La Crosse County, Wisconsin Obamacare 2024 Rates

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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 La Crosse County, WI.

The health insurance rates listed below are for calendar year 2024.

For information on 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

Obamacare Providers, 42 Plans and 2024 Rates for La Crosse County, Wisconsin

Below, you’ll find a summary of the 42 plans for La Crosse 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

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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
Gold

(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$488.56
$554.51
$624.37
$872.56
$1,325.94
$862.30
$928.25
$998.11
$1,246.30
$1,236.04
$1,301.99
$1,371.85
$1,620.04
$1,609.78
$1,675.73
$1,745.59
$1,993.78
$373.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$977.12
$1,109.02
$1,248.74
$1,745.12
$2,651.88
$1,350.86
$1,482.76
$1,622.48
$2,118.86
$1,724.60
$1,856.50
$1,996.22
$2,492.60
$2,098.34
$2,230.24
$2,369.96
$2,866.34
$373.74
Toc - Plan #2 Quartz
Gold

(HMO) QUARTZ ONE GOLD I410 STANDARD W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$492.36
$558.83
$629.23
$879.35
$1,336.26
$869.01
$935.48
$1,005.88
$1,256.00
$1,245.66
$1,312.13
$1,382.53
$1,632.65
$1,622.31
$1,688.78
$1,759.18
$2,009.30
$376.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$984.72
$1,117.66
$1,258.46
$1,758.70
$2,672.52
$1,361.37
$1,494.31
$1,635.11
$2,135.35
$1,738.02
$1,870.96
$2,011.76
$2,512.00
$2,114.67
$2,247.61
$2,388.41
$2,888.65
$376.65
Toc - Plan #3 Quartz
Silver

(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$520.47
$590.72
$665.15
$929.54
$1,412.53
$918.62
$988.87
$1,063.30
$1,327.69
$1,316.77
$1,387.02
$1,461.45
$1,725.84
$1,714.92
$1,785.17
$1,859.60
$2,123.99
$398.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,040.94
$1,181.44
$1,330.30
$1,859.08
$2,825.06
$1,439.09
$1,579.59
$1,728.45
$2,257.23
$1,837.24
$1,977.74
$2,126.60
$2,655.38
$2,235.39
$2,375.89
$2,524.75
$3,053.53
$398.15
Toc - Plan #4 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.25
$439.52
$494.89
$691.61
$1,050.97
$683.49
$735.76
$791.13
$987.85
$979.73
$1,032.00
$1,087.37
$1,284.09
$1,275.97
$1,328.24
$1,383.61
$1,580.33
$296.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774.50
$879.04
$989.78
$1,383.22
$2,101.94
$1,070.74
$1,175.28
$1,286.02
$1,679.46
$1,366.98
$1,471.52
$1,582.26
$1,975.70
$1,663.22
$1,767.76
$1,878.50
$2,271.94
$296.24
Toc - Plan #5 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376.89
$427.76
$481.66
$673.11
$1,022.86
$665.21
$716.08
$769.98
$961.43
$953.53
$1,004.40
$1,058.30
$1,249.75
$1,241.85
$1,292.72
$1,346.62
$1,538.07
$288.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753.78
$855.52
$963.32
$1,346.22
$2,045.72
$1,042.10
$1,143.84
$1,251.64
$1,634.54
$1,330.42
$1,432.16
$1,539.96
$1,922.86
$1,618.74
$1,720.48
$1,828.28
$2,211.18
$288.32
Toc - Plan #6 Quartz
Silver

(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$532.85
$604.78
$680.97
$951.66
$1,446.14
$940.48
$1,012.41
$1,088.60
$1,359.29
$1,348.11
$1,420.04
$1,496.23
$1,766.92
$1,755.74
$1,827.67
$1,903.86
$2,174.55
$407.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,065.70
$1,209.56
$1,361.94
$1,903.32
$2,892.28
$1,473.33
$1,617.19
$1,769.57
$2,310.95
$1,880.96
$2,024.82
$2,177.20
$2,718.58
$2,288.59
$2,432.45
$2,584.83
$3,126.21
$407.63
Toc - Plan #7 Quartz
Gold

