,07
$509,75
$636,50
$631,27
$664,95
$700,63
$827,38
$822,15
$855,83
$891,51
$1 018,26
$190,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$499,02
$566,38
$637,74
$891,24
$1 354,34
$689,90
$757,26
$828,62
$1 082,12
$880,78
$948,14
$1 019,50
$1 273,00
$1 071,66
$1 139,02
$1 210,38
$1 463,88
$190,88

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Ambetter from Buckeye Health

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Toc - Plan #55 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
$274,84
$311,93
$351,24
$490,85
$745,90
$485,09
$522,18
$561,49
$701,10
$695,34
$732,43
$771,74
$911,35
$905,59
$942,68
$981,99
$1 121,60
$210,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$549,68
$623,86
$702,48
$981,70
$1 491,80
$759,93
$834,11
$912,73
$1 191,95
$970,18
$1 044,36
$1 122,98
$1 402,20
$1 180,43
$1 254,61
$1 333,23
$1 612,45
$210,25
Toc - Plan #56 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
$269,84
$306,26
$344,84
$481,92
$732,32
$476,26
$512,68
$551,26
$688,34
$682,68
$719,10
$757,68
$894,76
$889,10
$925,52
$964,10
$1 101,18
$206,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$539,68
$612,52
$689,68
$963,84
$1 464,64
$746,10
$818,94
$896,10
$1 170,26
$952,52
$1 025,36
$1 102,52
$1 376,68
$1 158,94
$1 231,78
$1 308,94
$1 583,10
$206,42
Toc - Plan #57 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
$316,75
$359,50
$404,80
$565,71
$859,64
$559,06
$601,81
$647,11
$808,02
$801,37
$844,12
$889,42
$1 050,33
$1 043,68
$1 086,43
$1 131,73
$1 292,64
$242,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$633,50
$719,00
$809,60
$1 131,42
$1 719,28
$875,81
$961,31
$1 051,91
$1 373,73
$1 118,12
$1 203,62
$1 294,22
$1 616,04
$1 360,43
$1 445,93
$1 536,53
$1 858,35
$242,31
Toc - Plan #58 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
$208,14
$236,23
$265,99
$371,72
$564,87
$367,36
$395,45
$425,21
$530,94
$526,58
$554,67
$584,43
$690,16
$685,80
$713,89
$743,65
$849,38
$159,22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$416,28
$472,46
$531,98
$743,44
$1 129,74
$575,50
$631,68
$691,20
$902,66
$734,72
$790,90
$850,42
$1 061,88
$893,94
$950,12
$1 009,64
$1 221,10
$159,22
Toc - Plan #59 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
$225,29
$255,69
$287,91
$402,35
$611,41
$397,63
$428,03
$460,25
$574,69
$569,97
$600,37
$632,59
$747,03
$742,31
$772,71
$804,93
$919,37
$172,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$450,58
$511,38
$575,82
$804,70
$1 222,82
$622,92
$683,72
$748,16
$977,04
$795,26
$856,06
$920,50
$1 149,38
$967,60
$1 028,40
$1 092,84
$1 321,72
$172,34
Toc - Plan #60 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
$214,24
$243,15
$273,79
$382,62
$581,43
$378,13
$407,04
$437,68
$546,51
$542,02
$570,93
$601,57
$710,40
$705,91
$734,82
$765,46
$874,29
$163,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$428,48
$486,30
$547,58
$765,24
$1 162,86
$592,37
$650,19
$711,47
$929,13
$756,26
$814,08
$875,36
$1 093,02
$920,15
$977,97
$1 039,25
$1 256,91
$163,89
Toc - Plan #61 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
$279,35
$317,05
$357,00
$498,90
$758,13
$493,04
$530,74
$570,69
$712,59
$706,73
$744,43
$784,38
$926,28
$920,42
$958,12
$998,07
$1 139,97
$213,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$558,70
$634,10
$714,00
$997,80
$1 516,26
$772,39
$847,79
$927,69
$1 211,49
$986,08
$1 061,48
$1 141,38
$1 425,18
$1 199,77
$1 275,17
$1 355,07
$1 638,87
$213,69
Toc - Plan #62 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
$267,50
$303,61
$341,86
$477,74
$725,98
$472,13
$508,24
$546,49
$682,37
$676,76
$712,87
$751,12
$887,00
$881,39
$917,50
$955,75
$1 091,63
$204,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$535,00
$607,22
$683,72
$955,48
$1 451,96
$739,63
$811,85
$888,35
$1 160,11
$944,26
$1 016,48
$1 092,98
$1 364,74
$1 148,89
$1 221,11
$1 297,61
$1 569,37
$204,63
Toc - Plan #63 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
$281,96
$320,01
$360,33
$503,56
$765,21
$497,65
$535,70
$576,02
$719,25
$713,34
$751,39
$791,71
$934,94
$929,03
$967,08
$1 007,40
$1 150,63
$215,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$563,92
$640,02
$720,66
$1 007,12
$1 530,42
$779,61
$855,71
$936,35
$1 222,81
$995,30
$1 071,40
$1 152,04
$1 438,50
$1 210,99
$1 287,09
$1 367,73
$1 654,19
$215,69
