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You are viewing information for Pawnee County, OK

Obamacare 2023 Rates for Pawnee County

Obamacare > Rates > Oklahoma > Pawnee County

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

The health insurance rates listed below are for calendar year 2023.

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

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

Obamacare Providers, 37 Plans and 2023 Rates for Pawnee County, Oklahoma

Below, you’ll find a summary of the 37 plans for Pawnee County, Oklahoma and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777
Toc - Plan #1 Medica
Expanded Bronze

(PPO) Medica Quest Bronze Copay ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$525.68
$596.63
$671.80
$938.84
$1,426.67 		$927.82
$998.77
$1,073.94
$1,340.98 		$1,329.96
$1,400.91
$1,476.08
$1,743.12 		$1,732.10
$1,803.05
$1,878.22
$2,145.26 		$402.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,051.36
$1,193.26
$1,343.60
$1,877.68
$2,853.34 		$1,453.50
$1,595.40
$1,745.74
$2,279.82 		$1,855.64
$1,997.54
$2,147.88
$2,681.96 		$2,257.78
$2,399.68
$2,550.02
$3,084.10 		$402.14
Toc - Plan #2 Medica
Catastrophic

(PPO) Medica Quest Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$386.96
$439.18
$494.51
$691.08
$1,050.16 		$682.97
$735.19
$790.52
$987.09 		$978.98
$1,031.20
$1,086.53
$1,283.10 		$1,274.99
$1,327.21
$1,382.54
$1,579.11 		$296.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$773.92
$878.36
$989.02
$1,382.16
$2,100.32 		$1,069.93
$1,174.37
$1,285.03
$1,678.17 		$1,365.94
$1,470.38
$1,581.04
$1,974.18 		$1,661.95
$1,766.39
$1,877.05
$2,270.19 		$296.01
Toc - Plan #3 Medica
Expanded Bronze

(PPO) Medica Quest Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$564.83
$641.06
$721.83
$1,008.76
$1,532.90 		$996.91
$1,073.14
$1,153.91
$1,440.84 		$1,428.99
$1,505.22
$1,585.99
$1,872.92 		$1,861.07
$1,937.30
$2,018.07
$2,305.00 		$432.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,129.66
$1,282.12
$1,443.66
$2,017.52
$3,065.80 		$1,561.74
$1,714.20
$1,875.74
$2,449.60 		$1,993.82
$2,146.28
$2,307.82
$2,881.68 		$2,425.90
$2,578.36
$2,739.90
$3,313.76 		$432.08
Toc - Plan #4 Medica
Gold

(PPO) Medica Quest Gold Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$665.70
$755.56
$850.75
$1,188.92
$1,806.68 		$1,174.95
$1,264.81
$1,360.00
$1,698.17 		$1,684.20
$1,774.06
$1,869.25
$2,207.42 		$2,193.45
$2,283.31
$2,378.50
$2,716.67 		$509.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,331.40
$1,511.12
$1,701.50
$2,377.84
$3,613.36 		$1,840.65
$2,020.37
$2,210.75
$2,887.09 		$2,349.90
$2,529.62
$2,720.00
$3,396.34 		$2,859.15
$3,038.87
$3,229.25
$3,905.59 		$509.25
Toc - Plan #5 Medica
Silver

(PPO) Medica Quest Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$664.02
$753.65
$848.61
$1,185.92
$1,802.13 		$1,171.99
$1,261.62
$1,356.58
$1,693.89 		$1,679.96
$1,769.59
$1,864.55
$2,201.86 		$2,187.93
$2,277.56
$2,372.52
$2,709.83 		$507.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,328.04
$1,507.30
$1,697.22
$2,371.84
$3,604.26 		$1,836.01
$2,015.27
$2,205.19
$2,879.81 		$2,343.98
$2,523.24
$2,713.16
$3,387.78 		$2,851.95
$3,031.21
$3,221.13
$3,895.75 		$507.97
Toc - Plan #6 Medica
Bronze

(PPO) Medica Quest Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$521.79
$592.22
$666.83
$931.89
$1,416.10 		$920.95
$991.38
$1,065.99
$1,331.05 		$1,320.11
$1,390.54
$1,465.15
$1,730.21 		$1,719.27
$1,789.70
$1,864.31
$2,129.37 		$399.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,043.58
$1,184.44
$1,333.66
$1,863.78
$2,832.20 		$1,442.74
$1,583.60
$1,732.82
$2,262.94 		$1,841.90
$1,982.76
$2,131.98
$2,662.10 		$2,241.06
$2,381.92
$2,531.14
$3,061.26 		$399.16

