Glades County, Florida Obamacare 2024 Rates

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

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

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

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

Obamacare Providers, 60 Plans and 2024 Rates for Glades County, Florida

Below, you’ll find a summary of the 60 plans for Glades County, Florida and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

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Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$814.75
$924.74
$1,041.25
$1,455.14
$2,211.23
$1,438.03
$1,548.02
$1,664.53
$2,078.42
$2,061.31
$2,171.30
$2,287.81
$2,701.70
$2,684.59
$2,794.58
$2,911.09
$3,324.98
$623.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,629.50
$1,849.48
$2,082.50
$2,910.28
$4,422.46
$2,252.78
$2,472.76
$2,705.78
$3,533.56
$2,876.06
$3,096.04
$3,329.06
$4,156.84
$3,499.34
$3,719.32
$3,952.34
$4,780.12
$623.28
Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$582.34
$660.96
$744.23
$1,040.06
$1,580.47
$1,027.83
$1,106.45
$1,189.72
$1,485.55
$1,473.32
$1,551.94
$1,635.21
$1,931.04
$1,918.81
$1,997.43
$2,080.70
$2,376.53
$445.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,164.68
$1,321.92
$1,488.46
$2,080.12
$3,160.94
$1,610.17
$1,767.41
$1,933.95
$2,525.61
$2,055.66
$2,212.90
$2,379.44
$2,971.10
$2,501.15
$2,658.39
$2,824.93
$3,416.59
$445.49
Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,000 $8,000 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
$1,099.36
$1,247.77
$1,404.98
$1,963.46
$2,983.66
$1,940.37
$2,088.78
$2,245.99
$2,804.47
$2,781.38
$2,929.79
$3,087.00
$3,645.48
$3,622.39
$3,770.80
$3,928.01
$4,486.49
$841.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,198.72
$2,495.54
$2,809.96
$3,926.92
$5,967.32
$3,039.73
$3,336.55
$3,650.97
$4,767.93
$3,880.74
$4,177.56
$4,491.98
$5,608.94
$4,721.75
$5,018.57
$5,332.99
$6,449.95
$841.01
Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)
Bronze

