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Obamacare 2023 Rates for Marlboro County

Obamacare > Rates > South Carolina > Marlboro 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 Marlboro County, SC.

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, 51 Plans and 2023 Rates for Marlboro County, South Carolina

Below, you’ll find a summary of the 51 plans for Marlboro County, South Carolina and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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BlueCross BlueShield of South Carolina

Local: 1-855-404-6752 | Toll Free: 1-855-404-6752 | TTY: 1-855-889-4325

Toc - Plan #1 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$4,900 $9,800 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
$479.49
$544.22
$612.79
$856.37
$1,301.34
$846.30
$911.03
$979.60
$1,223.18
$1,213.11
$1,277.84
$1,346.41
$1,589.99
$1,579.92
$1,644.65
$1,713.22
$1,956.80
$366.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$958.98
$1,088.44
$1,225.58
$1,712.74
$2,602.68
$1,325.79
$1,455.25
$1,592.39
$2,079.55
$1,692.60
$1,822.06
$1,959.20
$2,446.36
$2,059.41
$2,188.87
$2,326.01
$2,813.17
$366.81
Toc - Plan #2 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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
$475.10
$539.24
$607.18
$848.54
$1,289.43
$838.56
$902.70
$970.64
$1,212.00
$1,202.02
$1,266.16
$1,334.10
$1,575.46
$1,565.48
$1,629.62
$1,697.56
$1,938.92
$363.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$950.20
$1,078.48
$1,214.36
$1,697.08
$2,578.86
$1,313.66
$1,441.94
$1,577.82
$2,060.54
$1,677.12
$1,805.40
$1,941.28
$2,424.00
$2,040.58
$2,168.86
$2,304.74
$2,787.46
$363.46
Toc - Plan #3 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials HD Gold 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,400 $6,800 Annual Deductible
$3,400 $6,800 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
$476.05
$540.31
$608.39
$850.22
$1,291.99
$840.22
$904.48
$972.56
$1,214.39
$1,204.39
$1,268.65
$1,336.73
$1,578.56
$1,568.56
$1,632.82
$1,700.90
$1,942.73
$364.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$952.10
$1,080.62
$1,216.78
$1,700.44
$2,583.98
$1,316.27
$1,444.79
$1,580.95
$2,064.61
$1,680.44
$1,808.96
$1,945.12
$2,428.78
$2,044.61
$2,173.13
$2,309.29
$2,792.95
$364.17
Toc - Plan #4 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials HD Silver 6