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Blue Cross and Blue Shield of Oklahoma

Local: 1-866-520-2507 | Toll Free: 1-866-520-2507 | TTY: 1-800-722-0353
Toc - Plan #7 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Preferred Silver PPO? 201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,750 $5,250 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$584.55
$663.47
$747.06
$1,044.01
$1,586.47 		$1,031.73
$1,110.65
$1,194.24
$1,491.19 		$1,478.91
$1,557.83
$1,641.42
$1,938.37 		$1,926.09
$2,005.01
$2,088.60
$2,385.55 		$447.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,169.10
$1,326.94
$1,494.12
$2,088.02
$3,172.94 		$1,616.28
$1,774.12
$1,941.30
$2,535.20 		$2,063.46
$2,221.30
$2,388.48
$2,982.38 		$2,510.64
$2,668.48
$2,835.66
$3,429.56 		$447.18
Toc - Plan #8 Blue Cross and Blue Shield of Oklahoma
Catastrophic

(PPO) Blue Preferred Security PPO? 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$362.28
$411.19
$463.00
$647.04
$983.23 		$639.43
$688.34
$740.15
$924.19 		$916.58
$965.49
$1,017.30
$1,201.34 		$1,193.73
$1,242.64
$1,294.45
$1,478.49 		$277.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$724.56
$822.38
$926.00
$1,294.08
$1,966.46 		$1,001.71
$1,099.53
$1,203.15
$1,571.23 		$1,278.86
$1,376.68
$1,480.30
$1,848.38 		$1,556.01
$1,653.83
$1,757.45
$2,125.53 		$277.15
Toc - Plan #9 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Preferred Gold PPO? 205

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$550 $1,650 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$539.09
$611.86
$688.95
$962.81
$1,463.08 		$951.49
$1,024.26
$1,101.35
$1,375.21 		$1,363.89
$1,436.66
$1,513.75
$1,787.61 		$1,776.29
$1,849.06
$1,926.15
$2,200.01 		$412.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,078.18
$1,223.72
$1,377.90
$1,925.62
$2,926.16 		$1,490.58
$1,636.12
$1,790.30
$2,338.02 		$1,902.98
$2,048.52
$2,202.70
$2,750.42 		$2,315.38
$2,460.92
$2,615.10
$3,162.82 		$412.40
Toc - Plan #10 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Preferred Bronze PPO? 206

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$6,000 $17,400 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$422.59
$479.64
$540.07
$754.75
$1,146.92 		$745.87
$802.92
$863.35
$1,078.03 		$1,069.15
$1,126.20
$1,186.63
$1,401.31 		$1,392.43
$1,449.48
$1,509.91
$1,724.59 		$323.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$845.18
$959.28
$1,080.14
$1,509.50
$2,293.84 		$1,168.46
$1,282.56
$1,403.42
$1,832.78 		$1,491.74
$1,605.84
$1,726.70
$2,156.06 		$1,815.02
$1,929.12
$2,049.98
$2,479.34 		$323.28
Toc - Plan #11 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Preferred Bronze PPO? 603

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$7,500 $17,400 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$407.31
$462.29
$520.54
$727.45
$1,105.43 		$718.90
$773.88
$832.13
$1,039.04 		$1,030.49
$1,085.47
$1,143.72
$1,350.63 		$1,342.08
$1,397.06
$1,455.31
$1,662.22 		$311.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$814.62
$924.58
$1,041.08
$1,454.90
$2,210.86 		$1,126.21
$1,236.17
$1,352.67
$1,766.49 		$1,437.80
$1,547.76
$1,664.26
$2,078.08 		$1,749.39
$1,859.35
$1,975.85
$2,389.67 		$311.59
Toc - Plan #12 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Preferred Gold PPO? 705

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$553.20
$627.88
$706.99
$988.02
$1,501.38 		$976.40
$1,051.08
$1,130.19
$1,411.22 		$1,399.60
$1,474.28
$1,553.39
$1,834.42 		$1,822.80
$1,897.48
$1,976.59
$2,257.62 		$423.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,106.40
$1,255.76
$1,413.98
$1,976.04
$3,002.76 		$1,529.60
$1,678.96
$1,837.18
$2,399.24 		$1,952.80
$2,102.16
$2,260.38
$2,822.44 		$2,376.00
$2,525.36
$2,683.58
$3,245.64 		$423.20
Toc - Plan #13 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Preferred Silver PPO? 701