(PPO) BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$544.83
$618.38
$696.29
$973.07
$1,478.67
$961.62
$1,035.17
$1,113.08
$1,389.86
$1,378.41
$1,451.96
$1,529.87
$1,806.65
$1,795.20
$1,868.75
$1,946.66
$2,223.44
$416.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,089.66
$1,236.76
$1,392.58
$1,946.14
$2,957.34
$1,506.45
$1,653.55
$1,809.37
$2,362.93
$1,923.24
$2,070.34
$2,226.16
$2,779.72
$2,340.03
$2,487.13
$2,642.95
$3,196.51
$416.79
Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 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
$871.55
$989.21
$1,113.84
$1,556.59
$2,365.39
$1,538.29
$1,655.95
$1,780.58
$2,223.33
$2,205.03
$2,322.69
$2,447.32
$2,890.07
$2,871.77
$2,989.43
$3,114.06
$3,556.81
$666.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,743.10
$1,978.42
$2,227.68
$3,113.18
$4,730.78
$2,409.84
$2,645.16
$2,894.42
$3,779.92
$3,076.58
$3,311.90
$3,561.16
$4,446.66
$3,743.32
$3,978.64
$4,227.90
$5,113.40
$666.74
Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 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
$1,143.45
$1,297.82
$1,461.33
$2,042.20
$3,103.32
$2,018.19
$2,172.56
$2,336.07
$2,916.94
$2,892.93
$3,047.30
$3,210.81
$3,791.68
$3,767.67
$3,922.04
$4,085.55
$4,666.42
$874.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,286.90
$2,595.64
$2,922.66
$4,084.40
$6,206.64
$3,161.64
$3,470.38
$3,797.40
$4,959.14
$4,036.38
$4,345.12
$4,672.14
$5,833.88
$4,911.12
$5,219.86
$5,546.88
$6,708.62
$874.74
Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$938.21
$1,064.87
$1,199.03
$1,675.64
$2,546.30
$1,655.94
$1,782.60
$1,916.76
$2,393.37
$2,373.67
$2,500.33
$2,634.49
$3,111.10
$3,091.40
$3,218.06
$3,352.22
$3,828.83
$717.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,876.42
$2,129.74
$2,398.06
$3,351.28
$5,092.60
$2,594.15
$2,847.47
$3,115.79
$4,069.01
$3,311.88
$3,565.20
$3,833.52
$4,786.74
$4,029.61
$4,282.93
$4,551.25
$5,504.47
$717.73
Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 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
$566.44
$642.91
$723.91
$1,011.66
$1,537.32
$999.77
$1,076.24
$1,157.24
$1,444.99
$1,433.10
$1,509.57
$1,590.57
$1,878.32
$1,866.43
$1,942.90
$2,023.90
$2,311.65
$433.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,132.88
$1,285.82
$1,447.82
$2,023.32
$3,074.64
$1,566.21
$1,719.15
$1,881.15
$2,456.65
$1,999.54
$2,152.48
$2,314.48
$2,889.98
$2,432.87
$2,585.81
$2,747.81
$3,323.31
$433.33
Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 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
$910.49
$1,033.41
$1,163.61
$1,626.14
$2,471.07
$1,607.01
$1,729.93
$1,860.13
$2,322.66
$2,303.53
$2,426.45
$2,556.65
$3,019.18
$3,000.05
$3,122.97
$3,253.17
$3,715.70
$696.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,820.98
$2,066.82
$2,327.22
$3,252.28
$4,942.14
$2,517.50
$2,763.34
$3,023.74
$3,948.80
$3,214.02
$3,459.86
$3,720.26
$4,645.32
$3,910.54
$4,156.38
$4,416.78
$5,341.84
$696.52
Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$609.75
$692.07
$779.26
$1,089.01
$1,654.86
$1,076.21
$1,158.53
$1,245.72
$1,555.47
$1,542.67
$1,624.99
$1,712.18
$2,021.93
$2,009.13
$2,091.45
$2,178.64
$2,488.39
$466.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,219.50
$1,384.14
$1,558.52
$2,178.02
$3,309.72
$1,685.96
$1,850.60
$2,024.98
$2,644.48
$2,152.42
$2,317.06
$2,491.44
$3,110.94
$2,618.88
$2,783.52
$2,957.90
$3,577.40
$466.46
Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$570.81
$647.87
$729.50
$1,019.47
$1,549.18
$1,007.48
$1,084.54
$1,166.17
$1,456.14
$1,444.15
$1,521.21
$1,602.84
$1,892.81
$1,880.82
$1,957.88
$2,039.51
$2,329.48
$436.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,141.62
$1,295.74
$1,459.00
$2,038.94
$3,098.36
$1,578.29
$1,732.41
$1,895.67
$2,475.61
$2,014.96
$2,169.08
$2,332.34
$2,912.28
$2,451.63
$2,605.75
$2,769.01
$3,348.95
$436.67
Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$846.76
$961.07
$1,082.16
$1,512.31
$2,298.11
$1,494.53
$1,608.84
$1,729.93
$2,160.08
$2,142.30
$2,256.61
$2,377.70
$2,807.85
$2,790.07
$2,904.38
$3,025.47
$3,455.62
$647.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,693.52
$1,922.14
$2,164.32
$3,024.62
$4,596.22
$2,341.29
$2,569.91
$2,812.09
$3,672.39
$2,989.06
$3,217.68
$3,459.86
$4,320.16
$3,636.83
$3,865.45
$4,107.63
$4,967.93
$647.77
Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$888.00
$1,007.88
$1,134.86
$1,585.97
$2,410.03
$1,567.32
$1,687.20
$1,814.18
$2,265.29
$2,246.64
$2,366.52
$2,493.50
$2,944.61
$2,925.96
$3,045.84
$3,172.82
$3,623.93
$679.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,776.00
$2,015.76
$2,269.72
$3,171.94
$4,820.06
$2,455.32
$2,695.08
$2,949.04
$3,851.26
$3,134.64
$3,374.40
$3,628.36
$4,530.58
$3,813.96
$4,053.72
$4,307.68
$5,209.90
$679.32
Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 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
$1,136.30
$1,289.70
$1,452.19
$2,029.43
$3,083.92
$2,005.57
$2,158.97
$2,321.46
$2,898.70
$2,874.84
$3,028.24
$3,190.73
$3,767.97
$3,744.11
$3,897.51
$4,060.00
$4,637.24
$869.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,272.60
$2,579.40
$2,904.38
$4,058.86
$6,167.84
$3,141.87
$3,448.67
$3,773.65
$4,928.13
$4,011.14
$4,317.94
$4,642.92
$5,797.40
$4,880.41
$5,187.21
$5,512.19
$6,666.67
$869.27

