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Obamacare 2021 Rates and Health Insurance Providers for Harris County , Texas


Obamacare > Rates > Texas > Harris 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 Harris County, Texas.

The health insurance rates listed below are for calendar year 2021.

Obamacare Providers, Plans and 2021 Rates for Harris County, Texas

Below, you’ll find a summary of the 87 plans for Harris County, Texas and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

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

  • Contact a licensed health insurance agent
  • Complete an application at
  • 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 Houston, TX area accept this insurance coverage as within the plan's network.

2021 Obamacare Rates, Providers, and Plans for Harris County

Obamacare Rates and Providers for Other Years

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ADVERTISEMENT

Oscar Insurance Company

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

 

Expanded Bronze

(EPO) Oscar Bronze Simple

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,300 $14,600
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$264,81
$300,55
$338,41
$472,93
$718,66
$529,62
$601,10
$676,82
$945,86
$1 437,32
$732,19
$803,67
$879,39
$1 148,43
$934,76
$1 006,24
$1 081,96
$1 351,00
$1 137,33
$1 208,81
$1 284,53
$1 553,57
$467,38
$503,12
$540,98
$675,50
$669,95
$705,69
$743,55
$878,07
$872,52
$908,26
$946,12
$1 080,64
$202,57
 

Expanded Bronze

(EPO) Oscar Bronze Classic PCP Copay

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$273,46
$310,37
$349,47
$488,39
$742,15
$546,92
$620,74
$698,94
$976,78
$1 484,30
$756,11
$829,93
$908,13
$1 185,97
$965,30
$1 039,12
$1 117,32
$1 395,16
$1 174,49
$1 248,31
$1 326,51
$1 604,35
$482,65
$519,56
$558,66
$697,58
$691,84
$728,75
$767,85
$906,77
$901,03
$937,94
$977,04
$1 115,96
$209,19
 

Expanded Bronze

(EPO) Oscar Bronze Classic

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$266,42
$302,38
$340,47
$475,81
$723,04
$532,84
$604,76
$680,94
$951,62
$1 446,08
$736,64
$808,56
$884,74
$1 155,42
$940,44
$1 012,36
$1 088,54
$1 359,22
$1 144,24
$1 216,16
$1 292,34
$1 563,02
$470,22
$506,18
$544,27
$679,61
$674,02
$709,98
$748,07
$883,41
$877,82
$913,78
$951,87
$1 087,21
$203,80
 

Expanded Bronze

(EPO) Oscar Bronze Classic Next

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$323,88
$367,59
$413,90
$578,42
$878,97
$647,76
$735,18
$827,80
$1 156,84
$1 757,94
$895,52
$982,94
$1 075,56
$1 404,60
$1 143,28
$1 230,70
$1 323,32
$1 652,36
$1 391,04
$1 478,46
$1 571,08
$1 900,12
$571,64
$615,35
$661,66
$826,18
$819,40
$863,11
$909,42
$1 073,94
$1 067,16
$1 110,87
$1 157,18
$1 321,70
$247,76
 

Silver

(EPO) Oscar Silver Classic

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$365,31
$414,61
$466,85
$652,42
$991,42
$730,62
$829,22
$933,70
$1 304,84
$1 982,84
$1 010,07
$1 108,67
$1 213,15
$1 584,29
$1 289,52
$1 388,12
$1 492,60
$1 863,74
$1 568,97
$1 667,57
$1 772,05
$2 143,19
$644,76
$694,06
$746,30
$931,87
$924,21
$973,51
$1 025,75
$1 211,32
$1 203,66
$1 252,96
$1 305,20
$1 490,77
$279,45
 

Silver

(EPO) Oscar Silver Saver 2

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,200 $12,400
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$358,62
$407,03
$458,31
$640,48
$973,28
$717,24
$814,06
$916,62
$1 280,96
$1 946,56
$991,58
$1 088,40
$1 190,96
$1 555,30
$1 265,92
$1 362,74
$1 465,30
$1 829,64
$1 540,26
$1 637,08
$1 739,64
$2 103,98
$632,96
$681,37
$732,65
$914,82
$907,30
$955,71
$1 006,99
$1 189,16
$1 181,64
$1 230,05
$1 281,33
$1 463,50
$274,34
 

Silver

(EPO) Oscar Silver Classic Next

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,000 $16,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$367,23
$416,79
$469,30
$655,85
$996,62
$734,46
$833,58
$938,60
$1 311,70
$1 993,24
$1 015,38
$1 114,50
$1 219,52
$1 592,62
$1 296,30
$1 395,42
$1 500,44
$1 873,54
$1 577,22
$1 676,34
$1 781,36
$2 154,46
$648,15
$697,71
$750,22
$936,77
$929,07
$978,63
$1 031,14
$1 217,69
$1 209,99
$1 259,55
$1 312,06
$1 498,61
$280,92
 

Catastrophic

(EPO) Oscar Secure

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$218,99
$248,54
$279,85
$391,10
$594,31
$437,98
$497,08
$559,70
$782,20
$1 188,62
$605,50
$664,60
$727,22
$949,72
$773,02
$832,12
$894,74
$1 117,24
$940,54
$999,64
$1 062,26
$1 284,76
$386,51
$416,06
$447,37
$558,62
$554,03
$583,58
$614,89
$726,14
$721,55
$751,10
$782,41
$893,66
$167,52
 

Expanded Bronze

(EPO) Oscar Bronze Classic Next 2

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$323,58
$367,25
$413,52
$577,89
$878,16
$647,16
$734,50
$827,04
$1 155,78
$1 756,32
$894,69
$982,03
$1 074,57
$1 403,31
$1 142,22
$1 229,56
$1 322,10
$1 650,84
$1 389,75
$1 477,09
$1 569,63
$1 898,37
$571,11
$614,78
$661,05
$825,42
$818,64
$862,31
$908,58
$1 072,95
$1 066,17
$1 109,84
$1 156,11
$1 320,48
$247,53
 

Gold

(EPO) Oscar Gold Classic

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,500 $5,000
Maximum Out of Pocket Per Year $6,000 $12,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387,87
$440,22
$495,69
$692,72
$1 052,65
$775,74
$880,44
$991,38
$1 385,44
$2 105,30
$1 072,45
$1 177,15
$1 288,09
$1 682,15
$1 369,16
$1 473,86
$1 584,80
$1 978,86
$1 665,87
$1 770,57
$1 881,51
$2 275,57
$684,58
$736,93
$792,40
$989,43
$981,29
$1 033,64
$1 089,11
$1 286,14
$1 278,00
$1 330,35
$1 385,82
$1 582,85
$296,71
 

