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You are viewing information for Niobrara County, WY

Obamacare 2023 Rates for Niobrara County

Obamacare > Rates > Wyoming > Niobrara County

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

The health insurance rates listed below are for calendar year 2023.

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, 25 Plans and 2023 Rates for Niobrara County, Wyoming

Below, you’ll find a summary of the 25 plans for Niobrara County, Wyoming and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Blue Cross Blue Shield of Wyoming

Local: 1-307-634-1393x2949 | Toll Free: 1-800-851-2227 | TTY: 1-800-696-4710
Toc - Plan #1 Blue Cross Blue Shield of Wyoming
Expanded Bronze

(PPO) BlueSelect Bronze Core

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$516.77
$586.53
$660.43
$922.95
$1,402.50 		$912.10
$981.86
$1,055.76
$1,318.28 		$1,307.43
$1,377.19
$1,451.09
$1,713.61 		$1,702.76
$1,772.52
$1,846.42
$2,108.94 		$395.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,033.54
$1,173.06
$1,320.86
$1,845.90
$2,805.00 		$1,428.87
$1,568.39
$1,716.19
$2,241.23 		$1,824.20
$1,963.72
$2,111.52
$2,636.56 		$2,219.53
$2,359.05
$2,506.85
$3,031.89 		$395.33
Toc - Plan #2 Blue Cross Blue Shield of Wyoming
Gold

(PPO) BlueSelect Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$800 $1,600 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 		$623.70
$707.90
$797.09
$1,113.92
$1,692.71 		$1,100.83
$1,185.03
$1,274.22
$1,591.05 		$1,577.96
$1,662.16
$1,751.35
$2,068.18 		$2,055.09
$2,139.29
$2,228.48
$2,545.31 		$477.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,247.40
$1,415.80
$1,594.18
$2,227.84
$3,385.42 		$1,724.53
$1,892.93
$2,071.31
$2,704.97 		$2,201.66
$2,370.06
$2,548.44
$3,182.10 		$2,678.79
$2,847.19
$3,025.57
$3,659.23 		$477.13
Toc - Plan #3 Blue Cross Blue Shield of Wyoming
Gold

(PPO) BlueSelect Gold HealthPlus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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 		$623.50
$707.68
$796.84
$1,113.57
$1,692.18 		$1,100.48
$1,184.66
$1,273.82
$1,590.55 		$1,577.46
$1,661.64
$1,750.80
$2,067.53 		$2,054.44
$2,138.62
$2,227.78
$2,544.51 		$476.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,247.00
$1,415.36
$1,593.68
$2,227.14
$3,384.36 		$1,723.98
$1,892.34
$2,070.66
$2,704.12 		$2,200.96
$2,369.32
$2,547.64
$3,181.10 		$2,677.94
$2,846.30
$3,024.62
$3,658.08 		$476.98
Toc - Plan #4 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 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 		$723.62
$821.30
$924.78
$1,292.38
$1,963.89 		$1,277.19
$1,374.87
$1,478.35
$1,845.95 		$1,830.76
$1,928.44
$2,031.92
$2,399.52 		$2,384.33
$2,482.01
$2,585.49
$2,953.09 		$553.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,447.24
$1,642.60
$1,849.56
$2,584.76
$3,927.78 		$2,000.81
$2,196.17
$2,403.13
$3,138.33 		$2,554.38
$2,749.74
$2,956.70
$3,691.90 		$3,107.95
$3,303.31
$3,510.27
$4,245.47 		$553.57
Toc - Plan #5 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver HealthPlus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$4,250 $8,500 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 		$721.81
$819.25
$922.47
$1,289.15
$1,958.98 		$1,274.00
$1,371.44
$1,474.66
$1,841.34 		$1,826.19
$1,923.63
$2,026.85
$2,393.53 		$2,378.38
$2,475.82
$2,579.04
$2,945.72 		$552.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,443.62
$1,638.50
$1,844.94
$2,578.30
$3,917.96 		$1,995.81
$2,190.69
$2,397.13
$3,130.49 		$2,548.00
$2,742.88
$2,949.32
$3,682.68 		$3,100.19
$3,295.07
$3,501.51
$4,234.87 		$552.19
Toc - Plan #6 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$725.63
$823.59
$927.35
$1,295.96
$1,969.34 		$1,280.74
$1,378.70
$1,482.46
$1,851.07 		$1,835.85
$1,933.81
$2,037.57
$2,406.18 		$2,390.96
$2,488.92
$2,592.68
$2,961.29 		$555.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,451.26
$1,647.18
$1,854.70
$2,591.92
$3,938.68 		$2,006.37
$2,202.29
$2,409.81
$3,147.03 		$2,561.48
$2,757.40
$2,964.92
$3,702.14 		$3,116.59
$3,312.51
$3,520.03
$4,257.25 		$555.11
Toc - Plan #7 Blue Cross Blue Shield of Wyoming
Bronze