(HMO) QUARTZ ONE GOLD I420 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$447.66
$508.09
$572.11
$799.51
$1,214.94
$790.12
$850.55
$914.57
$1,141.97
$1,132.58
$1,193.01
$1,257.03
$1,484.43
$1,475.04
$1,535.47
$1,599.49
$1,826.89
$342.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.32
$1,016.18
$1,144.22
$1,599.02
$2,429.88
$1,237.78
$1,358.64
$1,486.68
$1,941.48
$1,580.24
$1,701.10
$1,829.14
$2,283.94
$1,922.70
$2,043.56
$2,171.60
$2,626.40
$342.46
Toc - Plan #8 Quartz
Gold

(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$465.27
$528.08
$594.61
$830.96
$1,262.73
$821.20
$884.01
$950.54
$1,186.89
$1,177.13
$1,239.94
$1,306.47
$1,542.82
$1,533.06
$1,595.87
$1,662.40
$1,898.75
$355.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$930.54
$1,056.16
$1,189.22
$1,661.92
$2,525.46
$1,286.47
$1,412.09
$1,545.15
$2,017.85
$1,642.40
$1,768.02
$1,901.08
$2,373.78
$1,998.33
$2,123.95
$2,257.01
$2,729.71
$355.93
Toc - Plan #9 Quartz
Gold

(HMO) QUARTZ ONE GOLD I410 STANDARD

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$468.89
$532.19
$599.24
$837.44
$1,272.56
$827.59
$890.89
$957.94
$1,196.14
$1,186.29
$1,249.59
$1,316.64
$1,554.84
$1,544.99
$1,608.29
$1,675.34
$1,913.54
$358.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$937.78
$1,064.38
$1,198.48
$1,674.88
$2,545.12
$1,296.48
$1,423.08
$1,557.18
$2,033.58
$1,655.18
$1,781.78
$1,915.88
$2,392.28
$2,013.88
$2,140.48
$2,274.58
$2,750.98
$358.70
Toc - Plan #10 Quartz
Silver

(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$495.66
$562.56
$633.44
$885.23
$1,345.20
$874.83
$941.73
$1,012.61
$1,264.40
$1,254.00
$1,320.90
$1,391.78
$1,643.57
$1,633.17
$1,700.07
$1,770.95
$2,022.74
$379.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$991.32
$1,125.12
$1,266.88
$1,770.46
$2,690.40
$1,370.49
$1,504.29
$1,646.05
$2,149.63
$1,749.66
$1,883.46
$2,025.22
$2,528.80
$2,128.83
$2,262.63
$2,404.39
$2,907.97
$379.17
Toc - Plan #11 Quartz
Silver

(HMO) QUARTZ ONE SILVER I309 STANDARD

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$482.44
$547.56
$616.55
$861.62
$1,309.32
$851.50
$916.62
$985.61
$1,230.68
$1,220.56
$1,285.68
$1,354.67
$1,599.74
$1,589.62
$1,654.74
$1,723.73
$1,968.80
$369.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$964.88
$1,095.12
$1,233.10
$1,723.24
$2,618.64
$1,333.94
$1,464.18
$1,602.16
$2,092.30
$1,703.00
$1,833.24
$1,971.22
$2,461.36
$2,072.06
$2,202.30
$2,340.28
$2,830.42
$369.06
Toc - Plan #12 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368.79
$418.57
$471.30
$658.64
$1,000.87
$650.91
$700.69
$753.42
$940.76
$933.03
$982.81
$1,035.54
$1,222.88
$1,215.15
$1,264.93
$1,317.66
$1,505.00
$282.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737.58
$837.14
$942.60
$1,317.28
$2,001.74
$1,019.70
$1,119.26
$1,224.72
$1,599.40
$1,301.82
$1,401.38
$1,506.84
$1,881.52
$1,583.94
$1,683.50
$1,788.96
$2,163.64
$282.12
Toc - Plan #13 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$358.92
$407.37
$458.70
$641.03
$974.11
$633.49
$681.94
$733.27
$915.60
$908.06
$956.51
$1,007.84
$1,190.17
$1,182.63
$1,231.08
$1,282.41
$1,464.74
$274.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$717.84
$814.74
$917.40
$1,282.06
$1,948.22
$992.41
$1,089.31
$1,191.97
$1,556.63
$1,266.98
$1,363.88
$1,466.54
$1,831.20
$1,541.55
$1,638.45
$1,741.11
$2,105.77
$274.57
Toc - Plan #14 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I206 STANDARD

