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Providers for Zip Code 78643

Obamacare 2017 Marketplace Rates For Llano County, Texas

Saturday, December 10th, 2016

Click for Llano, Texas Forecast

Obamacare Providers, Plans and 2017 Rates for Llano County

The health insurance rates listed below are for calendar year 2017.

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Llano County, Texas.

Currently, there are 32 plans offered in Llano County.

Below, you’ll find a summary of plans 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 complete an application at HealthCare.gov or contact the provider directly.

 

The table below shows premiums for the following scenarios:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Llano County

 

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Llano, TX area accept this insurance coverage as within the plan's "network".

‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Llano County here.

Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683

TTY: 1-800-735-2989

Plan: (HMO) Blue Advantage Bronze HMO? 006

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,500 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$283.24
$321.48
$361.99
$505.87
$768.72
$566.48
$642.96
$723.98
$1011.74
$1537.44
$746.34
$822.82
$903.84
$1191.60
$926.20
$1002.68
$1083.70
$1371.46
$1106.06
$1182.54
$1263.56
$1551.32
$463.10
$501.34
$541.85
$685.73
$642.96
$681.20
$721.71
$865.59
$822.82
$861.06
$901.57
$1045.45
$179.86

SHA, LLC DBA FirstCare Health Plans

Local: 1-855-572-7238 | Toll Free: 1-855-572-7238

TTY: 1-800-562-5259

Plan: (HMO) Gold Coinsurance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-572-7238 - Provider Directory for This Plan: (SHA, LLC DBA FirstCare Health Plans)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $4,600 : Family: $9,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$434.56
$493.23
$555.37
$776.12
$1179.40
$869.12
$986.46
$1110.74
$1552.24
$2358.80
$1145.07
$1262.41
$1386.69
$1828.19
$1421.02
$1538.36
$1662.64
$2104.14
$1696.97
$1814.31
$1938.59
$2380.09
$710.51
$769.18
$831.32
$1052.07
$986.46
$1045.13
$1107.27
$1328.02
$1262.41
$1321.08
$1383.22
$1603.97
$275.95

Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683

TTY: 1-800-735-2989

Plan: (HMO) Blue Advantage Gold HMO? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $500 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,250 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$411.26
$466.78
$525.59
$734.52
$1116.17
$822.52
$933.56
$1051.18
$1469.04
$2232.34
$1083.67
$1194.71
$1312.33
$1730.19
$1344.82
$1455.86
$1573.48
$1991.34
$1605.97
$1717.01
$1834.63
$2252.49
$672.41
$727.93
$786.74
$995.67
$933.56
$989.08
$1047.89
$1256.82
$1194.71
$1250.23
$1309.04
$1517.97
$261.15

SHA, LLC DBA FirstCare Health Plans

Local: 1-855-572-7238 | Toll Free: 1-855-572-7238

TTY: 1-800-562-5259

Plan: (HMO) Silver Coinsurance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-572-7238 - Provider Directory for This Plan: (SHA, LLC DBA FirstCare Health Plans)

Deductible: Individual: $3,100 : Family: $6,200
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$347.64
$394.57
$444.28
$620.89
$943.49
$695.28
$789.14
$888.56
$1241.78
$1886.98
$916.03
$1009.89
$1109.31
$1462.53
$1136.78
$1230.64
$1330.06
$1683.28
$1357.53
$1451.39
$1550.81
$1904.03
$568.39
$615.32
$665.03
$841.64
$789.14
$836.07
$885.78
$1062.39
$1009.89
$1056.82
$1106.53
$1283.14
$220.75

Plan: (HMO) Bronze HSA(100%)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-572-7238 - Provider Directory for This Plan: (SHA, LLC DBA FirstCare Health Plans)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$258.12
$292.97
$329.88
$461.00
$700.54
$516.24
$585.94
$659.76
$922.00
$1401.08
$680.15
$749.85
$823.67
$1085.91
$844.06
$913.76
$987.58
$1249.82
$1007.97
$1077.67
$1151.49
$1413.73
$422.03
$456.88
$493.79
$624.91
$585.94
$620.79
$657.70
$788.82
$749.85
$784.70
$821.61
$952.73
$163.91

Plan: (HMO) Silver HSA(100%)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-572-7238 - Provider Directory for This Plan: (SHA, LLC DBA FirstCare Health Plans)

Deductible: Individual: $3,750 : Family: $7,500
Out of Pocket Maximum per year: Individual: $3,750 : Family: $7,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$356.33
$404.43
$455.39
$636.41
$967.08
$712.66
$808.86
$910.78
$1272.82
$1934.16
$938.93
$1035.13
$1137.05
$1499.09
$1165.20
$1261.40
$1363.32
$1725.36
$1391.47
$1487.67
$1589.59
$1951.63
$582.60
$630.70
$681.66
$862.68
$808.87
$856.97
$907.93
$1088.95
$1035.14
$1083.24
$1134.20
$1315.22
$226.27

