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Obamacare 2021 Rates and Health Insurance Providers for Waushara County , Wisconsin

Obamacare > Rates > Wisconsin > Waushara County

Obamacare Rates and Providers for Other Years

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

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 Waushara County, WI.

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

Obamacare Providers, Plans and 2021 Rates for Waushara County, Wisconsin

Below, you’ll find a summary of the 82 plans for Waushara County, Wisconsin and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

  • HealthPartners

    Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060

  • Quartz

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

  • Molina Healthcare

    Local: 1-888-560-2043 | Toll Free: 1-888-560-2043
  • Arise Health Plan

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

  • Aspirus Arise

    Local: 1-800-332-6290 | Toll Free: 1-800-332-6290 | TTY: 1-888-332-0144

  • Common Ground Healthcare Cooperative

    Local: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442

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

    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 Wautoma, WI area accept this insurance coverage as within the plan's network.

    2021 Obamacare Rates, Providers, and Plans for Waushara County

    ADVERTISEMENT

    HealthPartners

    Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060

    Toc - Plan #1

    Gold

    (PPO) Robin Oak $1,200 w/Copay Gold

    Annual Out of Pocket Expenses
    Individual Family
    $1,200 $2,400 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    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
    $406,11
    $460,93
    $519,01
    $725,31
    $1 102,18
    $812,22
    $921,86
    $1 038,02
    $1 450,62
    $2 204,36
    $1 122,89
    $1 232,53
    $1 348,69
    $1 761,29
    $1 433,56
    $1 543,20
    $1 659,36
    $2 071,96
    $1 744,23
    $1 853,87
    $1 970,03
    $2 382,63
    $716,78
    $771,60
    $829,68
    $1 035,98
    $1 027,45
    $1 082,27
    $1 140,35
    $1 346,65
    $1 338,12
    $1 392,94
    $1 451,02
    $1 657,32
    $310,67
    Toc - Plan #2

    Silver

    (PPO) Robin Oak $4,000 Plus Silver

    Annual Out of Pocket Expenses
    Individual Family
    $4,000 $8,000 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $366,09
    $415,51
    $467,86
    $653,84
    $993,57
    $732,18
    $831,02
    $935,72
    $1 307,68
    $1 987,14
    $1 012,24
    $1 111,08
    $1 215,78
    $1 587,74
    $1 292,30
    $1 391,14
    $1 495,84
    $1 867,80
    $1 572,36
    $1 671,20
    $1 775,90
    $2 147,86
    $646,15
    $695,57
    $747,92
    $933,90
    $926,21
    $975,63
    $1 027,98
    $1 213,96
    $1 206,27
    $1 255,69
    $1 308,04
    $1 494,02
    $280,06
    Toc - Plan #3

    Expanded Bronze

    (PPO) Robin Oak $6,800 Plus Bronze

    Annual Out of Pocket Expenses
    Individual Family
    $6,800 $13,600 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $290,60
    $329,83
    $371,39
    $519,01
    $788,69
    $581,20
    $659,66
    $742,78
    $1 038,02
    $1 577,38
    $803,51
    $881,97
    $965,09
    $1 260,33
    $1 025,82
    $1 104,28
    $1 187,40
    $1 482,64
    $1 248,13
    $1 326,59
    $1 409,71
    $1 704,95
    $512,91
    $552,14
    $593,70
    $741,32
    $735,22
    $774,45
    $816,01
    $963,63
    $957,53
    $996,76
    $1 038,32
    $1 185,94
    $222,31
    Toc - Plan #4

    Catastrophic

    (PPO) Robin Oak $8,550 Catastrophic

    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
    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
    $222,87
    $252,96
    $284,83
    $398,05
    $604,87
    $445,74
    $505,92
    $569,66
    $796,10
    $1 209,74
    $616,24
    $676,42
    $740,16
    $966,60
    $786,74
    $846,92
    $910,66
    $1 137,10
    $957,24
    $1 017,42
    $1 081,16
    $1 307,60
    $393,37
    $423,46
    $455,33
    $568,55
    $563,87
    $593,96
    $625,83
    $739,05
    $734,37
    $764,46
    $796,33
    $909,55
    $170,50
    Toc - Plan #5

    Silver

    (PPO) Robin Oak $3,500 w/Copay P-S Silver

    Annual Out of Pocket Expenses
    Individual Family
    $3,500 $7,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    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
    $404,17
    $458,73
    $516,53
    $721,85
    $1 096,92
    $808,34
    $917,46
    $1 033,06
    $1 443,70
    $2 193,84
    $1 117,53
    $1 226,65
    $1 342,25
    $1 752,89
    $1 426,72
    $1 535,84
    $1 651,44
    $2 062,08
    $1 735,91
    $1 845,03
    $1 960,63
    $2 371,27
    $713,36
    $767,92
    $825,72
    $1 031,04
    $1 022,55
    $1 077,11
    $1 134,91
    $1 340,23
    $1 331,74
    $1 386,30
    $1 444,10
    $1 649,42
    $309,19
    Toc - Plan #6

    Silver

    (PPO) Robin Oak $5,000 Plus Silver

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $353,20
    $400,88
    $451,39
    $630,82
    $958,58
    $706,40
    $801,76
    $902,78
    $1 261,64
    $1 917,16
    $976,60
    $1 071,96
    $1 172,98
    $1 531,84
    $1 246,80
    $1 342,16
    $1 443,18
    $1 802,04
    $1 517,00
    $1 612,36
    $1 713,38
    $2 072,24
    $623,40
    $671,08
    $721,59
    $901,02
    $893,60
    $941,28
    $991,79
    $1 171,22
    $1 163,80
    $1 211,48
    $1 261,99
    $1 441,42
    $270,20
    ADVERTISEMENT

    Quartz

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

    Toc - Plan #7

    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
    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
    $435,50
    $494,29
    $556,56
    $777,80
    $1 181,93
    $871,00
    $988,58
    $1 113,12
    $1 555,60
    $2 363,86
    $1 204,15
    $1 321,73
    $1 446,27
    $1 888,75
    $1 537,30
    $1 654,88
    $1 779,42
    $2 221,90
    $1 870,45
    $1 988,03
    $2 112,57
    $2 555,05
    $768,65
    $827,44
    $889,71
    $1 110,95
    $1 101,80
    $1 160,59
    $1 222,86
    $1 444,10
    $1 434,95
    $1 493,74
    $1 556,01
    $1 777,25
    $333,15
    Toc - Plan #8

    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
    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
    $419,34
    $475,95
    $535,91
    $748,94
    $1 138,08
    $838,68
    $951,90
    $1 071,82
    $1 497,88
    $2 276,16
    $1 159,47
    $1 272,69
    $1 392,61
    $1 818,67
    $1 480,26
    $1 593,48
    $1 713,40
    $2 139,46
    $1 801,05
    $1 914,27
    $2 034,19
    $2 460,25
    $740,13
    $796,74
    $856,70
    $1 069,73
    $1 060,92
    $1 117,53
    $1 177,49
    $1 390,52
    $1 381,71
    $1 438,32
    $1 498,28
    $1 711,31
    $320,79
    Toc - Plan #9

    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
    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
    $385,03
    $437,00
    $492,06
    $687,65
    $1 044,96
    $770,06
    $874,00
    $984,12
    $1 375,30
    $2 089,92
    $1 064,60
    $1 168,54
    $1 278,66
    $1 669,84
    $1 359,14
    $1 463,08
    $1 573,20
    $1 964,38
    $1 653,68
    $1 757,62
    $1 867,74
    $2 258,92
    $679,57
    $731,54
    $786,60
    $982,19
    $974,11
    $1 026,08
    $1 081,14
    $1 276,73
    $1 268,65
    $1 320,62
    $1 375,68
    $1 571,27
    $294,54
    Toc - Plan #10