Expanded Bronze

(EPO) Oscar Bronze HDHP

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,200 $10,400
Maximum Out of Pocket Per Year $7,000 $14,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$284,63
$323,04
$363,74
$508,33
$772,46
$569,26
$646,08
$727,48
$1 016,66
$1 544,92
$786,99
$863,81
$945,21
$1 234,39
$1 004,72
$1 081,54
$1 162,94
$1 452,12
$1 222,45
$1 299,27
$1 380,67
$1 669,85
$502,36
$540,77
$581,47
$726,06
$720,09
$758,50
$799,20
$943,79
$937,82
$976,23
$1 016,93
$1 161,52
$217,73
 

Silver

(EPO) Oscar Silver Classic Copay

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,000 $14,000
Maximum Out of Pocket Per Year $8,200 $16,400
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373,72
$424,17
$477,61
$667,45
$1 014,26
$747,44
$848,34
$955,22
$1 334,90
$2 028,52
$1 033,33
$1 134,23
$1 241,11
$1 620,79
$1 319,22
$1 420,12
$1 527,00
$1 906,68
$1 605,11
$1 706,01
$1 812,89
$2 192,57
$659,61
$710,06
$763,50
$953,34
$945,50
$995,95
$1 049,39
$1 239,23
$1 231,39
$1 281,84
$1 335,28
$1 525,12
$285,89
 

Silver

(EPO) Oscar Silver Classic $0 Ded

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387,01
$439,24
$494,58
$691,18
$1 050,31
$774,02
$878,48
$989,16
$1 382,36
$2 100,62
$1 070,07
$1 174,53
$1 285,21
$1 678,41
$1 366,12
$1 470,58
$1 581,26
$1 974,46
$1 662,17
$1 766,63
$1 877,31
$2 270,51
$683,06
$735,29
$790,63
$987,23
$979,11
$1 031,34
$1 086,68
$1 283,28
$1 275,16
$1 327,39
$1 382,73
$1 579,33
$296,05

ADVERTISEMENT

Community Health Choice

Local: 1-713-295-6704 | Toll Free: 1-855-315-5386 | TTY: 1-855-315-5386

 

Expanded Bronze

(HMO) Community Vital Bronze 003 (No Deductible for PCP, Free Preventive Care, 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,700 $15,400
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$301,94
$342,71
$385,88
$539,27
$819,48
$603,88
$685,42
$771,76
$1 078,54
$1 638,96
$834,87
$916,41
$1 002,75
$1 309,53
$1 065,86
$1 147,40
$1 233,74
$1 540,52
$1 296,85
$1 378,39
$1 464,73
$1 771,51
$532,93
$573,70
$616,87
$770,26
$763,92
$804,69
$847,86
$1 001,25
$994,91
$1 035,68
$1 078,85
$1 232,24
$230,99
 

Silver

(HMO) Community Advance Preferred Silver 004 (No deductible PCP, Specialists, Urgent Care and Generics, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,000 $6,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$401,98
$456,25
$513,73
$717,94
$1 090,97
$803,96
$912,50
$1 027,46
$1 435,88
$2 181,94
$1 111,47
$1 220,01
$1 334,97
$1 743,39
$1 418,98
$1 527,52
$1 642,48
$2 050,90
$1 726,49
$1 835,03
$1 949,99
$2 358,41
$709,49
$763,76
$821,24
$1 025,45
$1 017,00
$1 071,27
$1 128,75
$1 332,96
$1 324,51
$1 378,78
$1 436,26
$1 640,47
$307,51
 

Gold

(HMO) Community Enhanced Gold 005 (No Deductible PCP, Specialists & Generics, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383,95
$435,78
$490,68
$685,73
$1 042,03
$767,90
$871,56
$981,36
$1 371,46
$2 084,06
$1 061,62
$1 165,28
$1 275,08
$1 665,18
$1 355,34
$1 459,00
$1 568,80
$1 958,90
$1 649,06
$1 752,72
$1 862,52
$2 252,62
$677,67
$729,50
$784,40
$979,45
$971,39
$1 023,22
$1 078,12
$1 273,17
$1 265,11
$1 316,94
$1 371,84
$1 566,89
$293,72
 

Expanded Bronze

(HMO) Community Essential Bronze 008 HSA(No cost after deductible, No referrals for Specialists)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,000 $14,000
Maximum Out of Pocket Per Year $7,000 $14,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$310,05
$351,90
$396,24
$553,75
$841,47
$620,10
$703,80
$792,48
$1 107,50
$1 682,94
$857,29
$940,99
$1 029,67
$1 344,69
$1 094,48
$1 178,18
$1 266,86
$1 581,88
$1 331,67
$1 415,37
$1 504,05
$1 819,07
$547,24
$589,09
$633,43
$790,94
$784,43
$826,28
$870,62
$1 028,13
$1 021,62
$1 063,47
$1 107,81
$1 265,32
$237,19
 

Silver

(HMO) Community Standard Preferred Silver 009 (No deductible PCP, Urgent Care & Generics, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $7,000 $14,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393,56
$446,69
$502,97
$702,90
$1 068,13
$787,12
$893,38
$1 005,94
$1 405,80
$2 136,26
$1 088,20
$1 194,46
$1 307,02
$1 706,88
$1 389,28
$1 495,54
$1 608,10
$2 007,96
$1 690,36
$1 796,62
$1 909,18
$2 309,04
$694,64
$747,77
$804,05
$1 003,98
$995,72
$1 048,85
$1 105,13
$1 305,06
$1 296,80
$1 349,93
$1 406,21
$1 606,14
$301,08
 

Bronze

(HMO) Community Value Bronze 10 (Free Preventive Care, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$297,91
$338,13
$380,73
$532,07
$808,54
$595,82
$676,26
$761,46
$1 064,14
$1 617,08
$823,72
$904,16
$989,36
$1 292,04
$1 051,62
$1 132,06
$1 217,26
$1 519,94
$1 279,52
$1 359,96
$1 445,16
$1 747,84
$525,81
$566,03
$608,63
$759,97
$753,71
$793,93
$836,53
$987,87
$981,61
$1 021,83
$1 064,43
$1 215,77
$227,90
 

Expanded Bronze

(HMO) Community Virtual Now Bronze 11 (Unlimited Free 24/7 Virtual Visits)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$297,31
$337,45
$379,96
$530,99
$806,90
$594,62
$674,90
$759,92
$1 061,98
$1 613,80
$822,06
$902,34
$987,36
$1 289,42
$1 049,50
$1 129,78
$1 214,80
$1 516,86
$1 276,94
$1 357,22
$1 442,24
$1 744,30
$524,75
$564,89
$607,40
$758,43
$752,19
$792,33
$834,84
$985,87
$979,63
$1 019,77
$1 062,28
$1 213,31
$227,44
 

Silver

(HMO) Community Standard Silver 12 (No deductible PCP, Urgent Care & Generics, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$384,75
$436,70
$491,71
$687,17
$1 044,22
$769,50
$873,40
$983,42
$1 374,34
$2 088,44
$1 063,84
$1 167,74
$1 277,76
$1 668,68
$1 358,18
$1 462,08
$1 572,10
$1 963,02
$1 652,52
$1 756,42
$1 866,44
$2 257,36
$679,09
$731,04
$786,05
$981,51
$973,43
$1 025,38
$1 080,39
$1 275,85
$1 267,77
$1 319,72
$1 374,73
$1 570,19
$294,34
 