Plan: (HMO) Standard Bronze Coinsurance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-572-7238 - Provider Directory for This Plan: (SHA, LLC DBA FirstCare Health Plans)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$268.32
$304.54
$342.91
$479.22
$728.22
$536.64
$609.08
$685.82
$958.44
$1456.44
$707.02
$779.46
$856.20
$1128.82
$877.40
$949.84
$1026.58
$1299.20
$1047.78
$1120.22
$1196.96
$1469.58
$438.70
$474.92
$513.29
$649.60
$609.08
$645.30
$683.67
$819.98
$779.46
$815.68
$854.05
$990.36
$170.38
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Celtic Insurance Company

Local: 1-877-687-1196 | Toll Free: 1-877-687-1196

TTY: 1-800-735-2989

Plan: (EPO) Ambetter Secure Care 1 (2017) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$218.02
$247.44
$278.62
$389.36
$591.68
$436.04
$494.88
$557.24
$778.72
$1183.36
$574.48
$633.32
$695.68
$917.16
$712.92
$771.76
$834.12
$1055.60
$851.36
$910.20
$972.56
$1194.04
$356.46
$385.88
$417.06
$527.80
$494.90
$524.32
$555.50
$666.24
$633.34
$662.76
$693.94
$804.68
$138.44

Plan: (EPO) Ambetter Balanced Care 1 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$164.00
$186.13
$209.58
$292.89
$445.07
$328.00
$372.26
$419.16
$585.78
$890.14
$432.13
$476.39
$523.29
$689.91
$536.26
$580.52
$627.42
$794.04
$640.39
$684.65
$731.55
$898.17
$268.13
$290.26
$313.71
$397.02
$372.26
$394.39
$417.84
$501.15
$476.39
$498.52
$521.97
$605.28
$104.13

Plan: (EPO) Ambetter Balanced Care 2 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$161.26
$183.02
$206.08
$287.99
$437.63
$322.52
$366.04
$412.16
$575.98
$875.26
$424.91
$468.43
$514.55
$678.37
$527.30
$570.82
$616.94
$780.76
$629.69
$673.21
$719.33
$883.15
$263.65
$285.41
$308.47
$390.38
$366.04
$387.80
$410.86
$492.77
$468.43
$490.19
$513.25
$595.16
$102.39

Plan: (EPO) Ambetter Balanced Care 10 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$173.03
$196.38
$221.12
$309.01
$469.58
$346.06
$392.76
$442.24
$618.02
$939.16
$455.93
$502.63
$552.11
$727.89
$565.80
$612.50
$661.98
$837.76
$675.67
$722.37
$771.85
$947.63
$282.90
$306.25
$330.99
$418.88
$392.77
$416.12
$440.86
$528.75
$502.64
$525.99
$550.73
$638.62
$109.87

Plan: (EPO) Ambetter Essential Care 1 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$147.07
$166.91
$187.94
$262.65
$399.12
$294.14
$333.82
$375.88
$525.30
$798.24
$387.52
$427.20
$469.26
$618.68
$480.90
$520.58
$562.64
$712.06
$574.28
$613.96
$656.02
$805.44
$240.45
$260.29
$281.32
$356.03
$333.83
$353.67
$374.70
$449.41
$427.21
$447.05
$468.08
$542.79
$93.38

Plan: (EPO) Ambetter Balanced Care 3 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$171.74
$194.91
$219.47
$306.71
$466.08
$343.48
$389.82
$438.94
$613.42
$932.16
$452.53
$498.87
$547.99
$722.47
$561.58
$607.92
$657.04
$831.52
$670.63
$716.97
$766.09
$940.57
$280.79
$303.96
$328.52
$415.76
$389.84
$413.01
$437.57
$524.81
$498.89
$522.06
$546.62
$633.86
$109.05

Plan: (EPO) Ambetter Balanced Care 4 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $7,050 : Family: $14,100
Out of Pocket Maximum per year: Individual: $7,050 : Family: $14,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$155.94
$176.98
$199.28
$278.49
$423.19
$311.88
$353.96
$398.56
$556.98
$846.38
$410.89
$452.97
$497.57
$655.99
$509.90
$551.98
$596.58
$755.00
$608.91
$650.99
$695.59
$854.01
$254.95
$275.99
$298.29
$377.50
$353.96
$375.00
$397.30
$476.51
$452.97
$474.01
$496.31
$575.52
$99.01