    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
    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
    $389,47
    $442,04
    $497,73
    $695,58
    $1 057,00
    $778,94
    $884,08
    $995,46
    $1 391,16
    $2 114,00
    $1 076,88
    $1 182,02
    $1 293,40
    $1 689,10
    $1 374,82
    $1 479,96
    $1 591,34
    $1 987,04
    $1 672,76
    $1 777,90
    $1 889,28
    $2 284,98
    $687,41
    $739,98
    $795,67
    $993,52
    $985,35
    $1 037,92
    $1 093,61
    $1 291,46
    $1 283,29
    $1 335,86
    $1 391,55
    $1 589,40
    $297,94
    Toc - Plan #11

    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
    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
    $434,70
    $493,38
    $555,54
    $776,37
    $1 179,77
    $869,40
    $986,76
    $1 111,08
    $1 552,74
    $2 359,54
    $1 201,94
    $1 319,30
    $1 443,62
    $1 885,28
    $1 534,48
    $1 651,84
    $1 776,16
    $2 217,82
    $1 867,02
    $1 984,38
    $2 108,70
    $2 550,36
    $767,24
    $825,92
    $888,08
    $1 108,91
    $1 099,78
    $1 158,46
    $1 220,62
    $1 441,45
    $1 432,32
    $1 491,00
    $1 553,16
    $1 773,99
    $332,54
    Toc - Plan #12

    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
    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
    $300,39
    $340,94
    $383,90
    $536,49
    $815,26
    $600,78
    $681,88
    $767,80
    $1 072,98
    $1 630,52
    $830,58
    $911,68
    $997,60
    $1 302,78
    $1 060,38
    $1 141,48
    $1 227,40
    $1 532,58
    $1 290,18
    $1 371,28
    $1 457,20
    $1 762,38
    $530,19
    $570,74
    $613,70
    $766,29
    $759,99
    $800,54
    $843,50
    $996,09
    $989,79
    $1 030,34
    $1 073,30
    $1 225,89
    $229,80
    Toc - Plan #13

    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
    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
    $385,55
    $437,60
    $492,73
    $688,59
    $1 046,38
    $771,10
    $875,20
    $985,46
    $1 377,18
    $2 092,76
    $1 066,04
    $1 170,14
    $1 280,40
    $1 672,12
    $1 360,98
    $1 465,08
    $1 575,34
    $1 967,06
    $1 655,92
    $1 760,02
    $1 870,28
    $2 262,00
    $680,49
    $732,54
    $787,67
    $983,53
    $975,43
    $1 027,48
    $1 082,61
    $1 278,47
    $1 270,37
    $1 322,42
    $1 377,55
    $1 573,41
    $294,94
    Toc - Plan #14

    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
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $301,47
    $342,16
    $385,27
    $538,41
    $818,17
    $602,94
    $684,32
    $770,54
    $1 076,82
    $1 636,34
    $833,56
    $914,94
    $1 001,16
    $1 307,44
    $1 064,18
    $1 145,56
    $1 231,78
    $1 538,06
    $1 294,80
    $1 376,18
    $1 462,40
    $1 768,68
    $532,09
    $572,78
    $615,89
    $769,03
    $762,71
    $803,40
    $846,51
    $999,65
    $993,33
    $1 034,02
    $1 077,13
    $1 230,27
    $230,62
    Toc - Plan #15

    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
    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
    $313,85
    $356,22
    $401,10
    $560,53
    $851,78
    $627,70
    $712,44
    $802,20
    $1 121,06
    $1 703,56
    $867,79
    $952,53
    $1 042,29
    $1 361,15
    $1 107,88
    $1 192,62
    $1 282,38
    $1 601,24
    $1 347,97
    $1 432,71
    $1 522,47
    $1 841,33
    $553,94
    $596,31
    $641,19
    $800,62
    $794,03
    $836,40
    $881,28
    $1 040,71
    $1 034,12
    $1 076,49
    $1 121,37
    $1 280,80
    $240,09
    Toc - Plan #16

    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
    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
    $418,48
    $474,97
    $534,81
    $747,40
    $1 135,74
    $836,96
    $949,94
    $1 069,62
    $1 494,80
    $2 271,48
    $1 157,09
    $1 270,07
    $1 389,75
    $1 814,93
    $1 477,22
    $1 590,20
    $1 709,88
    $2 135,06
    $1 797,35
    $1 910,33
    $2 030,01
    $2 455,19
    $738,61
    $795,10
    $854,94
    $1 067,53
    $1 058,74
    $1 115,23
    $1 175,07
    $1 387,66
    $1 378,87
    $1 435,36
    $1 495,20
    $1 707,79
    $320,13
    Toc - Plan #17

    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
    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
    $402,95
    $457,35
    $514,97
    $719,67
    $1 093,60
    $805,90
    $914,70
    $1 029,94
    $1 439,34
    $2 187,20
    $1 114,16
    $1 222,96
    $1 338,20
    $1 747,60
    $1 422,42
    $1 531,22
    $1 646,46
    $2 055,86
    $1 730,68
    $1 839,48
    $1 954,72
    $2 364,12
    $711,21
    $765,61
    $823,23
    $1 027,93
    $1 019,47
    $1 073,87
    $1 131,49
    $1 336,19
    $1 327,73
    $1 382,13
    $1 439,75
    $1 644,45
    $308,26
    Toc - Plan #18

    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
    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
    $369,98
    $419,92
    $472,83
    $660,78
    $1 004,12
    $739,96
    $839,84
    $945,66
    $1 321,56
    $2 008,24
    $1 022,99
    $1 122,87
    $1 228,69
    $1 604,59
    $1 306,02
    $1 405,90
    $1 511,72
    $1 887,62
    $1 589,05
    $1 688,93
    $1 794,75
    $2 170,65
    $653,01
    $702,95
    $755,86
    $943,81
    $936,04
    $985,98
    $1 038,89
    $1 226,84
    $1 219,07
    $1 269,01
    $1 321,92
    $1 509,87
    $283,03
    Toc - Plan #19

    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
    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
    $374,24
    $424,76
    $478,28
    $668,39
    $1 015,68
    $748,48
    $849,52
    $956,56
    $1 336,78
    $2 031,36
    $1 034,77
    $1 135,81
    $1 242,85
    $1 623,07
    $1 321,06
    $1 422,10
    $1 529,14
    $1 909,36
    $1 607,35
    $1 708,39
    $1 815,43
    $2 195,65
    $660,53
    $711,05
    $764,57
    $954,68
    $946,82
    $997,34
    $1 050,86
    $1 240,97
    $1 233,11
    $1 283,63
    $1 337,15
    $1 527,26
    $286,29
    Toc - Plan #20

    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
    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
    $417,71
    $474,10
    $533,83
    $746,03
    $1 133,66
    $835,42
    $948,20
    $1 067,66
    $1 492,06
    $2 267,32
    $1 154,97
    $1 267,75
    $1 387,21
    $1 811,61
    $1 474,52
    $1 587,30
    $1 706,76
    $2 131,16
    $1 794,07
    $1 906,85
    $2 026,31
    $2 450,71
    $737,26
    $793,65
    $853,38
    $1 065,58
    $1 056,81
    $1 113,20
    $1 172,93
    $1 385,13
    $1 376,36
    $1 432,75
    $1 492,48
    $1 704,68
    $319,55
    Toc - Plan #21