Toc - Plan #64 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
$292,21
$331,65
$373,43
$521,87
$793,04
$515,74
$555,18
$596,96
$745,40
$739,27
$778,71
$820,49
$968,93
$962,80
$1 002,24
$1 044,02
$1 192,46
$223,53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$584,42
$663,30
$746,86
$1 043,74
$1 586,08
$807,95
$886,83
$970,39
$1 267,27
$1 031,48
$1 110,36
$1 193,92
$1 490,80
$1 255,01
$1 333,89
$1 417,45
$1 714,33
$223,53
Toc - Plan #65 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
$282,86
$321,04
$361,49
$505,18
$767,67
$499,24
$537,42
$577,87
$721,56
$715,62
$753,80
$794,25
$937,94
$932,00
$970,18
$1 010,63
$1 154,32
$216,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$565,72
$642,08
$722,98
$1 010,36
$1 535,34
$782,10
$858,46
$939,36
$1 226,74
$998,48
$1 074,84
$1 155,74
$1 443,12
$1 214,86
$1 291,22
$1 372,12
$1 659,50
$216,38
Toc - Plan #66 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
$288,11
$326,99
$368,19
$514,54
$781,90
$508,50
$547,38
$588,58
$734,93
$728,89
$767,77
$808,97
$955,32
$949,28
$988,16
$1 029,36
$1 175,71
$220,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$576,22
$653,98
$736,38
$1 029,08
$1 563,80
$796,61
$874,37
$956,77
$1 249,47
$1 017,00
$1 094,76
$1 177,16
$1 469,86
$1 237,39
$1 315,15
$1 397,55
$1 690,25
$220,39
Toc - Plan #67 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
$332,04
$376,86
$424,34
$593,01
$901,14
$586,05
$630,87
$678,35
$847,02
$840,06
$884,88
$932,36
$1 101,03
$1 094,07
$1 138,89
$1 186,37
$1 355,04
$254,01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$664,08
$753,72
$848,68
$1 186,02
$1 802,28
$918,09
$1 007,73
$1 102,69
$1 440,03
$1 172,10
$1 261,74
$1 356,70
$1 694,04
$1 426,11
$1 515,75
$1 610,71
$1 948,05
$254,01
Toc - Plan #68 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
$218,19
$247,63
$278,83
$389,66
$592,13
$385,10
$414,54
$445,74
$556,57
$552,01
$581,45
$612,65
$723,48
$718,92
$748,36
$779,56
$890,39
$166,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$436,38
$495,26
$557,66
$779,32
$1 184,26
$603,29
$662,17
$724,57
$946,23
$770,20
$829,08
$891,48
$1 113,14
$937,11
$995,99
$1 058,39
$1 280,05
$166,91
Toc - Plan #69 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
$236,16
$268,03
$301,80
$421,77
$640,92
$416,82
$448,69
$482,46
$602,43
$597,48
$629,35
$663,12
$783,09
$778,14
$810,01
$843,78
$963,75
$180,66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$472,32
$536,06
$603,60
$843,54
$1 281,84
$652,98
$716,72
$784,26
$1 024,20
$833,64
$897,38
$964,92
$1 204,86
$1 014,30
$1 078,04
$1 145,58
$1 385,52
$180,66
Toc - Plan #70 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
$224,58
$254,89
$287,00
$401,09
$609,49
$396,38
$426,69
$458,80
$572,89
$568,18
$598,49
$630,60
$744,69
$739,98
$770,29
$802,40
$916,49
$171,80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$449,16
$509,78
$574,00
$802,18
$1 218,98
$620,96
$681,58
$745,80
$973,98
$792,76
$853,38
$917,60
$1 145,78
$964,56
$1 025,18
$1 089,40
$1 317,58
$171,80
Toc - Plan #71 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
$292,83
$332,35
$374,23
$522,98
$794,72
$516,84
$556,36
$598,24
$746,99
$740,85
$780,37
$822,25
$971,00
$964,86
$1 004,38
$1 046,26
$1 195,01
$224,01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$585,66
$664,70
$748,46
$1 045,96
$1 589,44
$809,67
$888,71
$972,47
$1 269,97
$1 033,68
$1 112,72
$1 196,48
$1 493,98
$1 257,69
$1 336,73
$1 420,49
$1 717,99
$224,01
Toc - Plan #72 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
$295,57
$335,46
$377,73
$527,87
$802,15
$521,67
$561,56
$603,83
$753,97
$747,77
$787,66
$829,93
$980,07
$973,87
$1 013,76
$1 056,03
$1 206,17
$226,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$591,14
$670,92
$755,46
$1 055,74
$1 604,30
$817,24
$897,02
$981,56
$1 281,84
$1 043,34
$1 123,12
$1 207,66
$1 507,94
$1 269,44
$1 349,22
$1 433,76
$1 734,04
$226,10
Toc - Plan #73 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
$306,32
$347,66
$391,46
$547,06
$831,31
$540,64
$581,98
$625,78
$781,38
$774,96
$816,30
$860,10
$1 015,70
$1 009,28
$1 050,62
$1 094,42
$1 250,02
$234,32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$612,64
$695,32
$782,92
$1 094,12
$1 662,62
$846,96
$929,64
$1 017,24
$1 328,44
$1 081,28
$1 163,96
$1 251,56
$1 562,76
$1 315,60
$1 398,28
$1 485,88
$1 797,08
$234,32

