Obamacare 2020 Rates and Health Insurance Providers for Fond Du Lac County , Wisconsin


Obamacare > Rates > Wisconsin > Fond Du Lac 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 Fond Du Lac County, Wisconsin.

The health insurance rates listed below are for calendar year 2020.

Obamacare Providers, Plans and 2020 Rates for Fond Du Lac County, Wisconsin

Below, you’ll find a summary of the 58 plans for Fond Du Lac County, Wisconsin 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 Fond Du Lac, WI area accept this insurance coverage as within the plan's network.

2020 Obamacare Rates, Providers, and Plans for Fond Du Lac County

ADVERTISEMENT

Quartz Health Benefit Plans Corporation

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973

 

Silver

(HMO) Quartz One Silver I302 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$447.85
$508.30
$572.35
$799.85
$1,215.45
$895.70
$1,016.60
$1,144.70
$1,599.70
$2,430.90
$1,238.30
$1,359.20
$1,487.30
$1,942.30
$1,580.90
$1,701.80
$1,829.90
$2,284.90
$1,923.50
$2,044.40
$2,172.50
$2,627.50
$790.45
$850.90
$914.95
$1,142.45
$1,133.05
$1,193.50
$1,257.55
$1,485.05
$1,475.65
$1,536.10
$1,600.15
$1,827.65
$342.60
 

Silver

(HMO) Quartz One Silver I303 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,900 $15,800
Maximum Out of Pocket Per Year $7,900 $15,800
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
$435.43
$494.21
$556.48
$777.68
$1,181.75
$870.86
$988.42
$1,112.96
$1,555.36
$2,363.50
$1,203.96
$1,321.52
$1,446.06
$1,888.46
$1,537.06
$1,654.62
$1,779.16
$2,221.56
$1,870.16
$1,987.72
$2,112.26
$2,554.66
$768.53
$827.31
$889.58
$1,110.78
$1,101.63
$1,160.41
$1,222.68
$1,443.88
$1,434.73
$1,493.51
$1,555.78
$1,776.98
$333.10
 

Gold

(HMO) Quartz One Gold I402 Maintenance with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$414.08
$469.98
$529.19
$739.54
$1,123.80
$828.16
$939.96
$1,058.38
$1,479.08
$2,247.60
$1,144.93
$1,256.73
$1,375.15
$1,795.85
$1,461.70
$1,573.50
$1,691.92
$2,112.62
$1,778.47
$1,890.27
$2,008.69
$2,429.39
$730.85
$786.75
$845.96
$1,056.31
$1,047.62
$1,103.52
$1,162.73
$1,373.08
$1,364.39
$1,420.29
$1,479.50
$1,689.85
$316.77
 

Gold

(HMO) Quartz One Gold I401 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$408.77
$463.95
$522.41
$730.06
$1,109.40
$817.54
$927.90
$1,044.82
$1,460.12
$2,218.80
$1,130.25
$1,240.61
$1,357.53
$1,772.83
$1,442.96
$1,553.32
$1,670.24
$2,085.54
$1,755.67
$1,866.03
$1,982.95
$2,398.25
$721.48
$776.66
$835.12
$1,042.77
$1,034.19
$1,089.37
$1,147.83
$1,355.48
$1,346.90
$1,402.08
$1,460.54
$1,668.19
$312.71
 

Silver

(HMO) Quartz One Silver I301 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,300 $8,600
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
$449.85
$510.58
$574.90
$803.43
$1,220.88
$899.70
$1,021.16
$1,149.80
$1,606.86
$2,441.76
$1,243.83
$1,365.29
$1,493.93
$1,950.99
$1,587.96
$1,709.42
$1,838.06
$2,295.12
$1,932.09
$2,053.55
$2,182.19
$2,639.25
$793.98
$854.71
$919.03
$1,147.56
$1,138.11
$1,198.84
$1,263.16
$1,491.69
$1,482.24
$1,542.97
$1,607.29
$1,835.82
$344.13
 

Expanded Bronze

(HMO) Quartz One Bronze I201 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,000 $16,000
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
$305.68
$346.94
$390.65
$545.93
$829.59
$611.36
$693.88
$781.30
$1,091.86
$1,659.18
$845.20
$927.72
$1,015.14
$1,325.70
$1,079.04
$1,161.56
$1,248.98
$1,559.54
$1,312.88
$1,395.40
$1,482.82
$1,793.38
$539.52
$580.78
$624.49
$779.77
$773.36
$814.62
$858.33
$1,013.61
$1,007.20
$1,048.46
$1,092.17
$1,247.45
$233.84
 