(PPO) BlueSelect Bronze Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$524.39
$595.18
$670.17
$936.56
$1,423.19 		$925.55
$996.34
$1,071.33
$1,337.72 		$1,326.71
$1,397.50
$1,472.49
$1,738.88 		$1,727.87
$1,798.66
$1,873.65
$2,140.04 		$401.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,048.78
$1,190.36
$1,340.34
$1,873.12
$2,846.38 		$1,449.94
$1,591.52
$1,741.50
$2,274.28 		$1,851.10
$1,992.68
$2,142.66
$2,675.44 		$2,252.26
$2,393.84
$2,543.82
$3,076.60 		$401.16
Toc - Plan #8 Blue Cross Blue Shield of Wyoming
Bronze

(PPO) BlueSelect Bronze Balance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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 		$526.69
$597.79
$673.11
$940.66
$1,429.42 		$929.61
$1,000.71
$1,076.03
$1,343.58 		$1,332.53
$1,403.63
$1,478.95
$1,746.50 		$1,735.45
$1,806.55
$1,881.87
$2,149.42 		$402.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,053.38
$1,195.58
$1,346.22
$1,881.32
$2,858.84 		$1,456.30
$1,598.50
$1,749.14
$2,284.24 		$1,859.22
$2,001.42
$2,152.06
$2,687.16 		$2,262.14
$2,404.34
$2,554.98
$3,090.08 		$402.92
Toc - Plan #9 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Balance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$716.61
$813.35
$915.83
$1,279.86
$1,944.88 		$1,264.82
$1,361.56
$1,464.04
$1,828.07 		$1,813.03
$1,909.77
$2,012.25
$2,376.28 		$2,361.24
$2,457.98
$2,560.46
$2,924.49 		$548.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,433.22
$1,626.70
$1,831.66
$2,559.72
$3,889.76 		$1,981.43
$2,174.91
$2,379.87
$3,107.93 		$2,529.64
$2,723.12
$2,928.08
$3,656.14 		$3,077.85
$3,271.33
$3,476.29
$4,204.35 		$548.21
Toc - Plan #10 Blue Cross Blue Shield of Wyoming
Gold

(PPO) BlueSelect Gold Balance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$606.08
$687.90
$774.57
$1,082.45
$1,644.89 		$1,069.73
$1,151.55
$1,238.22
$1,546.10 		$1,533.38
$1,615.20
$1,701.87
$2,009.75 		$1,997.03
$2,078.85
$2,165.52
$2,473.40 		$463.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,212.16
$1,375.80
$1,549.14
$2,164.90
$3,289.78 		$1,675.81
$1,839.45
$2,012.79
$2,628.55 		$2,139.46
$2,303.10
$2,476.44
$3,092.20 		$2,603.11
$2,766.75
$2,940.09
$3,555.85 		$463.65
Toc - Plan #11 Blue Cross Blue Shield of Wyoming
Gold

(PPO) BlueSelect Gold Core

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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 		$598.11
$678.86
$764.39
$1,068.23
$1,623.27 		$1,055.67
$1,136.42
$1,221.95
$1,525.79 		$1,513.23
$1,593.98
$1,679.51
$1,983.35 		$1,970.79
$2,051.54
$2,137.07
$2,440.91 		$457.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,196.22
$1,357.72
$1,528.78
$2,136.46
$3,246.54 		$1,653.78
$1,815.28
$1,986.34
$2,594.02 		$2,111.34
$2,272.84
$2,443.90
$3,051.58 		$2,568.90
$2,730.40
$2,901.46
$3,509.14 		$457.56
Toc - Plan #12 Blue Cross Blue Shield of Wyoming
Bronze

(PPO) BlueSelect Bronze Basic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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 		$494.76
$561.56
$632.31
$883.65
$1,342.78 		$873.26
$940.06
$1,010.81
$1,262.15 		$1,251.76
$1,318.56
$1,389.31
$1,640.65 		$1,630.26
$1,697.06
$1,767.81
$2,019.15 		$378.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$989.52
$1,123.12
$1,264.62
$1,767.30
$2,685.56 		$1,368.02
$1,501.62
$1,643.12
$2,145.80 		$1,746.52
$1,880.12
$2,021.62
$2,524.30 		$2,125.02
$2,258.62
$2,400.12
$2,902.80 		$378.50
Toc - Plan #13 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Balance without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$713.75
$810.10
$912.17
$1,274.75
$1,937.10 		$1,259.77
$1,356.12
$1,458.19
$1,820.77 		$1,805.79
$1,902.14
$2,004.21
$2,366.79 		$2,351.81
$2,448.16
$2,550.23
$2,912.81 		$546.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,427.50
$1,620.20
$1,824.34
$2,549.50
$3,874.20 		$1,973.52
$2,166.22
$2,370.36
$3,095.52 		$2,519.54
$2,712.24
$2,916.38
$3,641.54 		$3,065.56
$3,258.26
$3,462.40
$4,187.56 		$546.02
Toc - Plan #14 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Classic without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 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 		$720.72
$818.02
$921.08
$1,287.21
$1,956.03 		$1,272.07
$1,369.37
$1,472.43
$1,838.56 		$1,823.42
$1,920.72
$2,023.78
$2,389.91 		$2,374.77
$2,472.07
$2,575.13
$2,941.26 		$551.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,441.44
$1,636.04
$1,842.16
$2,574.42
$3,912.06 		$1,992.79
$2,187.39
$2,393.51
$3,125.77 		$2,544.14
$2,738.74
$2,944.86
$3,677.12 		$3,095.49
$3,290.09
$3,496.21
$4,228.47 		$551.35
Toc - Plan #15 Blue Cross Blue Shield of Wyoming
Gold