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$5,000 $10,000 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
$481.58
$546.59
$615.46
$860.10
$1,307.00
$849.99
$915.00
$983.87
$1,228.51
$1,218.40
$1,283.41
$1,352.28
$1,596.92
$1,586.81
$1,651.82
$1,720.69
$1,965.33
$368.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$963.16
$1,093.18
$1,230.92
$1,720.20
$2,614.00
$1,331.57
$1,461.59
$1,599.33
$2,088.61
$1,699.98
$1,830.00
$1,967.74
$2,457.02
$2,068.39
$2,198.41
$2,336.15
$2,825.43
$368.41
Toc - Plan #5 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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
$318.93
$361.98
$407.59
$569.61
$865.57
$562.91
$605.96
$651.57
$813.59
$806.89
$849.94
$895.55
$1,057.57
$1,050.87
$1,093.92
$1,139.53
$1,301.55
$243.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$637.86
$723.96
$815.18
$1,139.22
$1,731.14
$881.84
$967.94
$1,059.16
$1,383.20
$1,125.82
$1,211.92
$1,303.14
$1,627.18
$1,369.80
$1,455.90
$1,547.12
$1,871.16
$243.98
Toc - Plan #6 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$307.67
$349.21
$393.20
$549.50
$835.02
$543.04
$584.58
$628.57
$784.87
$778.41
$819.95
$863.94
$1,020.24
$1,013.78
$1,055.32
$1,099.31
$1,255.61
$235.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$615.34
$698.42
$786.40
$1,099.00
$1,670.04
$850.71
$933.79
$1,021.77
$1,334.37
$1,086.08
$1,169.16
$1,257.14
$1,569.74
$1,321.45
$1,404.53
$1,492.51
$1,805.11
$235.37
Toc - Plan #7 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$313.92
$356.30
$401.19
$560.66
$851.97
$554.07
$596.45
$641.34
$800.81
$794.22
$836.60
$881.49
$1,040.96
$1,034.37
$1,076.75
$1,121.64
$1,281.11
$240.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$627.84
$712.60
$802.38
$1,121.32
$1,703.94
$867.99
$952.75
$1,042.53
$1,361.47
$1,108.14
$1,192.90
$1,282.68
$1,601.62
$1,348.29
$1,433.05
$1,522.83
$1,841.77
$240.15
Toc - Plan #8 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$8,400 $16,800 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
$461.93
$524.30
$590.35
$825.02
$1,253.69
$815.31
$877.68
$943.73
$1,178.40
$1,168.69
$1,231.06
$1,297.11
$1,531.78
$1,522.07
$1,584.44
$1,650.49
$1,885.16
$353.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$923.86
$1,048.60
$1,180.70
$1,650.04
$2,507.38
$1,277.24
$1,401.98
$1,534.08
$2,003.42
$1,630.62
$1,755.36
$1,887.46
$2,356.80
$1,984.00
$2,108.74
$2,240.84
$2,710.18
$353.38
Toc - Plan #9 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,600 $13,200 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
$459.03
$521.00
$586.64
$819.83
$1,245.81
$810.19
$872.16
$937.80
$1,170.99
$1,161.35
$1,223.32
$1,288.96
$1,522.15
$1,512.51
$1,574.48
$1,640.12
$1,873.31
$351.16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.06
$1,042.00
$1,173.28
$1,639.66
$2,491.62
$1,269.22
$1,393.16
$1,524.44
$1,990.82
$1,620.38
$1,744.32
$1,875.60
$2,341.98
$1,971.54
$2,095.48
$2,226.76
$2,693.14
$351.16
Toc - Plan #10 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 14

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$8,800 $17,600 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
$447.71
$508.15
$572.18
$799.61
$1,215.09
$790.21
$850.65
$914.68
$1,142.11
$1,132.71
$1,193.15
$1,257.18
$1,484.61
$1,475.21
$1,535.65
$1,599.68
$1,827.11
$342.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.42
$1,016.30
$1,144.36
$1,599.22
$2,430.18
$1,237.92
$1,358.80
$1,486.86
$1,941.72
$1,580.42
$1,701.30
$1,829.36
$2,284.22
$1,922.92
$2,043.80
$2,171.86
$2,626.72
$342.50
Toc - Plan #11 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 6

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$360.61
$409.29
$460.85
$644.04
$978.68
$636.47
$685.15
$736.71
$919.90
$912.33
$961.01
$1,012.57
$1,195.76
$1,188.19
$1,236.87
$1,288.43
$1,471.62
$275.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721.22
$818.58
$921.70
$1,288.08
$1,957.36
$997.08
$1,094.44
$1,197.56
$1,563.94
$1,272.94
$1,370.30
$1,473.42
$1,839.80
$1,548.80
$1,646.16
$1,749.28
$2,115.66
$275.86
Toc - Plan #12 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$250 $500 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
$450.34
$511.14
$575.53
$804.31
$1,222.22
$794.85
$855.65
$920.04
$1,148.82
$1,139.36
$1,200.16
$1,264.55
$1,493.33
$1,483.87
$1,544.67
$1,609.06
$1,837.84
$344.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$900.68
$1,022.28
$1,151.06
$1,608.62
$2,444.44
$1,245.19
$1,366.79
$1,495.57
$1,953.13
$1,589.70
$1,711.30
$1,840.08
$2,297.64
$1,934.21
$2,055.81
$2,184.59
$2,642.15
$344.51
Toc - Plan #13 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 38