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Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #15 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 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
$605.09
$686.77
$773.29
$1,080.67
$1,642.19
$1,067.98
$1,149.66
$1,236.18
$1,543.56
$1,530.87
$1,612.55
$1,699.07
$2,006.45
$1,993.76
$2,075.44
$2,161.96
$2,469.34
$462.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,210.18
$1,373.54
$1,546.58
$2,161.34
$3,284.38
$1,673.07
$1,836.43
$2,009.47
$2,624.23
$2,135.96
$2,299.32
$2,472.36
$3,087.12
$2,598.85
$2,762.21
$2,935.25
$3,550.01
$462.89
Toc - Plan #16 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$499.83
$567.30
$638.78
$892.69
$1,356.52
$882.20
$949.67
$1,021.15
$1,275.06
$1,264.57
$1,332.04
$1,403.52
$1,657.43
$1,646.94
$1,714.41
$1,785.89
$2,039.80
$382.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$999.66
$1,134.60
$1,277.56
$1,785.38
$2,713.04
$1,382.03
$1,516.97
$1,659.93
$2,167.75
$1,764.40
$1,899.34
$2,042.30
$2,550.12
$2,146.77
$2,281.71
$2,424.67
$2,932.49
$382.37
Toc - Plan #17 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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
$630.87
$716.02
$806.24
$1,126.71
$1,712.15
$1,113.48
$1,198.63
$1,288.85
$1,609.32
$1,596.09
$1,681.24
$1,771.46
$2,091.93
$2,078.70
$2,163.85
$2,254.07
$2,574.54
$482.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,261.74
$1,432.04
$1,612.48
$2,253.42
$3,424.30
$1,744.35
$1,914.65
$2,095.09
$2,736.03
$2,226.96
$2,397.26
$2,577.70
$3,218.64
$2,709.57
$2,879.87
$3,060.31
$3,701.25
$482.61
Toc - Plan #18 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$493.04
$559.59
$630.09
$880.55
$1,338.08
$870.21
$936.76
$1,007.26
$1,257.72
$1,247.38
$1,313.93
$1,384.43
$1,634.89
$1,624.55
$1,691.10
$1,761.60
$2,012.06
$377.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$986.08
$1,119.18
$1,260.18
$1,761.10
$2,676.16
$1,363.25
$1,496.35
$1,637.35
$2,138.27
$1,740.42
$1,873.52
$2,014.52
$2,515.44
$2,117.59
$2,250.69
$2,391.69
$2,892.61
$377.17
Toc - Plan #19 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$566.09
$642.50
$723.45
$1,011.01
$1,536.33
$999.14
$1,075.55
$1,156.50
$1,444.06
$1,432.19
$1,508.60
$1,589.55
$1,877.11
$1,865.24
$1,941.65
$2,022.60
$2,310.16
$433.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,132.18
$1,285.00
$1,446.90
$2,022.02
$3,072.66
$1,565.23
$1,718.05
$1,879.95
$2,455.07
$1,998.28
$2,151.10
$2,313.00
$2,888.12
$2,431.33
$2,584.15
$2,746.05
$3,321.17
$433.05
Toc - Plan #20 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$614.40
$697.33
$785.19
$1,097.30
$1,667.45
$1,084.41
$1,167.34
$1,255.20
$1,567.31
$1,554.42
$1,637.35
$1,725.21
$2,037.32
$2,024.43
$2,107.36
$2,195.22
$2,507.33
$470.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,228.80
$1,394.66
$1,570.38
$2,194.60
$3,334.90
$1,698.81
$1,864.67
$2,040.39
$2,664.61
$2,168.82
$2,334.68
$2,510.40
$3,134.62
$2,638.83
$2,804.69
$2,980.41
$3,604.63
$470.01
Toc - Plan #21 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$625.36
$709.77
$799.19
$1,116.87
$1,697.19
$1,103.75
$1,188.16
$1,277.58
$1,595.26
$1,582.14
$1,666.55
$1,755.97
$2,073.65
$2,060.53
$2,144.94
$2,234.36
$2,552.04
$478.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,250.72
$1,419.54
$1,598.38
$2,233.74
$3,394.38
$1,729.11
$1,897.93
$2,076.77
$2,712.13
$2,207.50
$2,376.32
$2,555.16
$3,190.52
$2,685.89
$2,854.71
$3,033.55
$3,668.91
$478.39
Toc - Plan #22 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 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
$578.39
$656.47
$739.17
$1,032.99
$1,569.73
$1,020.85
$1,098.93
$1,181.63
$1,475.45
$1,463.31
$1,541.39
$1,624.09
$1,917.91
$1,905.77
$1,983.85
$2,066.55
$2,360.37
$442.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,156.78
$1,312.94
$1,478.34
$2,065.98
$3,139.46
$1,599.24
$1,755.40
$1,920.80