    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
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $288,65
    $327,62
    $368,89
    $515,53
    $783,39
    $577,30
    $655,24
    $737,78
    $1 031,06
    $1 566,78
    $798,12
    $876,06
    $958,60
    $1 251,88
    $1 018,94
    $1 096,88
    $1 179,42
    $1 472,70
    $1 239,76
    $1 317,70
    $1 400,24
    $1 693,52
    $509,47
    $548,44
    $589,71
    $736,35
    $730,29
    $769,26
    $810,53
    $957,17
    $951,11
    $990,08
    $1 031,35
    $1 177,99
    $220,82
    Toc - Plan #22

    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
    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
    $370,48
    $420,49
    $473,47
    $661,68
    $1 005,48
    $740,96
    $840,98
    $946,94
    $1 323,36
    $2 010,96
    $1 024,38
    $1 124,40
    $1 230,36
    $1 606,78
    $1 307,80
    $1 407,82
    $1 513,78
    $1 890,20
    $1 591,22
    $1 691,24
    $1 797,20
    $2 173,62
    $653,90
    $703,91
    $756,89
    $945,10
    $937,32
    $987,33
    $1 040,31
    $1 228,52
    $1 220,74
    $1 270,75
    $1 323,73
    $1 511,94
    $283,42
    Toc - Plan #23

    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
    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
    $289,68
    $328,79
    $370,21
    $517,37
    $786,19
    $579,36
    $657,58
    $740,42
    $1 034,74
    $1 572,38
    $800,96
    $879,18
    $962,02
    $1 256,34
    $1 022,56
    $1 100,78
    $1 183,62
    $1 477,94
    $1 244,16
    $1 322,38
    $1 405,22
    $1 699,54
    $511,28
    $550,39
    $591,81
    $738,97
    $732,88
    $771,99
    $813,41
    $960,57
    $954,48
    $993,59
    $1 035,01
    $1 182,17
    $221,60
    Toc - Plan #24

    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
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $301,59
    $342,29
    $385,42
    $538,62
    $818,49
    $603,18
    $684,58
    $770,84
    $1 077,24
    $1 636,98
    $833,89
    $915,29
    $1 001,55
    $1 307,95
    $1 064,60
    $1 146,00
    $1 232,26
    $1 538,66
    $1 295,31
    $1 376,71
    $1 462,97
    $1 769,37
    $532,30
    $573,00
    $616,13
    $769,33
    $763,01
    $803,71
    $846,84
    $1 000,04
    $993,72
    $1 034,42
    $1 077,55
    $1 230,75
    $230,71
    Toc - Plan #25

    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
    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
    $390,06
    $442,71
    $498,49
    $696,63
    $1 058,60
    $780,12
    $885,42
    $996,98
    $1 393,26
    $2 117,20
    $1 078,51
    $1 183,81
    $1 295,37
    $1 691,65
    $1 376,90
    $1 482,20
    $1 593,76
    $1 990,04
    $1 675,29
    $1 780,59
    $1 892,15
    $2 288,43
    $688,45
    $741,10
    $796,88
    $995,02
    $986,84
    $1 039,49
    $1 095,27
    $1 293,41
    $1 285,23
    $1 337,88
    $1 393,66
    $1 591,80
    $298,39
    Toc - Plan #26

    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
    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
    $296,71
    $336,76
    $379,19
    $529,91
    $805,25
    $593,42
    $673,52
    $758,38
    $1 059,82
    $1 610,50
    $820,40
    $900,50
    $985,36
    $1 286,80
    $1 047,38
    $1 127,48
    $1 212,34
    $1 513,78
    $1 274,36
    $1 354,46
    $1 439,32
    $1 740,76
    $523,69
    $563,74
    $606,17
    $756,89
    $750,67
    $790,72
    $833,15
    $983,87
    $977,65
    $1 017,70
    $1 060,13
    $1 210,85
    $226,98
    Toc - Plan #27

    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
    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
    $216,08
    $245,24
    $276,14
    $385,90
    $586,42
    $432,16
    $490,48
    $552,28
    $771,80
    $1 172,84
    $597,45
    $655,77
    $717,57
    $937,09
    $762,74
    $821,06
    $882,86
    $1 102,38
    $928,03
    $986,35
    $1 048,15
    $1 267,67
    $381,37
    $410,53
    $441,43
    $551,19
    $546,66
    $575,82
    $606,72
    $716,48
    $711,95
    $741,11
    $772,01
    $881,77
    $165,29
    Toc - Plan #28

    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
    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
    $431,66
    $489,92
    $551,65
    $770,93
    $1 171,50
    $863,32
    $979,84
    $1 103,30
    $1 541,86
    $2 343,00
    $1 193,53
    $1 310,05
    $1 433,51
    $1 872,07
    $1 523,74
    $1 640,26
    $1 763,72
    $2 202,28
    $1 853,95
    $1 970,47
    $2 093,93
    $2 532,49
    $761,87
    $820,13
    $881,86
    $1 101,14
    $1 092,08
    $1 150,34
    $1 212,07
    $1 431,35
    $1 422,29
    $1 480,55
    $1 542,28
    $1 761,56
    $330,21
    Toc - Plan #29

    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
    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
    $395,80
    $449,22
    $505,82
    $706,88
    $1 074,18
    $791,60
    $898,44
    $1 011,64
    $1 413,76
    $2 148,36
    $1 094,38
    $1 201,22
    $1 314,42
    $1 716,54
    $1 397,16
    $1 504,00
    $1 617,20
    $2 019,32
    $1 699,94
    $1 806,78
    $1 919,98
    $2 322,10
    $698,58
    $752,00
    $808,60
    $1 009,66
    $1 001,36
    $1 054,78
    $1 111,38
    $1 312,44
    $1 304,14
    $1 357,56
    $1 414,16
    $1 615,22
    $302,78
    ADVERTISEMENT

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    Toc - Plan #30

    Gold

    (HMO) Confident Care Gold 1

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    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
    $395,71
    $449,13
    $505,72
    $706,74
    $1 073,96
    $791,42
    $898,26
    $1 011,44
    $1 413,48
    $2 147,92
    $1 094,14
    $1 200,98
    $1 314,16
    $1 716,20
    $1 396,86
    $1 503,70
    $1 616,88
    $2 018,92
    $1 699,58
    $1 806,42
    $1 919,60
    $2 321,64
    $698,43
    $751,85
    $808,44
    $1 009,46
    $1 001,15
    $1 054,57
    $1 111,16
    $1 312,18
    $1 303,87
    $1 357,29
    $1 413,88
    $1 614,90
    $302,72
    Toc - Plan #31

    Silver

    (HMO) Constant Care Silver 1

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    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
    $348,80
    $395,88
    $445,76
    $622,95
    $946,63
    $697,60
    $791,76
    $891,52
    $1 245,90
    $1 893,26
    $964,43
    $1 058,59
    $1 158,35
    $1 512,73
    $1 231,26
    $1 325,42
    $1 425,18
    $1 779,56
    $1 498,09
    $1 592,25
    $1 692,01
    $2 046,39
    $615,63
    $662,71
    $712,59
    $889,78
    $882,46
    $929,54
    $979,42
    $1 156,61
    $1 149,29
    $1 196,37
    $1 246,25
    $1 423,44
    $266,83
    Toc - Plan #32