Expanded Bronze

(HMO) Quartz One Bronze I202 with Dental

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,900 $15,800
Maximum Out of Pocket Per Year $7,900 $15,800
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
$312.86
$355.09
$399.82
$558.75
$849.08
$625.72
$710.18
$799.64
$1,117.50
$1,698.16
$865.05
$949.51
$1,038.97
$1,356.83
$1,104.38
$1,188.84
$1,278.30
$1,596.16
$1,343.71
$1,428.17
$1,517.63
$1,835.49
$552.19
$594.42
$639.15
$798.08
$791.52
$833.75
$878.48
$1,037.41
$1,030.85
$1,073.08
$1,117.81
$1,276.74
$239.33
 

Silver

(HMO) Quartz One Silver I302

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$427.00
$484.64
$545.70
$762.61
$1,158.86
$854.00
$969.28
$1,091.40
$1,525.22
$2,317.72
$1,180.65
$1,295.93
$1,418.05
$1,851.87
$1,507.30
$1,622.58
$1,744.70
$2,178.52
$1,833.95
$1,949.23
$2,071.35
$2,505.17
$753.65
$811.29
$872.35
$1,089.26
$1,080.30
$1,137.94
$1,199.00
$1,415.91
$1,406.95
$1,464.59
$1,525.65
$1,742.56
$326.65
 

Silver

(HMO) Quartz One Silver I303

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,900 $15,800
Maximum Out of Pocket Per Year $7,900 $15,800
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
$415.16
$471.20
$530.57
$741.47
$1,126.74
$830.32
$942.40
$1,061.14
$1,482.94
$2,253.48
$1,147.92
$1,260.00
$1,378.74
$1,800.54
$1,465.52
$1,577.60
$1,696.34
$2,118.14
$1,783.12
$1,895.20
$2,013.94
$2,435.74
$732.76
$788.80
$848.17
$1,059.07
$1,050.36
$1,106.40
$1,165.77
$1,376.67
$1,367.96
$1,424.00
$1,483.37
$1,694.27
$317.60
 

Gold

(HMO) Quartz One Gold I402 Maintenance

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$394.80
$448.10
$504.55
$705.11
$1,071.48
$789.60
$896.20
$1,009.10
$1,410.22
$2,142.96
$1,091.62
$1,198.22
$1,311.12
$1,712.24
$1,393.64
$1,500.24
$1,613.14
$2,014.26
$1,695.66
$1,802.26
$1,915.16
$2,316.28
$696.82
$750.12
$806.57
$1,007.13
$998.84
$1,052.14
$1,108.59
$1,309.15
$1,300.86
$1,354.16
$1,410.61
$1,611.17
$302.02
 

Gold

(HMO) Quartz One Gold I401

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
Maximum Out of Pocket Per Year $7,900 $15,800
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
$389.74
$442.35
$498.08
$696.07
$1,057.75
$779.48
$884.70
$996.16
$1,392.14
$2,115.50
$1,077.63
$1,182.85
$1,294.31
$1,690.29
$1,375.78
$1,481.00
$1,592.46
$1,988.44
$1,673.93
$1,779.15
$1,890.61
$2,286.59
$687.89
$740.50
$796.23
$994.22
$986.04
$1,038.65
$1,094.38
$1,292.37
$1,284.19
$1,336.80
$1,392.53
$1,590.52
$298.15
 

Silver

(HMO) Quartz One Silver I301

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,300 $8,600
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
$428.91
$486.81
$548.14
$766.02
$1,164.05
$857.82
$973.62
$1,096.28
$1,532.04
$2,328.10
$1,185.93
$1,301.73
$1,424.39
$1,860.15
$1,514.04
$1,629.84
$1,752.50
$2,188.26
$1,842.15
$1,957.95
$2,080.61
$2,516.37
$757.02
$814.92
$876.25
$1,094.13
$1,085.13
$1,143.03
$1,204.36
$1,422.24
$1,413.24
$1,471.14
$1,532.47
$1,750.35
$328.11
 

Expanded Bronze

(HMO) Quartz One Bronze I201

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,000 $16,000
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
$291.44
$330.78
$372.46
$520.51
$790.97
$582.88
$661.56
$744.92
$1,041.02
$1,581.94
$805.83
$884.51
$967.87
$1,263.97
$1,028.78
$1,107.46
$1,190.82
$1,486.92
$1,251.73
$1,330.41
$1,413.77
$1,709.87
$514.39
$553.73
$595.41
$743.46
$737.34
$776.68
$818.36
$966.41
$960.29
$999.63
$1,041.31
$1,189.36
$222.95
 

Expanded Bronze

(HMO) Quartz One Bronze I202

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,900 $15,800
Maximum Out of Pocket Per Year $7,900 $15,800
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
$298.29
$338.56
$381.21
$532.74
$809.55
$596.58
$677.12
$762.42
$1,065.48
$1,619.10
$824.77
$905.31
$990.61
$1,293.67
$1,052.96
$1,133.50
$1,218.80
$1,521.86
$1,281.15
$1,361.69
$1,446.99
$1,750.05
$526.48
$566.75
$609.40
$760.93
$754.67
$794.94
$837.59
$989.12
$982.86
$1,023.13
$1,065.78
$1,217.31
$228.19
 