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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
$441.63
$501.25
$564.40
$788.75
$1,198.58
$779.48
$839.10
$902.25
$1,126.60
$1,117.33
$1,176.95
$1,240.10
$1,464.45
$1,455.18
$1,514.80
$1,577.95
$1,802.30
$337.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$883.26
$1,002.50
$1,128.80
$1,577.50
$2,397.16
$1,221.11
$1,340.35
$1,466.65
$1,915.35
$1,558.96
$1,678.20
$1,804.50
$2,253.20
$1,896.81
$2,016.05
$2,142.35
$2,591.05
$337.85
Toc - Plan #14 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 39

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$457.17
$518.89
$584.26
$816.51
$1,240.76
$806.91
$868.63
$934.00
$1,166.25
$1,156.65
$1,218.37
$1,283.74
$1,515.99
$1,506.39
$1,568.11
$1,633.48
$1,865.73
$349.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$914.34
$1,037.78
$1,168.52
$1,633.02
$2,481.52
$1,264.08
$1,387.52
$1,518.26
$1,982.76
$1,613.82
$1,737.26
$1,868.00
$2,332.50
$1,963.56
$2,087.00
$2,217.74
$2,682.24
$349.74
Toc - Plan #15 BlueCross BlueShield of South Carolina
Catastrophic

(EPO) BlueEssentials Catastrophic 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$204.76
$232.40
$261.68
$365.69
$555.71
$361.40
$389.04
$418.32
$522.33
$518.04
$545.68
$574.96
$678.97
$674.68
$702.32
$731.60
$835.61
$156.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$409.52
$464.80
$523.36
$731.38
$1,111.42
$566.16
$621.44
$680.00
$888.02
$722.80
$778.08
$836.64
$1,044.66
$879.44
$934.72
$993.28
$1,201.30
$156.64
Toc - Plan #16 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$473.14
$537.02
$604.67
$845.03
$1,284.11
$835.09
$898.97
$966.62
$1,206.98
$1,197.04
$1,260.92
$1,328.57
$1,568.93
$1,558.99
$1,622.87
$1,690.52
$1,930.88
$361.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$946.28
$1,074.04
$1,209.34
$1,690.06
$2,568.22
$1,308.23
$1,435.99
$1,571.29
$2,052.01
$1,670.18
$1,797.94
$1,933.24
$2,413.96
$2,032.13
$2,159.89
$2,295.19
$2,775.91
$361.95
Toc - Plan #17 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$450.39
$511.19
$575.60
$804.40
$1,222.36
$794.94
$855.74
$920.15
$1,148.95
$1,139.49
$1,200.29
$1,264.70
$1,493.50
$1,484.04
$1,544.84
$1,609.25
$1,838.05
$344.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$900.78
$1,022.38
$1,151.20
$1,608.80
$2,444.72
$1,245.33
$1,366.93
$1,495.75
$1,953.35
$1,589.88
$1,711.48
$1,840.30
$2,297.90
$1,934.43
$2,056.03
$2,184.85
$2,642.45
$344.55
Toc - Plan #18 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$307.59
$349.11
$393.10
$549.35
$834.80
$542.90
$584.42
$628.41
$784.66
$778.21
$819.73
$863.72
$1,019.97
$1,013.52
$1,055.04
$1,099.03
$1,255.28
$235.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$615.18
$698.22
$786.20
$1,098.70
$1,669.60
$850.49
$933.53
$1,021.51
$1,334.01
$1,085.80
$1,168.84
$1,256.82
$1,569.32
$1,321.11
$1,404.15
$1,492.13
$1,804.63
$235.31
Toc - Plan #19 BlueCross BlueShield of South Carolina
Bronze

(EPO) BlueEssentials Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$300.48
$341.05
$384.02
$536.66
$815.51
$530.35
$570.92
$613.89
$766.53
$760.22
$800.79
$843.76
$996.40
$990.09
$1,030.66
$1,073.63
$1,226.27
$229.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600.96
$682.10
$768.04
$1,073.32
$1,631.02
$830.83
$911.97
$997.91
$1,303.19
$1,060.70
$1,141.84
$1,227.78
$1,533.06
$1,290.57
$1,371.71
$1,457.65
$1,762.93
$229.87

ADVERTISEMENT

Molina Healthcare

Local: 1-855-885-3176 | Toll Free: 1-855-885-3176 | TTY: 1-855-885-3176

Toc - Plan #20 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

Annual Out of Pocket Expenses:

