Obamacare 2022 Rates and Health Insurance Providers for Iowa County , Wisconsin
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Obamacare 2022 Rates and Health Insurance Providers for Iowa County , Wisconsin

Obamacare > Rates > Wisconsin > Iowa County

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Iowa County, WI.

The health insurance rates listed below are for calendar year 2022.

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

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

The table below shows premiums for the following profiles at various ages:

  • Individuals
  • Couples
  • Couples with 1, 2, or 3 children
  • Individuals with 1, 2, or 3 children
  • A child alone

Each plan links to the insurance provider's website. You can find the following:

  • Summary of plan benefits and costs
  • Plan brochure
  • Provider Directory where you can find out which doctors and hospitals in the Dodgeville, WI area accept this insurance coverage as within the plan's network.

Obamacare Providers, Plans and 2022 Rates for Iowa County, Wisconsin

Below, you’ll find a summary of the 48 plans for Iowa County, Wisconsin and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016| 2017 | 2018 | 2019 2020 2021 2022

You may also be interested in:

How To Sign Up for Obamacare in Wisconsin

For 2022 health plans, Wisconsin open enrollment has ended. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period. For example, if you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a 60-day special enrollment period that will allow you to sign up for a new health insurance plan. (See What Happens If I Missed the Enrollment Deadline for 2022?)

To get covered, you can go directly to the online health insurance marketplace for Wisconsin. If you need personalized help, you can reach out to an enrollment assistant. Most enrollment helpers are working remotely during the COVID crisis.

Where's the Wisconsin Health Care Exchange?

You can find the health insurance exchange for Wisconsin at Healthcare.gov. This is where you can learn about the various health insurance options available to you under the Affordable Care Act. If you see a plan you like, you'll be guided through the enrollment process online.

more...  

Wisconsin Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Wisconsin in 2021, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of October 2021, 12 states have not expanded their programs.

Wisconsin Has Not Expanded Medicaid

Wisconsin has repeatedly rejected federal funding to expand Medicaid under the Affordable Care Act, but the state is unique in that its Medicaid program -- called BadgerCare -- covers all state residents with incomes up to the federal poverty level. That makes Wisconsin the only non-Medicaid-expansion state without a coverage gap -- that is, a failure to provide coverage or subsidies for many adults with incomes under the poverty level.

If you're a low-income Wisconsin resident, you'll most likely qualify for BadgerCare or be eligible for subsidies to help you purchase health insurance at Healthcare.gov.

more...  

Get Help Finding a Health Insurance Plan in Wisconsin

Get Help From Wisconsin's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Healthcare.gov, the health insurance marketplace for Wisconsin.

Help by phone: 800-318-2596 (TTY: 855-889-4325)

In-person help: Go to Find Local Help, where you can enter your city and state or zip code to find an application assister, insurance agent, or health insurance broker in your area.

Get Help From a Licensed Insurance Broker

To directly connect with a Wisconsin insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Wisconsin?

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

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Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973
Toc - Plan #1 Quartz
Silver

(HMO) Quartz One Silver I302 with Dental

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$428,47
$486,31
$547,58
$765,24
$1 162,85 		$756,25
$814,09
$875,36
$1 093,02 		$1 084,03
$1 141,87
$1 203,14
$1 420,80 		$1 411,81
$1 469,65
$1 530,92
$1 748,58 		$327,78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$856,94
$972,62
$1 095,16
$1 530,48
$2 325,70 		$1 184,72
$1 300,40
$1 422,94
$1 858,26 		$1 512,50
$1 628,18
$1 750,72
$2 186,04 		$1 840,28
$1 955,96
$2 078,50
$2 513,82 		$327,78
Toc - Plan #2 Quartz
Silver

(HMO) Quartz One Silver I303 with Dental

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$412,57
$468,27
$527,26
$736,85
$1 119,71 		$728,18
$783,88
$842,87
$1 052,46 		$1 043,79
$1 099,49
$1 158,48
$1 368,07 		$1 359,40
$1 415,10
$1 474,09
$1 683,68 		$315,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$825,14
$936,54
$1 054,52
$1 473,70
$2 239,42 		$1 140,75
$1 252,15
$1 370,13
$1 789,31 		$1 456,36
$1 567,76
$1 685,74
$2 104,92 		$1 771,97
$1 883,37
$2 001,35
$2 420,53 		$315,61
Toc - Plan #3 Quartz
Gold