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$566.55
$643.03
$724.05
$1,011.86
$1,537.61 		$999.96
$1,076.44
$1,157.46
$1,445.27 		$1,433.37
$1,509.85
$1,590.87
$1,878.68 		$1,866.78
$1,943.26
$2,024.28
$2,312.09 		$433.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,133.10
$1,286.06
$1,448.10
$2,023.72
$3,075.22 		$1,566.51
$1,719.47
$1,881.51
$2,457.13 		$1,999.92
$2,152.88
$2,314.92
$2,890.54 		$2,433.33
$2,586.29
$2,748.33
$3,323.95 		$433.41
Toc - Plan #14 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Preferred Bronze PPO? 706

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$432.72
$491.14
$553.02
$772.85
$1,174.41 		$763.75
$822.17
$884.05
$1,103.88 		$1,094.78
$1,153.20
$1,215.08
$1,434.91 		$1,425.81
$1,484.23
$1,546.11
$1,765.94 		$331.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$865.44
$982.28
$1,106.04
$1,545.70
$2,348.82 		$1,196.47
$1,313.31
$1,437.07
$1,876.73 		$1,527.50
$1,644.34
$1,768.10
$2,207.76 		$1,858.53
$1,975.37
$2,099.13
$2,538.79 		$331.03
Toc - Plan #15 Blue Cross and Blue Shield of Oklahoma
Expanded Bronze

(PPO) Blue Preferred Bronze PPO? 707

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$474.00
$537.99
$605.77
$846.56
$1,286.43 		$836.61
$900.60
$968.38
$1,209.17 		$1,199.22
$1,263.21
$1,330.99
$1,571.78 		$1,561.83
$1,625.82
$1,693.60
$1,934.39 		$362.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$948.00
$1,075.98
$1,211.54
$1,693.12
$2,572.86 		$1,310.61
$1,438.59
$1,574.15
$2,055.73 		$1,673.22
$1,801.20
$1,936.76
$2,418.34 		$2,035.83
$2,163.81
$2,299.37
$2,780.95 		$362.61
Toc - Plan #16 Blue Cross and Blue Shield of Oklahoma
Expanded Bronze

(PPO) Blue Advantage Bronze PPO? 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$4,500 $13,500 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$399.81
$453.78
$510.95
$714.06
$1,085.08 		$705.66
$759.63
$816.80
$1,019.91 		$1,011.51
$1,065.48
$1,122.65
$1,325.76 		$1,317.36
$1,371.33
$1,428.50
$1,631.61 		$305.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$799.62
$907.56
$1,021.90
$1,428.12
$2,170.16 		$1,105.47
$1,213.41
$1,327.75
$1,733.97 		$1,411.32
$1,519.26
$1,633.60
$2,039.82 		$1,717.17
$1,825.11
$1,939.45
$2,345.67 		$305.85
Toc - Plan #17 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Advantage Silver PPO? 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$479.07
$543.74
$612.25
$855.61
$1,300.19 		$845.56
$910.23
$978.74
$1,222.10 		$1,212.05
$1,276.72
$1,345.23
$1,588.59 		$1,578.54
$1,643.21
$1,711.72
$1,955.08 		$366.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$958.14
$1,087.48
$1,224.50
$1,711.22
$2,600.38 		$1,324.63
$1,453.97
$1,590.99
$2,077.71 		$1,691.12
$1,820.46
$1,957.48
$2,444.20 		$2,057.61
$2,186.95
$2,323.97
$2,810.69 		$366.49
Toc - Plan #18 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Advantage Bronze PPO? 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$6,000 $18,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$345.31
$391.93
$441.31
$616.73
$937.18 		$609.47
$656.09
$705.47
$880.89 		$873.63
$920.25
$969.63
$1,145.05 		$1,137.79
$1,184.41
$1,233.79
$1,409.21 		$264.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$690.62
$783.86
$882.62
$1,233.46
$1,874.36 		$954.78
$1,048.02
$1,146.78
$1,497.62 		$1,218.94
$1,312.18
$1,410.94
$1,761.78 		$1,483.10
$1,576.34
$1,675.10
$2,025.94 		$264.16
Toc - Plan #19 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Advantage Gold PPO? 309