Gold

(HMO) Quartz One Gold I404 HSA

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
Maximum Out of Pocket Per Year $6,650 $13,300
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
$411.24
$466.75
$525.55
$734.46
$1,116.08
$822.48
$933.50
$1,051.10
$1,468.92
$2,232.16
$1,137.07
$1,248.09
$1,365.69
$1,783.51
$1,451.66
$1,562.68
$1,680.28
$2,098.10
$1,766.25
$1,877.27
$1,994.87
$2,412.69
$725.83
$781.34
$840.14
$1,049.05
$1,040.42
$1,095.93
$1,154.73
$1,363.64
$1,355.01
$1,410.52
$1,469.32
$1,678.23
$314.59
 

Expanded Bronze

(HMO) Quartz One Bronze I203 HSA

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,750 $13,500
Maximum Out of Pocket Per Year $6,750 $13,500
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
$302.52
$343.35
$386.61
$540.29
$821.02
$605.04
$686.70
$773.22
$1,080.58
$1,642.04
$836.46
$918.12
$1,004.64
$1,312.00
$1,067.88
$1,149.54
$1,236.06
$1,543.42
$1,299.30
$1,380.96
$1,467.48
$1,774.84
$533.94
$574.77
$618.03
$771.71
$765.36
$806.19
$849.45
$1,003.13
$996.78
$1,037.61
$1,080.87
$1,234.55
$231.42
 

Catastrophic

(HMO) Quartz One Catastrophic I101

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$222.02
$251.99
$283.74
$396.52
$602.56
$444.04
$503.98
$567.48
$793.04
$1,205.12
$613.88
$673.82
$737.32
$962.88
$783.72
$843.66
$907.16
$1,132.72
$953.56
$1,013.50
$1,077.00
$1,302.56
$391.86
$421.83
$453.58
$566.36
$561.70
$591.67
$623.42
$736.20
$731.54
$761.51
$793.26
$906.04
$169.84
 

Silver

(HMO) Quartz One Silver I304 HSA

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,250 $10,500
Maximum Out of Pocket Per Year $5,250 $10,500
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
$449.45
$510.12
$574.39
$802.71
$1,219.80
$898.90
$1,020.24
$1,148.78
$1,605.42
$2,439.60
$1,242.73
$1,364.07
$1,492.61
$1,949.25
$1,586.56
$1,707.90
$1,836.44
$2,293.08
$1,930.39
$2,051.73
$2,180.27
$2,636.91
$793.28
$853.95
$918.22
$1,146.54
$1,137.11
$1,197.78
$1,262.05
$1,490.37
$1,480.94
$1,541.61
$1,605.88
$1,834.20
$343.83
 

Gold

(HMO) Quartz One Gold I403 HSA

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,000 $6,000
Maximum Out of Pocket Per Year $3,000 $6,000
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
$414.87
$470.87
$530.19
$740.94
$1,125.94
$829.74
$941.74
$1,060.38
$1,481.88
$2,251.88
$1,147.11
$1,259.11
$1,377.75
$1,799.25
$1,464.48
$1,576.48
$1,695.12
$2,116.62
$1,781.85
$1,893.85
$2,012.49
$2,433.99
$732.24
$788.24
$847.56
$1,058.31
$1,049.61
$1,105.61
$1,164.93
$1,375.68
$1,366.98
$1,422.98
$1,482.30
$1,693.05
$317.37

ADVERTISEMENT

Dean Health Plan

Local: 1-608-828-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-947-3529

 

Gold

(HMO) Dean Gold Copay Plus 1500X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $1,500 $3,000
Maximum Out of Pocket Per Year $4,000 $8,000
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
$379.01
$430.17
$484.37
$676.91
$1,028.63
$758.02
$860.34
$968.74
$1,353.82
$2,057.26
$1,047.96
$1,150.28
$1,258.68
$1,643.76
$1,337.90
$1,440.22
$1,548.62
$1,933.70
$1,627.84
$1,730.16
$1,838.56
$2,223.64
$668.95
$720.11
$774.31
$966.85
$958.89
$1,010.05
$1,064.25
$1,256.79
$1,248.83
$1,299.99
$1,354.19
$1,546.73
$289.94
 

Silver

(HMO) Dean Silver Copay Plus 4400X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,400 $8,800
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
$370.96
$421.03
$474.08
$662.53
$1,006.77
$741.92
$842.06
$948.16
$1,325.06
$2,013.54
$1,025.70
$1,125.84
$1,231.94
$1,608.84
$1,309.48
$1,409.62
$1,515.72
$1,892.62
$1,593.26
$1,693.40
$1,799.50
$2,176.40
$654.74
$704.81
$757.86
$946.31
$938.52
$988.59
$1,041.64
$1,230.09
$1,222.30
$1,272.37
$1,325.42
$1,513.87
$283.78
 