(HMO) Quartz One Gold I402 Maintenance with Dental

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$378,81
$429,95
$484,12
$676,55
$1 028,09 		$668,60
$719,74
$773,91
$966,34 		$958,39
$1 009,53
$1 063,70
$1 256,13 		$1 248,18
$1 299,32
$1 353,49
$1 545,92 		$289,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$757,62
$859,90
$968,24
$1 353,10
$2 056,18 		$1 047,41
$1 149,69
$1 258,03
$1 642,89 		$1 337,20
$1 439,48
$1 547,82
$1 932,68 		$1 626,99
$1 729,27
$1 837,61
$2 222,47 		$289,79
Toc - Plan #4 Quartz
Gold

(HMO) Quartz One Gold I401 with Dental

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$383,18
$434,90
$489,70
$684,35
$1 039,93 		$676,31
$728,03
$782,83
$977,48 		$969,44
$1 021,16
$1 075,96
$1 270,61 		$1 262,57
$1 314,29
$1 369,09
$1 563,74 		$293,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$766,36
$869,80
$979,40
$1 368,70
$2 079,86 		$1 059,49
$1 162,93
$1 272,53
$1 661,83 		$1 352,62
$1 456,06
$1 565,66
$1 954,96 		$1 645,75
$1 749,19
$1 858,79
$2 248,09 		$293,13
Toc - Plan #5 Quartz
Silver

(HMO) Quartz One Silver I301 with Dental

Annual Out of Pocket Expenses
Individual Family
$4,400 $8,800 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$427,69
$485,42
$546,58
$763,84
$1 160,73 		$754,87
$812,60
$873,76
$1 091,02 		$1 082,05
$1 139,78
$1 200,94
$1 418,20 		$1 409,23
$1 466,96
$1 528,12
$1 745,38 		$327,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$855,38
$970,84
$1 093,16
$1 527,68
$2 321,46 		$1 182,56
$1 298,02
$1 420,34
$1 854,86 		$1 509,74
$1 625,20
$1 747,52
$2 182,04 		$1 836,92
$1 952,38
$2 074,70
$2 509,22 		$327,18
Toc - Plan #6 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202 with Dental

Annual Out of Pocket Expenses
Individual Family
$8,200 $16,400 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$295,54
$335,44
$377,70
$527,83
$802,09 		$521,63
$561,53
$603,79
$753,92 		$747,72
$787,62
$829,88
$980,01 		$973,81
$1 013,71
$1 055,97
$1 206,10 		$226,09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$591,08
$670,88
$755,40
$1 055,66
$1 604,18 		$817,17
$896,97
$981,49
$1 281,75 		$1 043,26
$1 123,06
$1 207,58
$1 507,84 		$1 269,35
$1 349,15
$1 433,67
$1 733,93 		$226,09
Toc - Plan #7 Quartz
Gold

(HMO) Quartz One Gold I405 with Dental

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$379,33
$430,53
$484,78
$677,47
$1 029,48 		$669,51
$720,71
$774,96
$967,65 		$959,69
$1 010,89
$1 065,14
$1 257,83 		$1 249,87
$1 301,07
$1 355,32
$1 548,01 		$290,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$758,66
$861,06
$969,56
$1 354,94
$2 058,96 		$1 048,84
$1 151,24
$1 259,74
$1 645,12 		$1 339,02
$1 441,42
$1 549,92
$1 935,30 		$1 629,20
$1 731,60
$1 840,10
$2 225,48 		$290,18
Toc - Plan #8 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201 with Dental

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$296,60
$336,64
$379,05
$529,72
$804,96 		$523,50
$563,54
$605,95
$756,62 		$750,40
$790,44
$832,85
$983,52 		$977,30
$1 017,34
$1 059,75
$1 210,42 		$226,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$593,20
$673,28
$758,10
$1 059,44
$1 609,92 		$820,10
$900,18
$985,00
$1 286,34 		$1 047,00
$1 127,08
$1 211,90
$1 513,24 		$1 273,90
$1 353,98
$1 438,80
$1 740,14 		$226,90
Toc - Plan #9 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204 with Dental

Annual Out of Pocket Expenses
Individual Family
$2,450 $4,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$308,79
$350,47
$394,62
$551,48
$838,03 		$545,01
$586,69
$630,84
$787,70 		$781,23
$822,91
$867,06
$1 023,92 		$1 017,45
$1 059,13
$1 103,28
$1 260,14 		$236,22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$617,58
$700,94
$789,24
$1 102,96
$1 676,06 		$853,80
$937,16
$1 025,46
$1 339,18 		$1 090,02
$1 173,38
$1 261,68
$1 575,40 		$1 326,24
$1 409,60
$1 497,90
$1 811,62 		$236,22
Toc - Plan #10 Quartz
Silver

