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Obamacare 2022 Rates and Health Insurance Providers for Wilson County , Tennessee

Obamacare > Rates > Tennessee > Wilson 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 Wilson County, TN.

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 Mount Juliet, TN area accept this insurance coverage as within the plan's network.

Obamacare Providers, Plans and 2022 Rates for Wilson County, Tennessee

Below, you’ll find a summary of the 66 plans for Wilson County, Tennessee 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 Tennessee

For 2022 health plans, Tennessee 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 Tennessee. 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 Tennessee Health Care Exchange?

You can find the health insurance exchange for Tennessee 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...  

Tennessee 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 Tennessee 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.

Tennessee Has Not Expanded Medicaid

Because Tennessee has not yet expanded Medicaid eligibility, you may have fewer options for health coverage than people in states where Medicaid is more inclusive.

The Medicaid Coverage Gap

The Affordable Care Act assumed that Medicaid would be expanded to cover all Americans with incomes at or below 138% of the federal poverty level. And it created health plan subsidies for people with incomes between 100% - 400% of the poverty level.

That means Tennessee residents with incomes below the poverty level may fall into a coverage gap where they can get neither Medicaid nor ACA subsidies.

more...  

Get Help Finding a Health Insurance Plan in Tennessee

Get Help From Tennessee'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 Tennessee.

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 Tennessee 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 Tennessee?

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

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BlueCross BlueShield of Tennessee

Local: 1-423-535-5600 | Toll Free: 1-800-565-9140

Toc - Plan #1 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B07S, Network S

Annual Out of Pocket Expenses
Individual Family
$5,950 $11,900 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 		$356,42
$404,54
$455,50
$636,57
$967,32 		$629,08
$677,20
$728,16
$909,23 		$901,74
$949,86
$1 000,82
$1 181,89 		$1 174,40
$1 222,52
$1 273,48
$1 454,55 		$272,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$712,84
$809,08
$911,00
$1 273,14
$1 934,64 		$985,50
$1 081,74
$1 183,66
$1 545,80 		$1 258,16
$1 354,40
$1 456,32
$1 818,46 		$1 530,82
$1 627,06
$1 728,98
$2 091,12 		$272,66
Toc - Plan #2 BlueCross BlueShield of Tennessee
Bronze

(EPO) Bronze B08S, Network S

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 		$289,59
$328,68
$370,10
$517,21
$785,95 		$511,13
$550,22
$591,64
$738,75 		$732,67
$771,76
$813,18
$960,29 		$954,21
$993,30
$1 034,72
$1 181,83 		$221,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$579,18
$657,36
$740,20
$1 034,42
$1 571,90 		$800,72
$878,90
$961,74
$1 255,96 		$1 022,26
$1 100,44
$1 183,28
$1 477,50 		$1 243,80
$1 321,98
$1 404,82
$1 699,04 		$221,54
Toc - Plan #3 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B11S, Network S

Annual Out of Pocket Expenses
Individual Family
$6,400 $12,800 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 		$337,19
$382,71
$430,93
$602,22
$915,13 		$595,14
$640,66
$688,88
$860,17 		$853,09
$898,61
$946,83
$1 118,12 		$1 111,04
$1 156,56
$1 204,78
$1 376,07 		$257,95
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674,38
$765,42
$861,86
$1 204,44
$1 830,26 		$932,33
$1 023,37
$1 119,81
$1 462,39 		$1 190,28
$1 281,32
$1 377,76
$1 720,34 		$1 448,23
$1 539,27
$1 635,71
$1 978,29 		$257,95
Toc - Plan #4 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S01S, Network S

Annual Out of Pocket Expenses
Individual Family
$750 $1,500 Annual Deductible
$7,800 $15,600 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 		$590,36
$670,06
$754,48
$1 054,38
$1 602,24 		$1 041,99
$1 121,69
$1 206,11
$1 506,01 		$1 493,62
$1 573,32
$1 657,74
$1 957,64 		$1 945,25
$2 024,95
$2 109,37
$2 409,27 		$451,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 180,72
$1 340,12
$1 508,96
$2 108,76
$3 204,48 		$1 632,35
$1 791,75
$1 960,59
$2 560,39 		$2 083,98
$2 243,38
$2 412,22
$3 012,02 		$2 535,61
$2 695,01
$2 863,85
$3 463,65 		$451,63
Toc - Plan #5 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S04S, Network S

Annual Out of Pocket Expenses
Individual Family
$3,500 $7,000 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 		$496,15
$563,13
$634,08
$886,12
$1 346,55 		$875,70
$942,68
$1 013,63
$1 265,67 		$1 255,25
$1 322,23
$1 393,18
$1 645,22 		$1 634,80
$1 701,78
$1 772,73
$2 024,77 		$379,55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$992,30
$1 126,26
$1 268,16
$1 772,24
$2 693,10 		$1 371,85
$1 505,81
$1 647,71
$2 151,79 		$1 751,40
$1 885,36
$2 027,26
$2 531,34 		$2 130,95
$2 264,91
$2 406,81
$2 910,89 		$379,55
Toc - Plan #6 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S21S, Network S

Annual Out of Pocket Expenses
Individual Family
$3,900 $7,800 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 		$492,25
$558,70
$629,10
$879,16
$1 335,97 		$868,82
$935,27
$1 005,67
$1 255,73 		$1 245,39
$1 311,84
$1 382,24
$1 632,30 		$1 621,96
$1 688,41
$1 758,81
$2 008,87 		$376,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$984,50
$1 117,40
$1 258,20
$1 758,32
$2 671,94 		$1 361,07
$1 493,97
$1 634,77
$2 134,89 		$1 737,64
$1 870,54
$2 011,34
$2 511,46 		$2 114,21
$2 247,11
$2 387,91
$2 888,03 		$376,57
Toc - Plan #7 BlueCross BlueShield of Tennessee
Gold