Expanded Bronze

(HMO) Dean Bronze Copay Plus 8100X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,100 $16,200
Maximum Out of Pocket Per Year $8,100 $16,200
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
$262.71
$298.17
$335.74
$469.20
$712.99
$525.42
$596.34
$671.48
$938.40
$1,425.98
$726.39
$797.31
$872.45
$1,139.37
$927.36
$998.28
$1,073.42
$1,340.34
$1,128.33
$1,199.25
$1,274.39
$1,541.31
$463.68
$499.14
$536.71
$670.17
$664.65
$700.11
$737.68
$871.14
$865.62
$901.08
$938.65
$1,072.11
$200.97
 

Silver

(HMO) Dean Silver Classic 5000X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
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
$359.96
$408.56
$460.03
$642.89
$976.94
$719.92
$817.12
$920.06
$1,285.78
$1,953.88
$995.29
$1,092.49
$1,195.43
$1,561.15
$1,270.66
$1,367.86
$1,470.80
$1,836.52
$1,546.03
$1,643.23
$1,746.17
$2,111.89
$635.33
$683.93
$735.40
$918.26
$910.70
$959.30
$1,010.77
$1,193.63
$1,186.07
$1,234.67
$1,286.14
$1,469.00
$275.37
 

Gold

(HMO) Dean Gold Value Copay 3700X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,700 $7,400
Maximum Out of Pocket Per Year $3,700 $7,400
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
$362.27
$411.18
$462.99
$647.02
$983.21
$724.54
$822.36
$925.98
$1,294.04
$1,966.42
$1,001.68
$1,099.50
$1,203.12
$1,571.18
$1,278.82
$1,376.64
$1,480.26
$1,848.32
$1,555.96
$1,653.78
$1,757.40
$2,125.46
$639.41
$688.32
$740.13
$924.16
$916.55
$965.46
$1,017.27
$1,201.30
$1,193.69
$1,242.60
$1,294.41
$1,478.44
$277.14
 

Silver

(HMO) Dean Silver Value Copay 5000X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
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
$368.75
$418.53
$471.26
$658.59
$1,000.79
$737.50
$837.06
$942.52
$1,317.18
$2,001.58
$1,019.59
$1,119.15
$1,224.61
$1,599.27
$1,301.68
$1,401.24
$1,506.70
$1,881.36
$1,583.77
$1,683.33
$1,788.79
$2,163.45
$650.84
$700.62
$753.35
$940.68
$932.93
$982.71
$1,035.44
$1,222.77
$1,215.02
$1,264.80
$1,317.53
$1,504.86
$282.09
 

Bronze

(HMO) Dean Bronze Value Copay 8100X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,100 $16,200
Maximum Out of Pocket Per Year $8,100 $16,200
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
$256.41
$291.02
$327.69
$457.94
$695.89
$512.82
$582.04
$655.38
$915.88
$1,391.78
$708.97
$778.19
$851.53
$1,112.03
$905.12
$974.34
$1,047.68
$1,308.18
$1,101.27
$1,170.49
$1,243.83
$1,504.33
$452.56
$487.17
$523.84
$654.09
$648.71
$683.32
$719.99
$850.24
$844.86
$879.47
$916.14
$1,046.39
$196.15
 

Silver

(HMO) Dean Silver HSA-E 4000X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,000 $8,000
Maximum Out of Pocket Per Year $6,750 $13,500
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
$354.99
$402.92
$453.68
$634.02
$963.45
$709.98
$805.84
$907.36
$1,268.04
$1,926.90
$981.55
$1,077.41
$1,178.93
$1,539.61
$1,253.12
$1,348.98
$1,450.50
$1,811.18
$1,524.69
$1,620.55
$1,722.07
$2,082.75
$626.56
$674.49
$725.25
$905.59
$898.13
$946.06
$996.82
$1,177.16
$1,169.70
$1,217.63
$1,268.39
$1,448.73
$271.57
 

Expanded Bronze

(HMO) Dean Bronze HSA-E 6700X

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,700 $13,400
Maximum Out of Pocket Per Year $6,700 $13,400
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
$254.38
$288.72
$325.09
$454.31
$690.38
$508.76
$577.44
$650.18
$908.62
$1,380.76
$703.36
$772.04
$844.78
$1,103.22
$897.96
$966.64
$1,039.38
$1,297.82
$1,092.56
$1,161.24
$1,233.98
$1,492.42
$448.98
$483.32
$519.69
$648.91
$643.58
$677.92
$714.29
$843.51
$838.18
$872.52
$908.89
$1,038.11
$194.60
 

Catastrophic

(HMO) Dean Catastrophic Safety Net

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$192.23
$218.19
$245.68
$343.33
$521.72
$384.46
$436.38
$491.36
$686.66
$1,043.44
$531.52
$583.44
$638.42
$833.72
$678.58
$730.50
$785.48
$980.78
$825.64
$877.56
$932.54
$1,127.84
$339.29
$365.25
$392.74
$490.39
$486.35
$512.31
$539.80
$637.45
$633.41
$659.37
$686.86
$784.51
$147.06

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Molina Healthcare of Wisconsin, Inc.