$2,508.44
$2,041.70
$2,197.86
$2,363.26
$2,950.90
$2,484.16
$2,640.32
$2,805.72
$3,393.36
$442.46
Toc - Plan #23 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$665.34
$755.15
$850.29
$1,188.28
$1,805.71
$1,174.32
$1,264.13
$1,359.27
$1,697.26
$1,683.30
$1,773.11
$1,868.25
$2,206.24
$2,192.28
$2,282.09
$2,377.23
$2,715.22
$508.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,330.68
$1,510.30
$1,700.58
$2,376.56
$3,611.42
$1,839.66
$2,019.28
$2,209.56
$2,885.54
$2,348.64
$2,528.26
$2,718.54
$3,394.52
$2,857.62
$3,037.24
$3,227.52
$3,903.50
$508.98
Toc - Plan #24 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$483.49
$548.75
$617.88
$863.49
$1,312.15
$853.35
$918.61
$987.74
$1,233.35
$1,223.21
$1,288.47
$1,357.60
$1,603.21
$1,593.07
$1,658.33
$1,727.46
$1,973.07
$369.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$966.98
$1,097.50
$1,235.76
$1,726.98
$2,624.30
$1,336.84
$1,467.36
$1,605.62
$2,096.84
$1,706.70
$1,837.22
$1,975.48
$2,466.70
$2,076.56
$2,207.08
$2,345.34
$2,836.56
$369.86
Toc - Plan #25 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$612.32
$694.97
$782.53
$1,093.58
$1,661.80
$1,080.73
$1,163.38
$1,250.94
$1,561.99
$1,549.14
$1,631.79
$1,719.35
$2,030.40
$2,017.55
$2,100.20
$2,187.76
$2,498.81
$468.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,224.64
$1,389.94
$1,565.06
$2,187.16
$3,323.60
$1,693.05
$1,858.35
$2,033.47
$2,655.57
$2,161.46
$2,326.76
$2,501.88
$3,123.98
$2,629.87
$2,795.17
$2,970.29
$3,592.39
$468.41
Toc - Plan #26 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$574.90
$652.50
$734.71
$1,026.76
$1,560.26
$1,014.69
$1,092.29
$1,174.50
$1,466.55
$1,454.48
$1,532.08
$1,614.29
$1,906.34
$1,894.27
$1,971.87
$2,054.08
$2,346.13
$439.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,149.80
$1,305.00
$1,469.42
$2,053.52
$3,120.52
$1,589.59
$1,744.79
$1,909.21
$2,493.31
$2,029.38
$2,184.58
$2,349.00
$2,933.10
$2,469.17
$2,624.37
$2,788.79
$3,372.89
$439.79
Toc - Plan #27 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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
$652.58
$740.67
$833.98
$1,165.49
$1,771.08
$1,151.80
$1,239.89
$1,333.20
$1,664.71
$1,651.02
$1,739.11
$1,832.42
$2,163.93
$2,150.24
$2,238.33
$2,331.64
$2,663.15
$499.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,305.16
$1,481.34
$1,667.96
$2,330.98
$3,542.16
$1,804.38
$1,980.56
$2,167.18
$2,830.20
$2,303.60
$2,479.78
$2,666.40
$3,329.42
$2,802.82
$2,979.00
$3,165.62
$3,828.64
$499.22
Toc - Plan #28 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$517.04
$586.83
$660.76
$923.41
$1,403.21
$912.57
$982.36
$1,056.29
$1,318.94
$1,308.10
$1,377.89
$1,451.82
$1,714.47
$1,703.63
$1,773.42
$1,847.35
$2,110.00
$395.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,034.08
$1,173.66
$1,321.52
$1,846.82
$2,806.42
$1,429.61
$1,569.19
$1,717.05
$2,242.35
$1,825.14
$1,964.72
$2,112.58
$2,637.88
$2,220.67
$2,360.25
$2,508.11
$3,033.41
$395.53
Toc - Plan #29 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 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
$625.92
$710.40
$799.91
$1,117.87
$1,698.71
$1,104.74
$1,189.22
$1,278.73
$1,596.69
$1,583.56
$1,668.04
$1,757.55
$2,075.51
$2,062.38
$2,146.86
$2,236.37
$2,554.33
$478.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,251.84
$1,420.80
$1,599.82
$2,235.74
$3,397.42
$1,730.66
$1,899.62
$2,078.64
$2,714.56
$2,209.48
$2,378.44
$2,557.46
$3,193.38
$2,688.30
$2,857.26
$3,036.28
$3,672.20
$478.82
Toc - Plan #30 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 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
$635.54
$721.33
$812.21
$1,135.06
$1,724.83
$1,121.72
$1,207.51
$1,298.39
$1,621.24
$1,607.90
$1,693.69
$1,784.57
$2,107.42
$2,094.08
$2,179.87
$2,270.75
$2,593.60
$486.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,271.08
$1,442.66
$1,624.42
$2,270.12
$3,449.66
$1,757.26
$1,928.84
$2,110.60