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$342.56
$388.80
$437.79
$611.80
$929.70
$604.61
$650.85
$699.84
$873.85
$866.66
$912.90
$961.89
$1,135.90
$1,128.71
$1,174.95
$1,223.94
$1,397.95
$262.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$685.12
$777.60
$875.58
$1,223.60
$1,859.40
$947.17
$1,039.65
$1,137.63
$1,485.65
$1,209.22
$1,301.70
$1,399.68
$1,747.70
$1,471.27
$1,563.75
$1,661.73
$2,009.75
$262.05
Toc - Plan #15 Quartz
Silver

(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$507.45
$575.95
$648.51
$906.30
$1,377.20
$895.64
$964.14
$1,036.70
$1,294.49
$1,283.83
$1,352.33
$1,424.89
$1,682.68
$1,672.02
$1,740.52
$1,813.08
$2,070.87
$388.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,014.90
$1,151.90
$1,297.02
$1,812.60
$2,754.40
$1,403.09
$1,540.09
$1,685.21
$2,200.79
$1,791.28
$1,928.28
$2,073.40
$2,588.98
$2,179.47
$2,316.47
$2,461.59
$2,977.17
$388.19
Toc - Plan #16 Quartz
Gold

(HMO) QUARTZ ONE GOLD I401 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.89
$500.40
$563.45
$787.42
$1,196.56
$778.17
$837.68
$900.73
$1,124.70
$1,115.45
$1,174.96
$1,238.01
$1,461.98
$1,452.73
$1,512.24
$1,575.29
$1,799.26
$337.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.78
$1,000.80
$1,126.90
$1,574.84
$2,393.12
$1,219.06
$1,338.08
$1,464.18
$1,912.12
$1,556.34
$1,675.36
$1,801.46
$2,249.40
$1,893.62
$2,012.64
$2,138.74
$2,586.68
$337.28
Toc - Plan #17 Quartz
Silver

(HMO) QUARTZ ONE SILVER I303 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.53
$535.18
$602.61
$842.14
$1,279.72
$832.25
$895.90
$963.33
$1,202.86
$1,192.97
$1,256.62
$1,324.05
$1,563.58
$1,553.69
$1,617.34
$1,684.77
$1,924.30
$360.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$943.06
$1,070.36
$1,205.22
$1,684.28
$2,559.44
$1,303.78
$1,431.08
$1,565.94
$2,045.00
$1,664.50
$1,791.80
$1,926.66
$2,405.72
$2,025.22
$2,152.52
$2,287.38
$2,766.44
$360.72
Toc - Plan #18 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I201 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$9,400 $18,800 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$322.80
$366.37
$412.53
$576.52
$876.07
$569.74
$613.31
$659.47
$823.46
$816.68
$860.25
$906.41
$1,070.40
$1,063.62
$1,107.19
$1,153.35
$1,317.34
$246.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$645.60
$732.74
$825.06
$1,153.04
$1,752.14
$892.54
$979.68
$1,072.00
$1,399.98
$1,139.48
$1,226.62
$1,318.94
$1,646.92
$1,386.42
$1,473.56
$1,565.88
$1,893.86
$246.94
Toc - Plan #19 Quartz
Expanded Bronze

(HMO) QUARTZ ONE BRONZE I203 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$350.84
$398.20
$448.37
$626.60
$952.17
$619.23
$666.59
$716.76
$894.99
$887.62
$934.98
$985.15
$1,163.38
$1,156.01
$1,203.37
$1,253.54
$1,431.77
$268.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701.68
$796.40
$896.74
$1,253.20
$1,904.34
$970.07
$1,064.79
$1,165.13
$1,521.59
$1,238.46
$1,333.18
$1,433.52
$1,789.98
$1,506.85
$1,601.57
$1,701.91
$2,058.37
$268.39
Toc - Plan #20 Quartz
Catastrophic