(EPO) Gold G06S, Network S

Annual Out of Pocket Expenses
Individual Family
$2,750 $5,500 Annual Deductible
$6,350 $12,700 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 		$639,56
$725,90
$817,36
$1 142,25
$1 735,77 		$1 128,82
$1 215,16
$1 306,62
$1 631,51 		$1 618,08
$1 704,42
$1 795,88
$2 120,77 		$2 107,34
$2 193,68
$2 285,14
$2 610,03 		$489,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 279,12
$1 451,80
$1 634,72
$2 284,50
$3 471,54 		$1 768,38
$1 941,06
$2 123,98
$2 773,76 		$2 257,64
$2 430,32
$2 613,24
$3 263,02 		$2 746,90
$2 919,58
$3 102,50
$3 752,28 		$489,26
Toc - Plan #8 BlueCross BlueShield of Tennessee
Gold

(EPO) Gold G07S, Network S

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 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 		$494,01
$560,70
$631,34
$882,30
$1 340,74 		$871,93
$938,62
$1 009,26
$1 260,22 		$1 249,85
$1 316,54
$1 387,18
$1 638,14 		$1 627,77
$1 694,46
$1 765,10
$2 016,06 		$377,92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$988,02
$1 121,40
$1 262,68
$1 764,60
$2 681,48 		$1 365,94
$1 499,32
$1 640,60
$2 142,52 		$1 743,86
$1 877,24
$2 018,52
$2 520,44 		$2 121,78
$2 255,16
$2 396,44
$2 898,36 		$377,92

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Oscar Insurance Company

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755 | TTY: 1-855-672-2755
Toc - Plan #9 Oscar Insurance Company
Expanded Bronze

(EPO) 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 		$335,96
$381,31
$429,35
$600,01
$911,78 		$592,97
$638,32
$686,36
$857,02 		$849,98
$895,33
$943,37
$1 114,03 		$1 106,99
$1 152,34
$1 200,38
$1 371,04 		$257,01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$671,92
$762,62
$858,70
$1 200,02
$1 823,56 		$928,93
$1 019,63
$1 115,71
$1 457,03 		$1 185,94
$1 276,64
$1 372,72
$1 714,04 		$1 442,95
$1 533,65
$1 629,73
$1 971,05 		$257,01
Toc - Plan #10 Oscar Insurance Company
Expanded Bronze

(EPO) 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 		$347,37
$394,25
$443,93
$620,39
$942,74 		$613,10
$659,98
$709,66
$886,12 		$878,83
$925,71
$975,39
$1 151,85 		$1 144,56
$1 191,44
$1 241,12
$1 417,58 		$265,73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694,74
$788,50
$887,86
$1 240,78
$1 885,48 		$960,47
$1 054,23
$1 153,59
$1 506,51 		$1 226,20
$1 319,96
$1 419,32
$1 772,24 		$1 491,93
$1 585,69
$1 685,05
$2 037,97 		$265,73
Toc - Plan #11 Oscar Insurance Company
Expanded Bronze

(EPO) 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 		$337,90
$383,51
$431,83
$603,48
$917,05 		$596,39
$642,00
$690,32
$861,97 		$854,88
$900,49
$948,81
$1 120,46 		$1 113,37
$1 158,98
$1 207,30
$1 378,95 		$258,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$675,80
$767,02
$863,66
$1 206,96
$1 834,10 		$934,29
$1 025,51
$1 122,15
$1 465,45 		$1 192,78
$1 284,00
$1 380,64
$1 723,94 		$1 451,27
$1 542,49
$1 639,13
$1 982,43 		$258,49
Toc - Plan #12 Oscar Insurance Company
Expanded Bronze

(EPO) 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 		$403,26
$457,69
$515,35
$720,21
$1 094,42 		$711,75
$766,18
$823,84
$1 028,70 		$1 020,24
$1 074,67
$1 132,33
$1 337,19 		$1 328,73
$1 383,16
$1 440,82
$1 645,68 		$308,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806,52
$915,38
$1 030,70
$1 440,42
$2 188,84 		$1 115,01
$1 223,87
$1 339,19
$1 748,91 		$1 423,50
$1 532,36
$1 647,68
$2 057,40 		$1 731,99
$1 840,85
$1 956,17
$2 365,89 		$308,49
Toc - Plan #13 Oscar Insurance Company
Silver

(EPO) 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 		$428,10
$485,88
$547,10
$764,57
$1 161,83 		$755,59
$813,37
$874,59
$1 092,06 		$1 083,08
$1 140,86
$1 202,08
$1 419,55 		$1 410,57
$1 468,35
$1 529,57
$1 747,04 		$327,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$856,20
$971,76
$1 094,20
$1 529,14
$2 323,66 		$1 183,69
$1 299,25
$1 421,69
$1 856,63 		$1 511,18
$1 626,74
$1 749,18
$2 184,12 		$1 838,67
$1 954,23
$2 076,67
$2 511,61 		$327,49
Toc - Plan #14 Oscar Insurance Company
Silver

(EPO) 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 		$421,14
$477,98
$538,20
$752,13
$1 142,94 		$743,30
$800,14
$860,36
$1 074,29 		$1 065,46
$1 122,30
$1 182,52
$1 396,45 		$1 387,62
$1 444,46
$1 504,68
$1 718,61 		$322,16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$842,28
$955,96
$1 076,40
$1 504,26
$2 285,88 		$1 164,44
$1 278,12
$1 398,56
$1 826,42 		$1 486,60
$1 600,28
$1 720,72
$2 148,58 		$1 808,76
$1 922,44
$2 042,88
$2 470,74 		$322,16
Toc - Plan #15 Oscar Insurance Company
Silver

(EPO) 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 		$430,88
$489,04
$550,65
$769,54
$1 169,39 		$760,50
$818,66
$880,27
$1 099,16 		$1 090,12
$1 148,28
$1 209,89
$1 428,78 		$1 419,74
$1 477,90
$1 539,51
$1 758,40 		$329,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$861,76
$978,08
$1 101,30
$1 539,08
$2 338,78 		$1 191,38
$1 307,70
$1 430,92
$1 868,70 		$1 521,00
$1 637,32
$1 760,54
$2 198,32 		$1 850,62
$1 966,94
$2 090,16
$2 527,94 		$329,62
Toc - Plan #16 Oscar Insurance Company
Catastrophic