$2,756.30
$2,243.44
$2,415.02
$2,596.78
$3,242.48
$2,729.62
$2,901.20
$3,082.96
$3,728.66
$486.18
Toc - Plan #31 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$688.24
$781.14
$879.56
$1,229.18
$1,867.85
$1,214.74
$1,307.64
$1,406.06
$1,755.68
$1,741.24
$1,834.14
$1,932.56
$2,282.18
$2,267.74
$2,360.64
$2,459.06
$2,808.68
$526.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,376.48
$1,562.28
$1,759.12
$2,458.36
$3,735.70
$1,902.98
$2,088.78
$2,285.62
$2,984.86
$2,429.48
$2,615.28
$2,812.12
$3,511.36
$2,955.98
$3,141.78
$3,338.62
$4,037.86
$526.50
Toc - Plan #32 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$500.13
$567.63
$639.15
$893.21
$1,357.31
$882.72
$950.22
$1,021.74
$1,275.80
$1,265.31
$1,332.81
$1,404.33
$1,658.39
$1,647.90
$1,715.40
$1,786.92
$2,040.98
$382.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,000.26
$1,135.26
$1,278.30
$1,786.42
$2,714.62
$1,382.85
$1,517.85
$1,660.89
$2,169.01
$1,765.44
$1,900.44
$2,043.48
$2,551.60
$2,148.03
$2,283.03
$2,426.07
$2,934.19
$382.59
Toc - Plan #33 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$633.39
$718.89
$809.46
$1,131.21
$1,718.99
$1,117.92
$1,203.42
$1,293.99
$1,615.74
$1,602.45
$1,687.95
$1,778.52
$2,100.27
$2,086.98
$2,172.48
$2,263.05
$2,584.80
$484.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,266.78
$1,437.78
$1,618.92
$2,262.42
$3,437.98
$1,751.31
$1,922.31
$2,103.45
$2,746.95
$2,235.84
$2,406.84
$2,587.98
$3,231.48
$2,720.37
$2,891.37
$3,072.51
$3,716.01
$484.53
Toc - Plan #34 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$594.69
$674.96
$760.00
$1,062.10
$1,613.96
$1,049.62
$1,129.89
$1,214.93
$1,517.03
$1,504.55
$1,584.82
$1,669.86
$1,971.96
$1,959.48
$2,039.75
$2,124.79
$2,426.89
$454.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,189.38
$1,349.92
$1,520.00
$2,124.20
$3,227.92
$1,644.31
$1,804.85
$1,974.93
$2,579.13
$2,099.24
$2,259.78
$2,429.86
$3,034.06
$2,554.17
$2,714.71
$2,884.79
$3,488.99
$454.93
Toc - Plan #35 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$510.01
$578.85
$651.78
$910.85
$1,384.13
$900.16
$969.00
$1,041.93
$1,301.00
$1,290.31
$1,359.15
$1,432.08
$1,691.15
$1,680.46
$1,749.30
$1,822.23
$2,081.30
$390.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,020.02
$1,157.70
$1,303.56
$1,821.70
$2,768.26
$1,410.17
$1,547.85
$1,693.71
$2,211.85
$1,800.32
$1,938.00
$2,083.86
$2,602.00
$2,190.47
$2,328.15
$2,474.01
$2,992.15
$390.15
Toc - Plan #36 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$585.57
$664.61
$748.34
$1,045.81
$1,589.21
$1,033.52
$1,112.56
$1,196.29
$1,493.76
$1,481.47
$1,560.51
$1,644.24
$1,941.71
$1,929.42
$2,008.46
$2,092.19
$2,389.66
$447.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,171.14
$1,329.22
$1,496.68
$2,091.62
$3,178.42
$1,619.09
$1,777.17
$1,944.63
$2,539.57
$2,067.04
$2,225.12
$2,392.58
$2,987.52
$2,514.99
$2,673.07
$2,840.53
$3,435.47
$447.95
Toc - Plan #37 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$646.88
$734.20
$826.70
$1,155.31
$1,755.60
$1,141.74
$1,229.06
$1,321.56
$1,650.17
$1,636.60
$1,723.92
$1,816.42
$2,145.03
$2,131.46
$2,218.78
$2,311.28
$2,639.89
$494.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,293.76
$1,468.40
$1,653.40
$2,310.62
$3,511.20
$1,788.62
$1,963.26
$2,148.26
$2,805.48
$2,283.48
$2,458.12
$2,643.12
$3,300.34
$2,778.34
$2,952.98
$3,137.98
$3,795.20
$494.86
Toc - Plan #38 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 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
$598.30
$679.06
$764.61
$1,068.55
$1,623.76
$1,055.99
$1,136.75
$1,222.30
$1,526.24
$1,513.68
$1,594.44
$1,679.99
$1,983.93
$1,971.37
$2,052.13
$2,137.68
$2,441.62
$457.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,196.60
$1,358.12
$1,529.22
$2,137.10
$3,247.52
$1,654.29
$1,815.81
$1,986.91
$2,594.79
$2,111.98
$2,273.50
$2,444.60
$3,052.48
$2,569.67
$2,731.19
$2,902.29
$3,510.17
$457.69