(PPO) BlueSelect Gold Standard without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$614.17
$697.08
$784.91
$1,096.91
$1,666.85 		$1,084.01
$1,166.92
$1,254.75
$1,566.75 		$1,553.85
$1,636.76
$1,724.59
$2,036.59 		$2,023.69
$2,106.60
$2,194.43
$2,506.43 		$469.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,228.34
$1,394.16
$1,569.82
$2,193.82
$3,333.70 		$1,698.18
$1,864.00
$2,039.66
$2,663.66 		$2,168.02
$2,333.84
$2,509.50
$3,133.50 		$2,637.86
$2,803.68
$2,979.34
$3,603.34 		$469.84
Toc - Plan #16 Blue Cross Blue Shield of Wyoming
Silver

(PPO) BlueSelect Silver Standard without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 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 		$713.61
$809.94
$911.99
$1,274.50
$1,936.72 		$1,259.52
$1,355.85
$1,457.90
$1,820.41 		$1,805.43
$1,901.76
$2,003.81
$2,366.32 		$2,351.34
$2,447.67
$2,549.72
$2,912.23 		$545.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,427.22
$1,619.88
$1,823.98
$2,549.00
$3,873.44 		$1,973.13
$2,165.79
$2,369.89
$3,094.91 		$2,519.04
$2,711.70
$2,915.80
$3,640.82 		$3,064.95
$3,257.61
$3,461.71
$4,186.73 		$545.91
Toc - Plan #17 Blue Cross Blue Shield of Wyoming
Bronze

(PPO) BlueSelect Bronze Standard without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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 		$492.79
$559.31
$629.78
$880.11
$1,337.41 		$869.77
$936.29
$1,006.76
$1,257.09 		$1,246.75
$1,313.27
$1,383.74
$1,634.07 		$1,623.73
$1,690.25
$1,760.72
$2,011.05 		$376.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$985.58
$1,118.62
$1,259.56
$1,760.22
$2,674.82 		$1,362.56
$1,495.60
$1,636.54
$2,137.20 		$1,739.54
$1,872.58
$2,013.52
$2,514.18 		$2,116.52
$2,249.56
$2,390.50
$2,891.16 		$376.98
Toc - Plan #18 Blue Cross Blue Shield of Wyoming
Expanded Bronze

(PPO) BlueSelect Expanded Bronze Standard without Kid's Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-851-2227

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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 		$559.28
$634.79
$714.76
$998.88
$1,517.89 		$987.13
$1,062.64
$1,142.61
$1,426.73 		$1,414.98
$1,490.49
$1,570.46
$1,854.58 		$1,842.83
$1,918.34
$1,998.31
$2,282.43 		$427.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,118.56
$1,269.58
$1,429.52
$1,997.76
$3,035.78 		$1,546.41
$1,697.43
$1,857.37
$2,425.61 		$1,974.26
$2,125.28
$2,285.22
$2,853.46 		$2,402.11
$2,553.13
$2,713.07
$3,281.31 		$427.85

ADVERTISEMENT

Mountain Health CO-OP

Local: 1-406-447-9510 | Toll Free: 1-855-447-2900 | TTY: 1-855-447-2900
Toc - Plan #19 Mountain Health CO-OP
Gold

(PPO) High Plains Ind Gold WY

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,000 $12,000 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 		$562.01
$637.89
$718.25
$1,003.76
$1,525.31 		$991.95
$1,067.83
$1,148.19
$1,433.70 		$1,421.89
$1,497.77
$1,578.13
$1,863.64 		$1,851.83
$1,927.71
$2,008.07
$2,293.58 		$429.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,124.02
$1,275.78
$1,436.50
$2,007.52
$3,050.62 		$1,553.96
$1,705.72
$1,866.44
$2,437.46 		$1,983.90
$2,135.66
$2,296.38
$2,867.40 		$2,413.84
$2,565.60
$2,726.32
$3,297.34 		$429.94
Toc - Plan #20 Mountain Health CO-OP
Silver