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$454.58
$515.95
$580.96
$811.88
$1,233.74 		$802.34
$863.71
$928.72
$1,159.64 		$1,150.10
$1,211.47
$1,276.48
$1,507.40 		$1,497.86
$1,559.23
$1,624.24
$1,855.16 		$347.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$909.16
$1,031.90
$1,161.92
$1,623.76
$2,467.48 		$1,256.92
$1,379.66
$1,509.68
$1,971.52 		$1,604.68
$1,727.42
$1,857.44
$2,319.28 		$1,952.44
$2,075.18
$2,205.20
$2,667.04 		$347.76
Toc - Plan #20 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Advantage Silver PPO? 605

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$498.24
$565.50
$636.75
$889.85
$1,352.22 		$879.39
$946.65
$1,017.90
$1,271.00 		$1,260.54
$1,327.80
$1,399.05
$1,652.15 		$1,641.69
$1,708.95
$1,780.20
$2,033.30 		$381.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$996.48
$1,131.00
$1,273.50
$1,779.70
$2,704.44 		$1,377.63
$1,512.15
$1,654.65
$2,160.85 		$1,758.78
$1,893.30
$2,035.80
$2,542.00 		$2,139.93
$2,274.45
$2,416.95
$2,923.15 		$381.15
Toc - Plan #21 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Advantage Gold PPO? 604

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,150 $3,450 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$444.14
$504.10
$567.62
$793.24
$1,205.41 		$783.91
$843.87
$907.39
$1,133.01 		$1,123.68
$1,183.64
$1,247.16
$1,472.78 		$1,463.45
$1,523.41
$1,586.93
$1,812.55 		$339.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$888.28
$1,008.20
$1,135.24
$1,586.48
$2,410.82 		$1,228.05
$1,347.97
$1,475.01
$1,926.25 		$1,567.82
$1,687.74
$1,814.78
$2,266.02 		$1,907.59
$2,027.51
$2,154.55
$2,605.79 		$339.77
Toc - Plan #22 Blue Cross and Blue Shield of Oklahoma
Gold

(HMO) MyBlue Gold HMO? 704

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,100 $3,300 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$395.97
$449.43
$506.05
$707.20
$1,074.67 		$698.89
$752.35
$808.97
$1,010.12 		$1,001.81
$1,055.27
$1,111.89
$1,313.04 		$1,304.73
$1,358.19
$1,414.81
$1,615.96 		$302.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791.94
$898.86
$1,012.10
$1,414.40
$2,149.34 		$1,094.86
$1,201.78
$1,315.02
$1,717.32 		$1,397.78
$1,504.70
$1,617.94
$2,020.24 		$1,700.70
$1,807.62
$1,920.86
$2,323.16 		$302.92
Toc - Plan #23 Blue Cross and Blue Shield of Oklahoma
Silver

(HMO) MyBlue Silver HMO? 705

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$2,600 $7,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$411.48
$467.03
$525.87
$734.90
$1,116.76 		$726.26
$781.81
$840.65
$1,049.68 		$1,041.04
$1,096.59
$1,155.43
$1,364.46 		$1,355.82
$1,411.37
$1,470.21
$1,679.24 		$314.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822.96
$934.06
$1,051.74
$1,469.80
$2,233.52 		$1,137.74
$1,248.84
$1,366.52
$1,784.58 		$1,452.52
$1,563.62
$1,681.30
$2,099.36 		$1,767.30
$1,878.40
$1,996.08
$2,414.14 		$314.78
Toc - Plan #24 Blue Cross and Blue Shield of Oklahoma
Gold

(HMO) MyBlue Gold HMO? 708

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$417.78
$474.18
$533.93
$746.16
$1,133.86 		$737.38
$793.78
$853.53
$1,065.76 		$1,056.98
$1,113.38
$1,173.13
$1,385.36 		$1,376.58
$1,432.98
$1,492.73
$1,704.96 		$319.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$835.56
$948.36
$1,067.86
$1,492.32
$2,267.72 		$1,155.16
$1,267.96
$1,387.46
$1,811.92 		$1,474.76
$1,587.56
$1,707.06
$2,131.52 		$1,794.36
$1,907.16
$2,026.66
$2,451.12 		$319.60
Toc - Plan #25 Blue Cross and Blue Shield of Oklahoma
Silver

(HMO) MyBlue Silver HMO? 709

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.94
$475.50
$535.40
$748.23
$1,137.00 		$739.43
$795.99
$855.89
$1,068.72 		$1,059.92
$1,116.48
$1,176.38
$1,389.21 		$1,380.41
$1,436.97
$1,496.87
$1,709.70 		$320.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$837.88
$951.00
$1,070.80
$1,496.46
$2,274.00 		$1,158.37
$1,271.49
$1,391.29
$1,816.95 		$1,478.86
$1,591.98
$1,711.78
$2,137.44 		$1,799.35
$1,912.47
$2,032.27
$2,457.93 		$320.49