(HMO) QUARTZ ONE CATASTROPHIC I101

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$254.73
$289.11
$325.54
$454.94
$691.32
$449.59
$483.97
$520.40
$649.80
$644.45
$678.83
$715.26
$844.66
$839.31
$873.69
$910.12
$1,039.52
$194.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$509.46
$578.22
$651.08
$909.88
$1,382.64
$704.32
$773.08
$845.94
$1,104.74
$899.18
$967.94
$1,040.80
$1,299.60
$1,094.04
$1,162.80
$1,235.66
$1,494.46
$194.86
Toc - Plan #21 Quartz
Silver

(HMO) QUARTZ ONE SILVER I304 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$500.11
$567.62
$639.13
$893.19
$1,357.28
$882.69
$950.20
$1,021.71
$1,275.77
$1,265.27
$1,332.78
$1,404.29
$1,658.35
$1,647.85
$1,715.36
$1,786.87
$2,040.93
$382.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,000.22
$1,135.24
$1,278.26
$1,786.38
$2,714.56
$1,382.80
$1,517.82
$1,660.84
$2,168.96
$1,765.38
$1,900.40
$2,043.42
$2,551.54
$2,147.96
$2,282.98
$2,426.00
$2,934.12
$382.58
Toc - Plan #22 Quartz
Gold

(HMO) QUARTZ ONE GOLD I403 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$3,500 $7,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$458.82
$520.76
$586.37
$819.45
$1,245.23
$809.82
$871.76
$937.37
$1,170.45
$1,160.82
$1,222.76
$1,288.37
$1,521.45
$1,511.82
$1,573.76
$1,639.37
$1,872.45
$351.00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$917.64
$1,041.52
$1,172.74
$1,638.90
$2,490.46
$1,268.64
$1,392.52
$1,523.74
$1,989.90
$1,619.64
$1,743.52
$1,874.74
$2,340.90
$1,970.64
$2,094.52
$2,225.74
$2,691.90
$351.00

ADVERTISEMENT

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-947-3529

Toc - Plan #23 Medica
Gold

(EPO) Engage by Medica Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$474.97
$539.09
$607.01
$848.30
$1,289.07
$838.32
$902.44
$970.36
$1,211.65
$1,201.67
$1,265.79
$1,333.71
$1,575.00
$1,565.02
$1,629.14
$1,697.06
$1,938.35
$363.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$949.94
$1,078.18
$1,214.02
$1,696.60
$2,578.14
$1,313.29
$1,441.53
$1,577.37
$2,059.95
$1,676.64
$1,804.88
$1,940.72
$2,423.30
$2,039.99
$2,168.23
$2,304.07
$2,786.65
$363.35
Toc - Plan #24 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373.06
$423.42
$476.77
$666.29
$1,012.49
$658.45
$708.81
$762.16
$951.68
$943.84
$994.20
$1,047.55
$1,237.07
$1,229.23
$1,279.59
$1,332.94
$1,522.46
$285.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$746.12
$846.84
$953.54
$1,332.58
$2,024.98
$1,031.51
$1,132.23
$1,238.93
$1,617.97
$1,316.90
$1,417.62
$1,524.32
$1,903.36
$1,602.29
$1,703.01
$1,809.71
$2,188.75
$285.39
Toc - Plan #25 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,750 $13,500 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$396.96
$450.55
$507.31
$708.96
$1,077.34
$700.63
$754.22
$810.98
$1,012.63
$1,004.30
$1,057.89
$1,114.65
$1,316.30
$1,307.97
$1,361.56
$1,418.32
$1,619.97
$303.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$793.92
$901.10
$1,014.62
$1,417.92
$2,154.68
$1,097.59
$1,204.77
$1,318.29
$1,721.59
$1,401.26
$1,508.44
$1,621.96
$2,025.26
$1,704.93
$1,812.11
$1,925.63
$2,328.93
$303.67
Toc - Plan #26 Medica
Silver