Individual Family
$1,900 $3,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$444.52
$504.53
$568.09
$793.91
$1,206.42
$784.57
$844.58
$908.14
$1,133.96
$1,124.62
$1,184.63
$1,248.19
$1,474.01
$1,464.67
$1,524.68
$1,588.24
$1,814.06
$340.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$889.04
$1,009.06
$1,136.18
$1,587.82
$2,412.84
$1,229.09
$1,349.11
$1,476.23
$1,927.87
$1,569.14
$1,689.16
$1,816.28
$2,267.92
$1,909.19
$2,029.21
$2,156.33
$2,607.97
$340.05
Toc - Plan #21 Molina Healthcare
Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

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
$426.23
$483.78
$544.73
$761.26
$1,156.80
$752.30
$809.85
$870.80
$1,087.33
$1,078.37
$1,135.92
$1,196.87
$1,413.40
$1,404.44
$1,461.99
$1,522.94
$1,739.47
$326.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$852.46
$967.56
$1,089.46
$1,522.52
$2,313.60
$1,178.53
$1,293.63
$1,415.53
$1,848.59
$1,504.60
$1,619.70
$1,741.60
$2,174.66
$1,830.67
$1,945.77
$2,067.67
$2,500.73
$326.07
Toc - Plan #22 Molina Healthcare
Gold

(HMO) Confident Care Gold 8

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

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
$444.47
$504.47
$568.03
$793.81
$1,206.28
$784.49
$844.49
$908.05
$1,133.83
$1,124.51
$1,184.51
$1,248.07
$1,473.85
$1,464.53
$1,524.53
$1,588.09
$1,813.87
$340.02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$888.94
$1,008.94
$1,136.06
$1,587.62
$2,412.56
$1,228.96
$1,348.96
$1,476.08
$1,927.64
$1,568.98
$1,688.98
$1,816.10
$2,267.66
$1,909.00
$2,029.00
$2,156.12
$2,607.68
$340.02
Toc - Plan #23 Molina Healthcare
Silver

(HMO) Constant Care Silver 8

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

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
$418.99
$475.55
$535.47
$748.32
$1,137.14
$739.52
$796.08
$856.00
$1,068.85
$1,060.05
$1,116.61
$1,176.53
$1,389.38
$1,380.58
$1,437.14
$1,497.06
$1,709.91
$320.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$837.98
$951.10
$1,070.94
$1,496.64
$2,274.28
$1,158.51
$1,271.63
$1,391.47
$1,817.17
$1,479.04
$1,592.16
$1,712.00
$2,137.70
$1,799.57
$1,912.69
$2,032.53
$2,458.23
$320.53
Toc - Plan #24 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

Annual Out of Pocket Expenses:

Individual Family
$1,900 $3,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$447.63
$508.06
$572.07
$799.47
$1,214.87
$790.07
$850.50
$914.51
$1,141.91
$1,132.51
$1,192.94
$1,256.95
$1,484.35
$1,474.95
$1,535.38
$1,599.39
$1,826.79
$342.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.26
$1,016.12
$1,144.14
$1,598.94
$2,429.74
$1,237.70
$1,358.56
$1,486.58
$1,941.38
$1,580.14
$1,701.00
$1,829.02
$2,283.82
$1,922.58
$2,043.44
$2,171.46
$2,626.26
$342.44
Toc - Plan #25 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-885-3176

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
$429.78
$487.81
$549.26
$767.60
$1,166.44
$758.57
$816.60
$878.05
$1,096.39
$1,087.36
$1,145.39
$1,206.84
$1,425.18
$1,416.15
$1,474.18
$1,535.63
$1,753.97
$328.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$859.56
$975.62
$1,098.52
$1,535.20
$2,332.88
$1,188.35
$1,304.41
$1,427.31
$1,863.99
$1,517.14
$1,633.20
$1,756.10
$2,192.78
$1,845.93
$1,961.99
$2,084.89
$2,521.57
$328.79