(EPO) 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 		$260,12
$295,23
$332,42
$464,56
$705,95 		$459,11
$494,22
$531,41
$663,55 		$658,10
$693,21
$730,40
$862,54 		$857,09
$892,20
$929,39
$1 061,53 		$198,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$520,24
$590,46
$664,84
$929,12
$1 411,90 		$719,23
$789,45
$863,83
$1 128,11 		$918,22
$988,44
$1 062,82
$1 327,10 		$1 117,21
$1 187,43
$1 261,81
$1 526,09 		$198,99
Toc - Plan #17 Oscar Insurance Company
Expanded Bronze

(EPO) Oscar Bronze Classic Next 2

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 		$403,14
$457,56
$515,21
$720,00
$1 094,11 		$711,54
$765,96
$823,61
$1 028,40 		$1 019,94
$1 074,36
$1 132,01
$1 336,80 		$1 328,34
$1 382,76
$1 440,41
$1 645,20 		$308,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806,28
$915,12
$1 030,42
$1 440,00
$2 188,22 		$1 114,68
$1 223,52
$1 338,82
$1 748,40 		$1 423,08
$1 531,92
$1 647,22
$2 056,80 		$1 731,48
$1 840,32
$1 955,62
$2 365,20 		$308,40
Toc - Plan #18 Oscar Insurance Company
Gold

(EPO) 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 		$573,81
$651,27
$733,32
$1 024,81
$1 557,30 		$1 012,77
$1 090,23
$1 172,28
$1 463,77 		$1 451,73
$1 529,19
$1 611,24
$1 902,73 		$1 890,69
$1 968,15
$2 050,20
$2 341,69 		$438,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 147,62
$1 302,54
$1 466,64
$2 049,62
$3 114,60 		$1 586,58
$1 741,50
$1 905,60
$2 488,58 		$2 025,54
$2 180,46
$2 344,56
$2 927,54 		$2 464,50
$2 619,42
$2 783,52
$3 366,50 		$438,96
Toc - Plan #19 Oscar Insurance Company
Expanded Bronze

(EPO) 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 		$356,26
$404,35
$455,29
$636,27
$966,87 		$628,79
$676,88
$727,82
$908,80 		$901,32
$949,41
$1 000,35
$1 181,33 		$1 173,85
$1 221,94
$1 272,88
$1 453,86 		$272,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$712,52
$808,70
$910,58
$1 272,54
$1 933,74 		$985,05
$1 081,23
$1 183,11
$1 545,07 		$1 257,58
$1 353,76
$1 455,64
$1 817,60 		$1 530,11
$1 626,29
$1 728,17
$2 090,13 		$272,53
Toc - Plan #20 Oscar Insurance Company
Silver

(EPO) 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 		$437,13
$496,13
$558,63
$780,69
$1 186,33 		$771,52
$830,52
$893,02
$1 115,08 		$1 105,91
$1 164,91
$1 227,41
$1 449,47 		$1 440,30
$1 499,30
$1 561,80
$1 783,86 		$334,39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$874,26
$992,26
$1 117,26
$1 561,38
$2 372,66 		$1 208,65
$1 326,65
$1 451,65
$1 895,77 		$1 543,04
$1 661,04
$1 786,04
$2 230,16 		$1 877,43
$1 995,43
$2 120,43
$2 564,55 		$334,39
Toc - Plan #21 Oscar Insurance Company
Silver

(EPO) 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 		$452,77
$513,88
$578,62
$808,62
$1 228,78 		$799,13
$860,24
$924,98
$1 154,98 		$1 145,49
$1 206,60
$1 271,34
$1 501,34 		$1 491,85
$1 552,96
$1 617,70
$1 847,70 		$346,36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$905,54
$1 027,76
$1 157,24
$1 617,24
$2 457,56 		$1 251,90
$1 374,12
$1 503,60
$1 963,60 		$1 598,26
$1 720,48
$1 849,96
$2 309,96 		$1 944,62
$2 066,84
$2 196,32
$2 656,32 		$346,36

ADVERTISEMENT

UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 

Toc - Plan #22 UnitedHealthcare
Gold

(EPO) Value Gold

Annual Out of Pocket Expenses
Individual Family
$2,350 $4,700 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 		$538,73
$611,46
$688,50
$962,18
$1 462,12 		$950,86
$1 023,59
$1 100,63
$1 374,31 		$1 362,99
$1 435,72
$1 512,76
$1 786,44 		$1 775,12
$1 847,85
$1 924,89
$2 198,57 		$412,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 077,46
$1 222,92
$1 377,00
$1 924,36
$2 924,24 		$1 489,59
$1 635,05
$1 789,13
$2 336,49 		$1 901,72
$2 047,18
$2 201,26
$2 748,62 		$2 313,85
$2 459,31
$2 613,39
$3 160,75 		$412,13
Toc - Plan #23 UnitedHealthcare
Silver

(EPO) Balance Plus Silver 3 Free Visits

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 		$403,82
$458,34
$516,09
$721,23
$1 095,98 		$712,75
$767,27
$825,02
$1 030,16 		$1 021,68
$1 076,20
$1 133,95
$1 339,09 		$1 330,61
$1 385,13
$1 442,88
$1 648,02 		$308,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$807,64
$916,68
$1 032,18
$1 442,46
$2 191,96 		$1 116,57
$1 225,61
$1 341,11
$1 751,39 		$1 425,50
$1 534,54
$1 650,04
$2 060,32 		$1 734,43
$1 843,47
$1 958,97
$2 369,25 		$308,93
Toc - Plan #24 UnitedHealthcare
Silver