Plan: (EPO) Ambetter Balanced Care 12 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$175.77
$199.49
$224.62
$313.91
$477.02
$351.54
$398.98
$449.24
$627.82
$954.04
$463.15
$510.59
$560.85
$739.43
$574.76
$622.20
$672.46
$851.04
$686.37
$733.81
$784.07
$962.65
$287.38
$311.10
$336.23
$425.52
$398.99
$422.71
$447.84
$537.13
$510.60
$534.32
$559.45
$648.74
$111.61

Plan: (EPO) Ambetter Balanced Care 1 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$167.30
$189.88
$213.80
$298.78
$454.03
$334.60
$379.76
$427.60
$597.56
$908.06
$440.83
$485.99
$533.83
$703.79
$547.06
$592.22
$640.06
$810.02
$653.29
$698.45
$746.29
$916.25
$273.53
$296.11
$320.03
$405.01
$379.76
$402.34
$426.26
$511.24
$485.99
$508.57
$532.49
$617.47
$106.23

Plan: (EPO) Ambetter Balanced Care 2 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$164.50
$186.70
$210.22
$293.79
$446.44
$329.00
$373.40
$420.44
$587.58
$892.88
$433.45
$477.85
$524.89
$692.03
$537.90
$582.30
$629.34
$796.48
$642.35
$686.75
$733.79
$900.93
$268.95
$291.15
$314.67
$398.24
$373.40
$395.60
$419.12
$502.69
$477.85
$500.05
$523.57
$607.14
$104.45

Plan: (EPO) Ambetter Balanced Care 10 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$176.51
$200.33
$225.57
$315.23
$479.03
$353.02
$400.66
$451.14
$630.46
$958.06
$465.10
$512.74
$563.22
$742.54
$577.18
$624.82
$675.30
$854.62
$689.26
$736.90
$787.38
$966.70
$288.59
$312.41
$337.65
$427.31
$400.67
$424.49
$449.73
$539.39
$512.75
$536.57
$561.81
$651.47
$112.08

Plan: (EPO) Ambetter Essential Care 1 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$150.03
$170.27
$191.72
$267.93
$407.15
$300.06
$340.54
$383.44
$535.86
$814.30
$395.32
$435.80
$478.70
$631.12
$490.58
$531.06
$573.96
$726.38
$585.84
$626.32
$669.22
$821.64
$245.29
$265.53
$286.98
$363.19
$340.55
$360.79
$382.24
$458.45
$435.81
$456.05
$477.50
$553.71
$95.26

Plan: (EPO) Ambetter Balanced Care 3 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1196 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$175.20
$198.84
$223.89
$312.88
$475.46
$350.40
$397.68
$447.78
$625.76
$950.92
$461.64
$508.92
$559.02
$737.00
$572.88
$620.16
$670.26
$848.24
$684.12
$731.40
$781.50
$959.48
$286.44
$310.08
$335.13
$424.12
$397.68
$421.32
$446.37
$535.36
$508.92
$532.56
$557.61
$646.60
$111.24
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Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683

TTY: 1-800-735-2989

Plan: (HMO) Blue Advantage Silver HMO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,000 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$327.94
$372.21
$419.11
$585.70
$890.03
$655.88
$744.42
$838.22
$1171.40
$1780.06
$864.12
$952.66
$1046.46
$1379.64
$1072.36
$1160.90
$1254.70
$1587.88
$1280.60
$1369.14
$1462.94
$1796.12
$536.18
$580.45
$627.35
$793.94
$744.42
$788.69
$835.59
$1002.18
$952.66
$996.93
$1043.83
$1210.42
$208.24

Plan: (HMO) Blue Advantage Silver HMO? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $3,750 : Family: $11,250

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$358.41
$406.80
$458.05
$640.13
$972.74
$716.82
$813.60
$916.10
$1280.26
$1945.48
$944.41
$1041.19
$1143.69
$1507.85
$1172.00
$1268.78
$1371.28
$1735.44
$1399.59
$1496.37
$1598.87
$1963.03
$586.00
$634.39
$685.64
$867.72
$813.59
$861.98
$913.23
$1095.31
$1041.18
$1089.57
$1140.82
$1322.90
$227.59

Plan: (HMO) Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,850 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$257.21
$291.93
$328.71
$459.38
$698.07
$514.42
$583.86
$657.42
$918.76
$1396.14
$677.75
$747.19
$820.75
$1082.09
$841.08
$910.52
$984.08
$1245.42
$1004.41
$1073.85
$1147.41
$1408.75
$420.54
$455.26
$492.04
$622.71
$583.87
$618.59
$655.37
$786.04
$747.20
$781.92
$818.70
$949.37
$163.33

Plan: (HMO) Blue Advantage Security HMO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$264.78
$300.52
$338.39
$472.90
$718.61
$529.56
$601.04
$676.78
$945.80
$1437.22
$697.69
$769.17
$844.91
$1113.93
$865.82
$937.30
$1013.04
$1282.06
$1033.95
$1105.43
$1181.17
$1450.19
$432.91
$468.65
$506.52
$641.03
$601.04
$636.78
$674.65
$809.16
$769.17
$804.91
$842.78
$977.29
$168.13