ADVERTISEMENT

Ambetter from Absolute Total Care

Local: 1-833-270-5443 | Toll Free: 1-833-270-5443

Toc - Plan #26 Ambetter from Absolute Total Care
Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 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
$285.62
$324.17
$365.01
$510.10
$775.14
$504.11
$542.66
$583.50
$728.59
$722.60
$761.15
$801.99
$947.08
$941.09
$979.64
$1,020.48
$1,165.57
$218.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$571.24
$648.34
$730.02
$1,020.20
$1,550.28
$789.73
$866.83
$948.51
$1,238.69
$1,008.22
$1,085.32
$1,167.00
$1,457.18
$1,226.71
$1,303.81
$1,385.49
$1,675.67
$218.49
Toc - Plan #27 Ambetter from Absolute Total Care
Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$408.20
$463.30
$521.67
$729.03
$1,107.83
$720.47
$775.57
$833.94
$1,041.30
$1,032.74
$1,087.84
$1,146.21
$1,353.57
$1,345.01
$1,400.11
$1,458.48
$1,665.84
$312.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$816.40
$926.60
$1,043.34
$1,458.06
$2,215.66
$1,128.67
$1,238.87
$1,355.61
$1,770.33
$1,440.94
$1,551.14
$1,667.88
$2,082.60
$1,753.21
$1,863.41
$1,980.15
$2,394.87
$312.27
Toc - Plan #28 Ambetter from Absolute Total Care
Silver

(HMO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$369.35
$419.20
$472.01
$659.64
$1,002.38
$651.89
$701.74
$754.55
$942.18
$934.43
$984.28
$1,037.09
$1,224.72
$1,216.97
$1,266.82
$1,319.63
$1,507.26
$282.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$738.70
$838.40
$944.02
$1,319.28
$2,004.76
$1,021.24
$1,120.94
$1,226.56
$1,601.82
$1,303.78
$1,403.48
$1,509.10
$1,884.36
$1,586.32
$1,686.02
$1,791.64
$2,166.90
$282.54
Toc - Plan #29 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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
$306.74
$348.14
$392.01
$547.83
$832.48
$541.39
$582.79
$626.66
$782.48
$776.04
$817.44
$861.31
$1,017.13
$1,010.69
$1,052.09
$1,095.96
$1,251.78
$234.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$613.48
$696.28
$784.02
$1,095.66
$1,664.96
$848.13
$930.93
$1,018.67
$1,330.31
$1,082.78
$1,165.58
$1,253.32
$1,564.96
$1,317.43
$1,400.23
$1,487.97
$1,799.61
$234.65
Toc - Plan #30 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$345.23
$391.82
$441.19
$616.56
$936.93
$609.32
$655.91
$705.28
$880.65
$873.41
$920.00
$969.37
$1,144.74
$1,137.50
$1,184.09
$1,233.46
$1,408.83
$264.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$690.46
$783.64
$882.38
$1,233.12
$1,873.86
$954.55
$1,047.73
$1,146.47
$1,497.21
$1,218.64
$1,311.82
$1,410.56
$1,761.30
$1,482.73
$1,575.91
$1,674.65
$2,025.39
$264.09
Toc - Plan #31 Ambetter from Absolute Total Care
Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$364.40
$413.58
$465.69
$650.80
$988.95
$643.16
$692.34
$744.45
$929.56
$921.92
$971.10
$1,023.21
$1,208.32
$1,200.68
$1,249.86
$1,301.97
$1,487.08
$278.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728.80
$827.16
$931.38
$1,301.60
$1,977.90
$1,007.56
$1,105.92
$1,210.14
$1,580.36
$1,286.32
$1,384.68
$1,488.90
$1,859.12
$1,565.08
$1,663.44
$1,767.66
$2,137.88
$278.76
Toc - Plan #32 Ambetter from Absolute Total Care
Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$367.87
$417.52
$470.12
$657.00
$998.37
$649.28
$698.93
$751.53
$938.41
$930.69
$980.34
$1,032.94
$1,219.82
$1,212.10
$1,261.75
$1,314.35
$1,501.23
$281.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735.74
$835.04
$940.24
$1,314.00
$1,996.74
$1,017.15
$1,116.45
$1,221.65
$1,595.41
$1,298.56
$1,397.86
$1,503.06
$1,876.82
$1,579.97
$1,679.27
$1,784.47
$2,158.23
$281.41
Toc - Plan #33 Ambetter from Absolute Total Care
Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$390.55
$443.26
$499.11
$697.50
$1,059.92
$689.31
$742.02
$797.87
$996.26
$988.07
$1,040.78
$1,096.63
$1,295.02
$1,286.83
$1,339.54
$1,395.39
$1,593.78
$298.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$781.10
$886.52
$998.22
$1,395.00
$2,119.84
$1,079.86
$1,185.28
$1,296.98
$1,693.76
$1,378.62
$1,484.04
$1,595.74
$1,992.52
$1,677.38
$1,782.80
$1,894.50
$2,291.28
$298.76
Toc - Plan #34 Ambetter from Absolute Total Care
Silver