ADVERTISEMENT

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #39 UnitedHealthcare
Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$3,900 $7,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$594.86
$675.17
$760.24
$1,062.43
$1,614.46
$1,049.93
$1,130.24
$1,215.31
$1,517.50
$1,505.00
$1,585.31
$1,670.38
$1,972.57
$1,960.07
$2,040.38
$2,125.45
$2,427.64
$455.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,189.72
$1,350.34
$1,520.48
$2,124.86
$3,228.92
$1,644.79
$1,805.41
$1,975.55
$2,579.93
$2,099.86
$2,260.48
$2,430.62
$3,035.00
$2,554.93
$2,715.55
$2,885.69
$3,490.07
$455.07
Toc - Plan #40 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$8,250 $16,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$476.74
$541.10
$609.28
$851.46
$1,293.88
$841.45
$905.81
$973.99
$1,216.17
$1,206.16
$1,270.52
$1,338.70
$1,580.88
$1,570.87
$1,635.23
$1,703.41
$1,945.59
$364.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$953.48
$1,082.20
$1,218.56
$1,702.92
$2,587.76
$1,318.19
$1,446.91
$1,583.27
$2,067.63
$1,682.90
$1,811.62
$1,947.98
$2,432.34
$2,047.61
$2,176.33
$2,312.69
$2,797.05
$364.71
Toc - Plan #41 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$477.47
$541.93
$610.21
$852.77
$1,295.87
$842.74
$907.20
$975.48
$1,218.04
$1,208.01
$1,272.47
$1,340.75
$1,583.31
$1,573.28
$1,637.74
$1,706.02
$1,948.58
$365.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$954.94
$1,083.86
$1,220.42
$1,705.54
$2,591.74
$1,320.21
$1,449.13
$1,585.69
$2,070.81
$1,685.48
$1,814.40
$1,950.96
$2,436.08
$2,050.75
$2,179.67
$2,316.23
$2,801.35
$365.27
Toc - Plan #42 UnitedHealthcare
Gold

(HMO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$683.72
$776.02
$873.79
$1,221.12
$1,855.62
$1,206.77
$1,299.07
$1,396.84
$1,744.17
$1,729.82
$1,822.12
$1,919.89
$2,267.22
$2,252.87
$2,345.17
$2,442.94
$2,790.27
$523.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,367.44
$1,552.04
$1,747.58
$2,442.24
$3,711.24
$1,890.49
$2,075.09
$2,270.63
$2,965.29
$2,413.54
$2,598.14
$2,793.68
$3,488.34
$2,936.59
$3,121.19
$3,316.73
$4,011.39
$523.05
Toc - Plan #43 UnitedHealthcare
Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$672.09
$762.82
$858.93
$1,200.35
$1,824.05
$1,186.24
$1,276.97
$1,373.08
$1,714.50
$1,700.39
$1,791.12
$1,887.23
$2,228.65
$2,214.54
$2,305.27
$2,401.38
$2,742.80
$514.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,344.18
$1,525.64
$1,717.86
$2,400.70
$3,648.10
$1,858.33
$2,039.79
$2,232.01
$2,914.85
$2,372.48
$2,553.94
$2,746.16
$3,429.00
$2,886.63
$3,068.09
$3,260.31
$3,943.15
$514.15
Toc - Plan #44 UnitedHealthcare
Silver

(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$618.79
$702.33
$790.82
$1,105.16
$1,679.40
$1,092.17
$1,175.71
$1,264.20
$1,578.54
$1,565.55
$1,649.09
$1,737.58
$2,051.92
$2,038.93
$2,122.47
$2,210.96
$2,525.30
$473.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,237.58
$1,404.66
$1,581.64
$2,210.32
$3,358.80
$1,710.96
$1,878.04
$2,055.02
$2,683.70
$2,184.34
$2,351.42
$2,528.40
$3,157.08
$2,657.72
$2,824.80
$3,001.78
$3,630.46
$473.38
Toc - Plan #45 UnitedHealthcare
Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$588.26
$667.68
$751.80
$1,050.64
$1,596.54
$1,038.28
$1,117.70
$1,201.82
$1,500.66
$1,488.30
$1,567.72
$1,651.84
$1,950.68
$1,938.32
$2,017.74
$2,101.86
$2,400.70
$450.02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,176.52
$1,335.36
$1,503.60
$2,101.28
$3,193.08
$1,626.54
$1,785.38
$1,953.62
$2,551.30
$2,076.56
$2,235.40
$2,403.64
$3,001.32
$2,526.58
$2,685.42
$2,853.66
$3,451.34
$450.02
Toc - Plan #46 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$469.75
$533.17
$600.34
$838.98
$1,274.91
$829.11
$892.53
$959.70
$1,198.34
$1,188.47
$1,251.89
$1,319.06
$1,557.70
$1,547.83
$1,611.25
$1,678.42
$1,917.06
$359.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$939.50
$1,066.34
$1,200.68
$1,677.96
$2,549.82
$1,298.86
$1,425.70
$1,560.04
$2,037.32
$1,658.22
$1,785.06
$1,919.40
$2,396.68
$2,017.58
$2,144.42
$2,278.76
$2,756.04
$359.36
Toc - Plan #47 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$478.17
$542.73
$611.11
$854.02
$1,297.76
$843.97
$908.53
$976.91
$1,219.82
$1,209.77
$1,274.33
$1,342.71
$1,585.62
$1,575.57
$1,640.13
$1,708.51
$1,951.42
$365.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$956.34
$1,085.46
$1,222.22
$1,708.04
$2,595.52
$1,322.14
$1,451.26
$1,588.02
$2,073.84
$1,687.94
$1,817.06
$1,953.82
$2,439.64
$2,053.74
$2,182.86
$2,319.62
$2,805.44
$365.80
Toc - Plan #48 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$501.43
$569.13
$640.83
$895.56
$1,360.89
$885.03
$952.73
$1,024.43
$1,279.16
$1,268.63
$1,336.33
$1,408.03
$1,662.76
$1,652.23
$1,719.93
$1,791.63
$2,046.36
$383.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,002.86
$1,138.26
$1,281.66
$1,791.12
$2,721.78
$1,386.46
$1,521.86
$1,665.26
$2,174.72
$1,770.06
$1,905.46
$2,048.86
$2,558.32
$2,153.66
$2,289.06
$2,432.46
$2,941.92
$383.60
Toc - Plan #49 UnitedHealthcare
Silver