    Bronze

    (HMO) Core Care Bronze 1

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $276,46
    $313,78
    $353,31
    $493,75
    $750,30
    $552,92
    $627,56
    $706,62
    $987,50
    $1 500,60
    $764,41
    $839,05
    $918,11
    $1 198,99
    $975,90
    $1 050,54
    $1 129,60
    $1 410,48
    $1 187,39
    $1 262,03
    $1 341,09
    $1 621,97
    $487,95
    $525,27
    $564,80
    $705,24
    $699,44
    $736,76
    $776,29
    $916,73
    $910,93
    $948,25
    $987,78
    $1 128,22
    $211,49
    Toc - Plan #33

    Silver

    (HMO) Constant Care Silver 4

    Annual Out of Pocket Expenses
    Individual Family
    $7,450 $14,900 Annual Deductible
    $7,450 $14,900 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $345,11
    $391,70
    $441,05
    $616,37
    $936,63
    $690,22
    $783,40
    $882,10
    $1 232,74
    $1 873,26
    $954,23
    $1 047,41
    $1 146,11
    $1 496,75
    $1 218,24
    $1 311,42
    $1 410,12
    $1 760,76
    $1 482,25
    $1 575,43
    $1 674,13
    $2 024,77
    $609,12
    $655,71
    $705,06
    $880,38
    $873,13
    $919,72
    $969,07
    $1 144,39
    $1 137,14
    $1 183,73
    $1 233,08
    $1 408,40
    $264,01
    Toc - Plan #34

    Expanded Bronze

    (HMO) Core Care Bronze 4

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $289,59
    $328,68
    $370,09
    $517,20
    $785,94
    $579,18
    $657,36
    $740,18
    $1 034,40
    $1 571,88
    $800,71
    $878,89
    $961,71
    $1 255,93
    $1 022,24
    $1 100,42
    $1 183,24
    $1 477,46
    $1 243,77
    $1 321,95
    $1 404,77
    $1 698,99
    $511,12
    $550,21
    $591,62
    $738,73
    $732,65
    $771,74
    $813,15
    $960,26
    $954,18
    $993,27
    $1 034,68
    $1 181,79
    $221,53
    Toc - Plan #35

    Expanded Bronze

    (HMO) Core Care Bronze 5

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $281,56
    $319,57
    $359,83
    $502,87
    $764,16
    $563,12
    $639,14
    $719,66
    $1 005,74
    $1 528,32
    $778,51
    $854,53
    $935,05
    $1 221,13
    $993,90
    $1 069,92
    $1 150,44
    $1 436,52
    $1 209,29
    $1 285,31
    $1 365,83
    $1 651,91
    $496,95
    $534,96
    $575,22
    $718,26
    $712,34
    $750,35
    $790,61
    $933,65
    $927,73
    $965,74
    $1 006,00
    $1 149,04
    $215,39
    Toc - Plan #36

    Gold

    (HMO) Confident Care Gold 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    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
    $398,84
    $452,68
    $509,72
    $712,33
    $1 082,45
    $797,68
    $905,36
    $1 019,44
    $1 424,66
    $2 164,90
    $1 102,79
    $1 210,47
    $1 324,55
    $1 729,77
    $1 407,90
    $1 515,58
    $1 629,66
    $2 034,88
    $1 713,01
    $1 820,69
    $1 934,77
    $2 339,99
    $703,95
    $757,79
    $814,83
    $1 017,44
    $1 009,06
    $1 062,90
    $1 119,94
    $1 322,55
    $1 314,17
    $1 368,01
    $1 425,05
    $1 627,66
    $305,11
    Toc - Plan #37

    Silver

    (HMO) Constant Care Silver 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    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
    $351,93
    $399,44
    $449,76
    $628,54
    $955,13
    $703,86
    $798,88
    $899,52
    $1 257,08
    $1 910,26
    $973,08
    $1 068,10
    $1 168,74
    $1 526,30
    $1 242,30
    $1 337,32
    $1 437,96
    $1 795,52
    $1 511,52
    $1 606,54
    $1 707,18
    $2 064,74
    $621,15
    $668,66
    $718,98
    $897,76
    $890,37
    $937,88
    $988,20
    $1 166,98
    $1 159,59
    $1 207,10
    $1 257,42
    $1 436,20
    $269,22
    Toc - Plan #38

    Bronze

    (HMO) Core Care Bronze 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $279,59
    $317,33
    $357,31
    $499,34
    $758,80
    $559,18
    $634,66
    $714,62
    $998,68
    $1 517,60
    $773,06
    $848,54
    $928,50
    $1 212,56
    $986,94
    $1 062,42
    $1 142,38
    $1 426,44
    $1 200,82
    $1 276,30
    $1 356,26
    $1 640,32
    $493,47
    $531,21
    $571,19
    $713,22
    $707,35
    $745,09
    $785,07
    $927,10
    $921,23
    $958,97
    $998,95
    $1 140,98
    $213,88
    Toc - Plan #39

    Silver

    (HMO) Constant Care Silver 2

    Annual Out of Pocket Expenses
    Individual Family
    $5,200 $10,400 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $348,42
    $395,46
    $445,28
    $622,28
    $945,61
    $696,84
    $790,92
    $890,56
    $1 244,56
    $1 891,22
    $963,38
    $1 057,46
    $1 157,10
    $1 511,10
    $1 229,92
    $1 324,00
    $1 423,64
    $1 777,64
    $1 496,46
    $1 590,54
    $1 690,18
    $2 044,18
    $614,96
    $662,00
    $711,82
    $888,82
    $881,50
    $928,54
    $978,36
    $1 155,36
    $1 148,04
    $1 195,08
    $1 244,90
    $1 421,90
    $266,54
    Toc - Plan #40

    Bronze

    (HMO) Core Care Bronze 2

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $274,01
    $311,01
    $350,19
    $489,39
    $743,67
    $548,02
    $622,02
    $700,38
    $978,78
    $1 487,34
    $757,64
    $831,64
    $910,00
    $1 188,40
    $967,26
    $1 041,26
    $1 119,62
    $1 398,02
    $1 176,88
    $1 250,88
    $1 329,24
    $1 607,64
    $483,63
    $520,63
    $559,81
    $699,01
    $693,25
    $730,25
    $769,43
    $908,63
    $902,87
    $939,87
    $979,05
    $1 118,25
    $209,62
    ADVERTISEMENT

    Arise Health Plan

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

    Toc - Plan #41

    Bronze

    (HMO) WPS HMO Bronze $8,550 | Select Network

    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
    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
    $299,32
    $339,73
    $382,53
    $534,59
    $812,35
    $598,64
    $679,46
    $765,06
    $1 069,18
    $1 624,70
    $827,62
    $908,44
    $994,04
    $1 298,16
    $1 056,60
    $1 137,42
    $1 223,02
    $1 527,14
    $1 285,58
    $1 366,40
    $1 452,00
    $1 756,12
    $528,30
    $568,71
    $611,51
    $763,57
    $757,28
    $797,69
    $840,49
    $992,55
    $986,26
    $1 026,67
    $1 069,47
    $1 221,53
    $228,98
    Toc - Plan #42

    Expanded Bronze

    (HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $310,79
    $352,75
    $397,19
    $555,07
    $843,48
    $621,58
    $705,50
    $794,38
    $1 110,14
    $1 686,96
    $859,33
    $943,25
    $1 032,13
    $1 347,89
    $1 097,08
    $1 181,00
    $1 269,88
    $1 585,64
    $1 334,83
    $1 418,75
    $1 507,63
    $1 823,39
    $548,54
    $590,50
    $634,94
    $792,82
    $786,29
    $828,25
    $872,69
    $1 030,57
    $1 024,04
    $1 066,00
    $1 110,44
    $1 268,32
    $237,75
    Toc - Plan #43