(EPO) Balance Silver 3 Free Visits

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 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 		$403,22
$457,66
$515,32
$720,15
$1 094,34 		$711,68
$766,12
$823,78
$1 028,61 		$1 020,14
$1 074,58
$1 132,24
$1 337,07 		$1 328,60
$1 383,04
$1 440,70
$1 645,53 		$308,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806,44
$915,32
$1 030,64
$1 440,30
$2 188,68 		$1 114,90
$1 223,78
$1 339,10
$1 748,76 		$1 423,36
$1 532,24
$1 647,56
$2 057,22 		$1 731,82
$1 840,70
$1 956,02
$2 365,68 		$308,46
Toc - Plan #25 UnitedHealthcare
Silver

(EPO) Value Silver 3 Free Visits

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 		$401,72
$455,95
$513,39
$717,46
$1 090,26 		$709,03
$763,26
$820,70
$1 024,77 		$1 016,34
$1 070,57
$1 128,01
$1 332,08 		$1 323,65
$1 377,88
$1 435,32
$1 639,39 		$307,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$803,44
$911,90
$1 026,78
$1 434,92
$2 180,52 		$1 110,75
$1 219,21
$1 334,09
$1 742,23 		$1 418,06
$1 526,52
$1 641,40
$2 049,54 		$1 725,37
$1 833,83
$1 948,71
$2 356,85 		$307,31
Toc - Plan #26 UnitedHealthcare
Expanded Bronze

(EPO) Value Bronze Saver (HSA)

Annual Out of Pocket Expenses
Individual Family
$5,900 $11,800 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 		$311,07
$353,07
$397,55
$555,58
$844,25 		$549,04
$591,04
$635,52
$793,55 		$787,01
$829,01
$873,49
$1 031,52 		$1 024,98
$1 066,98
$1 111,46
$1 269,49 		$237,97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$622,14
$706,14
$795,10
$1 111,16
$1 688,50 		$860,11
$944,11
$1 033,07
$1 349,13 		$1 098,08
$1 182,08
$1 271,04
$1 587,10 		$1 336,05
$1 420,05
$1 509,01
$1 825,07 		$237,97
Toc - Plan #27 UnitedHealthcare
Expanded Bronze

(EPO) Balance Bronze 3 Free Visits

Annual Out of Pocket Expenses
Individual Family
$7,500 $15,000 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 		$301,14
$341,79
$384,85
$537,83
$817,28 		$531,51
$572,16
$615,22
$768,20 		$761,88
$802,53
$845,59
$998,57 		$992,25
$1 032,90
$1 075,96
$1 228,94 		$230,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$602,28
$683,58
$769,70
$1 075,66
$1 634,56 		$832,65
$913,95
$1 000,07
$1 306,03 		$1 063,02
$1 144,32
$1 230,44
$1 536,40 		$1 293,39
$1 374,69
$1 460,81
$1 766,77 		$230,37
Toc - Plan #28 UnitedHealthcare
Expanded Bronze

(EPO) Value Bronze

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 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 		$301,44
$342,13
$385,24
$538,37
$818,10 		$532,04
$572,73
$615,84
$768,97 		$762,64
$803,33
$846,44
$999,57 		$993,24
$1 033,93
$1 077,04
$1 230,17 		$230,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$602,88
$684,26
$770,48
$1 076,74
$1 636,20 		$833,48
$914,86
$1 001,08
$1 307,34 		$1 064,08
$1 145,46
$1 231,68
$1 537,94 		$1 294,68
$1 376,06
$1 462,28
$1 768,54 		$230,60

ADVERTISEMENT

Ambetter of Tennessee

Local: 1-833-709-4735 | Toll Free: 1-833-709-4735

Toc - Plan #29 Ambetter of Tennessee
Bronze

(EPO) 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 		$283,56
$321,83
$362,38
$506,43
$769,56 		$500,48
$538,75
$579,30
$723,35 		$717,40
$755,67
$796,22
$940,27 		$934,32
$972,59
$1 013,14
$1 157,19 		$216,92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$567,12
$643,66
$724,76
$1 012,86
$1 539,12 		$784,04
$860,58
$941,68
$1 229,78 		$1 000,96
$1 077,50
$1 158,60
$1 446,70 		$1 217,88
$1 294,42
$1 375,52
$1 663,62 		$216,92
Toc - Plan #30 Ambetter of Tennessee
Silver

(EPO) 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 		$381,28
$432,75
$487,27
$680,96
$1 034,78 		$672,95
$724,42
$778,94
$972,63 		$964,62
$1 016,09
$1 070,61
$1 264,30 		$1 256,29
$1 307,76
$1 362,28
$1 555,97 		$291,67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$762,56
$865,50
$974,54
$1 361,92
$2 069,56 		$1 054,23
$1 157,17
$1 266,21
$1 653,59 		$1 345,90
$1 448,84
$1 557,88
$1 945,26 		$1 637,57
$1 740,51
$1 849,55
$2 236,93 		$291,67
Toc - Plan #31 Ambetter of Tennessee
Gold

(EPO) 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 		$439,38
$498,68
$561,51
$784,71
$1 192,45 		$775,50
$834,80
$897,63
$1 120,83 		$1 111,62
$1 170,92
$1 233,75
$1 456,95 		$1 447,74
$1 507,04
$1 569,87
$1 793,07 		$336,12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878,76
$997,36
$1 123,02
$1 569,42
$2 384,90 		$1 214,88
$1 333,48
$1 459,14
$1 905,54 		$1 551,00
$1 669,60
$1 795,26
$2 241,66 		$1 887,12
$2 005,72
$2 131,38
$2 577,78 		$336,12
Toc - Plan #32 Ambetter of Tennessee
Expanded Bronze

(EPO) 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 		$308,16
$349,75
$393,82
$550,36
$836,32 		$543,90
$585,49
$629,56
$786,10 		$779,64
$821,23
$865,30
$1 021,84 		$1 015,38
$1 056,97
$1 101,04
$1 257,58 		$235,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$616,32
$699,50
$787,64
$1 100,72
$1 672,64 		$852,06
$935,24
$1 023,38
$1 336,46 		$1 087,80
$1 170,98
$1 259,12
$1 572,20 		$1 323,54
$1 406,72
$1 494,86
$1 807,94 		$235,74
Toc - Plan #33 Ambetter of Tennessee
Silver