Local: 1-888-560-2043 | Toll Free: 1-888-560-2043

 

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 $6,000 $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
$379.44
$430.66
$484.92
$677.67
$1,029.79
$758.88
$861.32
$969.84
$1,355.34
$2,059.58
$1,049.15
$1,151.59
$1,260.11
$1,645.61
$1,339.42
$1,441.86
$1,550.38
$1,935.88
$1,629.69
$1,732.13
$1,840.65
$2,226.15
$669.71
$720.93
$775.19
$967.94
$959.98
$1,011.20
$1,065.46
$1,258.21
$1,250.25
$1,301.47
$1,355.73
$1,548.48
$290.27
 

Silver

(HMO) Constant Care Silver 1

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
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
$364.91
$414.18
$466.36
$651.74
$990.38
$729.82
$828.36
$932.72
$1,303.48
$1,980.76
$1,008.98
$1,107.52
$1,211.88
$1,582.64
$1,288.14
$1,386.68
$1,491.04
$1,861.80
$1,567.30
$1,665.84
$1,770.20
$2,140.96
$644.07
$693.34
$745.52
$930.90
$923.23
$972.50
$1,024.68
$1,210.06
$1,202.39
$1,251.66
$1,303.84
$1,489.22
$279.16
 

Bronze

(HMO) Core Care Bronze 1

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,800 $13,600
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
$270.92
$307.50
$346.24
$483.87
$735.29
$541.84
$615.00
$692.48
$967.74
$1,470.58
$749.10
$822.26
$899.74
$1,175.00
$956.36
$1,029.52
$1,107.00
$1,382.26
$1,163.62
$1,236.78
$1,314.26
$1,589.52
$478.18
$514.76
$553.50
$691.13
$685.44
$722.02
$760.76
$898.39
$892.70
$929.28
$968.02
$1,105.65
$207.26
 

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 $6,000 $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
$382.38
$434.00
$488.68
$682.93
$1,037.77
$764.76
$868.00
$977.36
$1,365.86
$2,075.54
$1,057.28
$1,160.52
$1,269.88
$1,658.38
$1,349.80
$1,453.04
$1,562.40
$1,950.90
$1,642.32
$1,745.56
$1,854.92
$2,243.42
$674.90
$726.52
$781.20
$975.45
$967.42
$1,019.04
$1,073.72
$1,267.97
$1,259.94
$1,311.56
$1,366.24
$1,560.49
$292.52
 

Silver

(HMO) Constant Care Silver 1 + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,000 $12,000
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
$367.93
$417.60
$470.21
$657.12
$998.56
$735.86
$835.20
$940.42
$1,314.24
$1,997.12
$1,017.33
$1,116.67
$1,221.89
$1,595.71
$1,298.80
$1,398.14
$1,503.36
$1,877.18
$1,580.27
$1,679.61
$1,784.83
$2,158.65
$649.40
$699.07
$751.68
$938.59
$930.87
$980.54
$1,033.15
$1,220.06
$1,212.34
$1,262.01
$1,314.62
$1,501.53
$281.47
 

Bronze

(HMO) Core Care Bronze 1 + Vision

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,800 $13,600
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
$273.87
$310.84
$350.00
$489.13
$743.27
$547.74
$621.68
$700.00
$978.26
$1,486.54
$757.25
$831.19
$909.51
$1,187.77
$966.76
$1,040.70
$1,119.02
$1,397.28
$1,176.27
$1,250.21
$1,328.53
$1,606.79
$483.38
$520.35
$559.51
$698.64
$692.89
$729.86
$769.02
$908.15
$902.40
$939.37
$978.53
$1,117.66
$209.51
 

Silver

(HMO) Constant Care Silver 2

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
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
$353.63
$401.37
$451.94
$631.59
$959.76
$707.26
$802.74
$903.88
$1,263.18
$1,919.52
$977.79
$1,073.27
$1,174.41
$1,533.71
$1,248.32
$1,343.80
$1,444.94
$1,804.24
$1,518.85
$1,614.33
$1,715.47
$2,074.77
$624.16
$671.90
$722.47
$902.12
$894.69
$942.43
$993.00
$1,172.65
$1,165.22
$1,212.96
$1,263.53
$1,443.18
$270.53
 

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 $8,150 $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
$258.20
$293.06
$329.98
$461.15
$700.76
$516.40
$586.12
$659.96
$922.30
$1,401.52
$713.93
$783.65
$857.49
$1,119.83
$911.46
$981.18
$1,055.02
$1,317.36
$1,108.99
$1,178.71
$1,252.55
$1,514.89
$455.73
$490.59
$527.51
$658.68
$653.26
$688.12
$725.04
$856.21
$850.79
$885.65
$922.57
$1,053.74
$197.53

ADVERTISEMENT

WPS Health Plan, Inc.