(EPO) Engage by Medica Silver Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$467.43
$530.53
$597.38
$834.83
$1,268.61
$825.02
$888.12
$954.97
$1,192.42
$1,182.61
$1,245.71
$1,312.56
$1,550.01
$1,540.20
$1,603.30
$1,670.15
$1,907.60
$357.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$934.86
$1,061.06
$1,194.76
$1,669.66
$2,537.22
$1,292.45
$1,418.65
$1,552.35
$2,027.25
$1,650.04
$1,776.24
$1,909.94
$2,384.84
$2,007.63
$2,133.83
$2,267.53
$2,742.43
$357.59
Toc - Plan #27 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376.78
$427.65
$481.53
$672.93
$1,022.59
$665.02
$715.89
$769.77
$961.17
$953.26
$1,004.13
$1,058.01
$1,249.41
$1,241.50
$1,292.37
$1,346.25
$1,537.65
$288.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753.56
$855.30
$963.06
$1,345.86
$2,045.18
$1,041.80
$1,143.54
$1,251.30
$1,634.10
$1,330.04
$1,431.78
$1,539.54
$1,922.34
$1,618.28
$1,720.02
$1,827.78
$2,210.58
$288.24
Toc - Plan #28 Medica
Gold

(EPO) Engage by Medica Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$489.92
$556.05
$626.11
$874.99
$1,329.63
$864.71
$930.84
$1,000.90
$1,249.78
$1,239.50
$1,305.63
$1,375.69
$1,624.57
$1,614.29
$1,680.42
$1,750.48
$1,999.36
$374.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$979.84
$1,112.10
$1,252.22
$1,749.98
$2,659.26
$1,354.63
$1,486.89
$1,627.01
$2,124.77
$1,729.42
$1,861.68
$2,001.80
$2,499.56
$2,104.21
$2,236.47
$2,376.59
$2,874.35
$374.79
Toc - Plan #29 Medica
Silver

(EPO) Engage by Medica Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$459.99
$522.09
$587.87
$821.54
$1,248.41
$811.88
$873.98
$939.76
$1,173.43
$1,163.77
$1,225.87
$1,291.65
$1,525.32
$1,515.66
$1,577.76
$1,643.54
$1,877.21
$351.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$919.98
$1,044.18
$1,175.74
$1,643.08
$2,496.82
$1,271.87
$1,396.07
$1,527.63
$1,994.97
$1,623.76
$1,747.96
$1,879.52
$2,346.86
$1,975.65
$2,099.85
$2,231.41
$2,698.75
$351.89
Toc - Plan #30 Medica
Bronze

(EPO) Engage by Medica Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344.79
$391.33
$440.64
$615.79
$935.76
$608.55
$655.09
$704.40
$879.55
$872.31
$918.85
$968.16
$1,143.31
$1,136.07
$1,182.61
$1,231.92
$1,407.07
$263.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$689.58
$782.66
$881.28
$1,231.58
$1,871.52
$953.34
$1,046.42
$1,145.04
$1,495.34
$1,217.10
$1,310.18
$1,408.80
$1,759.10
$1,480.86
$1,573.94
$1,672.56
$2,022.86
$263.76
Toc - Plan #31 Medica
Expanded Bronze

(EPO) Engage by Medica Expanded Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.68
$421.86
$475.01
$663.83
$1,008.75
$656.02
$706.20
$759.35
$948.17
$940.36
$990.54
$1,043.69
$1,232.51
$1,224.70
$1,274.88
$1,328.03
$1,516.85
$284.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.36
$843.72
$950.02
$1,327.66
$2,017.50
$1,027.70
$1,128.06
$1,234.36
$1,612.00
$1,312.04
$1,412.40
$1,518.70
$1,896.34
$1,596.38
$1,696.74
$1,803.04
$2,180.68
$284.34