(HMO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$593.55
$673.68
$758.56
$1,060.09
$1,610.91
$1,047.62
$1,127.75
$1,212.63
$1,514.16
$1,501.69
$1,581.82
$1,666.70
$1,968.23
$1,955.76
$2,035.89
$2,120.77
$2,422.30
$454.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,187.10
$1,347.36
$1,517.12
$2,120.18
$3,221.82
$1,641.17
$1,801.43
$1,971.19
$2,574.25
$2,095.24
$2,255.50
$2,425.26
$3,028.32
$2,549.31
$2,709.57
$2,879.33
$3,482.39
$454.07
Toc - Plan #50 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$600.26
$681.29
$767.13
$1,072.06
$1,629.09
$1,059.46
$1,140.49
$1,226.33
$1,531.26
$1,518.66
$1,599.69
$1,685.53
$1,990.46
$1,977.86
$2,058.89
$2,144.73
$2,449.66
$459.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,200.52
$1,362.58
$1,534.26
$2,144.12
$3,258.18
$1,659.72
$1,821.78
$1,993.46
$2,603.32
$2,118.92
$2,280.98
$2,452.66
$3,062.52
$2,578.12
$2,740.18
$2,911.86
$3,521.72
$459.20
Toc - Plan #51 UnitedHealthcare
Gold

(HMO) UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$668.33
$758.56
$854.13
$1,193.64
$1,813.85
$1,179.60
$1,269.83
$1,365.40
$1,704.91
$1,690.87
$1,781.10
$1,876.67
$2,216.18
$2,202.14
$2,292.37
$2,387.94
$2,727.45
$511.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,336.66
$1,517.12
$1,708.26
$2,387.28
$3,627.70
$1,847.93
$2,028.39
$2,219.53
$2,898.55
$2,359.20
$2,539.66
$2,730.80
$3,409.82
$2,870.47
$3,050.93
$3,242.07
$3,921.09
$511.27
Toc - Plan #52 UnitedHealthcare
Gold

(HMO) UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,400 $16,800 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
$670.13
$760.60
$856.43
$1,196.86
$1,818.74
$1,182.78
$1,273.25
$1,369.08
$1,709.51
$1,695.43
$1,785.90
$1,881.73
$2,222.16
$2,208.08
$2,298.55
$2,394.38
$2,734.81
$512.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,340.26
$1,521.20
$1,712.86
$2,393.72
$3,637.48
$1,852.91
$2,033.85
$2,225.51
$2,906.37
$2,365.56
$2,546.50
$2,738.16
$3,419.02
$2,878.21
$3,059.15
$3,250.81
$3,931.67
$512.65
Toc - Plan #53 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$708.53
$804.18
$905.50
$1,265.43
$1,922.94
$1,250.55
$1,346.20
$1,447.52
$1,807.45
$1,792.57
$1,888.22
$1,989.54
$2,349.47
$2,334.59
$2,430.24
$2,531.56
$2,891.49
$542.02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,417.06
$1,608.36
$1,811.00
$2,530.86
$3,845.88
$1,959.08
$2,150.38
$2,353.02
$3,072.88
$2,501.10
$2,692.40
$2,895.04
$3,614.90
$3,043.12
$3,234.42
$3,437.06
$4,156.92
$542.02
Toc - Plan #54 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$626.63
$711.23
$800.84
$1,119.17
$1,700.68
$1,106.00
$1,190.60
$1,280.21
$1,598.54
$1,585.37
$1,669.97
$1,759.58
$2,077.91
$2,064.74
$2,149.34
$2,238.95
$2,557.28
$479.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,253.26
$1,422.46
$1,601.68
$2,238.34
$3,401.36
$1,732.63
$1,901.83
$2,081.05
$2,717.71
$2,212.00
$2,381.20
$2,560.42
$3,197.08
$2,691.37
$2,860.57
$3,039.79
$3,676.45
$479.37