(HMO) Quartz One Silver I302

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$411,72
$467,30
$526,18
$735,33
$1 117,41 		$726,69
$782,27
$841,15
$1 050,30 		$1 041,66
$1 097,24
$1 156,12
$1 365,27 		$1 356,63
$1 412,21
$1 471,09
$1 680,24 		$314,97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$823,44
$934,60
$1 052,36
$1 470,66
$2 234,82 		$1 138,41
$1 249,57
$1 367,33
$1 785,63 		$1 453,38
$1 564,54
$1 682,30
$2 100,60 		$1 768,35
$1 879,51
$1 997,27
$2 415,57 		$314,97
Toc - Plan #11 Quartz
Silver

(HMO) Quartz One Silver I303

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$396,45
$449,96
$506,65
$708,05
$1 075,95 		$699,73
$753,24
$809,93
$1 011,33 		$1 003,01
$1 056,52
$1 113,21
$1 314,61 		$1 306,29
$1 359,80
$1 416,49
$1 617,89 		$303,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$792,90
$899,92
$1 013,30
$1 416,10
$2 151,90 		$1 096,18
$1 203,20
$1 316,58
$1 719,38 		$1 399,46
$1 506,48
$1 619,86
$2 022,66 		$1 702,74
$1 809,76
$1 923,14
$2 325,94 		$303,28
Toc - Plan #12 Quartz
Gold

(HMO) Quartz One Gold I402 Maintenance

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364,01
$413,14
$465,20
$650,11
$987,91 		$642,47
$691,60
$743,66
$928,57 		$920,93
$970,06
$1 022,12
$1 207,03 		$1 199,39
$1 248,52
$1 300,58
$1 485,49 		$278,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728,02
$826,28
$930,40
$1 300,22
$1 975,82 		$1 006,48
$1 104,74
$1 208,86
$1 578,68 		$1 284,94
$1 383,20
$1 487,32
$1 857,14 		$1 563,40
$1 661,66
$1 765,78
$2 135,60 		$278,46
Toc - Plan #13 Quartz
Gold

(HMO) Quartz One Gold I401

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$368,20
$417,90
$470,56
$657,60
$999,29 		$649,87
$699,57
$752,23
$939,27 		$931,54
$981,24
$1 033,90
$1 220,94 		$1 213,21
$1 262,91
$1 315,57
$1 502,61 		$281,67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$736,40
$835,80
$941,12
$1 315,20
$1 998,58 		$1 018,07
$1 117,47
$1 222,79
$1 596,87 		$1 299,74
$1 399,14
$1 504,46
$1 878,54 		$1 581,41
$1 680,81
$1 786,13
$2 160,21 		$281,67
Toc - Plan #14 Quartz
Silver

(HMO) Quartz One Silver I301

Annual Out of Pocket Expenses
Individual Family
$4,400 $8,800 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$410,97
$466,45
$525,21
$733,98
$1 115,36 		$725,36
$780,84
$839,60
$1 048,37 		$1 039,75
$1 095,23
$1 153,99
$1 362,76 		$1 354,14
$1 409,62
$1 468,38
$1 677,15 		$314,39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821,94
$932,90
$1 050,42
$1 467,96
$2 230,72 		$1 136,33
$1 247,29
$1 364,81
$1 782,35 		$1 450,72
$1 561,68
$1 679,20
$2 096,74 		$1 765,11
$1 876,07
$1 993,59
$2 411,13 		$314,39
Toc - Plan #15 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202

Annual Out of Pocket Expenses
Individual Family
$8,200 $16,400 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$283,99
$322,33
$362,94
$507,20
$770,75 		$501,24
$539,58
$580,19
$724,45 		$718,49
$756,83
$797,44
$941,70 		$935,74
$974,08
$1 014,69
$1 158,95 		$217,25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$567,98
$644,66
$725,88
$1 014,40
$1 541,50 		$785,23
$861,91
$943,13
$1 231,65 		$1 002,48
$1 079,16
$1 160,38
$1 448,90 		$1 219,73
$1 296,41
$1 377,63
$1 666,15 		$217,25
Toc - Plan #16 Quartz
Gold

(HMO) Quartz One Gold I405

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364,50
$413,71
$465,83
$650,99
$989,25 		$643,34
$692,55
$744,67
$929,83 		$922,18
$971,39
$1 023,51
$1 208,67 		$1 201,02
$1 250,23
$1 302,35
$1 487,51 		$278,84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$729,00
$827,42
$931,66
$1 301,98
$1 978,50 		$1 007,84
$1 106,26
$1 210,50
$1 580,82 		$1 286,68
$1 385,10
$1 489,34
$1 859,66 		$1 565,52
$1 663,94
$1 768,18
$2 138,50 		$278,84
Toc - Plan #17 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201