Silver

(HMO) Community Advance Silver 13 (No Deductible PCP, Specialists, Urgent Care & Generics, Free 24/7 Telehealth)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388,98
$441,49
$497,12
$694,72
$1 055,70
$777,96
$882,98
$994,24
$1 389,44
$2 111,40
$1 075,53
$1 180,55
$1 291,81
$1 687,01
$1 373,10
$1 478,12
$1 589,38
$1 984,58
$1 670,67
$1 775,69
$1 886,95
$2 282,15
$686,55
$739,06
$794,69
$992,29
$984,12
$1 036,63
$1 092,26
$1 289,86
$1 281,69
$1 334,20
$1 389,83
$1 587,43
$297,57

ADVERTISEMENT

Ambetter from Superior HealthPlan

Local: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989

 

Bronze

(EPO) Ambetter Essential Care 1 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,300 $16,600
Maximum Out of Pocket Per Year $8,300 $16,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$279,95
$317,73
$357,77
$499,98
$759,76
$559,90
$635,46
$715,54
$999,96
$1 519,52
$774,06
$849,62
$929,70
$1 214,12
$988,22
$1 063,78
$1 143,86
$1 428,28
$1 202,38
$1 277,94
$1 358,02
$1 642,44
$494,11
$531,89
$571,93
$714,14
$708,27
$746,05
$786,09
$928,30
$922,43
$960,21
$1 000,25
$1 142,46
$214,16
 

Silver

(EPO) Ambetter Balanced Care 11 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,500 $17,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$332,52
$377,40
$424,95
$593,87
$902,44
$665,04
$754,80
$849,90
$1 187,74
$1 804,88
$919,41
$1 009,17
$1 104,27
$1 442,11
$1 173,78
$1 263,54
$1 358,64
$1 696,48
$1 428,15
$1 517,91
$1 613,01
$1 950,85
$586,89
$631,77
$679,32
$848,24
$841,26
$886,14
$933,69
$1 102,61
$1 095,63
$1 140,51
$1 188,06
$1 356,98
$254,37
 

Silver

(EPO) Ambetter Balanced Care 5 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,350 $14,700
Maximum Out of Pocket Per Year $7,350 $14,700
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$331,62
$376,38
$423,80
$592,26
$900,00
$663,24
$752,76
$847,60
$1 184,52
$1 800,00
$916,92
$1 006,44
$1 101,28
$1 438,20
$1 170,60
$1 260,12
$1 354,96
$1 691,88
$1 424,28
$1 513,80
$1 608,64
$1 945,56
$585,30
$630,06
$677,48
$845,94
$838,98
$883,74
$931,16
$1 099,62
$1 092,66
$1 137,42
$1 184,84
$1 353,30
$253,68
 

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$290,16
$329,32
$370,81
$518,21
$787,47
$580,32
$658,64
$741,62
$1 036,42
$1 574,94
$802,28
$880,60
$963,58
$1 258,38
$1 024,24
$1 102,56
$1 185,54
$1 480,34
$1 246,20
$1 324,52
$1 407,50
$1 702,30
$512,12
$551,28
$592,77
$740,17
$734,08
$773,24
$814,73
$962,13
$956,04
$995,20
$1 036,69
$1 184,09
$221,96
 

Gold

(EPO) Ambetter Secure Care 5 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,450 $2,900
Maximum Out of Pocket Per Year $6,300 $12,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$442,75
$502,51
$565,82
$790,73
$1 201,59
$885,50
$1 005,02
$1 131,64
$1 581,46
$2 403,18
$1 224,20
$1 343,72
$1 470,34
$1 920,16
$1 562,90
$1 682,42
$1 809,04
$2 258,86
$1 901,60
$2 021,12
$2 147,74
$2 597,56
$781,45
$841,21
$904,52
$1 129,43
$1 120,15
$1 179,91
$1 243,22
$1 468,13
$1 458,85
$1 518,61
$1 581,92
$1 806,83
$338,70
 

Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$302,60
$343,43
$386,70
$540,42
$821,22
$605,20
$686,86
$773,40
$1 080,84
$1 642,44
$836,68
$918,34
$1 004,88
$1 312,32
$1 068,16
$1 149,82
$1 236,36
$1 543,80
$1 299,64
$1 381,30
$1 467,84
$1 775,28
$534,08
$574,91
$618,18
$771,90
$765,56
$806,39
$849,66
$1 003,38
$997,04
$1 037,87
$1 081,14
$1 234,86
$231,48
 

Silver

(EPO) Ambetter Balanced Care 12 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$325,67
$369,63
$416,20
$581,63
$883,85
$651,34
$739,26
$832,40
$1 163,26
$1 767,70
$900,47
$988,39
$1 081,53
$1 412,39
$1 149,60
$1 237,52
$1 330,66
$1 661,52
$1 398,73
$1 486,65
$1 579,79
$1 910,65
$574,80
$618,76
$665,33
$830,76
$823,93
$867,89
$914,46
$1 079,89
$1 073,06
$1 117,02
$1 163,59
$1 329,02
$249,13
 

Silver

(EPO) Ambetter Balanced Care 29 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,450 $10,900
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$322,81
$366,38
$412,54
$576,52
$876,09
$645,62
$732,76
$825,08
$1 153,04
$1 752,18
$892,56
$979,70
$1 072,02
$1 399,98
$1 139,50
$1 226,64
$1 318,96
$1 646,92
$1 386,44
$1 473,58
$1 565,90
$1 893,86
$569,75
$613,32
$659,48
$823,46
$816,69
$860,26
$906,42
$1 070,40
$1 063,63
$1 107,20
$1 153,36
$1 317,34
$246,94
 

Silver

(EPO) Ambetter Balanced Care 25 HSA (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,800 $9,600
Maximum Out of Pocket Per Year $4,800 $9,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$336,28
$381,67
$429,75
$600,58
$912,63
$672,56
$763,34
$859,50
$1 201,16
$1 825,26
$929,81
$1 020,59
$1 116,75
$1 458,41
$1 187,06
$1 277,84
$1 374,00
$1 715,66
$1 444,31
$1 535,09
$1 631,25
$1 972,91
$593,53
$638,92
$687,00
$857,83
$850,78
$896,17
$944,25
$1 115,08
$1 108,03
$1 153,42
$1 201,50
$1 372,33
$257,25
 