    Expanded Bronze

    (HMO) WPS HMO Bronze $7,200 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $304,51
    $345,62
    $389,16
    $543,85
    $826,44
    $609,02
    $691,24
    $778,32
    $1 087,70
    $1 652,88
    $841,97
    $924,19
    $1 011,27
    $1 320,65
    $1 074,92
    $1 157,14
    $1 244,22
    $1 553,60
    $1 307,87
    $1 390,09
    $1 477,17
    $1 786,55
    $537,46
    $578,57
    $622,11
    $776,80
    $770,41
    $811,52
    $855,06
    $1 009,75
    $1 003,36
    $1 044,47
    $1 088,01
    $1 242,70
    $232,95
    Toc - Plan #44

    Silver

    (HMO) WPS HMO Silver $7,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $7,500 $15,000 Annual Deductible
    $7,500 $15,000 Maximum Out of Pocket Per Year
    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
    $402,38
    $456,70
    $514,24
    $718,65
    $1 092,06
    $804,76
    $913,40
    $1 028,48
    $1 437,30
    $2 184,12
    $1 112,58
    $1 221,22
    $1 336,30
    $1 745,12
    $1 420,40
    $1 529,04
    $1 644,12
    $2 052,94
    $1 728,22
    $1 836,86
    $1 951,94
    $2 360,76
    $710,20
    $764,52
    $822,06
    $1 026,47
    $1 018,02
    $1 072,34
    $1 129,88
    $1 334,29
    $1 325,84
    $1 380,16
    $1 437,70
    $1 642,11
    $307,82
    Toc - Plan #45

    Silver

    (HMO) WPS HMO Silver $4,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $403,34
    $457,79
    $515,47
    $720,37
    $1 094,66
    $806,68
    $915,58
    $1 030,94
    $1 440,74
    $2 189,32
    $1 115,24
    $1 224,14
    $1 339,50
    $1 749,30
    $1 423,80
    $1 532,70
    $1 648,06
    $2 057,86
    $1 732,36
    $1 841,26
    $1 956,62
    $2 366,42
    $711,90
    $766,35
    $824,03
    $1 028,93
    $1 020,46
    $1 074,91
    $1 132,59
    $1 337,49
    $1 329,02
    $1 383,47
    $1 441,15
    $1 646,05
    $308,56
    Toc - Plan #46

    Silver

    (HMO) WPS HMO Silver $5,000 with 3 Free PCP Visits | Select Network

    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
    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
    $419,56
    $476,20
    $536,20
    $749,33
    $1 138,69
    $839,12
    $952,40
    $1 072,40
    $1 498,66
    $2 277,38
    $1 160,08
    $1 273,36
    $1 393,36
    $1 819,62
    $1 481,04
    $1 594,32
    $1 714,32
    $2 140,58
    $1 802,00
    $1 915,28
    $2 035,28
    $2 461,54
    $740,52
    $797,16
    $857,16
    $1 070,29
    $1 061,48
    $1 118,12
    $1 178,12
    $1 391,25
    $1 382,44
    $1 439,08
    $1 499,08
    $1 712,21
    $320,96
    Toc - Plan #47

    Gold

    (HMO) WPS HMO Gold $2,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    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
    $555,76
    $630,79
    $710,26
    $992,59
    $1 508,33
    $1 111,52
    $1 261,58
    $1 420,52
    $1 985,18
    $3 016,66
    $1 536,68
    $1 686,74
    $1 845,68
    $2 410,34
    $1 961,84
    $2 111,90
    $2 270,84
    $2 835,50
    $2 387,00
    $2 537,06
    $2 696,00
    $3 260,66
    $980,92
    $1 055,95
    $1 135,42
    $1 417,75
    $1 406,08
    $1 481,11
    $1 560,58
    $1 842,91
    $1 831,24
    $1 906,27
    $1 985,74
    $2 268,07
    $425,16
    Toc - Plan #48

    Catastrophic

    (HMO) WPS HMO Catastrophic $8,550 with 3 Free PCP Visits | Select Network

    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
    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
    $260,22
    $295,35
    $332,56
    $464,75
    $706,24
    $520,44
    $590,70
    $665,12
    $929,50
    $1 412,48
    $719,51
    $789,77
    $864,19
    $1 128,57
    $918,58
    $988,84
    $1 063,26
    $1 327,64
    $1 117,65
    $1 187,91
    $1 262,33
    $1 526,71
    $459,29
    $494,42
    $531,63
    $663,82
    $658,36
    $693,49
    $730,70
    $862,89
    $857,43
    $892,56
    $929,77
    $1 061,96
    $199,07
    Toc - Plan #49

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $7,000 | Select Network

    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
    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
    $311,17
    $353,18
    $397,68
    $555,75
    $844,52
    $622,34
    $706,36
    $795,36
    $1 111,50
    $1 689,04
    $860,39
    $944,41
    $1 033,41
    $1 349,55
    $1 098,44
    $1 182,46
    $1 271,46
    $1 587,60
    $1 336,49
    $1 420,51
    $1 509,51
    $1 825,65
    $549,22
    $591,23
    $635,73
    $793,80
    $787,27
    $829,28
    $873,78
    $1 031,85
    $1 025,32
    $1 067,33
    $1 111,83
    $1 269,90
    $238,05
    Toc - Plan #50

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $6,830 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,830 $13,660 Annual Deductible
    $6,830 $13,660 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $317,52
    $360,39
    $405,79
    $567,09
    $861,75
    $635,04
    $720,78
    $811,58
    $1 134,18
    $1 723,50
    $877,94
    $963,68
    $1 054,48
    $1 377,08
    $1 120,84
    $1 206,58
    $1 297,38
    $1 619,98
    $1 363,74
    $1 449,48
    $1 540,28
    $1 862,88
    $560,42
    $603,29
    $648,69
    $809,99
    $803,32
    $846,19
    $891,59
    $1 052,89
    $1 046,22
    $1 089,09
    $1 134,49
    $1 295,79
    $242,90
    Toc - Plan #51

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $6,000 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    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
    $311,82
    $353,92
    $398,51
    $556,91
    $846,28
    $623,64
    $707,84
    $797,02
    $1 113,82
    $1 692,56
    $862,18
    $946,38
    $1 035,56
    $1 352,36
    $1 100,72
    $1 184,92
    $1 274,10
    $1 590,90
    $1 339,26
    $1 423,46
    $1 512,64
    $1 829,44
    $550,36
    $592,46
    $637,05
    $795,45
    $788,90
    $831,00
    $875,59
    $1 033,99
    $1 027,44
    $1 069,54
    $1 114,13
    $1 272,53
    $238,54
    Toc - Plan #52

    Silver

    (HMO) WPS HMO HDHP Silver $2,800 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $2,800 $5,600 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    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
    $413,53
    $469,36
    $528,49
    $738,56
    $1 122,32
    $827,06
    $938,72
    $1 056,98
    $1 477,12
    $2 244,64
    $1 143,41
    $1 255,07
    $1 373,33
    $1 793,47
    $1 459,76
    $1 571,42
    $1 689,68
    $2 109,82
    $1 776,11
    $1 887,77
    $2 006,03
    $2 426,17
    $729,88
    $785,71
    $844,84
    $1 054,91
    $1 046,23
    $1 102,06
    $1 161,19
    $1 371,26
    $1 362,58
    $1 418,41
    $1 477,54
    $1 687,61
    $316,35
    Toc - Plan #53