Annual Out of Pocket Expenses
Individual Family
$8,000 $16,000 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$285,01
$323,48
$364,23
$509,02
$773,50 		$503,04
$541,51
$582,26
$727,05 		$721,07
$759,54
$800,29
$945,08 		$939,10
$977,57
$1 018,32
$1 163,11 		$218,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$570,02
$646,96
$728,46
$1 018,04
$1 547,00 		$788,05
$864,99
$946,49
$1 236,07 		$1 006,08
$1 083,02
$1 164,52
$1 454,10 		$1 224,11
$1 301,05
$1 382,55
$1 672,13 		$218,03
Toc - Plan #18 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204

Annual Out of Pocket Expenses
Individual Family
$2,450 $4,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$296,72
$336,77
$379,20
$529,93
$805,28 		$523,71
$563,76
$606,19
$756,92 		$750,70
$790,75
$833,18
$983,91 		$977,69
$1 017,74
$1 060,17
$1 210,90 		$226,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$593,44
$673,54
$758,40
$1 059,86
$1 610,56 		$820,43
$900,53
$985,39
$1 286,85 		$1 047,42
$1 127,52
$1 212,38
$1 513,84 		$1 274,41
$1 354,51
$1 439,37
$1 740,83 		$226,99
Toc - Plan #19 Quartz
Gold

(HMO) Quartz One Gold I404 HSA

Annual Out of Pocket Expenses
Individual Family
$2,000 $4,000 Annual Deductible
$6,650 $13,300 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$383,76
$435,56
$490,44
$685,39
$1 041,51 		$677,33
$729,13
$784,01
$978,96 		$970,90
$1 022,70
$1 077,58
$1 272,53 		$1 264,47
$1 316,27
$1 371,15
$1 566,10 		$293,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767,52
$871,12
$980,88
$1 370,78
$2 083,02 		$1 061,09
$1 164,69
$1 274,45
$1 664,35 		$1 354,66
$1 458,26
$1 568,02
$1 957,92 		$1 648,23
$1 751,83
$1 861,59
$2 251,49 		$293,57
Toc - Plan #20 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I203 HSA

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$291,92
$331,32
$373,07
$521,36
$792,25 		$515,23
$554,63
$596,38
$744,67 		$738,54
$777,94
$819,69
$967,98 		$961,85
$1 001,25
$1 043,00
$1 191,29 		$223,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$583,84
$662,64
$746,14
$1 042,72
$1 584,50 		$807,15
$885,95
$969,45
$1 266,03 		$1 030,46
$1 109,26
$1 192,76
$1 489,34 		$1 253,77
$1 332,57
$1 416,07
$1 712,65 		$223,31
Toc - Plan #21 Quartz
Catastrophic

(HMO) Quartz One Catastrophic I101

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$212,59
$241,28
$271,68
$379,67
$576,95 		$375,22
$403,91
$434,31
$542,30 		$537,85
$566,54
$596,94
$704,93 		$700,48
$729,17
$759,57
$867,56 		$162,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$425,18
$482,56
$543,36
$759,34
$1 153,90 		$587,81
$645,19
$705,99
$921,97 		$750,44
$807,82
$868,62
$1 084,60 		$913,07
$970,45
$1 031,25
$1 247,23 		$162,63
Toc - Plan #22 Quartz
Silver

(HMO) Quartz One Silver I304 HSA

Annual Out of Pocket Expenses
Individual Family
$5,250 $10,500 Annual Deductible
$5,250 $10,500 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$424,69
$482,02
$542,75
$758,49
$1 152,59 		$749,57
$806,90
$867,63
$1 083,37 		$1 074,45
$1 131,78
$1 192,51
$1 408,25 		$1 399,33
$1 456,66
$1 517,39
$1 733,13 		$324,88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$849,38
$964,04
$1 085,50
$1 516,98
$2 305,18 		$1 174,26
$1 288,92
$1 410,38
$1 841,86 		$1 499,14
$1 613,80
$1 735,26
$2 166,74 		$1 824,02
$1 938,68
$2 060,14
$2 491,62 		$324,88
Toc - Plan #23 Quartz
Gold

(HMO) Quartz One Gold I403 HSA

Annual Out of Pocket Expenses
Individual Family
$3,000 $6,000 Annual Deductible
$3,000 $6,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$389,41
$441,97
$497,66
$695,47
$1 056,84 		$687,30
$739,86
$795,55
$993,36 		$985,19
$1 037,75
$1 093,44
$1 291,25 		$1 283,08
$1 335,64
$1 391,33
$1 589,14 		$297,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$778,82
$883,94
$995,32
$1 390,94
$2 113,68 		$1 076,71
$1 181,83
$1 293,21
$1 688,83 		$1 374,60
$1 479,72
$1 591,10
$1 986,72 		$1 672,49
$1 777,61
$1 888,99
$2 284,61 		$297,89