ADVERTISEMENT

Oscar Insurance Corporation of Ohio

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #74 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Simple

Annual Out of Pocket Expenses
Individual Family
$7,300 $14,600 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
$319,95
$363,13
$408,88
$571,41
$868,32
$564,70
$607,88
$653,63
$816,16
$809,45
$852,63
$898,38
$1 060,91
$1 054,20
$1 097,38
$1 143,13
$1 305,66
$244,75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$639,90
$726,26
$817,76
$1 142,82
$1 736,64
$884,65
$971,01
$1 062,51
$1 387,57
$1 129,40
$1 215,76
$1 307,26
$1 632,32
$1 374,15
$1 460,51
$1 552,01
$1 877,07
$244,75
Toc - Plan #75 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic PCP Copay

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
$329,05
$373,46
$420,51
$587,66
$893,00
$580,76
$625,17
$672,22
$839,37
$832,47
$876,88
$923,93
$1 091,08
$1 084,18
$1 128,59
$1 175,64
$1 342,79
$251,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658,10
$746,92
$841,02
$1 175,32
$1 786,00
$909,81
$998,63
$1 092,73
$1 427,03
$1 161,52
$1 250,34
$1 344,44
$1 678,74
$1 413,23
$1 502,05
$1 596,15
$1 930,45
$251,71
Toc - Plan #76 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic

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
$321,98
$365,43
$411,47
$575,03
$873,82
$568,28
$611,73
$657,77
$821,33
$814,58
$858,03
$904,07
$1 067,63
$1 060,88
$1 104,33
$1 150,37
$1 313,93
$246,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$643,96
$730,86
$822,94
$1 150,06
$1 747,64
$890,26
$977,16
$1 069,24
$1 396,36
$1 136,56
$1 223,46
$1 315,54
$1 642,66
$1 382,86
$1 469,76
$1 561,84
$1 888,96
$246,30
Toc - Plan #77 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic Next

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
$383,24
$434,97
$489,77
$684,45
$1 040,09
$676,41
$728,14
$782,94
$977,62
$969,58
$1 021,31
$1 076,11
$1 270,79
$1 262,75
$1 314,48
$1 369,28
$1 563,96
$293,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766,48
$869,94
$979,54
$1 368,90
$2 080,18
$1 059,65
$1 163,11
$1 272,71
$1 662,07
$1 352,82
$1 456,28
$1 565,88
$1 955,24
$1 645,99
$1 749,45
$1 859,05
$2 248,41
$293,17
Toc - Plan #78 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic

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
$382,82
$434,49
$489,23
$683,70
$1 038,95
$675,67
$727,34
$782,08
$976,55
$968,52
$1 020,19
$1 074,93
$1 269,40
$1 261,37
$1 313,04
$1 367,78
$1 562,25
$292,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$765,64
$868,98
$978,46
$1 367,40
$2 077,90
$1 058,49
$1 161,83
$1 271,31
$1 660,25
$1 351,34
$1 454,68
$1 564,16
$1 953,10
$1 644,19
$1 747,53
$1 857,01
$2 245,95
$292,85
Toc - Plan #79 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Saver 2

Annual Out of Pocket Expenses
Individual Family
$6,200 $12,400 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
$375,46
$426,13
$479,82
$670,55
$1 018,96
$662,68
$713,35
$767,04
$957,77
$949,90
$1 000,57
$1 054,26
$1 244,99
$1 237,12
$1 287,79
$1 341,48
$1 532,21
$287,22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$750,92
$852,26
$959,64
$1 341,10
$2 037,92
$1 038,14
$1 139,48
$1 246,86
$1 628,32
$1 325,36
$1 426,70
$1 534,08
$1 915,54
$1 612,58
$1 713,92
$1 821,30
$2 202,76
$287,22
Toc - Plan #80 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic Next

Annual Out of Pocket Expenses
Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 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
$388,68
$441,15
$496,73
$694,17
$1 054,86
$686,02
$738,49
$794,07
$991,51
$983,36
$1 035,83
$1 091,41
$1 288,85
$1 280,70
$1 333,17
$1 388,75
$1 586,19
$297,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777,36
$882,30
$993,46
$1 388,34
$2 109,72
$1 074,70
$1 179,64
$1 290,80
$1 685,68
$1 372,04
$1 476,98
$1 588,14
$1 983,02
$1 669,38
$1 774,32
$1 885,48
$2 280,36
$297,34
Toc - Plan #81 Oscar Insurance Corporation of Ohio
Catastrophic

(HMO) Oscar Secure

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
$224,67
$254,99
$287,12
$401,25
$609,73
$396,54
$426,86
$458,99
$573,12
$568,41
$598,73
$630,86
$744,99
$740,28
$770,60
$802,73
$916,86
$171,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$449,34
$509,98
$574,24
$802,50
$1 219,46
$621,21
$681,85
$746,11
$974,37
$793,08
$853,72
$917,98
$1 146,24
$964,95
$1 025,59
$1 089,85
$1 318,11
$171,87
Toc - Plan #82 Oscar Insurance Corporation of Ohio
Gold