Silver

(EPO) Ambetter Balanced Care 27 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,750 $5,500
Maximum Out of Pocket Per Year $6,500 $13,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$355,43
$403,40
$454,23
$634,78
$964,61
$710,86
$806,80
$908,46
$1 269,56
$1 929,22
$982,76
$1 078,70
$1 180,36
$1 541,46
$1 254,66
$1 350,60
$1 452,26
$1 813,36
$1 526,56
$1 622,50
$1 724,16
$2 085,26
$627,33
$675,30
$726,13
$906,68
$899,23
$947,20
$998,03
$1 178,58
$1 171,13
$1 219,10
$1 269,93
$1 450,48
$271,90
 

Silver

(EPO) Ambetter Balanced Care 28 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,200 $16,400
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$358,32
$406,69
$457,93
$639,95
$972,47
$716,64
$813,38
$915,86
$1 279,90
$1 944,94
$990,75
$1 087,49
$1 189,97
$1 554,01
$1 264,86
$1 361,60
$1 464,08
$1 828,12
$1 538,97
$1 635,71
$1 738,19
$2 102,23
$632,43
$680,80
$732,04
$914,06
$906,54
$954,91
$1 006,15
$1 188,17
$1 180,65
$1 229,02
$1 280,26
$1 462,28
$274,11
 

Gold

(EPO) Ambetter Secure Care 15 (2021)

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,150 $2,300
Maximum Out of Pocket Per Year $4,450 $8,900
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$452,23
$513,26
$577,93
$807,66
$1 227,31
$904,46
$1 026,52
$1 155,86
$1 615,32
$2 454,62
$1 250,41
$1 372,47
$1 501,81
$1 961,27
$1 596,36
$1 718,42
$1 847,76
$2 307,22
$1 942,31
$2 064,37
$2 193,71
$2 653,17
$798,18
$859,21
$923,88
$1 153,61
$1 144,13
$1 205,16
$1 269,83
$1 499,56
$1 490,08
$1 551,11
$1 615,78
$1 845,51
$345,95
 

Gold

(EPO) Ambetter Secure Care 5 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,450 $2,900
Maximum Out of Pocket Per Year $6,300 $12,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$447,83
$508,28
$572,32
$799,81
$1 215,39
$895,66
$1 016,56
$1 144,64
$1 599,62
$2 430,78
$1 238,24
$1 359,14
$1 487,22
$1 942,20
$1 580,82
$1 701,72
$1 829,80
$2 284,78
$1 923,40
$2 044,30
$2 172,38
$2 627,36
$790,41
$850,86
$914,90
$1 142,39
$1 132,99
$1 193,44
$1 257,48
$1 484,97
$1 475,57
$1 536,02
$1 600,06
$1 827,55
$342,58
 

Bronze

(EPO) Ambetter Essential Care 1 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,300 $16,600
Maximum Out of Pocket Per Year $8,300 $16,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$283,17
$321,38
$361,87
$505,72
$768,48
$566,34
$642,76
$723,74
$1 011,44
$1 536,96
$782,95
$859,37
$940,35
$1 228,05
$999,56
$1 075,98
$1 156,96
$1 444,66
$1 216,17
$1 292,59
$1 373,57
$1 661,27
$499,78
$537,99
$578,48
$722,33
$716,39
$754,60
$795,09
$938,94
$933,00
$971,21
$1 011,70
$1 155,55
$216,61
 

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$293,49
$333,10
$375,07
$524,16
$796,51
$586,98
$666,20
$750,14
$1 048,32
$1 593,02
$811,49
$890,71
$974,65
$1 272,83
$1 036,00
$1 115,22
$1 199,16
$1 497,34
$1 260,51
$1 339,73
$1 423,67
$1 721,85
$518,00
$557,61
$599,58
$748,67
$742,51
$782,12
$824,09
$973,18
$967,02
$1 006,63
$1 048,60
$1 197,69
$224,51
 

Silver

(EPO) Ambetter Balanced Care 11 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,500 $17,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$336,34
$381,73
$429,83
$600,68
$912,80
$672,68
$763,46
$859,66
$1 201,36
$1 825,60
$929,97
$1 020,75
$1 116,95
$1 458,65
$1 187,26
$1 278,04
$1 374,24
$1 715,94
$1 444,55
$1 535,33
$1 631,53
$1 973,23
$593,63
$639,02
$687,12
$857,97
$850,92
$896,31
$944,41
$1 115,26
$1 108,21
$1 153,60
$1 201,70
$1 372,55
$257,29
 

Silver

(EPO) Ambetter Balanced Care 5 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,350 $14,700
Maximum Out of Pocket Per Year $7,350 $14,700
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$335,43
$380,70
$428,67
$599,06
$910,33
$670,86
$761,40
$857,34
$1 198,12
$1 820,66
$927,46
$1 018,00
$1 113,94
$1 454,72
$1 184,06
$1 274,60
$1 370,54
$1 711,32
$1 440,66
$1 531,20
$1 627,14
$1 967,92
$592,03
$637,30
$685,27
$855,66
$848,63
$893,90
$941,87
$1 112,26
$1 105,23
$1 150,50
$1 198,47
$1 368,86
$256,60
 

Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$306,07
$347,38
$391,14
$546,62
$830,65
$612,14
$694,76
$782,28
$1 093,24
$1 661,30
$846,28
$928,90
$1 016,42
$1 327,38
$1 080,42
$1 163,04
$1 250,56
$1 561,52
$1 314,56
$1 397,18
$1 484,70
$1 795,66
$540,21
$581,52
$625,28
$780,76
$774,35
$815,66
$859,42
$1 014,90
$1 008,49
$1 049,80
$1 093,56
$1 249,04
$234,14
 

Silver

(EPO) Ambetter Balanced Care 12 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$329,41
$373,87
$420,97
$588,31
$893,99
$658,82
$747,74
$841,94
$1 176,62
$1 787,98
$910,81
$999,73
$1 093,93
$1 428,61
$1 162,80
$1 251,72
$1 345,92
$1 680,60
$1 414,79
$1 503,71
$1 597,91
$1 932,59
$581,40
$625,86
$672,96
$840,30
$833,39
$877,85
$924,95
$1 092,29
$1 085,38
$1 129,84
$1 176,94
$1 344,28
$251,99
 

Silver

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

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,800 $9,600
Maximum Out of Pocket Per Year $4,800 $9,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340,14
$386,05
$434,69
$607,47
$923,11
$680,28
$772,10
$869,38
$1 214,94
$1 846,22
$940,48
$1 032,30
$1 129,58
$1 475,14
$1 200,68
$1 292,50
$1 389,78
$1 735,34
$1 460,88
$1 552,70
$1 649,98
$1 995,54
$600,34
$646,25
$694,89
$867,67
$860,54
$906,45
$955,09
$1 127,87
$1 120,74
$1 166,65
$1 215,29
$1 388,07
$260,20
 