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Dean Health Plan

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Toc - Plan #24 Dean Health Plan
Catastrophic

(HMO) Dean Catastrophic Safety Net

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$193,63
$219,78
$247,46
$345,83
$525,52 		$341,76
$367,91
$395,59
$493,96 		$489,89
$516,04
$543,72
$642,09 		$638,02
$664,17
$691,85
$790,22 		$148,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$387,26
$439,56
$494,92
$691,66
$1 051,04 		$535,39
$587,69
$643,05
$839,79 		$683,52
$735,82
$791,18
$987,92 		$831,65
$883,95
$939,31
$1 136,05 		$148,13
Toc - Plan #25 Dean Health Plan
Silver

(HMO) Dean Silver Copay Plus 4800X

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364,96
$414,23
$466,42
$651,82
$990,50 		$644,15
$693,42
$745,61
$931,01 		$923,34
$972,61
$1 024,80
$1 210,20 		$1 202,53
$1 251,80
$1 303,99
$1 489,39 		$279,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$729,92
$828,46
$932,84
$1 303,64
$1 981,00 		$1 009,11
$1 107,65
$1 212,03
$1 582,83 		$1 288,30
$1 386,84
$1 491,22
$1 862,02 		$1 567,49
$1 666,03
$1 770,41
$2 141,21 		$279,19
Toc - Plan #26 Dean Health Plan
Silver

(HMO) Dean Silver Classic 5000X

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$357,50
$405,77
$456,89
$638,50
$970,26 		$630,99
$679,26
$730,38
$911,99 		$904,48
$952,75
$1 003,87
$1 185,48 		$1 177,97
$1 226,24
$1 277,36
$1 458,97 		$273,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$715,00
$811,54
$913,78
$1 277,00
$1 940,52 		$988,49
$1 085,03
$1 187,27
$1 550,49 		$1 261,98
$1 358,52
$1 460,76
$1 823,98 		$1 535,47
$1 632,01
$1 734,25
$2 097,47 		$273,49
Toc - Plan #27 Dean Health Plan
Silver

(HMO) Dean Silver Value Copay 5000X

Annual Out of Pocket Expenses
Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$364,06
$413,21
$465,27
$650,21
$988,06 		$642,56
$691,71
$743,77
$928,71 		$921,06
$970,21
$1 022,27
$1 207,21 		$1 199,56
$1 248,71
$1 300,77
$1 485,71 		$278,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728,12
$826,42
$930,54
$1 300,42
$1 976,12 		$1 006,62
$1 104,92
$1 209,04
$1 578,92 		$1 285,12
$1 383,42
$1 487,54
$1 857,42 		$1 563,62
$1 661,92
$1 766,04
$2 135,92 		$278,50
Toc - Plan #28 Dean Health Plan
Gold

(HMO) Dean Gold Value Copay 3700X

Annual Out of Pocket Expenses
Individual Family
$3,700 $7,400 Annual Deductible
$3,700 $7,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$348,34
$395,36
$445,17
$622,13
$945,39 		$614,82
$661,84
$711,65
$888,61 		$881,30
$928,32
$978,13
$1 155,09 		$1 147,78
$1 194,80
$1 244,61
$1 421,57 		$266,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$696,68
$790,72
$890,34
$1 244,26
$1 890,78 		$963,16
$1 057,20
$1 156,82
$1 510,74 		$1 229,64
$1 323,68
$1 423,30
$1 777,22 		$1 496,12
$1 590,16
$1 689,78
$2 043,70 		$266,48
Toc - Plan #29 Dean Health Plan
Bronze

(HMO) Dean Bronze Value Copay 8500X

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$233,84
$265,41
$298,85
$417,64
$634,64 		$412,73
$444,30
$477,74
$596,53 		$591,62
$623,19
$656,63
$775,42 		$770,51
$802,08
$835,52
$954,31 		$178,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$467,68
$530,82
$597,70
$835,28
$1 269,28 		$646,57
$709,71
$776,59
$1 014,17 		$825,46
$888,60
$955,48
$1 193,06 		$1 004,35
$1 067,49
$1 134,37
$1 371,95 		$178,89
Toc - Plan #30 Dean Health Plan
Silver

(HMO) Dean Silver HSA-E 4500X

Annual Out of Pocket Expenses
Individual Family
$4,500 $9,000 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$349,30
$396,46
$446,41
$623,85
$948,00 		$616,51
$663,67
$713,62
$891,06 		$883,72
$930,88
$980,83
$1 158,27 		$1 150,93
$1 198,09
$1 248,04
$1 425,48 		$267,21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698,60
$792,92
$892,82
$1 247,70
$1 896,00 		$965,81
$1 060,13
$1 160,03
$1 514,91 		$1 233,02
$1 327,34
$1 427,24
$1 782,12 		$1 500,23
$1 594,55
$1 694,45
$2 049,33 		$267,21
Toc - Plan #31 Dean Health Plan
Gold