    Silver

    (HMO) WPS HMO HDHP Silver $4,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $4,500 $9,000 Maximum Out of Pocket Per Year
    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
    $412,57
    $468,27
    $527,26
    $736,85
    $1 119,71
    $825,14
    $936,54
    $1 054,52
    $1 473,70
    $2 239,42
    $1 140,76
    $1 252,16
    $1 370,14
    $1 789,32
    $1 456,38
    $1 567,78
    $1 685,76
    $2 104,94
    $1 772,00
    $1 883,40
    $2 001,38
    $2 420,56
    $728,19
    $783,89
    $842,88
    $1 052,47
    $1 043,81
    $1 099,51
    $1 158,50
    $1 368,09
    $1 359,43
    $1 415,13
    $1 474,12
    $1 683,71
    $315,62
    Toc - Plan #54

    Silver

    (HMO) WPS HMO HDHP Silver $5,500 | Select Network

    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:
    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
    $391,74
    $444,62
    $500,64
    $699,65
    $1 063,18
    $783,48
    $889,24
    $1 001,28
    $1 399,30
    $2 126,36
    $1 083,16
    $1 188,92
    $1 300,96
    $1 698,98
    $1 382,84
    $1 488,60
    $1 600,64
    $1 998,66
    $1 682,52
    $1 788,28
    $1 900,32
    $2 298,34
    $691,42
    $744,30
    $800,32
    $999,33
    $991,10
    $1 043,98
    $1 100,00
    $1 299,01
    $1 290,78
    $1 343,66
    $1 399,68
    $1 598,69
    $299,68
    Toc - Plan #55

    Bronze

    (POS) WPS POS Bronze $8,550 | Select Network

    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
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $320,15
    $363,37
    $409,15
    $571,79
    $868,89
    $640,30
    $726,74
    $818,30
    $1 143,58
    $1 737,78
    $885,21
    $971,65
    $1 063,21
    $1 388,49
    $1 130,12
    $1 216,56
    $1 308,12
    $1 633,40
    $1 375,03
    $1 461,47
    $1 553,03
    $1 878,31
    $565,06
    $608,28
    $654,06
    $816,70
    $809,97
    $853,19
    $898,97
    $1 061,61
    $1 054,88
    $1 098,10
    $1 143,88
    $1 306,52
    $244,91
    Toc - Plan #56

    Expanded Bronze

    (POS) WPS POS HDHP Bronze $6,000 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    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
    $333,48
    $378,50
    $426,19
    $595,60
    $905,06
    $666,96
    $757,00
    $852,38
    $1 191,20
    $1 810,12
    $922,07
    $1 012,11
    $1 107,49
    $1 446,31
    $1 177,18
    $1 267,22
    $1 362,60
    $1 701,42
    $1 432,29
    $1 522,33
    $1 617,71
    $1 956,53
    $588,59
    $633,61
    $681,30
    $850,71
    $843,70
    $888,72
    $936,41
    $1 105,82
    $1 098,81
    $1 143,83
    $1 191,52
    $1 360,93
    $255,11
    ADVERTISEMENT

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    Toc - Plan #57

    Silver

    (HMO) HMO Silver 7150

    Annual Out of Pocket Expenses
    Individual Family
    $7,150 $14,300 Annual Deductible
    $7,150 $14,300 Maximum Out of Pocket Per Year
    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
    $390,67
    $443,41
    $499,28
    $697,74
    $1 060,28
    $781,34
    $886,82
    $998,56
    $1 395,48
    $2 120,56
    $1 080,20
    $1 185,68
    $1 297,42
    $1 694,34
    $1 379,06
    $1 484,54
    $1 596,28
    $1 993,20
    $1 677,92
    $1 783,40
    $1 895,14
    $2 292,06
    $689,53
    $742,27
    $798,14
    $996,60
    $988,39
    $1 041,13
    $1 097,00
    $1 295,46
    $1 287,25
    $1 339,99
    $1 395,86
    $1 594,32
    $298,86
    Toc - Plan #58

    Silver

    (HMO) HMO Silver 5000 with 3 Free PCP Visits

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $406,26
    $461,11
    $519,20
    $725,58
    $1 102,59
    $812,52
    $922,22
    $1 038,40
    $1 451,16
    $2 205,18
    $1 123,31
    $1 233,01
    $1 349,19
    $1 761,95
    $1 434,10
    $1 543,80
    $1 659,98
    $2 072,74
    $1 744,89
    $1 854,59
    $1 970,77
    $2 383,53
    $717,05
    $771,90
    $829,99
    $1 036,37
    $1 027,84
    $1 082,69
    $1 140,78
    $1 347,16
    $1 338,63
    $1 393,48
    $1 451,57
    $1 657,95
    $310,79
    Toc - Plan #59

    Expanded Bronze

    (HMO) HMO HDHP Bronze 6000

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $6,950 $13,900 Maximum Out of Pocket Per Year
    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
    $274,85
    $311,95
    $351,26
    $490,88
    $745,94
    $549,70
    $623,90
    $702,52
    $981,76
    $1 491,88
    $759,96
    $834,16
    $912,78
    $1 192,02
    $970,22
    $1 044,42
    $1 123,04
    $1 402,28
    $1 180,48
    $1 254,68
    $1 333,30
    $1 612,54
    $485,11
    $522,21
    $561,52
    $701,14
    $695,37
    $732,47
    $771,78
    $911,40
    $905,63
    $942,73
    $982,04
    $1 121,66
    $210,26
    Toc - Plan #60

    Silver

    (HMO) HMO HDHP Silver 2800

    Annual Out of Pocket Expenses
    Individual Family
    $2,800 $5,600 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    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
    $400,77
    $454,87
    $512,18
    $715,78
    $1 087,69
    $801,54
    $909,74
    $1 024,36
    $1 431,56
    $2 175,38
    $1 108,13
    $1 216,33
    $1 330,95
    $1 738,15
    $1 414,72
    $1 522,92
    $1 637,54
    $2 044,74
    $1 721,31
    $1 829,51
    $1 944,13
    $2 351,33
    $707,36
    $761,46
    $818,77
    $1 022,37
    $1 013,95
    $1 068,05
    $1 125,36
    $1 328,96
    $1 320,54
    $1 374,64
    $1 431,95
    $1 635,55
    $306,59
    Toc - Plan #61

    Bronze

    (HMO) HMO Bronze 8550

    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
    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
    $263,15
    $298,68
    $336,31
    $469,99
    $714,19
    $526,30
    $597,36
    $672,62
    $939,98
    $1 428,38
    $727,61
    $798,67
    $873,93
    $1 141,29
    $928,92
    $999,98
    $1 075,24
    $1 342,60
    $1 130,23
    $1 201,29
    $1 276,55
    $1 543,91
    $464,46
    $499,99
    $537,62
    $671,30
    $665,77
    $701,30
    $738,93
    $872,61
    $867,08
    $902,61
    $940,24
    $1 073,92
    $201,31
    Toc - Plan #62

    Expanded Bronze

    (HMO) HMO Bronze 6500 with 3 Free PCP Visits

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $273,24
    $310,13
    $349,20
    $488,01
    $741,57
    $546,48
    $620,26
    $698,40
    $976,02
    $1 483,14
    $755,51
    $829,29
    $907,43
    $1 185,05
    $964,54
    $1 038,32
    $1 116,46
    $1 394,08
    $1 173,57
    $1 247,35
    $1 325,49
    $1 603,11
    $482,27
    $519,16
    $558,23
    $697,04
    $691,30
    $728,19
    $767,26
    $906,07
    $900,33
    $937,22
    $976,29
    $1 115,10
    $209,03
    Toc - Plan #63