(HMO) Oscar Gold Classic

Annual Out of Pocket Expenses
Individual Family
$2,500 $5,000 Annual Deductible
$6,000 $12,000 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
$445,13
$505,21
$568,87
$794,99
$1 208,06
$785,65
$845,73
$909,39
$1 135,51
$1 126,17
$1 186,25
$1 249,91
$1 476,03
$1 466,69
$1 526,77
$1 590,43
$1 816,55
$340,52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890,26
$1 010,42
$1 137,74
$1 589,98
$2 416,12
$1 230,78
$1 350,94
$1 478,26
$1 930,50
$1 571,30
$1 691,46
$1 818,78
$2 271,02
$1 911,82
$2 031,98
$2 159,30
$2 611,54
$340,52
Toc - Plan #83 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze HDHP

Annual Out of Pocket Expenses
Individual Family
$5,200 $10,400 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
$344,52
$391,01
$440,28
$615,29
$934,99
$608,07
$654,56
$703,83
$878,84
$871,62
$918,11
$967,38
$1 142,39
$1 135,17
$1 181,66
$1 230,93
$1 405,94
$263,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$689,04
$782,02
$880,56
$1 230,58
$1 869,98
$952,59
$1 045,57
$1 144,11
$1 494,13
$1 216,14
$1 309,12
$1 407,66
$1 757,68
$1 479,69
$1 572,67
$1 671,21
$2 021,23
$263,55
Toc - Plan #84 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic Copay

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 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
$392,23
$445,17
$501,25
$700,50
$1 064,48
$692,28
$745,22
$801,30
$1 000,55
$992,33
$1 045,27
$1 101,35
$1 300,60
$1 292,38
$1 345,32
$1 401,40
$1 600,65
$300,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$784,46
$890,34
$1 002,50
$1 401,00
$2 128,96
$1 084,51
$1 190,39
$1 302,55
$1 701,05
$1 384,56
$1 490,44
$1 602,60
$2 001,10
$1 684,61
$1 790,49
$1 902,65
$2 301,15
$300,05
Toc - Plan #85 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic $0 Ded

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
$419,44
$476,05
$536,03
$749,10
$1 138,32
$740,30
$796,91
$856,89
$1 069,96
$1 061,16
$1 117,77
$1 177,75
$1 390,82
$1 382,02
$1 438,63
$1 498,61
$1 711,68
$320,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838,88
$952,10
$1 072,06
$1 498,20
$2 276,64
$1 159,74
$1 272,96
$1 392,92
$1 819,06
$1 480,60
$1 593,82
$1 713,78
$2 139,92
$1 801,46
$1 914,68
$2 034,64
$2 460,78
$320,86

ADVERTISEMENT

SummaCare

Local: 1-330-996-8675 | Toll Free: 1-888-996-8675 | TTY: 1-800-750-0750

Toc - Plan #86 SummaCare
Catastrophic

(HMO) SummaCare Value with SCConnect Network and 3 Free PCP Visits

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
$230,82
$261,97
$294,98
$412,23
$626,43
$407,39
$438,54
$471,55
$588,80
$583,96
$615,11
$648,12
$765,37
$760,53
$791,68
$824,69
$941,94
$176,57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$461,64
$523,94
$589,96
$824,46
$1 252,86
$638,21
$700,51
$766,53
$1 001,03
$814,78
$877,08
$943,10
$1 177,60
$991,35
$1 053,65
$1 119,67
$1 354,17
$176,57
Toc - Plan #87 SummaCare
Expanded Bronze

(HMO) SummaCare Bronze 8550 with SCConnect Network and 3 Free PCP Visits

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
$294,79
$334,58
$376,73
$526,48
$800,04
$520,30
$560,09
$602,24
$751,99
$745,81
$785,60
$827,75
$977,50
$971,32
$1 011,11
$1 053,26
$1 203,01
$225,51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$589,58
$669,16
$753,46
$1 052,96
$1 600,08
$815,09
$894,67
$978,97
$1 278,47
$1 040,60
$1 120,18
$1 204,48
$1 503,98
$1 266,11
$1 345,69
$1 429,99
$1 729,49
$225,51
Toc - Plan #88 SummaCare
Silver

(HMO) SummaCare Silver 3500 with SCConnect Network and 3 Free PCP Visits

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
$417,72
$474,10
$533,83
$746,02
$1 133,65
$737,27
$793,65
$853,38
$1 065,57
$1 056,82
$1 113,20
$1 172,93
$1 385,12
$1 376,37
$1 432,75
$1 492,48
$1 704,67
$319,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835,44
$948,20
$1 067,66
$1 492,04
$2 267,30
$1 154,99
$1 267,75
$1 387,21
$1 811,59
$1 474,54
$1 587,30
$1 706,76
$2 131,14
$1 794,09
$1 906,85
$2 026,31
$2 450,69
$319,55
Toc - Plan #89 SummaCare
Silver

(HMO) SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits

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
$413,59
$469,41
$528,55
$738,65
$1 122,45
$729,98
$785,80
$844,94
$1 055,04
$1 046,37
$1 102,19
$1 161,33
$1 371,43
$1 362,76
$1 418,58
$1 477,72
$1 687,82
$316,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827,18
$938,82
$1 057,10
$1 477,30
$2 244,90
$1 143,57
$1 255,21
$1 373,49
$1 793,69
$1 459,96
$1 571,60
$1 689,88
$2 110,08
$1 776,35
$1 887,99
$2 006,27
$2 426,47
$316,39
Toc - Plan #90 SummaCare
Silver