Local: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144

 

Bronze

(HMO) HMO Bronze 8150

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$335.85
$381.19
$429.22
$599.83
$911.50
$671.70
$762.38
$858.44
$1,199.66
$1,823.00
$928.63
$1,019.31
$1,115.37
$1,456.59
$1,185.56
$1,276.24
$1,372.30
$1,713.52
$1,442.49
$1,533.17
$1,629.23
$1,970.45
$592.78
$638.12
$686.15
$856.76
$849.71
$895.05
$943.08
$1,113.69
$1,106.64
$1,151.98
$1,200.01
$1,370.62
$256.93
 

Expanded Bronze

(HMO) HMO Bronze 6250 with 3 Free PCP Visits

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,250 $12,500
Maximum Out of Pocket Per Year $7,900 $15,800
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
$349.59
$396.78
$446.78
$624.37
$948.79
$699.18
$793.56
$893.56
$1,248.74
$1,897.58
$966.62
$1,061.00
$1,161.00
$1,516.18
$1,234.06
$1,328.44
$1,428.44
$1,783.62
$1,501.50
$1,595.88
$1,695.88
$2,051.06
$617.03
$664.22
$714.22
$891.81
$884.47
$931.66
$981.66
$1,159.25
$1,151.91
$1,199.10
$1,249.10
$1,426.69
$267.44
 

Bronze

(HMO) HMO Bronze 7200

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,200 $14,400
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
$340.84
$386.85
$435.59
$608.74
$925.04
$681.68
$773.70
$871.18
$1,217.48
$1,850.08
$942.42
$1,034.44
$1,131.92
$1,478.22
$1,203.16
$1,295.18
$1,392.66
$1,738.96
$1,463.90
$1,555.92
$1,653.40
$1,999.70
$601.58
$647.59
$696.33
$869.48
$862.32
$908.33
$957.07
$1,130.22
$1,123.06
$1,169.07
$1,217.81
$1,390.96
$260.74
 

Silver

(HMO) HMO Silver 7150

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $7,150 $14,300
Maximum Out of Pocket Per Year $7,150 $14,300
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
$495.93
$562.88
$633.80
$885.73
$1,345.95
$991.86
$1,125.76
$1,267.60
$1,771.46
$2,691.90
$1,371.25
$1,505.15
$1,646.99
$2,150.85
$1,750.64
$1,884.54
$2,026.38
$2,530.24
$2,130.03
$2,263.93
$2,405.77
$2,909.63
$875.32
$942.27
$1,013.19
$1,265.12
$1,254.71
$1,321.66
$1,392.58
$1,644.51
$1,634.10
$1,701.05
$1,771.97
$2,023.90
$379.39
 

Silver

(HMO) HMO Silver 4500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,500 $9,000
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
$496.30
$563.30
$634.27
$886.39
$1,346.96
$992.60
$1,126.60
$1,268.54
$1,772.78
$2,693.92
$1,372.27
$1,506.27
$1,648.21
$2,152.45
$1,751.94
$1,885.94
$2,027.88
$2,532.12
$2,131.61
$2,265.61
$2,407.55
$2,911.79
$875.97
$942.97
$1,013.94
$1,266.06
$1,255.64
$1,322.64
$1,393.61
$1,645.73
$1,635.31
$1,702.31
$1,773.28
$2,025.40
$379.67
 

Silver

(HMO) HMO Silver 5000 with 3 Free PCP Visits

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,000 $10,000
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
$515.95
$585.60
$659.38
$921.49
$1,400.29
$1,031.90
$1,171.20
$1,318.76
$1,842.98
$2,800.58
$1,426.60
$1,565.90
$1,713.46
$2,237.68
$1,821.30
$1,960.60
$2,108.16
$2,632.38
$2,216.00
$2,355.30
$2,502.86
$3,027.08
$910.65
$980.30
$1,054.08
$1,316.19
$1,305.35
$1,375.00
$1,448.78
$1,710.89
$1,700.05
$1,769.70
$1,843.48
$2,105.59
$394.70
 

Gold

(HMO) HMO Gold 2250

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,250 $4,500
Maximum Out of Pocket Per Year $4,000 $8,000
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
$694.06
$787.76
$887.01
$1,239.59
$1,883.68
$1,388.12
$1,575.52
$1,774.02
$2,479.18
$3,767.36
$1,919.08
$2,106.48
$2,304.98
$3,010.14
$2,450.04
$2,637.44
$2,835.94
$3,541.10
$2,981.00
$3,168.40
$3,366.90
$4,072.06
$1,225.02
$1,318.72
$1,417.97
$1,770.55
$1,755.98
$1,849.68
$1,948.93
$2,301.51
$2,286.94
$2,380.64
$2,479.89
$2,832.47
$530.96
 