Silver

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

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,750 $5,500
Maximum Out of Pocket Per Year $6,500 $13,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$359,51
$408,03
$459,44
$642,07
$975,69
$719,02
$816,06
$918,88
$1 284,14
$1 951,38
$994,04
$1 091,08
$1 193,90
$1 559,16
$1 269,06
$1 366,10
$1 468,92
$1 834,18
$1 544,08
$1 641,12
$1 743,94
$2 109,20
$634,53
$683,05
$734,46
$917,09
$909,55
$958,07
$1 009,48
$1 192,11
$1 184,57
$1 233,09
$1 284,50
$1 467,13
$275,02
 

Silver

(EPO) Ambetter Balanced Care 28 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,200 $16,400
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362,44
$411,36
$463,18
$647,30
$983,63
$724,88
$822,72
$926,36
$1 294,60
$1 967,26
$1 002,14
$1 099,98
$1 203,62
$1 571,86
$1 279,40
$1 377,24
$1 480,88
$1 849,12
$1 556,66
$1 654,50
$1 758,14
$2 126,38
$639,70
$688,62
$740,44
$924,56
$916,96
$965,88
$1 017,70
$1 201,82
$1 194,22
$1 243,14
$1 294,96
$1 479,08
$277,26
 

Gold

(EPO) Ambetter Secure Care 15 (2021) + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,150 $2,300
Maximum Out of Pocket Per Year $4,450 $8,900
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$457,42
$519,16
$584,57
$816,93
$1 241,40
$914,84
$1 038,32
$1 169,14
$1 633,86
$2 482,80
$1 264,76
$1 388,24
$1 519,06
$1 983,78
$1 614,68
$1 738,16
$1 868,98
$2 333,70
$1 964,60
$2 088,08
$2 218,90
$2 683,62
$807,34
$869,08
$934,49
$1 166,85
$1 157,26
$1 219,00
$1 284,41
$1 516,77
$1 507,18
$1 568,92
$1 634,33
$1 866,69
$349,92
 

Gold

(EPO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,450 $2,900
Maximum Out of Pocket Per Year $6,300 $12,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$463,88
$526,50
$592,83
$828,48
$1 258,96
$927,76
$1 053,00
$1 185,66
$1 656,96
$2 517,92
$1 282,62
$1 407,86
$1 540,52
$2 011,82
$1 637,48
$1 762,72
$1 895,38
$2 366,68
$1 992,34
$2 117,58
$2 250,24
$2 721,54
$818,74
$881,36
$947,69
$1 183,34
$1 173,60
$1 236,22
$1 302,55
$1 538,20
$1 528,46
$1 591,08
$1 657,41
$1 893,06
$354,86
 

Bronze

(EPO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,300 $16,600
Maximum Out of Pocket Per Year $8,300 $16,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$293,32
$332,90
$374,84
$523,84
$796,03
$586,64
$665,80
$749,68
$1 047,68
$1 592,06
$811,02
$890,18
$974,06
$1 272,06
$1 035,40
$1 114,56
$1 198,44
$1 496,44
$1 259,78
$1 338,94
$1 422,82
$1 720,82
$517,70
$557,28
$599,22
$748,22
$742,08
$781,66
$823,60
$972,60
$966,46
$1 006,04
$1 047,98
$1 196,98
$224,38
 

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$304,01
$345,04
$388,51
$542,95
$825,06
$608,02
$690,08
$777,02
$1 085,90
$1 650,12
$840,58
$922,64
$1 009,58
$1 318,46
$1 073,14
$1 155,20
$1 242,14
$1 551,02
$1 305,70
$1 387,76
$1 474,70
$1 783,58
$536,57
$577,60
$621,07
$775,51
$769,13
$810,16
$853,63
$1 008,07
$1 001,69
$1 042,72
$1 086,19
$1 240,63
$232,56
 

Silver

(EPO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
Maximum Out of Pocket Per Year $8,500 $17,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$348,39
$395,42
$445,24
$622,22
$945,52
$696,78
$790,84
$890,48
$1 244,44
$1 891,04
$963,29
$1 057,35
$1 156,99
$1 510,95
$1 229,80
$1 323,86
$1 423,50
$1 777,46
$1 496,31
$1 590,37
$1 690,01
$2 043,97
$614,90
$661,93
$711,75
$888,73
$881,41
$928,44
$978,26
$1 155,24
$1 147,92
$1 194,95
$1 244,77
$1 421,75
$266,51
 

Silver

(EPO) Ambetter Balanced Care 5 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,350 $14,700
Maximum Out of Pocket Per Year $7,350 $14,700
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347,45
$394,35
$444,03
$620,54
$942,96
$694,90
$788,70
$888,06
$1 241,08
$1 885,92
$960,69
$1 054,49
$1 153,85
$1 506,87
$1 226,48
$1 320,28
$1 419,64
$1 772,66
$1 492,27
$1 586,07
$1 685,43
$2 038,45
$613,24
$660,14
$709,82
$886,33
$879,03
$925,93
$975,61
$1 152,12
$1 144,82
$1 191,72
$1 241,40
$1 417,91
$265,79
 

Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$317,04
$359,83
$405,16
$566,22
$860,42
$634,08
$719,66
$810,32
$1 132,44
$1 720,84
$876,61
$962,19
$1 052,85
$1 374,97
$1 119,14
$1 204,72
$1 295,38
$1 617,50
$1 361,67
$1 447,25
$1 537,91
$1 860,03
$559,57
$602,36
$647,69
$808,75
$802,10
$844,89
$890,22
$1 051,28
$1 044,63
$1 087,42
$1 132,75
$1 293,81
$242,53
 

Silver

(EPO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
Maximum Out of Pocket Per Year $8,400 $16,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$341,22
$387,27
$436,06
$609,40
$926,04
$682,44
$774,54
$872,12
$1 218,80
$1 852,08
$943,46
$1 035,56
$1 133,14
$1 479,82
$1 204,48
$1 296,58
$1 394,16
$1 740,84
$1 465,50
$1 557,60
$1 655,18
$2 001,86
$602,24
$648,29
$697,08
$870,42
$863,26
$909,31
$958,10
$1 131,44
$1 124,28
$1 170,33
$1 219,12
$1 392,46
$261,02
 

Silver

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

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,800 $9,600
Maximum Out of Pocket Per Year $4,800 $9,600
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352,33
$399,89
$450,27
$629,25
$956,20
$704,66
$799,78
$900,54
$1 258,50
$1 912,40
$974,19
$1 069,31
$1 170,07
$1 528,03
$1 243,72
$1 338,84
$1 439,60
$1 797,56
$1 513,25
$1 608,37
$1 709,13
$2 067,09
$621,86
$669,42
$719,80
$898,78
$891,39
$938,95
$989,33
$1 168,31
$1 160,92
$1 208,48
$1 258,86
$1 437,84
$269,53
 