(HMO) SummaCare Silver 5000 40 with SCConnect Network

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
$369,37
$419,23
$472,04
$659,68
$1 002,45
$651,93
$701,79
$754,60
$942,24
$934,49
$984,35
$1 037,16
$1 224,80
$1 217,05
$1 266,91
$1 319,72
$1 507,36
$282,56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$738,74
$838,46
$944,08
$1 319,36
$2 004,90
$1 021,30
$1 121,02
$1 226,64
$1 601,92
$1 303,86
$1 403,58
$1 509,20
$1 884,48
$1 586,42
$1 686,14
$1 791,76
$2 167,04
$282,56
Toc - Plan #91 SummaCare
Gold

(HMO) SummaCare Gold 1800 with SCConnect Network and 3 Free PCP Visits

Annual Out of Pocket Expenses
Individual Family
$1,800 $3,600 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
$435,70
$494,51
$556,81
$778,14
$1 182,46
$769,00
$827,81
$890,11
$1 111,44
$1 102,30
$1 161,11
$1 223,41
$1 444,74
$1 435,60
$1 494,41
$1 556,71
$1 778,04
$333,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871,40
$989,02
$1 113,62
$1 556,28
$2 364,92
$1 204,70
$1 322,32
$1 446,92
$1 889,58
$1 538,00
$1 655,62
$1 780,22
$2 222,88
$1 871,30
$1 988,92
$2 113,52
$2 556,18
$333,30
Toc - Plan #92 SummaCare
Expanded Bronze

(HMO) SummaCare Bronze 6850 HSA with SCConnect Network

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
$329,58
$374,06
$421,19
$588,61
$894,44
$581,70
$626,18
$673,31
$840,73
$833,82
$878,30
$925,43
$1 092,85
$1 085,94
$1 130,42
$1 177,55
$1 344,97
$252,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$659,16
$748,12
$842,38
$1 177,22
$1 788,88
$911,28
$1 000,24
$1 094,50
$1 429,34
$1 163,40
$1 252,36
$1 346,62
$1 681,46
$1 415,52
$1 504,48
$1 598,74
$1 933,58
$252,12
Toc - Plan #93 SummaCare
Silver

(HMO) SummaCare Silver 6000 with SCConnect Network

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
$354,63
$402,50
$453,21
$633,36
$962,45
$625,92
$673,79
$724,50
$904,65
$897,21
$945,08
$995,79
$1 175,94
$1 168,50
$1 216,37
$1 267,08
$1 447,23
$271,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709,26
$805,00
$906,42
$1 266,72
$1 924,90
$980,55
$1 076,29
$1 177,71
$1 538,01
$1 251,84
$1 347,58
$1 449,00
$1 809,30
$1 523,13
$1 618,87
$1 720,29
$2 080,59
$271,29