(EPO) 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 		$373,84
$424,30
$477,76
$667,67
$1 014,59 		$659,82
$710,28
$763,74
$953,65 		$945,80
$996,26
$1 049,72
$1 239,63 		$1 231,78
$1 282,24
$1 335,70
$1 525,61 		$285,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$747,68
$848,60
$955,52
$1 335,34
$2 029,18 		$1 033,66
$1 134,58
$1 241,50
$1 621,32 		$1 319,64
$1 420,56
$1 527,48
$1 907,30 		$1 605,62
$1 706,54
$1 813,46
$2 193,28 		$285,98
Toc - Plan #34 Ambetter of Tennessee
Silver

(EPO) 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 		$370,56
$420,57
$473,56
$661,79
$1 005,66 		$654,03
$704,04
$757,03
$945,26 		$937,50
$987,51
$1 040,50
$1 228,73 		$1 220,97
$1 270,98
$1 323,97
$1 512,20 		$283,47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$741,12
$841,14
$947,12
$1 323,58
$2 011,32 		$1 024,59
$1 124,61
$1 230,59
$1 607,05 		$1 308,06
$1 408,08
$1 514,06
$1 890,52 		$1 591,53
$1 691,55
$1 797,53
$2 173,99 		$283,47
Toc - Plan #35 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 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 		$389,81
$442,42
$498,16
$696,18
$1 057,91 		$688,01
$740,62
$796,36
$994,38 		$986,21
$1 038,82
$1 094,56
$1 292,58 		$1 284,41
$1 337,02
$1 392,76
$1 590,78 		$298,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$779,62
$884,84
$996,32
$1 392,36
$2 115,82 		$1 077,82
$1 183,04
$1 294,52
$1 690,56 		$1 376,02
$1 481,24
$1 592,72
$1 988,76 		$1 674,22
$1 779,44
$1 890,92
$2 286,96 		$298,20
Toc - Plan #36 Ambetter of Tennessee
Silver

(EPO) 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 		$391,38
$444,20
$500,17
$698,98
$1 062,17 		$690,78
$743,60
$799,57
$998,38 		$990,18
$1 043,00
$1 098,97
$1 297,78 		$1 289,58
$1 342,40
$1 398,37
$1 597,18 		$299,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$782,76
$888,40
$1 000,34
$1 397,96
$2 124,34 		$1 082,16
$1 187,80
$1 299,74
$1 697,36 		$1 381,56
$1 487,20
$1 599,14
$1 996,76 		$1 680,96
$1 786,60
$1 898,54
$2 296,16 		$299,40
Toc - Plan #37 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 27 (2021)

Annual Out of Pocket Expenses
Individual Family
$2,750 $5,500 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 		$407,53
$462,53
$520,81
$727,83
$1 106,00 		$719,28
$774,28
$832,56
$1 039,58 		$1 031,03
$1 086,03
$1 144,31
$1 351,33 		$1 342,78
$1 397,78
$1 456,06
$1 663,08 		$311,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815,06
$925,06
$1 041,62
$1 455,66
$2 212,00 		$1 126,81
$1 236,81
$1 353,37
$1 767,41 		$1 438,56
$1 548,56
$1 665,12
$2 079,16 		$1 750,31
$1 860,31
$1 976,87
$2 390,91 		$311,75
Toc - Plan #38 Ambetter of Tennessee
Silver

(EPO) 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 		$407,83
$462,87
$521,19
$728,36
$1 106,81 		$719,81
$774,85
$833,17
$1 040,34 		$1 031,79
$1 086,83
$1 145,15
$1 352,32 		$1 343,77
$1 398,81
$1 457,13
$1 664,30 		$311,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815,66
$925,74
$1 042,38
$1 456,72
$2 213,62 		$1 127,64
$1 237,72
$1 354,36
$1 768,70 		$1 439,62
$1 549,70
$1 666,34
$2 080,68 		$1 751,60
$1 861,68
$1 978,32
$2 392,66 		$311,98
Toc - Plan #39 Ambetter of Tennessee
Bronze

(EPO) 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 		$295,96
$335,90
$378,22
$528,56
$803,20 		$522,36
$562,30
$604,62
$754,96 		$748,76
$788,70
$831,02
$981,36 		$975,16
$1 015,10
$1 057,42
$1 207,76 		$226,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$591,92
$671,80
$756,44
$1 057,12
$1 606,40 		$818,32
$898,20
$982,84
$1 283,52 		$1 044,72
$1 124,60
$1 209,24
$1 509,92 		$1 271,12
$1 351,00
$1 435,64
$1 736,32 		$226,40
Toc - Plan #40 Ambetter of Tennessee
Silver

(EPO) 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 		$397,95
$451,66
$508,56
$710,72
$1 080,00 		$702,37
$756,08
$812,98
$1 015,14 		$1 006,79
$1 060,50
$1 117,40
$1 319,56 		$1 311,21
$1 364,92
$1 421,82
$1 623,98 		$304,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795,90
$903,32
$1 017,12
$1 421,44
$2 160,00 		$1 100,32
$1 207,74
$1 321,54
$1 725,86 		$1 404,74
$1 512,16
$1 625,96
$2 030,28 		$1 709,16
$1 816,58
$1 930,38
$2 334,70 		$304,42
Toc - Plan #41 Ambetter of Tennessee
Gold

(EPO) 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 		$458,58
$520,48
$586,05
$819,01
$1 244,56 		$809,39
$871,29
$936,86
$1 169,82 		$1 160,20
$1 222,10
$1 287,67
$1 520,63 		$1 511,01
$1 572,91
$1 638,48
$1 871,44 		$350,81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$917,16
$1 040,96
$1 172,10
$1 638,02
$2 489,12 		$1 267,97
$1 391,77
$1 522,91
$1 988,83 		$1 618,78
$1 742,58
$1 873,72
$2 339,64 		$1 969,59
$2 093,39
$2 224,53
$2 690,45 		$350,81
Toc - Plan #42 Ambetter of Tennessee
Expanded Bronze