ADVERTISEMENT

CommunityCare

Local: 1-918-594-5242 | Toll Free: 1-800-777-4890 | TTY: 1-800-722-0353
Toc - Plan #26 CommunityCare
Catastrophic

(HMO) CommunityCare Catastrophic Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$210.01
$238.36
$268.39
$375.07
$569.96 		$370.67
$399.02
$429.05
$535.73 		$531.33
$559.68
$589.71
$696.39 		$691.99
$720.34
$750.37
$857.05 		$160.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$420.02
$476.72
$536.78
$750.14
$1,139.92 		$580.68
$637.38
$697.44
$910.80 		$741.34
$798.04
$858.10
$1,071.46 		$902.00
$958.70
$1,018.76
$1,232.12 		$160.66
Toc - Plan #27 CommunityCare
Gold

(HMO) CommunityCare Gold L21 Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$4,000 $12,000 Annual Deductible
$8,300 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$419.22
$475.81
$535.76
$748.73
$1,137.76 		$739.92
$796.51
$856.46
$1,069.43 		$1,060.62
$1,117.21
$1,177.16
$1,390.13 		$1,381.32
$1,437.91
$1,497.86
$1,710.83 		$320.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$838.44
$951.62
$1,071.52
$1,497.46
$2,275.52 		$1,159.14
$1,272.32
$1,392.22
$1,818.16 		$1,479.84
$1,593.02
$1,712.92
$2,138.86 		$1,800.54
$1,913.72
$2,033.62
$2,459.56 		$320.70
Toc - Plan #28 CommunityCare
Silver

(HMO) CommunityCare Silver L21 Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$7,700 $17,100 Annual Deductible
$8,500 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$450.87
$511.74
$576.21
$805.26
$1,223.67 		$795.79
$856.66
$921.13
$1,150.18 		$1,140.71
$1,201.58
$1,266.05
$1,495.10 		$1,485.63
$1,546.50
$1,610.97
$1,840.02 		$344.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$901.74
$1,023.48
$1,152.42
$1,610.52
$2,447.34 		$1,246.66
$1,368.40
$1,497.34
$1,955.44 		$1,591.58
$1,713.32
$1,842.26
$2,300.36 		$1,936.50
$2,058.24
$2,187.18
$2,645.28 		$344.92
Toc - Plan #29 CommunityCare
Gold

(HMO) CommunityCare Gold IH221

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$1,100 $3,300 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$427.00
$484.65
$545.71
$762.63
$1,158.89 		$753.66
$811.31
$872.37
$1,089.29 		$1,080.32
$1,137.97
$1,199.03
$1,415.95 		$1,406.98
$1,464.63
$1,525.69
$1,742.61 		$326.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$854.00
$969.30
$1,091.42
$1,525.26
$2,317.78 		$1,180.66
$1,295.96
$1,418.08
$1,851.92 		$1,507.32
$1,622.62
$1,744.74
$2,178.58 		$1,833.98
$1,949.28
$2,071.40
$2,505.24 		$326.66
Toc - Plan #30 CommunityCare
Gold

(HMO) CommunityCare Gold IH222

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$2,200 $6,600 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$420.59
$477.37
$537.51
$751.17
$1,141.48 		$742.34
$799.12
$859.26
$1,072.92 		$1,064.09
$1,120.87
$1,181.01
$1,394.67 		$1,385.84
$1,442.62
$1,502.76
$1,716.42 		$321.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$841.18
$954.74
$1,075.02
$1,502.34
$2,282.96 		$1,162.93
$1,276.49
$1,396.77
$1,824.09 		$1,484.68
$1,598.24
$1,718.52
$2,145.84 		$1,806.43
$1,919.99
$2,040.27
$2,467.59 		$321.75
Toc - Plan #31 CommunityCare
Expanded Bronze

(HMO) CommunityCare Bronze IH223

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$5,000 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$309.59
$351.39
$395.66
$552.93
$840.23 		$546.43
$588.23
$632.50
$789.77 		$783.27
$825.07
$869.34
$1,026.61 		$1,020.11
$1,061.91
$1,106.18
$1,263.45 		$236.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$619.18
$702.78
$791.32
$1,105.86
$1,680.46 		$856.02
$939.62
$1,028.16
$1,342.70 		$1,092.86
$1,176.46
$1,265.00
$1,579.54 		$1,329.70
$1,413.30
$1,501.84
$1,816.38 		$236.84
Toc - Plan #32 CommunityCare
Expanded Bronze