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

Local: 1-855-748-1813 | Toll Free: 1-855-748-1813

Toc - Plan #32 Anthem Blue Cross and Blue Shield
Expanded Bronze

(POS) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$490.70
$556.94
$627.11
$876.39
$1,331.76
$866.09
$932.33
$1,002.50
$1,251.78
$1,241.48
$1,307.72
$1,377.89
$1,627.17
$1,616.87
$1,683.11
$1,753.28
$2,002.56
$375.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$981.40
$1,113.88
$1,254.22
$1,752.78
$2,663.52
$1,356.79
$1,489.27
$1,629.61
$2,128.17
$1,732.18
$1,864.66
$2,005.00
$2,503.56
$2,107.57
$2,240.05
$2,380.39
$2,878.95
$375.39
Toc - Plan #33 Anthem Blue Cross and Blue Shield
Silver

(POS) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$7,700 $15,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$580.82
$659.23
$742.29
$1,037.34
$1,576.35
$1,025.15
$1,103.56
$1,186.62
$1,481.67
$1,469.48
$1,547.89
$1,630.95
$1,926.00
$1,913.81
$1,992.22
$2,075.28
$2,370.33
$444.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,161.64
$1,318.46
$1,484.58
$2,074.68
$3,152.70
$1,605.97
$1,762.79
$1,928.91
$2,519.01
$2,050.30
$2,207.12
$2,373.24
$2,963.34
$2,494.63
$2,651.45
$2,817.57
$3,407.67
$444.33
Toc - Plan #34 Anthem Blue Cross and Blue Shield
Bronze

(POS) Anthem Bronze Blue Preferred/Broad 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$444.65
$504.68
$568.26
$794.14
$1,206.78
$784.81
$844.84
$908.42
$1,134.30
$1,124.97
$1,185.00
$1,248.58
$1,474.46
$1,465.13
$1,525.16
$1,588.74
$1,814.62
$340.16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$889.30
$1,009.36
$1,136.52
$1,588.28
$2,413.56
$1,229.46
$1,349.52
$1,476.68
$1,928.44
$1,569.62
$1,689.68
$1,816.84
$2,268.60
$1,909.78
$2,029.84
$2,157.00
$2,608.76
$340.16
Toc - Plan #35 Anthem Blue Cross and Blue Shield
Expanded Bronze

(POS) Anthem Bronze Blue Preferred/Broad 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$466.44
$529.41
$596.11
$833.06
$1,265.92
$823.27
$886.24
$952.94
$1,189.89
$1,180.10
$1,243.07
$1,309.77
$1,546.72
$1,536.93
$1,599.90
$1,666.60
$1,903.55
$356.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$932.88
$1,058.82
$1,192.22
$1,666.12
$2,531.84
$1,289.71
$1,415.65
$1,549.05
$2,022.95
$1,646.54
$1,772.48
$1,905.88
$2,379.78
$2,003.37
$2,129.31
$2,262.71
$2,736.61
$356.83
Toc - Plan #36 Anthem Blue Cross and Blue Shield
Expanded Bronze

(POS) Anthem Bronze Blue Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$468.22
$531.43
$598.39
$836.24
$1,270.75
$826.41
$889.62
$956.58
$1,194.43
$1,184.60
$1,247.81
$1,314.77
$1,552.62
$1,542.79
$1,606.00
$1,672.96
$1,910.81
$358.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$936.44
$1,062.86
$1,196.78
$1,672.48
$2,541.50
$1,294.63
$1,421.05
$1,554.97
$2,030.67
$1,652.82
$1,779.24
$1,913.16
$2,388.86
$2,011.01
$2,137.43
$2,271.35
$2,747.05
$358.19
Toc - Plan #37 Anthem Blue Cross and Blue Shield
Silver

(POS) Anthem Silver Blue Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$567.18
$643.75
$724.86
$1,012.98
$1,539.33
$1,001.07
$1,077.64
$1,158.75
$1,446.87
$1,434.96
$1,511.53
$1,592.64
$1,880.76
$1,868.85
$1,945.42
$2,026.53
$2,314.65
$433.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,134.36
$1,287.50
$1,449.72
$2,025.96
$3,078.66
$1,568.25
$1,721.39
$1,883.61
$2,459.85
$2,002.14
$2,155.28
$2,317.50
$2,893.74
$2,436.03
$2,589.17
$2,751.39
$3,327.63
$433.89
Toc - Plan #38 Anthem Blue Cross and Blue Shield
Gold