Plan: (HMO) Blue Advantage Silver HMO? 107

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$359.78
$408.35
$459.79
$642.56
$976.43
$719.56
$816.70
$919.58
$1285.12
$1952.86
$948.02
$1045.16
$1148.04
$1513.58
$1176.48
$1273.62
$1376.50
$1742.04
$1404.94
$1502.08
$1604.96
$1970.50
$588.24
$636.81
$688.25
$871.02
$816.70
$865.27
$916.71
$1099.48
$1045.16
$1093.73
$1145.17
$1327.94
$228.46

Plan: (HMO) Blue Advantage Plus Gold? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $2,750 : Family: $8,250
Out of Pocket Maximum per year: Individual: $3,500 : Family: $10,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$430.41
$488.52
$550.07
$768.72
$1168.14
$860.82
$977.04
$1100.14
$1537.44
$2336.28
$1134.13
$1250.35
$1373.45
$1810.75
$1407.44
$1523.66
$1646.76
$2084.06
$1680.75
$1796.97
$1920.07
$2357.37
$703.72
$761.83
$823.38
$1042.03
$977.03
$1035.14
$1096.69
$1315.34
$1250.34
$1308.45
$1370.00
$1588.65
$273.31

Plan: (HMO) Blue Advantage Plus Silver? 102 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,250 : Family: $9,750
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$370.47
$420.49
$473.47
$661.67
$1005.47
$740.94
$840.98
$946.94
$1323.34
$2010.94
$976.19
$1076.23
$1182.19
$1558.59
$1211.44
$1311.48
$1417.44
$1793.84
$1446.69
$1546.73
$1652.69
$2029.09
$605.72
$655.74
$708.72
$896.92
$840.97
$890.99
$943.97
$1132.17
$1076.22
$1126.24
$1179.22
$1367.42
$235.25

Plan: (HMO) Blue Advantage Plus Bronze? 103 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,600 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$272.47
$309.26
$348.22
$486.64
$739.49
$544.94
$618.52
$696.44
$973.28
$1478.98
$717.96
$791.54
$869.46
$1146.30
$890.98
$964.56
$1042.48
$1319.32
$1064.00
$1137.58
$1215.50
$1492.34
$445.49
$482.28
$521.24
$659.66
$618.51
$655.30
$694.26
$832.68
$791.53
$828.32
$867.28
$1005.70
$173.02

Plan: (HMO) Blue Advantage Plus Bronze? 104

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $5,000 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$294.73
$334.52
$376.66
$526.39
$799.90
$589.46
$669.04
$753.32
$1052.78
$1599.80
$776.61
$856.19
$940.47
$1239.93
$963.76
$1043.34
$1127.62
$1427.08
$1150.91
$1230.49
$1314.77
$1614.23
$481.88
$521.67
$563.81
$713.54
$669.03
$708.82
$750.96
$900.69
$856.18
$895.97
$938.11
$1087.84
$187.15

Plan: (HMO) Blue Cross Blue Shield Premier? 101, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,800 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$440.85
$500.36
$563.41
$787.36
$1196.47
$881.70
$1000.72
$1126.82
$1574.72
$2392.94
$1161.64
$1280.66
$1406.76
$1854.66
$1441.58
$1560.60
$1686.70
$2134.60
$1721.52
$1840.54
$1966.64
$2414.54
$720.79
$780.30
$843.35
$1067.30
$1000.73
$1060.24
$1123.29
$1347.24
$1280.67
$1340.18
$1403.23
$1627.18
$279.94

Plan: (HMO) Blue Cross Blue Shield Solution? 102, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$361.86
$410.71
$462.45
$646.28
$982.08
$723.72
$821.42
$924.90
$1292.56
$1964.16
$953.50
$1051.20
$1154.68
$1522.34
$1183.28
$1280.98
$1384.46
$1752.12
$1413.06
$1510.76
$1614.24
$1981.90
$591.64
$640.49
$692.23
$876.06
$821.42
$870.27
$922.01
$1105.84
$1051.20
$1100.05
$1151.79
$1335.62
$229.78

Plan: (HMO) Blue Cross Blue Shield Basic? 103, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,250 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$273.08
$309.95
$349.00
$487.73
$741.15
$546.16
$619.90
$698.00
$975.46
$1482.30
$719.57
$793.31
$871.41
$1148.87
$892.98
$966.72
$1044.82
$1322.28
$1066.39
$1140.13
$1218.23
$1495.69
$446.49
$483.36
$522.41
$661.14
$619.90
$656.77
$695.82
$834.55
$793.31
$830.18
$869.23
$1007.96
$173.41