    Gold

    (HMO) HMO Gold 2500

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    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
    $594,14
    $674,35
    $759,31
    $1 061,13
    $1 612,50
    $1 188,28
    $1 348,70
    $1 518,62
    $2 122,26
    $3 225,00
    $1 642,80
    $1 803,22
    $1 973,14
    $2 576,78
    $2 097,32
    $2 257,74
    $2 427,66
    $3 031,30
    $2 551,84
    $2 712,26
    $2 882,18
    $3 485,82
    $1 048,66
    $1 128,87
    $1 213,83
    $1 515,65
    $1 503,18
    $1 583,39
    $1 668,35
    $1 970,17
    $1 957,70
    $2 037,91
    $2 122,87
    $2 424,69
    $454,52
    Toc - Plan #64

    Catastrophic

    (HMO) HMO Catastrophic 8550 with 3 Free PCP Visits

    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
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $218,94
    $248,50
    $279,81
    $391,03
    $594,20
    $437,88
    $497,00
    $559,62
    $782,06
    $1 188,40
    $605,37
    $664,49
    $727,11
    $949,55
    $772,86
    $831,98
    $894,60
    $1 117,04
    $940,35
    $999,47
    $1 062,09
    $1 284,53
    $386,43
    $415,99
    $447,30
    $558,52
    $553,92
    $583,48
    $614,79
    $726,01
    $721,41
    $750,97
    $782,28
    $893,50
    $167,49
    Toc - Plan #65

    Expanded Bronze

    (HMO) HMO HDHP Bronze 6900

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    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
    $275,24
    $312,40
    $351,76
    $491,58
    $747,00
    $550,48
    $624,80
    $703,52
    $983,16
    $1 494,00
    $761,04
    $835,36
    $914,08
    $1 193,72
    $971,60
    $1 045,92
    $1 124,64
    $1 404,28
    $1 182,16
    $1 256,48
    $1 335,20
    $1 614,84
    $485,80
    $522,96
    $562,32
    $702,14
    $696,36
    $733,52
    $772,88
    $912,70
    $906,92
    $944,08
    $983,44
    $1 123,26
    $210,56
    Toc - Plan #66

    Silver

    (HMO) HMO HDHP Silver 4500

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $4,500 $9,000 Maximum Out of Pocket Per Year
    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
    $399,38
    $453,30
    $510,41
    $713,29
    $1 083,92
    $798,76
    $906,60
    $1 020,82
    $1 426,58
    $2 167,84
    $1 104,29
    $1 212,13
    $1 326,35
    $1 732,11
    $1 409,82
    $1 517,66
    $1 631,88
    $2 037,64
    $1 715,35
    $1 823,19
    $1 937,41
    $2 343,17
    $704,91
    $758,83
    $815,94
    $1 018,82
    $1 010,44
    $1 064,36
    $1 121,47
    $1 324,35
    $1 315,97
    $1 369,89
    $1 427,00
    $1 629,88
    $305,53
    Toc - Plan #67

    Expanded Bronze

    (HMO) HMO Bronze 7200

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $267,81
    $303,96
    $342,26
    $478,31
    $726,84
    $535,62
    $607,92
    $684,52
    $956,62
    $1 453,68
    $740,49
    $812,79
    $889,39
    $1 161,49
    $945,36
    $1 017,66
    $1 094,26
    $1 366,36
    $1 150,23
    $1 222,53
    $1 299,13
    $1 571,23
    $472,68
    $508,83
    $547,13
    $683,18
    $677,55
    $713,70
    $752,00
    $888,05
    $882,42
    $918,57
    $956,87
    $1 092,92
    $204,87
    Toc - Plan #68

    Silver

    (HMO) HMO Silver 4500

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $390,78
    $443,54
    $499,42
    $697,93
    $1 060,58
    $781,56
    $887,08
    $998,84
    $1 395,86
    $2 121,16
    $1 080,51
    $1 186,03
    $1 297,79
    $1 694,81
    $1 379,46
    $1 484,98
    $1 596,74
    $1 993,76
    $1 678,41
    $1 783,93
    $1 895,69
    $2 292,71
    $689,73
    $742,49
    $798,37
    $996,88
    $988,68
    $1 041,44
    $1 097,32
    $1 295,83
    $1 287,63
    $1 340,39
    $1 396,27
    $1 594,78
    $298,95
    Toc - Plan #69

    Silver

    (HMO) HMO HDHP Silver 5500

    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:
    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
    $379,24
    $430,44
    $484,67
    $677,32
    $1 029,26
    $758,48
    $860,88
    $969,34
    $1 354,64
    $2 058,52
    $1 048,60
    $1 151,00
    $1 259,46
    $1 644,76
    $1 338,72
    $1 441,12
    $1 549,58
    $1 934,88
    $1 628,84
    $1 731,24
    $1 839,70
    $2 225,00
    $669,36
    $720,56
    $774,79
    $967,44
    $959,48
    $1 010,68
    $1 064,91
    $1 257,56
    $1 249,60
    $1 300,80
    $1 355,03
    $1 547,68
    $290,12
    Toc - Plan #70

    Silver

    (POS) POS Silver 7150

    Annual Out of Pocket Expenses
    Individual Family
    $7,150 $14,300 Annual Deductible
    $7,150 $14,300 Maximum Out of Pocket Per Year
    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
    $429,78
    $487,80
    $549,26
    $767,59
    $1 166,42
    $859,56
    $975,60
    $1 098,52
    $1 535,18
    $2 332,84
    $1 188,34
    $1 304,38
    $1 427,30
    $1 863,96
    $1 517,12
    $1 633,16
    $1 756,08
    $2 192,74
    $1 845,90
    $1 961,94
    $2 084,86
    $2 521,52
    $758,56
    $816,58
    $878,04
    $1 096,37
    $1 087,34
    $1 145,36
    $1 206,82
    $1 425,15
    $1 416,12
    $1 474,14
    $1 535,60
    $1 753,93
    $328,78
    Toc - Plan #71

    Silver

    (POS) POS Silver 5000 with 3 Free PCP Visits

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $446,92
    $507,25
    $571,16
    $798,20
    $1 212,94
    $893,84
    $1 014,50
    $1 142,32
    $1 596,40
    $2 425,88
    $1 235,73
    $1 356,39
    $1 484,21
    $1 938,29
    $1 577,62
    $1 698,28
    $1 826,10
    $2 280,18
    $1 919,51
    $2 040,17
    $2 167,99
    $2 622,07
    $788,81
    $849,14
    $913,05
    $1 140,09
    $1 130,70
    $1 191,03
    $1 254,94
    $1 481,98
    $1 472,59
    $1 532,92
    $1 596,83
    $1 823,87
    $341,89
    Toc - Plan #72

    Expanded Bronze

    (POS) POS HDHP Bronze 6000

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $6,950 $13,900 Maximum Out of Pocket Per Year
    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
    $302,36
    $343,18
    $386,42
    $540,01
    $820,61
    $604,72
    $686,36
    $772,84
    $1 080,02
    $1 641,22
    $836,03
    $917,67
    $1 004,15
    $1 311,33
    $1 067,34
    $1 148,98
    $1 235,46
    $1 542,64
    $1 298,65
    $1 380,29
    $1 466,77
    $1 773,95
    $533,67
    $574,49
    $617,73
    $771,32
    $764,98
    $805,80
    $849,04
    $1 002,63
    $996,29
    $1 037,11
    $1 080,35
    $1 233,94
    $231,31
    Toc - Plan #73