(HMO) Enhanced Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$3,850 $7,700 Annual Deductible
$8,600 $17,200 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
$368.94
$418.74
$471.49
$658.91
$1,001.28
$651.17
$700.97
$753.72
$941.14
$933.40
$983.20
$1,035.95
$1,223.37
$1,215.63
$1,265.43
$1,318.18
$1,505.60
$282.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737.88
$837.48
$942.98
$1,317.82
$2,002.56
$1,020.11
$1,119.71
$1,225.21
$1,600.05
$1,302.34
$1,401.94
$1,507.44
$1,882.28
$1,584.57
$1,684.17
$1,789.67
$2,164.51
$282.23
Toc - Plan #35 Ambetter from Absolute Total Care
Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 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
$450.27
$511.04
$575.43
$804.16
$1,222.00
$794.72
$855.49
$919.88
$1,148.61
$1,139.17
$1,199.94
$1,264.33
$1,493.06
$1,483.62
$1,544.39
$1,608.78
$1,837.51
$344.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$900.54
$1,022.08
$1,150.86
$1,608.32
$2,444.00
$1,244.99
$1,366.53
$1,495.31
$1,952.77
$1,589.44
$1,710.98
$1,839.76
$2,297.22
$1,933.89
$2,055.43
$2,184.21
$2,641.67
$344.45
Toc - Plan #36 Ambetter from Absolute Total Care
Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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
$272.43
$309.20
$348.16
$486.55
$739.36
$480.83
$517.60
$556.56
$694.95
$689.23
$726.00
$764.96
$903.35
$897.63
$934.40
$973.36
$1,111.75
$208.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$544.86
$618.40
$696.32
$973.10
$1,478.72
$753.26
$826.80
$904.72
$1,181.50
$961.66
$1,035.20
$1,113.12
$1,389.90
$1,170.06
$1,243.60
$1,321.52
$1,598.30
$208.40
Toc - Plan #37 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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
$300.32
$340.85
$383.79
$536.35
$815.04
$530.06
$570.59
$613.53
$766.09
$759.80
$800.33
$843.27
$995.83
$989.54
$1,030.07
$1,073.01
$1,225.57
$229.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600.64
$681.70
$767.58
$1,072.70
$1,630.08
$830.38
$911.44
$997.32
$1,302.44
$1,060.12
$1,141.18
$1,227.06
$1,532.18
$1,289.86
$1,370.92
$1,456.80
$1,761.92
$229.74
Toc - Plan #38 Ambetter from Absolute Total Care
Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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
$364.07
$413.20
$465.26
$650.20
$988.05
$642.57
$691.70
$743.76
$928.70
$921.07
$970.20
$1,022.26
$1,207.20
$1,199.57
$1,248.70
$1,300.76
$1,485.70
$278.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728.14
$826.40
$930.52
$1,300.40
$1,976.10
$1,006.64
$1,104.90
$1,209.02
$1,578.90
$1,285.14
$1,383.40
$1,487.52
$1,857.40
$1,563.64
$1,661.90
$1,766.02
$2,135.90
$278.50
Toc - Plan #39 Ambetter from Absolute Total Care
Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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
$385.19
$437.18
$492.26
$687.93
$1,045.38
$679.85
$731.84
$786.92
$982.59
$974.51
$1,026.50
$1,081.58
$1,277.25
$1,269.17
$1,321.16
$1,376.24
$1,571.91
$294.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$770.38
$874.36
$984.52
$1,375.86
$2,090.76
$1,065.04
$1,169.02
$1,279.18
$1,670.52
$1,359.70
$1,463.68
$1,573.84
$1,965.18
$1,654.36
$1,758.34
$1,868.50
$2,259.84
$294.66
Toc - Plan #40 Ambetter from Absolute Total Care
Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$424.54
$481.84
$542.54
$758.20
$1,152.16
$749.30
$806.60
$867.30
$1,082.96
$1,074.06
$1,131.36
$1,192.06
$1,407.72
$1,398.82
$1,456.12
$1,516.82
$1,732.48
$324.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$849.08
$963.68
$1,085.08
$1,516.40
$2,304.32
$1,173.84
$1,288.44
$1,409.84
$1,841.16
$1,498.60
$1,613.20
$1,734.60
$2,165.92
$1,823.36
$1,937.96
$2,059.36
$2,490.68
$324.76
Toc - Plan #41 Ambetter from Absolute Total Care
Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 Annual Deductible
$8,600 $17,200 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
$297.05
$337.14
$379.61
$530.51
$806.16
$524.28
$564.37
$606.84
$757.74
$751.51
$791.60
$834.07
$984.97
$978.74
$1,018.83
$1,061.30
$1,212.20
$227.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$594.10
$674.28
$759.22
$1,061.02
$1,612.32
$821.33
$901.51
$986.45
$1,288.25
$1,048.56
$1,128.74
$1,213.68
$1,515.48
$1,275.79
$1,355.97
$1,440.91
$1,742.71
$227.23
Toc - Plan #42 Ambetter from Absolute Total Care
Silver