ADVERTISEMENT

Molina Healthcare

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

Toc - Plan #94 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
$330,42
$375,03
$422,28
$590,13
$896,76
$583,19
$627,80
$675,05
$842,90
$835,96
$880,57
$927,82
$1 095,67
$1 088,73
$1 133,34
$1 180,59
$1 348,44
$252,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$660,84
$750,06
$844,56
$1 180,26
$1 793,52
$913,61
$1 002,83
$1 097,33
$1 433,03
$1 166,38
$1 255,60
$1 350,10
$1 685,80
$1 419,15
$1 508,37
$1 602,87
$1 938,57
$252,77
Toc - Plan #95 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
$282,44
$320,57
$360,96
$504,44
$766,54
$498,51
$536,64
$577,03
$720,51
$714,58
$752,71
$793,10
$936,58
$930,65
$968,78
$1 009,17
$1 152,65
$216,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$564,88
$641,14
$721,92
$1 008,88
$1 533,08
$780,95
$857,21
$937,99
$1 224,95
$997,02
$1 073,28
$1 154,06
$1 441,02
$1 213,09
$1 289,35
$1 370,13
$1 657,09
$216,07
Toc - Plan #96 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
$230,19
$261,26
$294,18
$411,12
$624,73
$406,28
$437,35
$470,27
$587,21
$582,37
$613,44
$646,36
$763,30
$758,46
$789,53
$822,45
$939,39
$176,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$460,38
$522,52
$588,36
$822,24
$1 249,46
$636,47
$698,61
$764,45
$998,33
$812,56
$874,70
$940,54
$1 174,42
$988,65
$1 050,79
$1 116,63
$1 350,51
$176,09
Toc - Plan #97 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
$279,78
$317,56
$357,56
$499,70
$759,33
$493,82
$531,60
$571,60
$713,74
$707,86
$745,64
$785,64
$927,78
$921,90
$959,68
$999,68
$1 141,82
$214,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$559,56
$635,12
$715,12
$999,40
$1 518,66
$773,60
$849,16
$929,16
$1 213,44
$987,64
$1 063,20
$1 143,20
$1 427,48
$1 201,68
$1 277,24
$1 357,24
$1 641,52
$214,04
Toc - Plan #98 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
$241,10
$273,64
$308,12
$430,60
$654,33
$425,54
$458,08
$492,56
$615,04
$609,98
$642,52
$677,00
$799,48
$794,42
$826,96
$861,44
$983,92
$184,44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$482,20
$547,28
$616,24
$861,20
$1 308,66
$666,64
$731,72
$800,68
$1 045,64
$851,08
$916,16
$985,12
$1 230,08
$1 035,52
$1 100,60
$1 169,56
$1 414,52
$184,44
Toc - Plan #99 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
$234,43
$266,08
$299,60
$418,69
$636,24
$413,77
$445,42
$478,94
$598,03
$593,11
$624,76
$658,28
$777,37
$772,45
$804,10
$837,62
$956,71
$179,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$468,86
$532,16
$599,20
$837,38
$1 272,48
$648,20
$711,50
$778,54
$1 016,72
$827,54
$890,84
$957,88
$1 196,06
$1 006,88
$1 070,18
$1 137,22
$1 375,40
$179,34
Toc - Plan #100 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
$333,33
$378,33
$425,99
$595,32
$904,65
$588,32
$633,32
$680,98
$850,31
$843,31
$888,31
$935,97
$1 105,30
$1 098,30
$1 143,30
$1 190,96
$1 360,29
$254,99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$666,66
$756,66
$851,98
$1 190,64
$1 809,30
$921,65
$1 011,65
$1 106,97
$1 445,63
$1 176,64
$1 266,64
$1 361,96
$1 700,62
$1 431,63
$1 521,63
$1 616,95
$1 955,61
$254,99
Toc - Plan #101 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
$285,35
$323,87
$364,67
$509,63
$774,43
$503,64
$542,16
$582,96
$727,92
$721,93
$760,45
$801,25
$946,21
$940,22
$978,74
$1 019,54
$1 164,50
$218,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$570,70
$647,74
$729,34
$1 019,26
$1 548,86
$788,99
$866,03
$947,63
$1 237,55
$1 007,28
$1 084,32
$1 165,92
$1 455,84
$1 225,57
$1 302,61
$1 384,21
$1 674,13
$218,29
Toc - Plan #102 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
$233,09
$264,56
$297,89
$416,31
$632,62
$411,41
$442,88
$476,21
$594,63
$589,73
$621,20
$654,53
$772,95
$768,05
$799,52
$832,85
$951,27
$178,32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$466,18
$529,12
$595,78
$832,62
$1 265,24
$644,50
$707,44
$774,10
$1 010,94
$822,82
$885,76
$952,42
$1 189,26
$1 001,14
$1 064,08
$1 130,74
$1 367,58
$178,32
Toc - Plan #103 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
$281,84
$319,88
$360,19
$503,36
$764,90
$497,44
$535,48
$575,79
$718,96
$713,04
$751,08
$791,39
$934,56
$928,64
$966,68
$1 006,99
$1 150,16
$215,60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$563,68
$639,76
$720,38
$1 006,72
$1 529,80
$779,28
$855,36
$935,98
$1 222,32
$994,88
$1 070,96
$1 151,58
$1 437,92
$1 210,48
$1 286,56
$1 367,18
$1 653,52
$215,60
Toc - Plan #104 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
$228,16
$258,96
$291,59
$407,49
$619,23
$402,70
$433,50
$466,13
$582,03
$577,24
$608,04
$640,67
$756,57
$751,78
$782,58
$815,21
$931,11
$174,54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$456,32
$517,92
$583,18
$814,98
$1 238,46
$630,86
$692,46
$757,72
$989,52
$805,40
$867,00
$932,26
$1 164,06
$979,94
$1 041,54
$1 106,80
$1 338,60
$174,54