Silver

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

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,750 $5,500
Maximum Out of Pocket Per Year $6,500 $13,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$372,40
$422,66
$475,91
$665,09
$1 010,66
$744,80
$845,32
$951,82
$1 330,18
$2 021,32
$1 029,68
$1 130,20
$1 236,70
$1 615,06
$1 314,56
$1 415,08
$1 521,58
$1 899,94
$1 599,44
$1 699,96
$1 806,46
$2 184,82
$657,28
$707,54
$760,79
$949,97
$942,16
$992,42
$1 045,67
$1 234,85
$1 227,04
$1 277,30
$1 330,55
$1 519,73
$284,88
 

Silver

(EPO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,200 $16,400
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$375,43
$426,10
$479,79
$670,50
$1 018,89
$750,86
$852,20
$959,58
$1 341,00
$2 037,78
$1 038,06
$1 139,40
$1 246,78
$1 628,20
$1 325,26
$1 426,60
$1 533,98
$1 915,40
$1 612,46
$1 713,80
$1 821,18
$2 202,60
$662,63
$713,30
$766,99
$957,70
$949,83
$1 000,50
$1 054,19
$1 244,90
$1 237,03
$1 287,70
$1 341,39
$1 532,10
$287,20
 

Gold

(EPO) Ambetter Secure Care 15 (2021) + Vision + Adult Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,150 $2,300
Maximum Out of Pocket Per Year $4,450 $8,900
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$473,81
$537,77
$605,52
$846,21
$1 285,90
$947,62
$1 075,54
$1 211,04
$1 692,42
$2 571,80
$1 310,08
$1 438,00
$1 573,50
$2 054,88
$1 672,54
$1 800,46
$1 935,96
$2 417,34
$2 035,00
$2 162,92
$2 298,42
$2 779,80
$836,27
$900,23
$967,98
$1 208,67
$1 198,73
$1 262,69
$1 330,44
$1 571,13
$1 561,19
$1 625,15
$1 692,90
$1 933,59
$362,46

ADVERTISEMENT

Blue Cross and Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683 | TTY: 1-800-735-2989

 

Gold

(HMO) Blue Advantage Gold HMO_ 206

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $750 $2,250
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387,37
$439,67
$495,06
$691,85
$1 051,33
$774,74
$879,34
$990,12
$1 383,70
$2 102,66
$1 071,08
$1 175,68
$1 286,46
$1 680,04
$1 367,42
$1 472,02
$1 582,80
$1 976,38
$1 663,76
$1 768,36
$1 879,14
$2 272,72
$683,71
$736,01
$791,40
$988,19
$980,05
$1 032,35
$1 087,74
$1 284,53
$1 276,39
$1 328,69
$1 384,08
$1 580,87
$296,34
 

Catastrophic

(HMO) Blue Advantage Security HMO_ 200

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$264,18
$299,84
$337,62
$471,83
$716,99
$528,36
$599,68
$675,24
$943,66
$1 433,98
$730,46
$801,78
$877,34
$1 145,76
$932,56
$1 003,88
$1 079,44
$1 347,86
$1 134,66
$1 205,98
$1 281,54
$1 549,96
$466,28
$501,94
$539,72
$673,93
$668,38
$704,04
$741,82
$876,03
$870,48
$906,14
$943,92
$1 078,13
$202,10
 

Silver

(HMO) Blue Advantage Silver HMO_ 205

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,900 $5,700
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386,49
$438,67
$493,94
$690,28
$1 048,94
$772,98
$877,34
$987,88
$1 380,56
$2 097,88
$1 068,65
$1 173,01
$1 283,55
$1 676,23
$1 364,32
$1 468,68
$1 579,22
$1 971,90
$1 659,99
$1 764,35
$1 874,89
$2 267,57
$682,16
$734,34
$789,61
$985,95
$977,83
$1 030,01
$1 085,28
$1 281,62
$1 273,50
$1 325,68
$1 380,95
$1 577,29
$295,67
 

Expanded Bronze

(HMO) Blue Advantage Bronze HMO_ 204

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$290,70
$329,95
$371,52
$519,19
$788,96
$581,40
$659,90
$743,04
$1 038,38
$1 577,92
$803,79
$882,29
$965,43
$1 260,77
$1 026,18
$1 104,68
$1 187,82
$1 483,16
$1 248,57
$1 327,07
$1 410,21
$1 705,55
$513,09
$552,34
$593,91
$741,58
$735,48
$774,73
$816,30
$963,97
$957,87
$997,12
$1 038,69
$1 186,36
$222,39
 

Bronze

(HMO) Blue Advantage Bronze HMO_ 301

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$288,28
$327,20
$368,43
$514,87
$782,40
$576,56
$654,40
$736,86
$1 029,74
$1 564,80
$797,10
$874,94
$957,40
$1 250,28
$1 017,64
$1 095,48
$1 177,94
$1 470,82
$1 238,18
$1 316,02
$1 398,48
$1 691,36
$508,82
$547,74
$588,97
$735,41
$729,36
$768,28
$809,51
$955,95
$949,90
$988,82
$1 030,05
$1 176,49
$220,54
 

Gold

(HMO) Blue Advantage Plus Gold_ 203

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $750 $2,250
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$457,69
$519,48
$584,93
$817,43
$1 242,17
$915,38
$1 038,96
$1 169,86
$1 634,86
$2 484,34
$1 265,51
$1 389,09
$1 519,99
$1 984,99
$1 615,64
$1 739,22
$1 870,12
$2 335,12
$1 965,77
$2 089,35
$2 220,25
$2 685,25
$807,82
$869,61
$935,06
$1 167,56
$1 157,95
$1 219,74
$1 285,19
$1 517,69
$1 508,08
$1 569,87
$1 635,32
$1 867,82
$350,13
 

Silver

(HMO) Blue Advantage Plus Silver_ 202

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,250 $3,750
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$454,07
$515,37
$580,30
$810,96
$1 232,34
$908,14
$1 030,74
$1 160,60
$1 621,92
$2 464,68
$1 255,50
$1 378,10
$1 507,96
$1 969,28
$1 602,86
$1 725,46
$1 855,32
$2 316,64
$1 950,22
$2 072,82
$2 202,68
$2 664,00
$801,43
$862,73
$927,66
$1 158,32
$1 148,79
$1 210,09
$1 275,02
$1 505,68
$1 496,15
$1 557,45
$1 622,38
$1 853,04
$347,36
 

Expanded Bronze

(HMO) Blue Advantage Plus Bronze_ 303

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,900 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343,77
$390,18
$439,34
$613,98
$933,00
$687,54
$780,36
$878,68
$1 227,96
$1 866,00
$950,53
$1 043,35
$1 141,67
$1 490,95
$1 213,52
$1 306,34
$1 404,66
$1 753,94
$1 476,51
$1 569,33
$1 667,65
$2 016,93
$606,76
$653,17
$702,33
$876,97
$869,75
$916,16
$965,32
$1 139,96
$1 132,74
$1 179,15
$1 228,31
$1 402,95
$262,99
 