(POS) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,800 $13,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$621.09
$704.94
$793.75
$1,109.27
$1,685.64
$1,096.22
$1,180.07
$1,268.88
$1,584.40
$1,571.35
$1,655.20
$1,744.01
$2,059.53
$2,046.48
$2,130.33
$2,219.14
$2,534.66
$475.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,242.18
$1,409.88
$1,587.50
$2,218.54
$3,371.28
$1,717.31
$1,885.01
$2,062.63
$2,693.67
$2,192.44
$2,360.14
$2,537.76
$3,168.80
$2,667.57
$2,835.27
$3,012.89
$3,643.93
$475.13
Toc - Plan #39 Anthem Blue Cross and Blue Shield
Expanded Bronze

(POS) Anthem Bronze Blue Preferred/Broad 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$466.85
$529.87
$596.63
$833.79
$1,267.03
$823.99
$887.01
$953.77
$1,190.93
$1,181.13
$1,244.15
$1,310.91
$1,548.07
$1,538.27
$1,601.29
$1,668.05
$1,905.21
$357.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$933.70
$1,059.74
$1,193.26
$1,667.58
$2,534.06
$1,290.84
$1,416.88
$1,550.40
$2,024.72
$1,647.98
$1,774.02
$1,907.54
$2,381.86
$2,005.12
$2,131.16
$2,264.68
$2,739.00
$357.14
Toc - Plan #40 Anthem Blue Cross and Blue Shield
Silver

(POS) Anthem Silver Blue Preferred/Broad 5900/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$566.72
$643.23
$724.27
$1,012.16
$1,538.08
$1,000.26
$1,076.77
$1,157.81
$1,445.70
$1,433.80
$1,510.31
$1,591.35
$1,879.24
$1,867.34
$1,943.85
$2,024.89
$2,312.78
$433.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,133.44
$1,286.46
$1,448.54
$2,024.32
$3,076.16
$1,566.98
$1,720.00
$1,882.08
$2,457.86
$2,000.52
$2,153.54
$2,315.62
$2,891.40
$2,434.06
$2,587.08
$2,749.16
$3,324.94
$433.54
Toc - Plan #41 Anthem Blue Cross and Blue Shield
Gold

(POS) Anthem Gold Blue Preferred/Broad 1500/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$632.77
$718.19
$808.68
$1,130.13
$1,717.34
$1,116.84
$1,202.26
$1,292.75
$1,614.20
$1,600.91
$1,686.33
$1,776.82
$2,098.27
$2,084.98
$2,170.40
$2,260.89
$2,582.34
$484.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,265.54
$1,436.38
$1,617.36
$2,260.26
$3,434.68
$1,749.61
$1,920.45
$2,101.43
$2,744.33
$2,233.68
$2,404.52
$2,585.50
$3,228.40
$2,717.75
$2,888.59
$3,069.57
$3,712.47
$484.07
Toc - Plan #42 Anthem Blue Cross and Blue Shield
Silver

(POS) Anthem Silver Blue Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$580.50
$658.87
$741.88
$1,036.77
$1,575.48
$1,024.58
$1,102.95
$1,185.96
$1,480.85
$1,468.66
$1,547.03
$1,630.04
$1,924.93
$1,912.74
$1,991.11
$2,074.12
$2,369.01
$444.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,161.00
$1,317.74
$1,483.76
$2,073.54
$3,150.96
$1,605.08
$1,761.82
$1,927.84
$2,517.62
$2,049.16
$2,205.90
$2,371.92
$2,961.70
$2,493.24
$2,649.98
$2,816.00
$3,405.78
$444.08

‡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 La Crosse County here.

La Crosse County is in “Rating Area 6” of Wisconsin.

Currently, there are 42 plans offered in Rating Area 6.

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2024 Obamacare Plans for La Crosse County, WI

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