(EPO) 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 		$321,63
$365,04
$411,03
$574,41
$872,87 		$567,67
$611,08
$657,07
$820,45 		$813,71
$857,12
$903,11
$1 066,49 		$1 059,75
$1 103,16
$1 149,15
$1 312,53 		$246,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$643,26
$730,08
$822,06
$1 148,82
$1 745,74 		$889,30
$976,12
$1 068,10
$1 394,86 		$1 135,34
$1 222,16
$1 314,14
$1 640,90 		$1 381,38
$1 468,20
$1 560,18
$1 886,94 		$246,04
Toc - Plan #43 Ambetter of Tennessee
Silver

(EPO) 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 		$390,18
$442,85
$498,64
$696,85
$1 058,93 		$688,66
$741,33
$797,12
$995,33 		$987,14
$1 039,81
$1 095,60
$1 293,81 		$1 285,62
$1 338,29
$1 394,08
$1 592,29 		$298,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$780,36
$885,70
$997,28
$1 393,70
$2 117,86 		$1 078,84
$1 184,18
$1 295,76
$1 692,18 		$1 377,32
$1 482,66
$1 594,24
$1 990,66 		$1 675,80
$1 781,14
$1 892,72
$2 289,14 		$298,48
Toc - Plan #44 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 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 		$406,84
$461,76
$519,93
$726,60
$1 104,14 		$718,07
$772,99
$831,16
$1 037,83 		$1 029,30
$1 084,22
$1 142,39
$1 349,06 		$1 340,53
$1 395,45
$1 453,62
$1 660,29 		$311,23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$813,68
$923,52
$1 039,86
$1 453,20
$2 208,28 		$1 124,91
$1 234,75
$1 351,09
$1 764,43 		$1 436,14
$1 545,98
$1 662,32
$2 075,66 		$1 747,37
$1 857,21
$1 973,55
$2 386,89 		$311,23
Toc - Plan #45 Ambetter of Tennessee
Silver

(EPO) 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 		$408,48
$463,62
$522,03
$729,53
$1 108,59 		$720,96
$776,10
$834,51
$1 042,01 		$1 033,44
$1 088,58
$1 146,99
$1 354,49 		$1 345,92
$1 401,06
$1 459,47
$1 666,97 		$312,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$816,96
$927,24
$1 044,06
$1 459,06
$2 217,18 		$1 129,44
$1 239,72
$1 356,54
$1 771,54 		$1 441,92
$1 552,20
$1 669,02
$2 084,02 		$1 754,40
$1 864,68
$1 981,50
$2 396,50 		$312,48
Toc - Plan #46 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 27 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
$2,750 $5,500 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 		$425,34
$482,75
$543,57
$759,63
$1 154,34 		$750,72
$808,13
$868,95
$1 085,01 		$1 076,10
$1 133,51
$1 194,33
$1 410,39 		$1 401,48
$1 458,89
$1 519,71
$1 735,77 		$325,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$850,68
$965,50
$1 087,14
$1 519,26
$2 308,68 		$1 176,06
$1 290,88
$1 412,52
$1 844,64 		$1 501,44
$1 616,26
$1 737,90
$2 170,02 		$1 826,82
$1 941,64
$2 063,28
$2 495,40 		$325,38
Toc - Plan #47 Ambetter of Tennessee
Silver

(EPO) 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 		$425,65
$483,10
$543,97
$760,19
$1 155,18 		$751,26
$808,71
$869,58
$1 085,80 		$1 076,87
$1 134,32
$1 195,19
$1 411,41 		$1 402,48
$1 459,93
$1 520,80
$1 737,02 		$325,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$851,30
$966,20
$1 087,94
$1 520,38
$2 310,36 		$1 176,91
$1 291,81
$1 413,55
$1 845,99 		$1 502,52
$1 617,42
$1 739,16
$2 171,60 		$1 828,13
$1 943,03
$2 064,77
$2 497,21 		$325,61

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Bright Health

Local: 1-855-827-4448 | Toll Free: 1-855-827-4448

Toc - Plan #48 Bright Health
Gold

(EPO) Gold 1000 Direct

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 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 		$532,57
$604,46
$680,62
$951,16
$1 445,38 		$939,98
$1 011,87
$1 088,03
$1 358,57 		$1 347,39
$1 419,28
$1 495,44
$1 765,98 		$1 754,80
$1 826,69
$1 902,85
$2 173,39 		$407,41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 065,14
$1 208,92
$1 361,24
$1 902,32
$2 890,76 		$1 472,55
$1 616,33
$1 768,65
$2 309,73 		$1 879,96
$2 023,74
$2 176,06
$2 717,14 		$2 287,37
$2 431,15
$2 583,47
$3 124,55 		$407,41
Toc - Plan #49 Bright Health
Silver

(EPO) Silver $0 Deductible

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 		$388,34
$440,77
$496,30
$693,58
$1 053,96 		$685,42
$737,85
$793,38
$990,66 		$982,50
$1 034,93
$1 090,46
$1 287,74 		$1 279,58
$1 332,01
$1 387,54
$1 584,82 		$297,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$776,68
$881,54
$992,60
$1 387,16
$2 107,92 		$1 073,76
$1 178,62
$1 289,68
$1 684,24 		$1 370,84
$1 475,70
$1 586,76
$1 981,32 		$1 667,92
$1 772,78
$1 883,84
$2 278,40 		$297,08
Toc - Plan #50 Bright Health
Silver