(HMO) Dean Gold Copay Plus 1500X

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,100 $10,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$359,52
$408,06
$459,47
$642,11
$975,74 		$634,55
$683,09
$734,50
$917,14 		$909,58
$958,12
$1 009,53
$1 192,17 		$1 184,61
$1 233,15
$1 284,56
$1 467,20 		$275,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$719,04
$816,12
$918,94
$1 284,22
$1 951,48 		$994,07
$1 091,15
$1 193,97
$1 559,25 		$1 269,10
$1 366,18
$1 469,00
$1 834,28 		$1 544,13
$1 641,21
$1 744,03
$2 109,31 		$275,03
Toc - Plan #32 Dean Health Plan
Expanded Bronze

(HMO) Dean Bronze HSA-E 6850X

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$248,38
$281,91
$317,43
$443,61
$674,11 		$438,39
$471,92
$507,44
$633,62 		$628,40
$661,93
$697,45
$823,63 		$818,41
$851,94
$887,46
$1 013,64 		$190,01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$496,76
$563,82
$634,86
$887,22
$1 348,22 		$686,77
$753,83
$824,87
$1 077,23 		$876,78
$943,84
$1 014,88
$1 267,24 		$1 066,79
$1 133,85
$1 204,89
$1 457,25 		$190,01
Toc - Plan #33 Dean Health Plan
Expanded Bronze

(HMO) Dean Bronze Copay Plus 8500X

Annual Out of Pocket Expenses
Individual Family
$8,500 $17,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$240,12
$272,53
$306,87
$428,85
$651,68 		$423,81
$456,22
$490,56
$612,54 		$607,50
$639,91
$674,25
$796,23 		$791,19
$823,60
$857,94
$979,92 		$183,69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$480,24
$545,06
$613,74
$857,70
$1 303,36 		$663,93
$728,75
$797,43
$1 041,39 		$847,62
$912,44
$981,12
$1 225,08 		$1 031,31
$1 096,13
$1 164,81
$1 408,77 		$183,69
Toc - Plan #34 Dean Health Plan
Gold

(HMO) Dean Gold Copay Elite 1500X

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$5,100 $10,200 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$341,78
$387,92
$436,80
$610,42
$927,59 		$603,24
$649,38
$698,26
$871,88 		$864,70
$910,84
$959,72
$1 133,34 		$1 126,16
$1 172,30
$1 221,18
$1 394,80 		$261,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$683,56
$775,84
$873,60
$1 220,84
$1 855,18 		$945,02
$1 037,30
$1 135,06
$1 482,30 		$1 206,48
$1 298,76
$1 396,52
$1 743,76 		$1 467,94
$1 560,22
$1 657,98
$2 005,22 		$261,46
Toc - Plan #35 Dean Health Plan
Silver

(HMO) Dean Silver Copay Elite 4800X

Annual Out of Pocket Expenses
Individual Family
$4,800 $9,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347,09
$393,95
$443,59
$619,91
$942,01 		$612,62
$659,48
$709,12
$885,44 		$878,15
$925,01
$974,65
$1 150,97 		$1 143,68
$1 190,54
$1 240,18
$1 416,50 		$265,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694,18
$787,90
$887,18
$1 239,82
$1 884,02 		$959,71
$1 053,43
$1 152,71
$1 505,35 		$1 225,24
$1 318,96
$1 418,24
$1 770,88 		$1 490,77
$1 584,49
$1 683,77
$2 036,41 		$265,53

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Group Health Cooperative-SCW

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Toc - Plan #36 Group Health Cooperative-SCW
Platinum

(HMO) Platinum 500 Ded/1500 MOOP

Annual Out of Pocket Expenses
Individual Family
$500 $1,000 Annual Deductible
$1,500 $3,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$431,21
$489,42
$551,08
$770,13
$1 170,29 		$761,09
$819,30
$880,96
$1 100,01 		$1 090,97
$1 149,18
$1 210,84
$1 429,89 		$1 420,85
$1 479,06
$1 540,72
$1 759,77 		$329,88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$862,42
$978,84
$1 102,16
$1 540,26
$2 340,58 		$1 192,30
$1 308,72
$1 432,04
$1 870,14 		$1 522,18
$1 638,60
$1 761,92
$2 200,02 		$1 852,06
$1 968,48
$2 091,80
$2 529,90 		$329,88
Toc - Plan #37 Group Health Cooperative-SCW
Gold