ADVERTISEMENT

CareSource

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502 | TTY: 1-800-750-0750

Toc - Plan #105 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
$269,46
$305,84
$344,37
$481,25
$731,31
$475,60
$511,98
$550,51
$687,39
$681,74
$718,12
$756,65
$893,53
$887,88
$924,26
$962,79
$1 099,67
$206,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$538,92
$611,68
$688,74
$962,50
$1 462,62
$745,06
$817,82
$894,88
$1 168,64
$951,20
$1 023,96
$1 101,02
$1 374,78
$1 157,34
$1 230,10
$1 307,16
$1 580,92
$206,14
Toc - Plan #106 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
$342,63
$388,88
$437,88
$611,93
$929,89
$604,74
$650,99
$699,99
$874,04
$866,85
$913,10
$962,10
$1 136,15
$1 128,96
$1 175,21
$1 224,21
$1 398,26
$262,11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685,26
$777,76
$875,76
$1 223,86
$1 859,78
$947,37
$1 039,87
$1 137,87
$1 485,97
$1 209,48
$1 301,98
$1 399,98
$1 748,08
$1 471,59
$1 564,09
$1 662,09
$2 010,19
$262,11
Toc - Plan #107 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
$461,95
$524,31
$590,37
$825,05
$1 253,74
$815,34
$877,70
$943,76
$1 178,44
$1 168,73
$1 231,09
$1 297,15
$1 531,83
$1 522,12
$1 584,48
$1 650,54
$1 885,22
$353,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$923,90
$1 048,62
$1 180,74
$1 650,10
$2 507,48
$1 277,29
$1 402,01
$1 534,13
$2 003,49
$1 630,68
$1 755,40
$1 887,52
$2 356,88
$1 984,07
$2 108,79
$2 240,91
$2 710,27
$353,39
Toc - Plan #108 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
$360,59
$409,26
$460,83
$644,00
$978,63
$636,44
$685,11
$736,68
$919,85
$912,29
$960,96
$1 012,53
$1 195,70
$1 188,14
$1 236,81
$1 288,38
$1 471,55
$275,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721,18
$818,52
$921,66
$1 288,00
$1 957,26
$997,03
$1 094,37
$1 197,51
$1 563,85
$1 272,88
$1 370,22
$1 473,36
$1 839,70
$1 548,73
$1 646,07
$1 749,21
$2 115,55
$275,85
Toc - Plan #109 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
$242,97
$275,77
$310,51
$433,94
$659,41
$428,84
$461,64
$496,38
$619,81
$614,71
$647,51
$682,25
$805,68
$800,58
$833,38
$868,12
$991,55
$185,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$485,94
$551,54
$621,02
$867,88
$1 318,82
$671,81
$737,41
$806,89
$1 053,75
$857,68
$923,28
$992,76
$1 239,62
$1 043,55
$1 109,15
$1 178,63
$1 425,49
$185,87
Toc - Plan #110 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
$370,21
$420,18
$473,12
$661,19
$1 004,74
$653,42
$703,39
$756,33
$944,40
$936,63
$986,60
$1 039,54
$1 227,61
$1 219,84
$1 269,81
$1 322,75
$1 510,82
$283,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$740,42
$840,36
$946,24
$1 322,38
$2 009,48
$1 023,63
$1 123,57
$1 229,45
$1 605,59
$1 306,84
$1 406,78
$1 512,66
$1 888,80
$1 590,05
$1 689,99
$1 795,87
$2 172,01
$283,21
Toc - Plan #111 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
$356,97
$405,16
$456,21
$637,55
$968,82
$630,05
$678,24
$729,29
$910,63
$903,13
$951,32
$1 002,37
$1 183,71
$1 176,21
$1 224,40
$1 275,45
$1 456,79
$273,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$713,94
$810,32
$912,42
$1 275,10
$1 937,64
$987,02
$1 083,40
$1 185,50
$1 548,18
$1 260,10
$1 356,48
$1 458,58
$1 821,26
$1 533,18
$1 629,56
$1 731,66
$2 094,34
$273,08
Toc - Plan #112 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
$482,00
$547,07
$616,00
$860,85
$1 308,15
$850,73
$915,80
$984,73
$1 229,58
$1 219,46
$1 284,53
$1 353,46
$1 598,31
$1 588,19
$1 653,26
$1 722,19
$1 967,04
$368,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$964,00
$1 094,14
$1 232,00
$1 721,70
$2 616,30
$1 332,73
$1 462,87
$1 600,73
$2 090,43
$1 701,46
$1 831,60
$1 969,46
$2 459,16
$2 070,19
$2 200,33
$2 338,19
$2 827,89
$368,73
Toc - Plan #113 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
$376,05
$426,82
$480,59
$671,62
$1 020,60
$663,73
$714,50
$768,27
$959,30
$951,41
$1 002,18
$1 055,95
$1 246,98
$1 239,09
$1 289,86
$1 343,63
$1 534,66
$287,68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$752,10
$853,64
$961,18
$1 343,24
$2 041,20
$1 039,78
$1 141,32
$1 248,86
$1 630,92
$1 327,46
$1 429,00
$1 536,54
$1 918,60
$1 615,14
$1 716,68
$1 824,22
$2 206,28
$287,68
Toc - Plan #114 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
$253,95
$288,23
$324,54
$453,55
$689,21
$448,22
$482,50
$518,81
$647,82
$642,49
$676,77
$713,08
$842,09
$836,76
$871,04
$907,35
$1 036,36
$194,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$507,90
$576,46
$649,08
$907,10
$1 378,42
$702,17
$770,73
$843,35
$1 101,37
$896,44
$965,00
$1 037,62
$1 295,64
$1 090,71
$1 159,27
$1 231,89
$1 489,91
$194,27
Toc - Plan #115 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
$386,76
$438,97
$494,28
$690,75
$1 049,66
$682,63
$734,84
$790,15
$986,62
$978,50
$1 030,71
$1 086,02
$1 282,49
$1 274,37
$1 326,58
$1 381,89
$1 578,36
$295,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773,52
$877,94
$988,56
$1 381,50
$2 099,32
$1 069,39
$1 173,81
$1 284,43
$1 677,37
$1 365,26
$1 469,68
$1 580,30
$1 973,24
$1 661,13
$1 765,55
$1 876,17
$2 269,11
$295,87

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Toc - Plan #116 MedMutual
Gold

(HMO) Market HMO 2000 - NE Ohio

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
$490,08
$556,24
$626,32
$875,28
$1 330,07
$864,99
$931,15
$1 001,23
$1 250,19
$1 239,90
$1 306,06
$1 376,14
$1 625,10
$1 614,81
$1 680,97
$1 751,05
$2 000,01
$374,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$980,16
$1 112,48
$1 252,64
$1 750,56
$2 660,14
$1 355,07
$1 487,39
$1 627,55
$2 125,47
$1 729,98
$1 862,30
$2 002,46
$2 500,38
$2 104,89
$2 237,21
$2 377,37
$2 875,29
$374,91
Toc - Plan #117 MedMutual
Silver