(HMO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$384.13
$435.97
$490.90
$686.03
$1,042.49
$677.98
$729.82
$784.75
$979.88
$971.83
$1,023.67
$1,078.60
$1,273.73
$1,265.68
$1,317.52
$1,372.45
$1,567.58
$293.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$768.26
$871.94
$981.80
$1,372.06
$2,084.98
$1,062.11
$1,165.79
$1,275.65
$1,665.91
$1,355.96
$1,459.64
$1,569.50
$1,959.76
$1,649.81
$1,753.49
$1,863.35
$2,253.61
$293.85
Toc - Plan #43 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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
$319.02
$362.08
$407.69
$569.75
$865.79
$563.06
$606.12
$651.73
$813.79
$807.10
$850.16
$895.77
$1,057.83
$1,051.14
$1,094.20
$1,139.81
$1,301.87
$244.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$638.04
$724.16
$815.38
$1,139.50
$1,731.58
$882.08
$968.20
$1,059.42
$1,383.54
$1,126.12
$1,212.24
$1,303.46
$1,627.58
$1,370.16
$1,456.28
$1,547.50
$1,871.62
$244.04
Toc - Plan #44 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$359.04
$407.50
$458.85
$641.24
$974.42
$633.70
$682.16
$733.51
$915.90
$908.36
$956.82
$1,008.17
$1,190.56
$1,183.02
$1,231.48
$1,282.83
$1,465.22
$274.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$718.08
$815.00
$917.70
$1,282.48
$1,948.84
$992.74
$1,089.66
$1,192.36
$1,557.14
$1,267.40
$1,364.32
$1,467.02
$1,831.80
$1,542.06
$1,638.98
$1,741.68
$2,106.46
$274.66
Toc - Plan #45 Ambetter from Absolute Total Care
Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$378.98
$430.13
$484.32
$676.84
$1,028.52
$668.89
$720.04
$774.23
$966.75
$958.80
$1,009.95
$1,064.14
$1,256.66
$1,248.71
$1,299.86
$1,354.05
$1,546.57
$289.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757.96
$860.26
$968.64
$1,353.68
$2,057.04
$1,047.87
$1,150.17
$1,258.55
$1,643.59
$1,337.78
$1,440.08
$1,548.46
$1,933.50
$1,627.69
$1,729.99
$1,838.37
$2,223.41
$289.91
Toc - Plan #46 Ambetter from Absolute Total Care
Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$382.59
$434.23
$488.94
$683.29
$1,038.32
$675.26
$726.90
$781.61
$975.96
$967.93
$1,019.57
$1,074.28
$1,268.63
$1,260.60
$1,312.24
$1,366.95
$1,561.30
$292.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$765.18
$868.46
$977.88
$1,366.58
$2,076.64
$1,057.85
$1,161.13
$1,270.55
$1,659.25
$1,350.52
$1,453.80
$1,563.22
$1,951.92
$1,643.19
$1,746.47
$1,855.89
$2,244.59
$292.67
Toc - Plan #47 Ambetter from Absolute Total Care
Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$406.18
$461.00
$519.08
$725.41
$1,102.33
$716.90
$771.72
$829.80
$1,036.13
$1,027.62
$1,082.44
$1,140.52
$1,346.85
$1,338.34
$1,393.16
$1,451.24
$1,657.57
$310.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812.36
$922.00
$1,038.16
$1,450.82
$2,204.66
$1,123.08
$1,232.72
$1,348.88
$1,761.54
$1,433.80
$1,543.44
$1,659.60
$2,072.26
$1,744.52
$1,854.16
$1,970.32
$2,382.98
$310.72
Toc - Plan #48 Ambetter from Absolute Total Care
Silver