(HMO) Gold 2500 Ded/2500 MOOP HSA

Annual Out of Pocket Expenses
Individual Family
$2,500 $5,000 Annual Deductible
$2,500 $5,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352,53
$400,13
$450,54
$629,62
$956,77 		$622,22
$669,82
$720,23
$899,31 		$891,91
$939,51
$989,92
$1 169,00 		$1 161,60
$1 209,20
$1 259,61
$1 438,69 		$269,69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705,06
$800,26
$901,08
$1 259,24
$1 913,54 		$974,75
$1 069,95
$1 170,77
$1 528,93 		$1 244,44
$1 339,64
$1 440,46
$1 798,62 		$1 514,13
$1 609,33
$1 710,15
$2 068,31 		$269,69
Toc - Plan #38 Group Health Cooperative-SCW
Expanded Bronze

(HMO) Bronze 4000 Ded/8500 MOOP

Annual Out of Pocket Expenses
Individual Family
$4,000 $8,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$274,92
$312,03
$351,34
$491,00
$746,12 		$485,23
$522,34
$561,65
$701,31 		$695,54
$732,65
$771,96
$911,62 		$905,85
$942,96
$982,27
$1 121,93 		$210,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$549,84
$624,06
$702,68
$982,00
$1 492,24 		$760,15
$834,37
$912,99
$1 192,31 		$970,46
$1 044,68
$1 123,30
$1 402,62 		$1 180,77
$1 254,99
$1 333,61
$1 612,93 		$210,31
Toc - Plan #39 Group Health Cooperative-SCW
Expanded Bronze

(HMO) Bronze 7000 Ded/7000 MOOP HSA

Annual Out of Pocket Expenses
Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$275,07
$312,20
$351,53
$491,26
$746,52 		$485,50
$522,63
$561,96
$701,69 		$695,93
$733,06
$772,39
$912,12 		$906,36
$943,49
$982,82
$1 122,55 		$210,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$550,14
$624,40
$703,06
$982,52
$1 493,04 		$760,57
$834,83
$913,49
$1 192,95 		$971,00
$1 045,26
$1 123,92
$1 403,38 		$1 181,43
$1 255,69
$1 334,35
$1 613,81 		$210,43
Toc - Plan #40 Group Health Cooperative-SCW
Gold

(HMO) Gold 2500 Ded/6500 MOOP

Annual Out of Pocket Expenses
Individual Family
$2,500 $5,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$348,87
$395,96
$445,85
$623,07
$946,81 		$615,75
$662,84
$712,73
$889,95 		$882,63
$929,72
$979,61
$1 156,83 		$1 149,51
$1 196,60
$1 246,49
$1 423,71 		$266,88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$697,74
$791,92
$891,70
$1 246,14
$1 893,62 		$964,62
$1 058,80
$1 158,58
$1 513,02 		$1 231,50
$1 325,68
$1 425,46
$1 779,90 		$1 498,38
$1 592,56
$1 692,34
$2 046,78 		$266,88
Toc - Plan #41 Group Health Cooperative-SCW
Gold

(HMO) Gold Simple Choice 1600 Ded/5400 MOOP

Annual Out of Pocket Expenses
Individual Family
$1,600 $3,200 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$359,04
$407,51
$458,86
$641,25
$974,43 		$633,71
$682,18
$733,53
$915,92 		$908,38
$956,85
$1 008,20
$1 190,59 		$1 183,05
$1 231,52
$1 282,87
$1 465,26 		$274,67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718,08
$815,02
$917,72
$1 282,50
$1 948,86 		$992,75
$1 089,69
$1 192,39
$1 557,17 		$1 267,42
$1 364,36
$1 467,06
$1 831,84 		$1 542,09
$1 639,03
$1 741,73
$2 106,51 		$274,67
Toc - Plan #42 Group Health Cooperative-SCW
Silver

(HMO) Silver Simple Choice 4550X Ded/7900 MOOP

Annual Out of Pocket Expenses
Individual Family
$4,000 $8,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393,13
$446,20
$502,42
$702,12
$1 066,94 		$693,87
$746,94
$803,16
$1 002,86 		$994,61
$1 047,68
$1 103,90
$1 303,60 		$1 295,35
$1 348,42
$1 404,64
$1 604,34 		$300,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786,26
$892,40
$1 004,84
$1 404,24
$2 133,88 		$1 087,00
$1 193,14
$1 305,58
$1 704,98 		$1 387,74
$1 493,88
$1 606,32
$2 005,72 		$1 688,48
$1 794,62
$1 907,06
$2 306,46 		$300,74
Toc - Plan #43 Group Health Cooperative-SCW
Expanded Bronze