Catastrophic

(HMO) HMO Catastrophic 8150 with 3 Free PCP Visits

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$291.84
$331.24
$372.97
$521.23
$792.05
$583.68
$662.48
$745.94
$1,042.46
$1,584.10
$806.94
$885.74
$969.20
$1,265.72
$1,030.20
$1,109.00
$1,192.46
$1,488.98
$1,253.46
$1,332.26
$1,415.72
$1,712.24
$515.10
$554.50
$596.23
$744.49
$738.36
$777.76
$819.49
$967.75
$961.62
$1,001.02
$1,042.75
$1,191.01
$223.26
 

Expanded Bronze

(HMO) HMO HDHP Bronze 6900

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
$346.67
$393.47
$443.04
$619.15
$940.86
$693.34
$786.94
$886.08
$1,238.30
$1,881.72
$958.54
$1,052.14
$1,151.28
$1,503.50
$1,223.74
$1,317.34
$1,416.48
$1,768.70
$1,488.94
$1,582.54
$1,681.68
$2,033.90
$611.87
$658.67
$708.24
$884.35
$877.07
$923.87
$973.44
$1,149.55
$1,142.27
$1,189.07
$1,238.64
$1,414.75
$265.20
 

Expanded Bronze

(HMO) HMO HDHP Bronze 6450

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,450 $12,900
Maximum Out of Pocket Per Year $6,450 $12,900
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
$356.35
$404.46
$455.42
$636.44
$967.13
$712.70
$808.92
$910.84
$1,272.88
$1,934.26
$985.31
$1,081.53
$1,183.45
$1,545.49
$1,257.92
$1,354.14
$1,456.06
$1,818.10
$1,530.53
$1,626.75
$1,728.67
$2,090.71
$628.96
$677.07
$728.03
$909.05
$901.57
$949.68
$1,000.64
$1,181.66
$1,174.18
$1,222.29
$1,273.25
$1,454.27
$272.61
 

Expanded Bronze

(HMO) HMO HDHP Bronze 5500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,500 $11,000
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
$348.45
$395.49
$445.32
$622.33
$945.69
$696.90
$790.98
$890.64
$1,244.66
$1,891.38
$963.46
$1,057.54
$1,157.20
$1,511.22
$1,230.02
$1,324.10
$1,423.76
$1,777.78
$1,496.58
$1,590.66
$1,690.32
$2,044.34
$615.01
$662.05
$711.88
$888.89
$881.57
$928.61
$978.44
$1,155.45
$1,148.13
$1,195.17
$1,245.00
$1,422.01
$266.56
 

Silver

(HMO) HMO HDHP Silver 2800

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,800 $5,600
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
$506.47
$574.84
$647.27
$904.56
$1,374.56
$1,012.94
$1,149.68
$1,294.54
$1,809.12
$2,749.12
$1,400.39
$1,537.13
$1,681.99
$2,196.57
$1,787.84
$1,924.58
$2,069.44
$2,584.02
$2,175.29
$2,312.03
$2,456.89
$2,971.47
$893.92
$962.29
$1,034.72
$1,292.01
$1,281.37
$1,349.74
$1,422.17
$1,679.46
$1,668.82
$1,737.19
$1,809.62
$2,066.91
$387.45
 

Silver

(HMO) HMO HDHP Silver 4500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,500 $9,000
Maximum Out of Pocket Per Year $4,500 $9,000
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
$504.69
$572.82
$644.99
$901.38
$1,369.73
$1,009.38
$1,145.64
$1,289.98
$1,802.76
$2,739.46
$1,395.47
$1,531.73
$1,676.07
$2,188.85
$1,781.56
$1,917.82
$2,062.16
$2,574.94
$2,167.65
$2,303.91
$2,448.25
$2,961.03
$890.78
$958.91
$1,031.08
$1,287.47
$1,276.87
$1,345.00
$1,417.17
$1,673.56
$1,662.96
$1,731.09
$1,803.26
$2,059.65
$386.09
 

Silver

(HMO) HMO HDHP Silver 5500

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $5,500 $11,000
Maximum Out of Pocket Per Year $5,500 $11,000
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
$479.20
$543.89
$612.42
$855.85
$1,300.55
$958.40
$1,087.78
$1,224.84
$1,711.70
$2,601.10
$1,324.99
$1,454.37
$1,591.43
$2,078.29
$1,691.58
$1,820.96
$1,958.02
$2,444.88
$2,058.17
$2,187.55
$2,324.61
$2,811.47
$845.79
$910.48
$979.01
$1,222.44
$1,212.38
$1,277.07
$1,345.60
$1,589.03
$1,578.97
$1,643.66
$1,712.19
$1,955.62
$366.59