(EPO) Silver $0 Primary Care

Annual Out of Pocket Expenses
Individual Family
$6,700 $13,400 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 		$381,21
$432,67
$487,18
$680,84
$1 034,60 		$672,83
$724,29
$778,80
$972,46 		$964,45
$1 015,91
$1 070,42
$1 264,08 		$1 256,07
$1 307,53
$1 362,04
$1 555,70 		$291,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$762,42
$865,34
$974,36
$1 361,68
$2 069,20 		$1 054,04
$1 156,96
$1 265,98
$1 653,30 		$1 345,66
$1 448,58
$1 557,60
$1 944,92 		$1 637,28
$1 740,20
$1 849,22
$2 236,54 		$291,62
Toc - Plan #51 Bright Health
Expanded Bronze

(EPO) Bronze 8550 Direct

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 		$297,40
$337,55
$380,07
$531,15
$807,13 		$524,91
$565,06
$607,58
$758,66 		$752,42
$792,57
$835,09
$986,17 		$979,93
$1 020,08
$1 062,60
$1 213,68 		$227,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$594,80
$675,10
$760,14
$1 062,30
$1 614,26 		$822,31
$902,61
$987,65
$1 289,81 		$1 049,82
$1 130,12
$1 215,16
$1 517,32 		$1 277,33
$1 357,63
$1 442,67
$1 744,83 		$227,51
Toc - Plan #52 Bright Health
Expanded Bronze

(EPO) Bronze 5900 Direct

Annual Out of Pocket Expenses
Individual Family
$5,900 $11,800 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 		$310,55
$352,48
$396,89
$554,65
$842,84 		$548,12
$590,05
$634,46
$792,22 		$785,69
$827,62
$872,03
$1 029,79 		$1 023,26
$1 065,19
$1 109,60
$1 267,36 		$237,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$621,10
$704,96
$793,78
$1 109,30
$1 685,68 		$858,67
$942,53
$1 031,35
$1 346,87 		$1 096,24
$1 180,10
$1 268,92
$1 584,44 		$1 333,81
$1 417,67
$1 506,49
$1 822,01 		$237,57
Toc - Plan #53 Bright Health
Expanded Bronze

(EPO) Bronze 7000 HSA Direct

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 		$350,85
$398,21
$448,38
$626,61
$952,20 		$619,25
$666,61
$716,78
$895,01 		$887,65
$935,01
$985,18
$1 163,41 		$1 156,05
$1 203,41
$1 253,58
$1 431,81 		$268,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$701,70
$796,42
$896,76
$1 253,22
$1 904,40 		$970,10
$1 064,82
$1 165,16
$1 521,62 		$1 238,50
$1 333,22
$1 433,56
$1 790,02 		$1 506,90
$1 601,62
$1 701,96
$2 058,42 		$268,40
Toc - Plan #54 Bright Health
Catastrophic

(EPO) Catastrophic 3 $0 PCP Visits Direct

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 		$273,96
$310,95
$350,12
$489,30
$743,53 		$483,54
$520,53
$559,70
$698,88 		$693,12
$730,11
$769,28
$908,46 		$902,70
$939,69
$978,86
$1 118,04 		$209,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$547,92
$621,90
$700,24
$978,60
$1 487,06 		$757,50
$831,48
$909,82
$1 188,18 		$967,08
$1 041,06
$1 119,40
$1 397,76 		$1 176,66
$1 250,64
$1 328,98
$1 607,34 		$209,58
Toc - Plan #55 Bright Health
Silver

(EPO) Silver 5000 Direct

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 		$377,46
$428,42
$482,39
$674,14
$1 024,42 		$666,22
$717,18
$771,15
$962,90 		$954,98
$1 005,94
$1 059,91
$1 251,66 		$1 243,74
$1 294,70
$1 348,67
$1 540,42 		$288,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$754,92
$856,84
$964,78
$1 348,28
$2 048,84 		$1 043,68
$1 145,60
$1 253,54
$1 637,04 		$1 332,44
$1 434,36
$1 542,30
$1 925,80 		$1 621,20
$1 723,12
$1 831,06
$2 214,56 		$288,76
Toc - Plan #56 Bright Health
Silver

(EPO) Silver 3000 Direct

Annual Out of Pocket Expenses
Individual Family
$3,000 $6,000 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 		$380,21
$431,54
$485,91
$679,06
$1 031,89 		$671,07
$722,40
$776,77
$969,92 		$961,93
$1 013,26
$1 067,63
$1 260,78 		$1 252,79
$1 304,12
$1 358,49
$1 551,64 		$290,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$760,42
$863,08
$971,82
$1 358,12
$2 063,78 		$1 051,28
$1 153,94
$1 262,68
$1 648,98 		$1 342,14
$1 444,80
$1 553,54
$1 939,84 		$1 633,00
$1 735,66
$1 844,40
$2 230,70 		$290,86
Toc - Plan #57 Bright Health
Expanded Bronze

(EPO) Bronze $0 Medical Deductible Direct

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 		$346,63
$393,42
$442,99
$619,08
$940,75 		$611,80
$658,59
$708,16
$884,25 		$876,97
$923,76
$973,33
$1 149,42 		$1 142,14
$1 188,93
$1 238,50
$1 414,59 		$265,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$693,26
$786,84
$885,98
$1 238,16
$1 881,50 		$958,43
$1 052,01
$1 151,15
$1 503,33 		$1 223,60
$1 317,18
$1 416,32
$1 768,50 		$1 488,77
$1 582,35
$1 681,49
$2 033,67 		$265,17
Toc - Plan #58 Bright Health
Expanded Bronze

(EPO) Bronze $0 Primary Care Direct

Annual Out of Pocket Expenses
Individual Family
$7,200 $14,400 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 		$310,80
$352,76
$397,21
$555,09
$843,52 		$548,56
$590,52
$634,97
$792,85 		$786,32
$828,28
$872,73
$1 030,61 		$1 024,08
$1 066,04
$1 110,49
$1 268,37 		$237,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$621,60
$705,52
$794,42
$1 110,18
$1 687,04 		$859,36
$943,28
$1 032,18
$1 347,94 		$1 097,12
$1 181,04
$1 269,94
$1 585,70 		$1 334,88
$1 418,80
$1 507,70
$1 823,46 		$237,76

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Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777
Toc - Plan #59 Cigna Healthcare
Silver