ADVERTISEMENT

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #55 Ambetter from Sunshine Health
Expanded Bronze

(HMO) Ambetter Virtual Access Bronze (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

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
$512.48
$581.65
$654.93
$915.26
$1,390.83
$904.52
$973.69
$1,046.97
$1,307.30
$1,296.56
$1,365.73
$1,439.01
$1,699.34
$1,688.60
$1,757.77
$1,831.05
$2,091.38
$392.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,024.96
$1,163.30
$1,309.86
$1,830.52
$2,781.66
$1,417.00
$1,555.34
$1,701.90
$2,222.56
$1,809.04
$1,947.38
$2,093.94
$2,614.60
$2,201.08
$2,339.42
$2,485.98
$3,006.64
$392.04
Toc - Plan #56 Ambetter from Sunshine Health
Silver

(HMO) Ambetter Virtual Access Silver (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,400 $14,800 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
$641.05
$727.59
$819.25
$1,144.90
$1,739.79
$1,131.45
$1,217.99
$1,309.65
$1,635.30
$1,621.85
$1,708.39
$1,800.05
$2,125.70
$2,112.25
$2,198.79
$2,290.45
$2,616.10
$490.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,282.10
$1,455.18
$1,638.50
$2,289.80
$3,479.58
$1,772.50
$1,945.58
$2,128.90
$2,780.20
$2,262.90
$2,435.98
$2,619.30
$3,270.60
$2,753.30
$2,926.38
$3,109.70
$3,761.00
$490.40
Toc - Plan #57 Ambetter from Sunshine Health
Gold

(HMO) Ambetter Virtual Access Gold (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$950 $1,900 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
$612.28
$694.93
$782.49
$1,093.52
$1,661.71
$1,080.67
$1,163.32
$1,250.88
$1,561.91
$1,549.06
$1,631.71
$1,719.27
$2,030.30
$2,017.45
$2,100.10
$2,187.66
$2,498.69
$468.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,224.56
$1,389.86
$1,564.98
$2,187.04
$3,323.42
$1,692.95
$1,858.25
$2,033.37
$2,655.43
$2,161.34
$2,326.64
$2,501.76
$3,123.82
$2,629.73
$2,795.03
$2,970.15
$3,592.21
$468.39
Toc - Plan #58 Ambetter from Sunshine Health
Expanded Bronze

(HMO) Standard Ambetter Virtual Access Expanded Bronze (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$505.79
$574.06
$646.39
$903.33
$1,372.69
$892.71
$960.98
$1,033.31
$1,290.25
$1,279.63
$1,347.90
$1,420.23
$1,677.17
$1,666.55
$1,734.82
$1,807.15
$2,064.09
$386.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,011.58
$1,148.12
$1,292.78
$1,806.66
$2,745.38
$1,398.50
$1,535.04
$1,679.70
$2,193.58
$1,785.42
$1,921.96
$2,066.62
$2,580.50
$2,172.34
$2,308.88
$2,453.54
$2,967.42
$386.92
Toc - Plan #59 Ambetter from Sunshine Health
Silver

(HMO) Standard Ambetter Virtual Access Silver (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$640.61
$727.08
$818.69
$1,144.11
$1,738.58
$1,130.67
$1,217.14
$1,308.75
$1,634.17
$1,620.73
$1,707.20
$1,798.81
$2,124.23
$2,110.79
$2,197.26
$2,288.87
$2,614.29
$490.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,281.22
$1,454.16
$1,637.38
$2,288.22
$3,477.16
$1,771.28
$1,944.22
$2,127.44
$2,778.28
$2,261.34
$2,434.28
$2,617.50
$3,268.34
$2,751.40
$2,924.34
$3,107.56
$3,758.40
$490.06
Toc - Plan #60 Ambetter from Sunshine Health
Gold

(HMO) Standard Ambetter Virtual Access Gold (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$601.46
$682.65
$768.66
$1,074.19
$1,632.34
$1,061.57
$1,142.76
$1,228.77
$1,534.30
$1,521.68
$1,602.87
$1,688.88
$1,994.41
$1,981.79
$2,062.98
$2,148.99
$2,454.52
$460.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,202.92
$1,365.30
$1,537.32
$2,148.38
$3,264.68
$1,663.03
$1,825.41
$1,997.43
$2,608.49
$2,123.14
$2,285.52
$2,457.54
$3,068.60
$2,583.25
$2,745.63
$2,917.65
$3,528.71
$460.11

‡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 Glades County here.

Glades County is in “Rating Area 21” of Florida.

Currently, there are 60 plans offered in Rating Area 21.

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2024 Obamacare Plans for Glades County, FL

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