Bronze

(HMO) Blue Advantage Plus Bronze_ 305

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $15,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$320,94
$364,27
$410,16
$573,20
$871,03
$641,88
$728,54
$820,32
$1 146,40
$1 742,06
$887,40
$974,06
$1 065,84
$1 391,92
$1 132,92
$1 219,58
$1 311,36
$1 637,44
$1 378,44
$1 465,10
$1 556,88
$1 882,96
$566,46
$609,79
$655,68
$818,72
$811,98
$855,31
$901,20
$1 064,24
$1 057,50
$1 100,83
$1 146,72
$1 309,76
$245,52
 

Expanded Bronze

(HMO) MyBlue Health Bronze_ 402

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,400 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$226,56
$257,14
$289,54
$404,63
$614,88
$453,12
$514,28
$579,08
$809,26
$1 229,76
$626,44
$687,60
$752,40
$982,58
$799,76
$860,92
$925,72
$1 155,90
$973,08
$1 034,24
$1 099,04
$1 329,22
$399,88
$430,46
$462,86
$577,95
$573,20
$603,78
$636,18
$751,27
$746,52
$777,10
$809,50
$924,59
$173,32
 

Gold

(HMO) MyBlue Health Gold_ 403

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,100 $3,300
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$301,75
$342,48
$385,63
$538,92
$818,94
$603,50
$684,96
$771,26
$1 077,84
$1 637,88
$834,34
$915,80
$1 002,10
$1 308,68
$1 065,18
$1 146,64
$1 232,94
$1 539,52
$1 296,02
$1 377,48
$1 463,78
$1 770,36
$532,59
$573,32
$616,47
$769,76
$763,43
$804,16
$847,31
$1 000,60
$994,27
$1 035,00
$1 078,15
$1 231,44
$230,84
 

Silver

(HMO) MyBlue Health Silver_ 405

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,300 $9,900
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$298,02
$338,25
$380,87
$532,26
$808,83
$596,04
$676,50
$761,74
$1 064,52
$1 617,66
$824,03
$904,49
$989,73
$1 292,51
$1 052,02
$1 132,48
$1 217,72
$1 520,50
$1 280,01
$1 360,47
$1 445,71
$1 748,49
$526,01
$566,24
$608,86
$760,25
$754,00
$794,23
$836,85
$988,24
$981,99
$1 022,22
$1 064,84
$1 216,23
$227,99

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Molina Healthcare

Local: 1-888-560-2025 | Toll Free: 1-888-560-2025

 

Gold

(HMO) Molina Gold 3

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343,64
$390,03
$439,17
$613,73
$932,63
$687,28
$780,06
$878,34
$1 227,46
$1 865,26
$950,16
$1 042,94
$1 141,22
$1 490,34
$1 213,04
$1 305,82
$1 404,10
$1 753,22
$1 475,92
$1 568,70
$1 666,98
$2 016,10
$606,52
$652,91
$702,05
$876,61
$869,40
$915,79
$964,93
$1 139,49
$1 132,28
$1 178,67
$1 227,81
$1 402,37
$262,88
 

Silver

(HMO) Molina Silver 3 250

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$323,30
$366,95
$413,18
$577,42
$877,45
$646,60
$733,90
$826,36
$1 154,84
$1 754,90
$893,93
$981,23
$1 073,69
$1 402,17
$1 141,26
$1 228,56
$1 321,02
$1 649,50
$1 388,59
$1 475,89
$1 568,35
$1 896,83
$570,63
$614,28
$660,51
$824,75
$817,96
$861,61
$907,84
$1 072,08
$1 065,29
$1 108,94
$1 155,17
$1 319,41
$247,33
 

Gold

(HMO) Confident Care Gold 1

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,925 $5,850
Maximum Out of Pocket Per Year $6,500 $13,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$345,88
$392,57
$442,03
$617,74
$938,71
$691,76
$785,14
$884,06
$1 235,48
$1 877,42
$956,36
$1 049,74
$1 148,66
$1 500,08
$1 220,96
$1 314,34
$1 413,26
$1 764,68
$1 485,56
$1 578,94
$1 677,86
$2 029,28
$610,48
$657,17
$706,63
$882,34
$875,08
$921,77
$971,23
$1 146,94
$1 139,68
$1 186,37
$1 235,83
$1 411,54
$264,60
 

Silver

(HMO) Constant Care Silver 1 250

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,500 $17,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$322,46
$365,99
$412,10
$575,91
$875,15
$644,92
$731,98
$824,20
$1 151,82
$1 750,30
$891,60
$978,66
$1 070,88
$1 398,50
$1 138,28
$1 225,34
$1 317,56
$1 645,18
$1 384,96
$1 472,02
$1 564,24
$1 891,86
$569,14
$612,67
$658,78
$822,59
$815,82
$859,35
$905,46
$1 069,27
$1 062,50
$1 106,03
$1 152,14
$1 315,95
$246,68
 

Bronze

(HMO) Core Care Bronze 1

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,100 $12,200
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$228,27
$259,09
$291,73
$407,69
$619,52
$456,54
$518,18
$583,46
$815,38
$1 239,04
$631,17
$692,81
$758,09
$990,01
$805,80
$867,44
$932,72
$1 164,64
$980,43
$1 042,07
$1 107,35
$1 339,27
$402,90
$433,72
$466,36
$582,32
$577,53
$608,35
$640,99
$756,95
$752,16
$782,98
$815,62
$931,58
$174,63
 

Silver

(HMO) Constant Care Silver 2 250

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,200 $10,400
Maximum Out of Pocket Per Year $8,150 $16,300
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$322,16
$365,65
$411,72
$575,38
$874,35
$644,32
$731,30
$823,44
$1 150,76
$1 748,70
$890,77
$977,75
$1 069,89
$1 397,21
$1 137,22
$1 224,20
$1 316,34
$1 643,66
$1 383,67
$1 470,65
$1 562,79
$1 890,11
$568,61
$612,10
$658,17
$821,83
$815,06
$858,55
$904,62
$1 068,28
$1 061,51
$1 105,00
$1 151,07
$1 314,73
$246,45
 

Bronze

(HMO) Core Care Bronze 2

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,000 $16,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$226,30
$256,85
$289,21
$404,17
$614,17
$452,60
$513,70
$578,42
$808,34
$1 228,34
$625,72
$686,82
$751,54
$981,46
$798,84
$859,94
$924,66
$1 154,58
$971,96
$1 033,06
$1 097,78
$1 327,70
$399,42
$429,97
$462,33
$577,29
$572,54
$603,09
$635,45
$750,41
$745,66
$776,21
$808,57
$923,53
$173,12
 

Silver

(HMO) Constant Care Silver 4 250

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,450 $14,900
Maximum Out of Pocket Per Year $7,450 $14,900
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$318,83
$361,88
$407,47
$569,44
$865,32
$637,66
$723,76
$814,94
$1 138,88
$1 730,64
$881,57
$967,67
$1 058,85
$1 382,79
$1 125,48
$1 211,58
$1 302,76
$1 626,70
$1 369,39
$1 455,49
$1 546,67
$1 870,61
$562,74
$605,79
$651,38
$813,35
$806,65
$849,70
$895,29
$1 057,26
$1 050,56
$1 093,61
$1 139,20
$1 301,17
$243,91
 