ADVERTISEMENT

Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-855-643-5001

 

Gold

(EPO) Envision - Gold 2000/80

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $2,000 $4,000
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
$412.70
$468.41
$527.42
$737.07
$1,120.05
$825.40
$936.82
$1,054.84
$1,474.14
$2,240.10
$1,141.11
$1,252.53
$1,370.55
$1,789.85
$1,456.82
$1,568.24
$1,686.26
$2,105.56
$1,772.53
$1,883.95
$2,001.97
$2,421.27
$728.41
$784.12
$843.13
$1,052.78
$1,044.12
$1,099.83
$1,158.84
$1,368.49
$1,359.83
$1,415.54
$1,474.55
$1,684.20
$315.71
 

Silver

(EPO) Envision - Silver 4000/75

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $4,000 $8,000
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
$411.47
$467.01
$525.85
$734.87
$1,116.70
$822.94
$934.02
$1,051.70
$1,469.74
$2,233.40
$1,137.71
$1,248.79
$1,366.47
$1,784.51
$1,452.48
$1,563.56
$1,681.24
$2,099.28
$1,767.25
$1,878.33
$1,996.01
$2,414.05
$726.24
$781.78
$840.62
$1,049.64
$1,041.01
$1,096.55
$1,155.39
$1,364.41
$1,355.78
$1,411.32
$1,470.16
$1,679.18
$314.77
 

Silver

(EPO) Envison - Silver 3000/75/Copay40

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $3,000 $6,000
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
$428.58
$486.43
$547.71
$765.43
$1,163.14
$857.16
$972.86
$1,095.42
$1,530.86
$2,326.28
$1,185.02
$1,300.72
$1,423.28
$1,858.72
$1,512.88
$1,628.58
$1,751.14
$2,186.58
$1,840.74
$1,956.44
$2,079.00
$2,514.44
$756.44
$814.29
$875.57
$1,093.29
$1,084.30
$1,142.15
$1,203.43
$1,421.15
$1,412.16
$1,470.01
$1,531.29
$1,749.01
$327.86
 

Catastrophic

(EPO) Envision - Catastrophic 8150/100

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$216.99
$246.27
$277.30
$387.52
$588.88
$433.98
$492.54
$554.60
$775.04
$1,177.76
$599.97
$658.53
$720.59
$941.03
$765.96
$824.52
$886.58
$1,107.02
$931.95
$990.51
$1,052.57
$1,273.01
$382.98
$412.26
$443.29
$553.51
$548.97
$578.25
$609.28
$719.50
$714.96
$744.24
$775.27
$885.49
$165.99
 

Expanded Bronze

(EPO) Envision - Bronze 8150/100

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $8,150 $16,300
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
$281.25
$319.21
$359.43
$502.30
$763.29
$562.50
$638.42
$718.86
$1,004.60
$1,526.58
$777.65
$853.57
$934.01
$1,219.75
$992.80
$1,068.72
$1,149.16
$1,434.90
$1,207.95
$1,283.87
$1,364.31
$1,650.05
$496.40
$534.36
$574.58
$717.45
$711.55
$749.51
$789.73
$932.60
$926.70
$964.66
$1,004.88
$1,147.75
$215.15
 

Expanded Bronze

(EPO) Envision 6750/100

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,750 $13,500
Maximum Out of Pocket Per Year $6,750 $13,500
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
$308.08
$349.66
$393.72
$550.22
$836.11
$616.16
$699.32
$787.44
$1,100.44
$1,672.22
$851.83
$934.99
$1,023.11
$1,336.11
$1,087.50
$1,170.66
$1,258.78
$1,571.78
$1,323.17
$1,406.33
$1,494.45
$1,807.45
$543.75
$585.33
$629.39
$785.89
$779.42
$821.00
$865.06
$1,021.56
$1,015.09
$1,056.67
$1,100.73
$1,257.23
$235.67
 

Silver

(EPO) Envision - Silver 6500/75

Annual Out of Pocket Expenses
Individual Family
Annual Deductible $6,500 $13,000
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
$346.54
$393.31
$442.86
$618.90
$940.47
$693.08
$786.62
$885.72
$1,237.80
$1,880.94
$958.17
$1,051.71
$1,150.81
$1,502.89
$1,223.26
$1,316.80
$1,415.90
$1,767.98
$1,488.35
$1,581.89
$1,680.99
$2,033.07
$611.63
$658.40
$707.95
$883.99
$876.72
$923.49
$973.04
$1,149.08
$1,141.81
$1,188.58
$1,238.13
$1,414.17
$265.09

‡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 Fond Du Lac County here.

Fond Du Lac County is in “Rating Area 11” of Wisconsin.

Currently, there are 58 plans offered in Rating Area 11.

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Obamacare Rates and Providers for Other Years

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