(HMO) Bronze Simple Choice 6850 Ded/8200 MOOP

Annual Out of Pocket Expenses
Individual Family
$6,850 $13,700 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$284,09
$322,44
$363,07
$507,38
$771,01 		$501,42
$539,77
$580,40
$724,71 		$718,75
$757,10
$797,73
$942,04 		$936,08
$974,43
$1 015,06
$1 159,37 		$217,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$568,18
$644,88
$726,14
$1 014,76
$1 542,02 		$785,51
$862,21
$943,47
$1 232,09 		$1 002,84
$1 079,54
$1 160,80
$1 449,42 		$1 220,17
$1 296,87
$1 378,13
$1 666,75 		$217,33
Toc - Plan #44 Group Health Cooperative-SCW
Platinum

(HMO) Platinum No Ded/2000 MOOP

Annual Out of Pocket Expenses
Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$435,73
$494,55
$556,86
$778,20
$1 182,55 		$769,06
$827,88
$890,19
$1 111,53 		$1 102,39
$1 161,21
$1 223,52
$1 444,86 		$1 435,72
$1 494,54
$1 556,85
$1 778,19 		$333,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$871,46
$989,10
$1 113,72
$1 556,40
$2 365,10 		$1 204,79
$1 322,43
$1 447,05
$1 889,73 		$1 538,12
$1 655,76
$1 780,38
$2 223,06 		$1 871,45
$1 989,09
$2 113,71
$2 556,39 		$333,33
Toc - Plan #45 Group Health Cooperative-SCW
Bronze

(HMO) Bronze 8550 Ded/8550 MOOP

Annual Out of Pocket Expenses
Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$270,02
$306,47
$345,08
$482,24
$732,81 		$476,58
$513,03
$551,64
$688,80 		$683,14
$719,59
$758,20
$895,36 		$889,70
$926,15
$964,76
$1 101,92 		$206,56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$540,04
$612,94
$690,16
$964,48
$1 465,62 		$746,60
$819,50
$896,72
$1 171,04 		$953,16
$1 026,06
$1 103,28
$1 377,60 		$1 159,72
$1 232,62
$1 309,84
$1 584,16 		$206,56
Toc - Plan #46 Group Health Cooperative-SCW
Silver

(HMO) Silver 4900 Ded/7900 MOOP

Annual Out of Pocket Expenses
Individual Family
$4,900 $9,800 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$440,99
$500,52
$563,58
$787,61
$1 196,84 		$778,35
$837,88
$900,94
$1 124,97 		$1 115,71
$1 175,24
$1 238,30
$1 462,33 		$1 453,07
$1 512,60
$1 575,66
$1 799,69 		$337,36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$881,98
$1 001,04
$1 127,16
$1 575,22
$2 393,68 		$1 219,34
$1 338,40
$1 464,52
$1 912,58 		$1 556,70
$1 675,76
$1 801,88
$2 249,94 		$1 894,06
$2 013,12
$2 139,24
$2 587,30 		$337,36
Toc - Plan #47 Group Health Cooperative-SCW
Gold

(HMO) Gold 1500 Ded/8550 MOOP

Annual Out of Pocket Expenses
Individual Family
$1,500 $3,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$336,70
$382,16
$430,31
$601,35
$913,80 		$594,28
$639,74
$687,89
$858,93 		$851,86
$897,32
$945,47
$1 116,51 		$1 109,44
$1 154,90
$1 203,05
$1 374,09 		$257,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$673,40
$764,32
$860,62
$1 202,70
$1 827,60 		$930,98
$1 021,90
$1 118,20
$1 460,28 		$1 188,56
$1 279,48
$1 375,78
$1 717,86 		$1 446,14
$1 537,06
$1 633,36
$1 975,44 		$257,58
Toc - Plan #48 Group Health Cooperative-SCW
Silver

(HMO) Silver 8100X Ded/8150 MOOP

Annual Out of Pocket Expenses
Individual Family
$7,400 $14,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year
Monthly Premiums:
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$408,54
$463,69
$522,11
$729,65
$1 108,76 		$721,07
$776,22
$834,64
$1 042,18 		$1 033,60
$1 088,75
$1 147,17
$1 354,71 		$1 346,13
$1 401,28
$1 459,70
$1 667,24 		$312,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$817,08
$927,38
$1 044,22
$1 459,30
$2 217,52 		$1 129,61
$1 239,91
$1 356,75
$1 771,83 		$1 442,14
$1 552,44
$1 669,28
$2 084,36 		$1 754,67
$1 864,97
$1 981,81
$2 396,89 		$312,53

‡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 Iowa County here.

Iowa County is in “Rating Area 7” of Wisconsin.

Currently, there are 48 plans offered in Rating Area 7.

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