    Silver

    (POS) POS HDHP Silver 2800

    Annual Out of Pocket Expenses
    Individual Family
    $2,800 $5,600 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    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
    $440,87
    $500,39
    $563,43
    $787,39
    $1 196,52
    $881,74
    $1 000,78
    $1 126,86
    $1 574,78
    $2 393,04
    $1 219,01
    $1 338,05
    $1 464,13
    $1 912,05
    $1 556,28
    $1 675,32
    $1 801,40
    $2 249,32
    $1 893,55
    $2 012,59
    $2 138,67
    $2 586,59
    $778,14
    $837,66
    $900,70
    $1 124,66
    $1 115,41
    $1 174,93
    $1 237,97
    $1 461,93
    $1 452,68
    $1 512,20
    $1 575,24
    $1 799,20
    $337,27
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    Toc - Plan #74

    Gold

    (EPO) Envision - Gold 1800/80

    Annual Out of Pocket Expenses
    Individual Family
    $1,800 $3,600 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    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
    $405,48
    $460,21
    $518,20
    $724,18
    $1 100,46
    $810,96
    $920,42
    $1 036,40
    $1 448,36
    $2 200,92
    $1 121,15
    $1 230,61
    $1 346,59
    $1 758,55
    $1 431,34
    $1 540,80
    $1 656,78
    $2 068,74
    $1 741,53
    $1 850,99
    $1 966,97
    $2 378,93
    $715,67
    $770,40
    $828,39
    $1 034,37
    $1 025,86
    $1 080,59
    $1 138,58
    $1 344,56
    $1 336,05
    $1 390,78
    $1 448,77
    $1 654,75
    $310,19
    Toc - Plan #75

    Gold

    (EPO) Envision - Gold 2000/80

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $381,23
    $432,69
    $487,20
    $680,86
    $1 034,64
    $762,46
    $865,38
    $974,40
    $1 361,72
    $2 069,28
    $1 054,10
    $1 157,02
    $1 266,04
    $1 653,36
    $1 345,74
    $1 448,66
    $1 557,68
    $1 945,00
    $1 637,38
    $1 740,30
    $1 849,32
    $2 236,64
    $672,87
    $724,33
    $778,84
    $972,50
    $964,51
    $1 015,97
    $1 070,48
    $1 264,14
    $1 256,15
    $1 307,61
    $1 362,12
    $1 555,78
    $291,64
    Toc - Plan #76

    Silver

    (EPO) Envision - Silver 4000/75

    Annual Out of Pocket Expenses
    Individual Family
    $4,000 $8,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $372,86
    $423,18
    $476,50
    $665,90
    $1 011,91
    $745,72
    $846,36
    $953,00
    $1 331,80
    $2 023,82
    $1 030,95
    $1 131,59
    $1 238,23
    $1 617,03
    $1 316,18
    $1 416,82
    $1 523,46
    $1 902,26
    $1 601,41
    $1 702,05
    $1 808,69
    $2 187,49
    $658,09
    $708,41
    $761,73
    $951,13
    $943,32
    $993,64
    $1 046,96
    $1 236,36
    $1 228,55
    $1 278,87
    $1 332,19
    $1 521,59
    $285,23
    Toc - Plan #77

    Silver

    (EPO) Envision - Silver 3000/75/Copay40

    Annual Out of Pocket Expenses
    Individual Family
    $3,000 $6,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    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
    $389,94
    $442,57
    $498,33
    $696,41
    $1 058,26
    $779,88
    $885,14
    $996,66
    $1 392,82
    $2 116,52
    $1 078,17
    $1 183,43
    $1 294,95
    $1 691,11
    $1 376,46
    $1 481,72
    $1 593,24
    $1 989,40
    $1 674,75
    $1 780,01
    $1 891,53
    $2 287,69
    $688,23
    $740,86
    $796,62
    $994,70
    $986,52
    $1 039,15
    $1 094,91
    $1 292,99
    $1 284,81
    $1 337,44
    $1 393,20
    $1 591,28
    $298,29
    Toc - Plan #78

    Catastrophic

    (EPO) Envision - Catastrophic 8550/100

    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
    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
    $184,53
    $209,43
    $235,81
    $329,55
    $500,78
    $369,06
    $418,86
    $471,62
    $659,10
    $1 001,56
    $510,22
    $560,02
    $612,78
    $800,26
    $651,38
    $701,18
    $753,94
    $941,42
    $792,54
    $842,34
    $895,10
    $1 082,58
    $325,69
    $350,59
    $376,97
    $470,71
    $466,85
    $491,75
    $518,13
    $611,87
    $608,01
    $632,91
    $659,29
    $753,03
    $141,16
    Toc - Plan #79

    Expanded Bronze

    (EPO) Envision - Bronze 8550/100

    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
    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
    $259,60
    $294,64
    $331,76
    $463,64
    $704,54
    $519,20
    $589,28
    $663,52
    $927,28
    $1 409,08
    $717,79
    $787,87
    $862,11
    $1 125,87
    $916,38
    $986,46
    $1 060,70
    $1 324,46
    $1 114,97
    $1 185,05
    $1 259,29
    $1 523,05
    $458,19
    $493,23
    $530,35
    $662,23
    $656,78
    $691,82
    $728,94
    $860,82
    $855,37
    $890,41
    $927,53
    $1 059,41
    $198,59
    Toc - Plan #80

    Expanded Bronze

    (EPO) Envision - Bronze 8150/ 100

    Annual Out of Pocket Expenses
    Individual Family
    $8,150 $16,300 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    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
    $276,53
    $313,85
    $353,39
    $493,87
    $750,48
    $553,06
    $627,70
    $706,78
    $987,74
    $1 500,96
    $764,60
    $839,24
    $918,32
    $1 199,28
    $976,14
    $1 050,78
    $1 129,86
    $1 410,82
    $1 187,68
    $1 262,32
    $1 341,40
    $1 622,36
    $488,07
    $525,39
    $564,93
    $705,41
    $699,61
    $736,93
    $776,47
    $916,95
    $911,15
    $948,47
    $988,01
    $1 128,49
    $211,54
    Toc - Plan #81

    Expanded Bronze

    (EPO) Envision - HSA Bronze 7000/100

    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
    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
    $274,29
    $311,31
    $350,53
    $489,87
    $744,40
    $548,58
    $622,62
    $701,06
    $979,74
    $1 488,80
    $758,41
    $832,45
    $910,89
    $1 189,57
    $968,24
    $1 042,28
    $1 120,72
    $1 399,40
    $1 178,07
    $1 252,11
    $1 330,55
    $1 609,23
    $484,12
    $521,14
    $560,36
    $699,70
    $693,95
    $730,97
    $770,19
    $909,53
    $903,78
    $940,80
    $980,02
    $1 119,36
    $209,83
    Toc - Plan #82

    Silver

    (EPO) Envision - Silver 7000/75

    Annual Out of Pocket Expenses
    Individual Family
    $7,000 $14,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $310,01
    $351,85
    $396,18
    $553,65
    $841,33
    $620,02
    $703,70
    $792,36
    $1 107,30
    $1 682,66
    $857,17
    $940,85
    $1 029,51
    $1 344,45
    $1 094,32
    $1 178,00
    $1 266,66
    $1 581,60
    $1 331,47
    $1 415,15
    $1 503,81
    $1 818,75
    $547,16
    $589,00
    $633,33
    $790,80
    $784,31
    $826,15
    $870,48
    $1 027,95
    $1 021,46
    $1 063,30
    $1 107,63
    $1 265,10
    $237,15

    ‡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 Waushara County here.

    Waushara County is in “Rating Area 15” of Wisconsin.

    Currently, there are 82 plans offered in Rating Area 15.

    Obamacare Rates and Providers for Other Years

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