(HMO) Market HMO 3000 - NE Ohio

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
$381,83
$433,38
$487,98
$681,95
$1 036,29
$673,93
$725,48
$780,08
$974,05
$966,03
$1 017,58
$1 072,18
$1 266,15
$1 258,13
$1 309,68
$1 364,28
$1 558,25
$292,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$763,66
$866,76
$975,96
$1 363,90
$2 072,58
$1 055,76
$1 158,86
$1 268,06
$1 656,00
$1 347,86
$1 450,96
$1 560,16
$1 948,10
$1 639,96
$1 743,06
$1 852,26
$2 240,20
$292,10
Toc - Plan #118 MedMutual
Silver

(HMO) Market HMO 4000 HSA - NE Ohio

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
$380,35
$431,70
$486,09
$679,31
$1 032,27
$671,32
$722,67
$777,06
$970,28
$962,29
$1 013,64
$1 068,03
$1 261,25
$1 253,26
$1 304,61
$1 359,00
$1 552,22
$290,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$760,70
$863,40
$972,18
$1 358,62
$2 064,54
$1 051,67
$1 154,37
$1 263,15
$1 649,59
$1 342,64
$1 445,34
$1 554,12
$1 940,56
$1 633,61
$1 736,31
$1 845,09
$2 231,53
$290,97
Toc - Plan #119 MedMutual
Silver

(HMO) Market HMO 6500 - NE Ohio

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
$395,43
$448,82
$505,37
$706,25
$1 073,21
$697,94
$751,33
$807,88
$1 008,76
$1 000,45
$1 053,84
$1 110,39
$1 311,27
$1 302,96
$1 356,35
$1 412,90
$1 613,78
$302,51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790,86
$897,64
$1 010,74
$1 412,50
$2 146,42
$1 093,37
$1 200,15
$1 313,25
$1 715,01
$1 395,88
$1 502,66
$1 615,76
$2 017,52
$1 698,39
$1 805,17
$1 918,27
$2 320,03
$302,51
Toc - Plan #120 MedMutual
Expanded Bronze

(HMO) Market HMO 5850 HSA - NE Ohio

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
$314,40
$356,84
$401,80
$561,51
$853,27
$554,91
$597,35
$642,31
$802,02
$795,42
$837,86
$882,82
$1 042,53
$1 035,93
$1 078,37
$1 123,33
$1 283,04
$240,51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$628,80
$713,68
$803,60
$1 123,02
$1 706,54
$869,31
$954,19
$1 044,11
$1 363,53
$1 109,82
$1 194,70
$1 284,62
$1 604,04
$1 350,33
$1 435,21
$1 525,13
$1 844,55
$240,51
Toc - Plan #121 MedMutual
Expanded Bronze

(HMO) Market HMO 7000 HSA - NE Ohio

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
$293,40
$333,01
$374,96
$524,01
$796,28
$517,85
$557,46
$599,41
$748,46
$742,30
$781,91
$823,86
$972,91
$966,75
$1 006,36
$1 048,31
$1 197,36
$224,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$586,80
$666,02
$749,92
$1 048,02
$1 592,56
$811,25
$890,47
$974,37
$1 272,47
$1 035,70
$1 114,92
$1 198,82
$1 496,92
$1 260,15
$1 339,37
$1 423,27
$1 721,37
$224,45
Toc - Plan #122 MedMutual
Bronze

(HMO) Market HMO 8500 - NE Ohio

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
$282,16
$320,25
$360,60
$503,93
$765,78
$498,01
$536,10
$576,45
$719,78
$713,86
$751,95
$792,30
$935,63
$929,71
$967,80
$1 008,15
$1 151,48
$215,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$564,32
$640,50
$721,20
$1 007,86
$1 531,56
$780,17
$856,35
$937,05
$1 223,71
$996,02
$1 072,20
$1 152,90
$1 439,56
$1 211,87
$1 288,05
$1 368,75
$1 655,41
$215,85
Toc - Plan #123 MedMutual
Expanded Bronze

(HMO) Market HMO $0 Deductible - NE Ohio

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
$327,11
$371,27
$418,05
$584,23
$887,79
$577,35
$621,51
$668,29
$834,47
$827,59
$871,75
$918,53
$1 084,71
$1 077,83
$1 121,99
$1 168,77
$1 334,95
$250,24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654,22
$742,54
$836,10
$1 168,46
$1 775,58
$904,46
$992,78
$1 086,34
$1 418,70
$1 154,70
$1 243,02
$1 336,58
$1 668,94
$1 404,94
$1 493,26
$1 586,82
$1 919,18
$250,24
Toc - Plan #124 MedMutual
Catastrophic

(HMO) Market HMO Young Adult Essentials - NE Ohio

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
$176,87
$200,74
$226,04
$315,88
$480,01
$312,17
$336,04
$361,34
$451,18
$447,47
$471,34
$496,64
$586,48
$582,77
$606,64
$631,94
$721,78
$135,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$353,74
$401,48
$452,08
$631,76
$960,02
$489,04
$536,78
$587,38
$767,06
$624,34
$672,08
$722,68
$902,36
$759,64
$807,38
$857,98
$1 037,66
$135,30

‡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 Stark County here.

Stark County is in “Rating Area 15” of Ohio.

Currently, there are 124 plans offered in Rating Area 15.

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2022 Obamacare Rates for Stark County

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