(HMO) CommunityCare Bronze IH224

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$316.20
$358.88
$404.10
$564.73
$858.15 		$558.09
$600.77
$645.99
$806.62 		$799.98
$842.66
$887.88
$1,048.51 		$1,041.87
$1,084.55
$1,129.77
$1,290.40 		$241.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$632.40
$717.76
$808.20
$1,129.46
$1,716.30 		$874.29
$959.65
$1,050.09
$1,371.35 		$1,116.18
$1,201.54
$1,291.98
$1,613.24 		$1,358.07
$1,443.43
$1,533.87
$1,855.13 		$241.89
Toc - Plan #33 CommunityCare
Gold

(HMO) CommunityCare Gold Standardized Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.51
$475.01
$534.86
$747.46
$1,135.84 		$738.67
$795.17
$855.02
$1,067.62 		$1,058.83
$1,115.33
$1,175.18
$1,387.78 		$1,378.99
$1,435.49
$1,495.34
$1,707.94 		$320.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$837.02
$950.02
$1,069.72
$1,494.92
$2,271.68 		$1,157.18
$1,270.18
$1,389.88
$1,815.08 		$1,477.34
$1,590.34
$1,710.04
$2,135.24 		$1,797.50
$1,910.50
$2,030.20
$2,455.40 		$320.16
Toc - Plan #34 CommunityCare
Silver

(HMO) CommunityCare Silver Standardized Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$412.71
$468.43
$527.44
$737.10
$1,120.10 		$728.43
$784.15
$843.16
$1,052.82 		$1,044.15
$1,099.87
$1,158.88
$1,368.54 		$1,359.87
$1,415.59
$1,474.60
$1,684.26 		$315.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$825.42
$936.86
$1,054.88
$1,474.20
$2,240.20 		$1,141.14
$1,252.58
$1,370.60
$1,789.92 		$1,456.86
$1,568.30
$1,686.32
$2,105.64 		$1,772.58
$1,884.02
$2,002.04
$2,421.36 		$315.72
Toc - Plan #35 CommunityCare
Bronze

(HMO) CommunityCare Bronze Standardized Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$282.04
$320.12
$360.45
$503.73
$765.46 		$497.80
$535.88
$576.21
$719.49 		$713.56
$751.64
$791.97
$935.25 		$929.32
$967.40
$1,007.73
$1,151.01 		$215.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$564.08
$640.24
$720.90
$1,007.46
$1,530.92 		$779.84
$856.00
$936.66
$1,223.22 		$995.60
$1,071.76
$1,152.42
$1,438.98 		$1,211.36
$1,287.52
$1,368.18
$1,654.74 		$215.76
Toc - Plan #36 CommunityCare
Expanded Bronze

(HMO) CommunityCare Expanded Bronze Standardized Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$301.81
$342.55
$385.71
$539.03
$819.11 		$532.69
$573.43
$616.59
$769.91 		$763.57
$804.31
$847.47
$1,000.79 		$994.45
$1,035.19
$1,078.35
$1,231.67 		$230.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603.62
$685.10
$771.42
$1,078.06
$1,638.22 		$834.50
$915.98
$1,002.30
$1,308.94 		$1,065.38
$1,146.86
$1,233.18
$1,539.82 		$1,296.26
$1,377.74
$1,464.06
$1,770.70 		$230.88
Toc - Plan #37 CommunityCare
Silver

(HMO) CommunityCare Silver SLIH23 Select Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-777-4890

Annual Out of Pocket Expenses:

Individual Family
$6,600 $17,900 Annual Deductible
$8,900 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.28
$474.74
$534.56
$747.04
$1,135.20 		$738.26
$794.72
$854.54
$1,067.02 		$1,058.24
$1,114.70
$1,174.52
$1,387.00 		$1,378.22
$1,434.68
$1,494.50
$1,706.98 		$319.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$836.56
$949.48
$1,069.12
$1,494.08
$2,270.40 		$1,156.54
$1,269.46
$1,389.10
$1,814.06 		$1,476.52
$1,589.44
$1,709.08
$2,134.04 		$1,796.50
$1,909.42
$2,029.06
$2,454.02 		$319.98

‡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 Pawnee County here.

Pawnee County is in “Rating Area 4” of Oklahoma.

Currently, there are 37 plans offered in Rating Area 4.

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2023 Obamacare Plans for Pawnee County, OK

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