(PPO) High Plains Ind Silver WY

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$626.92
$711.56
$801.21
$1,119.68
$1,701.47 		$1,106.52
$1,191.16
$1,280.81
$1,599.28 		$1,586.12
$1,670.76
$1,760.41
$2,078.88 		$2,065.72
$2,150.36
$2,240.01
$2,558.48 		$479.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,253.84
$1,423.12
$1,602.42
$2,239.36
$3,402.94 		$1,733.44
$1,902.72
$2,082.02
$2,718.96 		$2,213.04
$2,382.32
$2,561.62
$3,198.56 		$2,692.64
$2,861.92
$3,041.22
$3,678.16 		$479.60
Toc - Plan #21 Mountain Health CO-OP
Expanded Bronze

(PPO) High Plains Ind Bronze WY Expanded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,150 $16,300 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 		$448.03
$508.52
$572.59
$800.19
$1,215.96 		$790.78
$851.27
$915.34
$1,142.94 		$1,133.53
$1,194.02
$1,258.09
$1,485.69 		$1,476.28
$1,536.77
$1,600.84
$1,828.44 		$342.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$896.06
$1,017.04
$1,145.18
$1,600.38
$2,431.92 		$1,238.81
$1,359.79
$1,487.93
$1,943.13 		$1,581.56
$1,702.54
$1,830.68
$2,285.88 		$1,924.31
$2,045.29
$2,173.43
$2,628.63 		$342.75
Toc - Plan #22 Mountain Health CO-OP
Expanded Bronze

(PPO) High Plains Ind Bronze WY HD

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$467.15
$530.22
$597.02
$834.33
$1,267.85 		$824.52
$887.59
$954.39
$1,191.70 		$1,181.89
$1,244.96
$1,311.76
$1,549.07 		$1,539.26
$1,602.33
$1,669.13
$1,906.44 		$357.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$934.30
$1,060.44
$1,194.04
$1,668.66
$2,535.70 		$1,291.67
$1,417.81
$1,551.41
$2,026.03 		$1,649.04
$1,775.18
$1,908.78
$2,383.40 		$2,006.41
$2,132.55
$2,266.15
$2,740.77 		$357.37
Toc - Plan #23 Mountain Health CO-OP
Gold

(PPO) High Plains Ind Gold Standard WY

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$554.29
$629.12
$708.39
$989.97
$1,504.36 		$978.33
$1,053.16
$1,132.43
$1,414.01 		$1,402.37
$1,477.20
$1,556.47
$1,838.05 		$1,826.41
$1,901.24
$1,980.51
$2,262.09 		$424.04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,108.58
$1,258.24
$1,416.78
$1,979.94
$3,008.72 		$1,532.62
$1,682.28
$1,840.82
$2,403.98 		$1,956.66
$2,106.32
$2,264.86
$2,828.02 		$2,380.70
$2,530.36
$2,688.90
$3,252.06 		$424.04
Toc - Plan #24 Mountain Health CO-OP
Silver

(PPO) High Plains Ind Silver Standard WY

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 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 		$627.85
$712.61
$802.40
$1,121.35
$1,703.99 		$1,108.16
$1,192.92
$1,282.71
$1,601.66 		$1,588.47
$1,673.23
$1,763.02
$2,081.97 		$2,068.78
$2,153.54
$2,243.33
$2,562.28 		$480.31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,255.70
$1,425.22
$1,604.80
$2,242.70
$3,407.98 		$1,736.01
$1,905.53
$2,085.11
$2,723.01 		$2,216.32
$2,385.84
$2,565.42
$3,203.32 		$2,696.63
$2,866.15
$3,045.73
$3,683.63 		$480.31
Toc - Plan #25 Mountain Health CO-OP
Expanded Bronze

(PPO) High Plains Ind Bronze Standard WY Expanded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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 		$459.44
$521.47
$587.17
$820.56
$1,246.93 		$810.91
$872.94
$938.64
$1,172.03 		$1,162.38
$1,224.41
$1,290.11
$1,523.50 		$1,513.85
$1,575.88
$1,641.58
$1,874.97 		$351.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$918.88
$1,042.94
$1,174.34
$1,641.12
$2,493.86 		$1,270.35
$1,394.41
$1,525.81
$1,992.59 		$1,621.82
$1,745.88
$1,877.28
$2,344.06 		$1,973.29
$2,097.35
$2,228.75
$2,695.53 		$351.47

‡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 Niobrara County here.

Niobrara County is in “Rating Area 3” of Wyoming.

Currently, there are 25 plans offered in Rating Area 3.

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2023 Obamacare Plans for Niobrara County, WY

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