(EPO) Cigna Connect 4750

Annual Out of Pocket Expenses
Individual Family
$4,750 $9,500 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 		$350,02
$397,27
$447,32
$625,13
$949,95 		$617,78
$665,03
$715,08
$892,89 		$885,54
$932,79
$982,84
$1 160,65 		$1 153,30
$1 200,55
$1 250,60
$1 428,41 		$267,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$700,04
$794,54
$894,64
$1 250,26
$1 899,90 		$967,80
$1 062,30
$1 162,40
$1 518,02 		$1 235,56
$1 330,06
$1 430,16
$1 785,78 		$1 503,32
$1 597,82
$1 697,92
$2 053,54 		$267,76
Toc - Plan #60 Cigna Healthcare
Gold

(EPO) Cigna Connect 1000

Annual Out of Pocket Expenses
Individual Family
$1,000 $2,000 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 		$523,37
$594,03
$668,87
$934,74
$1 420,43 		$923,75
$994,41
$1 069,25
$1 335,12 		$1 324,13
$1 394,79
$1 469,63
$1 735,50 		$1 724,51
$1 795,17
$1 870,01
$2 135,88 		$400,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 046,74
$1 188,06
$1 337,74
$1 869,48
$2 840,86 		$1 447,12
$1 588,44
$1 738,12
$2 269,86 		$1 847,50
$1 988,82
$2 138,50
$2 670,24 		$2 247,88
$2 389,20
$2 538,88
$3 070,62 		$400,38
Toc - Plan #61 Cigna Healthcare
Bronze

(EPO) Cigna Connect 6500

Annual Out of Pocket Expenses
Individual Family
$6,500 $13,000 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 		$293,50
$333,13
$375,10
$524,20
$796,57 		$518,03
$557,66
$599,63
$748,73 		$742,56
$782,19
$824,16
$973,26 		$967,09
$1 006,72
$1 048,69
$1 197,79 		$224,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587,00
$666,26
$750,20
$1 048,40
$1 593,14 		$811,53
$890,79
$974,73
$1 272,93 		$1 036,06
$1 115,32
$1 199,26
$1 497,46 		$1 260,59
$1 339,85
$1 423,79
$1 721,99 		$224,53
Toc - Plan #62 Cigna Healthcare
Expanded Bronze

(EPO) Cigna Connect 5900

Annual Out of Pocket Expenses
Individual Family
$5,900 $11,800 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 		$305,12
$346,31
$389,94
$544,94
$828,09 		$538,53
$579,72
$623,35
$778,35 		$771,94
$813,13
$856,76
$1 011,76 		$1 005,35
$1 046,54
$1 090,17
$1 245,17 		$233,41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$610,24
$692,62
$779,88
$1 089,88
$1 656,18 		$843,65
$926,03
$1 013,29
$1 323,29 		$1 077,06
$1 159,44
$1 246,70
$1 556,70 		$1 310,47
$1 392,85
$1 480,11
$1 790,11 		$233,41
Toc - Plan #63 Cigna Healthcare
Silver

(EPO) Cigna Connect 3200

Annual Out of Pocket Expenses
Individual Family
$3,200 $6,400 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 		$352,92
$400,57
$451,04
$630,32
$957,83 		$622,91
$670,56
$721,03
$900,31 		$892,90
$940,55
$991,02
$1 170,30 		$1 162,89
$1 210,54
$1 261,01
$1 440,29 		$269,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705,84
$801,14
$902,08
$1 260,64
$1 915,66 		$975,83
$1 071,13
$1 172,07
$1 530,63 		$1 245,82
$1 341,12
$1 442,06
$1 800,62 		$1 515,81
$1 611,11
$1 712,05
$2 070,61 		$269,99
Toc - Plan #64 Cigna Healthcare
Bronze

(EPO) Cigna Connect 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 		$292,48
$331,96
$373,79
$522,37
$793,79 		$516,23
$555,71
$597,54
$746,12 		$739,98
$779,46
$821,29
$969,87 		$963,73
$1 003,21
$1 045,04
$1 193,62 		$223,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$584,96
$663,92
$747,58
$1 044,74
$1 587,58 		$808,71
$887,67
$971,33
$1 268,49 		$1 032,46
$1 111,42
$1 195,08
$1 492,24 		$1 256,21
$1 335,17
$1 418,83
$1 715,99 		$223,75
Toc - Plan #65 Cigna Healthcare
Silver

(EPO) Cigna Connect 7300

Annual Out of Pocket Expenses
Individual Family
$7,300 $14,600 Annual Deductible
$7,300 $14,600 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 		$349,57
$396,76
$446,75
$624,33
$948,73 		$616,99
$664,18
$714,17
$891,75 		$884,41
$931,60
$981,59
$1 159,17 		$1 151,83
$1 199,02
$1 249,01
$1 426,59 		$267,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$699,14
$793,52
$893,50
$1 248,66
$1 897,46 		$966,56
$1 060,94
$1 160,92
$1 516,08 		$1 233,98
$1 328,36
$1 428,34
$1 783,50 		$1 501,40
$1 595,78
$1 695,76
$2 050,92 		$267,42
Toc - Plan #66 Cigna Healthcare
Silver

(EPO) Cigna Connect 3500 Diabetes Care

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 		$352,80
$400,43
$450,88
$630,10
$957,50 		$622,69
$670,32
$720,77
$899,99 		$892,58
$940,21
$990,66
$1 169,88 		$1 162,47
$1 210,10
$1 260,55
$1 439,77 		$269,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705,60
$800,86
$901,76
$1 260,20
$1 915,00 		$975,49
$1 070,75
$1 171,65
$1 530,09 		$1 245,38
$1 340,64
$1 441,54
$1 799,98 		$1 515,27
$1 610,53
$1 711,43
$2 069,87 		$269,89

‡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 Wilson County here.

Wilson County is in “Rating Area 4” of Tennessee.

Currently, there are 66 plans offered in Rating Area 4.

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2022 Obamacare Rates for Wilson County

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