(HMO) Enhanced Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$3,850 $7,700 Annual Deductible
$8,600 $17,200 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
$383.70
$435.49
$490.36
$685.28
$1,041.35
$677.23
$729.02
$783.89
$978.81
$970.76
$1,022.55
$1,077.42
$1,272.34
$1,264.29
$1,316.08
$1,370.95
$1,565.87
$293.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$767.40
$870.98
$980.72
$1,370.56
$2,082.70
$1,060.93
$1,164.51
$1,274.25
$1,664.09
$1,354.46
$1,458.04
$1,567.78
$1,957.62
$1,647.99
$1,751.57
$1,861.31
$2,251.15
$293.53
Toc - Plan #49 Ambetter from Absolute Total Care
Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,000 $10,000 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
$468.29
$531.49
$598.46
$836.34
$1,270.90
$826.52
$889.72
$956.69
$1,194.57
$1,184.75
$1,247.95
$1,314.92
$1,552.80
$1,542.98
$1,606.18
$1,673.15
$1,911.03
$358.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$936.58
$1,062.98
$1,196.92
$1,672.68
$2,541.80
$1,294.81
$1,421.21
$1,555.15
$2,030.91
$1,653.04
$1,779.44
$1,913.38
$2,389.14
$2,011.27
$2,137.67
$2,271.61
$2,747.37
$358.23
Toc - Plan #50 Ambetter from Absolute Total Care
Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

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:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$298.62
$338.92
$381.62
$533.32
$810.43
$527.06
$567.36
$610.06
$761.76
$755.50
$795.80
$838.50
$990.20
$983.94
$1,024.24
$1,066.94
$1,218.64
$228.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$597.24
$677.84
$763.24
$1,066.64
$1,620.86
$825.68
$906.28
$991.68
$1,295.08
$1,054.12
$1,134.72
$1,220.12
$1,523.52
$1,282.56
$1,363.16
$1,448.56
$1,751.96
$228.44
Toc - Plan #51 Ambetter from Absolute Total Care
Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-270-5443

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,400 $14,800 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
$359.89
$408.47
$459.93
$642.75
$976.72
$635.20
$683.78
$735.24
$918.06
$910.51
$959.09
$1,010.55
$1,193.37
$1,185.82
$1,234.40
$1,285.86
$1,468.68
$275.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719.78
$816.94
$919.86
$1,285.50
$1,953.44
$995.09
$1,092.25
$1,195.17
$1,560.81
$1,270.40
$1,367.56
$1,470.48
$1,836.12
$1,545.71
$1,642.87
$1,745.79
$2,111.43
$275.31

‡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 Marlboro County here.

Marlboro County is in “Rating Area 35” of South Carolina.

Currently, there are 51 plans offered in Rating Area 35.

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2023 Obamacare Plans for Marlboro County, SC

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