Expanded Bronze

(HMO) Core Care Bronze 4

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$238,86
$271,11
$305,26
$426,61
$648,27
$477,72
$542,22
$610,52
$853,22
$1 296,54
$660,45
$724,95
$793,25
$1 035,95
$843,18
$907,68
$975,98
$1 218,68
$1 025,91
$1 090,41
$1 158,71
$1 401,41
$421,59
$453,84
$487,99
$609,34
$604,32
$636,57
$670,72
$792,07
$787,05
$819,30
$853,45
$974,80
$182,73
 

Expanded Bronze

(HMO) Core Care Bronze 5

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$232,39
$263,76
$296,99
$415,04
$630,70
$464,78
$527,52
$593,98
$830,08
$1 261,40
$642,56
$705,30
$771,76
$1 007,86
$820,34
$883,08
$949,54
$1 185,64
$998,12
$1 060,86
$1 127,32
$1 363,42
$410,17
$441,54
$474,77
$592,82
$587,95
$619,32
$652,55
$770,60
$765,73
$797,10
$830,33
$948,38
$177,78
 

Gold

(HMO) Confident Care Gold 1 + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,925 $5,850
Maximum Out of Pocket Per Year $6,500 $13,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$349,24
$396,39
$446,33
$623,74
$947,84
$698,48
$792,78
$892,66
$1 247,48
$1 895,68
$965,65
$1 059,95
$1 159,83
$1 514,65
$1 232,82
$1 327,12
$1 427,00
$1 781,82
$1 499,99
$1 594,29
$1 694,17
$2 048,99
$616,41
$663,56
$713,50
$890,91
$883,58
$930,73
$980,67
$1 158,08
$1 150,75
$1 197,90
$1 247,84
$1 425,25
$267,17
 

Silver

(HMO) Constant Care Silver 1 250 + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $0 $0
Maximum Out of Pocket Per Year $8,500 $17,000
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$325,82
$369,80
$416,40
$581,91
$884,27
$651,64
$739,60
$832,80
$1 163,82
$1 768,54
$900,89
$988,85
$1 082,05
$1 413,07
$1 150,14
$1 238,10
$1 331,30
$1 662,32
$1 399,39
$1 487,35
$1 580,55
$1 911,57
$575,07
$619,05
$665,65
$831,16
$824,32
$868,30
$914,90
$1 080,41
$1 073,57
$1 117,55
$1 164,15
$1 329,66
$249,25
 

Bronze

(HMO) Core Care Bronze 1 + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,100 $12,200
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$231,63
$262,90
$296,02
$413,69
$628,65
$463,26
$525,80
$592,04
$827,38
$1 257,30
$640,46
$703,00
$769,24
$1 004,58
$817,66
$880,20
$946,44
$1 181,78
$994,86
$1 057,40
$1 123,64
$1 358,98
$408,83
$440,10
$473,22
$590,89
$586,03
$617,30
$650,42
$768,09
$763,23
$794,50
$827,62
$945,29
$177,20

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Catastrophic

(EPO) Friday Catastrophic

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$185,03
$210,00
$236,46
$330,45
$502,16
$370,06
$420,00
$472,92
$660,90
$1 004,32
$511,60
$561,54
$614,46
$802,44
$653,14
$703,08
$756,00
$943,98
$794,68
$844,62
$897,54
$1 085,52
$326,57
$351,54
$378,00
$471,99
$468,11
$493,08
$519,54
$613,53
$609,65
$634,62
$661,08
$755,07
$141,54
 

Bronze

(EPO) Friday Bronze

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$200,34
$227,39
$256,04
$357,81
$543,73
$400,68
$454,78
$512,08
$715,62
$1 087,46
$553,94
$608,04
$665,34
$868,88
$707,20
$761,30
$818,60
$1 022,14
$860,46
$914,56
$971,86
$1 175,40
$353,60
$380,65
$409,30
$511,07
$506,86
$533,91
$562,56
$664,33
$660,12
$687,17
$715,82
$817,59
$153,26
 

Expanded Bronze

(EPO) Friday Bronze Plus

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,550 $17,100
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$212,06
$240,68
$271,01
$378,73
$575,52
$424,12
$481,36
$542,02
$757,46
$1 151,04
$586,34
$643,58
$704,24
$919,68
$748,56
$805,80
$866,46
$1 081,90
$910,78
$968,02
$1 028,68
$1 244,12
$374,28
$402,90
$433,23
$540,95
$536,50
$565,12
$595,45
$703,17
$698,72
$727,34
$757,67
$865,39
$162,22
 

Expanded Bronze

(EPO) Friday Bronze HSA

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,900 $13,800
Maximum Out of Pocket Per Year $6,900 $13,800
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$238,93
$271,18
$305,35
$426,73
$648,45
$477,86
$542,36
$610,70
$853,46
$1 296,90
$660,64
$725,14
$793,48
$1 036,24
$843,42
$907,92
$976,26
$1 219,02
$1 026,20
$1 090,70
$1 159,04
$1 401,80
$421,71
$453,96
$488,13
$609,51
$604,49
$636,74
$670,91
$792,29
$787,27
$819,52
$853,69
$975,07
$182,78
 

Silver

(EPO) Friday Silver

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,500 $11,000
Maximum Out of Pocket Per Year $8,550 $17,100
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$305,92
$347,22
$390,96
$546,37
$830,26
$611,84
$694,44
$781,92
$1 092,74
$1 660,52
$845,87
$928,47
$1 015,95
$1 326,77
$1 079,90
$1 162,50
$1 249,98
$1 560,80
$1 313,93
$1 396,53
$1 484,01
$1 794,83
$539,95
$581,25
$624,99
$780,40
$773,98
$815,28
$859,02
$1 014,43
$1 008,01
$1 049,31
$1 093,05
$1 248,46
$234,03
 

Gold

(EPO) Friday Gold

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,300 $4,600
Maximum Out of Pocket Per Year $8,250 $16,500
Monthly Premiums:
Age Individual
Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$288,29
$327,21
$368,43
$514,88
$782,41
$576,58
$654,42
$736,86
$1 029,76
$1 564,82
$797,12
$874,96
$957,40
$1 250,30
$1 017,66
$1 095,50
$1 177,94
$1 470,84
$1 238,20
$1 316,04
$1 398,48
$1 691,38
$508,83
$547,75
$588,97
$735,42
$729,37
$768,29
$809,51
$955,96
$949,91
$988,83
$1 030,05
$1 176,50
$220,54

‡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 Harris County here.

Harris County is in “Rating Area 10” of Texas.

Currently, there are 87 plans offered in Rating Area 10.

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