Belknap County, New Hampshire 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 Belknap County, NH.

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, 47 Plans and 2024 Rates for Belknap County, New Hampshire

Below, you’ll find a summary of the 47 plans for Belknap County, New Hampshire 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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Harvard Pilgrim Health Care

Local: 1-877-907-4742 | Toll Free: 1-877-907-4742 | TTY: 1-800-637-8257

Toc - Plan #1 Harvard Pilgrim Health Care
Gold

(HMO) NH Local Choice HMO Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$354.86
$402.76
$453.51
$633.77
$963.08
$626.33
$674.23
$724.98
$905.24
$897.80
$945.70
$996.45
$1,176.71
$1,169.27
$1,217.17
$1,267.92
$1,448.18
$271.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709.72
$805.52
$907.02
$1,267.54
$1,926.16
$981.19
$1,076.99
$1,178.49
$1,539.01
$1,252.66
$1,348.46
$1,449.96
$1,810.48
$1,524.13
$1,619.93
$1,721.43
$2,081.95
$271.47
Toc - Plan #2 Harvard Pilgrim Health Care
Gold

(HMO) NH Local Choice HMO Gold 1400

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$1,400 $2,800 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
$368.46
$418.20
$470.89
$658.07
$1,000.00
$650.33
$700.07
$752.76
$939.94
$932.20
$981.94
$1,034.63
$1,221.81
$1,214.07
$1,263.81
$1,316.50
$1,503.68
$281.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736.92
$836.40
$941.78
$1,316.14
$2,000.00
$1,018.79
$1,118.27
$1,223.65
$1,598.01
$1,300.66
$1,400.14
$1,505.52
$1,879.88
$1,582.53
$1,682.01
$1,787.39
$2,161.75
$281.87
Toc - Plan #3 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 2500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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
$329.06
$373.48
$420.53
$587.69
$893.06
$580.79
$625.21
$672.26
$839.42
$832.52
$876.94
$923.99
$1,091.15
$1,084.25
$1,128.67
$1,175.72
$1,342.88
$251.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658.12
$746.96
$841.06
$1,175.38
$1,786.12
$909.85
$998.69
$1,092.79
$1,427.11
$1,161.58
$1,250.42
$1,344.52
$1,678.84
$1,413.31
$1,502.15
$1,596.25
$1,930.57
$251.73
Toc - Plan #4 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$330.46
$375.08
$422.33
$590.21
$896.88
$583.26
$627.88
$675.13
$843.01
$836.06
$880.68
$927.93
$1,095.81
$1,088.86
$1,133.48
$1,180.73
$1,348.61
$252.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$660.92
$750.16
$844.66
$1,180.42
$1,793.76
$913.72
$1,002.96
$1,097.46
$1,433.22
$1,166.52
$1,255.76
$1,350.26
$1,686.02
$1,419.32
$1,508.56
$1,603.06
$1,938.82
$252.80
Toc - Plan #5 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$331.40
$376.14
$423.53
$591.88
$899.42
$584.92
$629.66
$677.05
$845.40
$838.44
$883.18
$930.57
$1,098.92
$1,091.96
$1,136.70
$1,184.09
$1,352.44
$253.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$662.80
$752.28
$847.06
$1,183.76
$1,798.84
$916.32
$1,005.80
$1,100.58
$1,437.28
$1,169.84
$1,259.32
$1,354.10
$1,690.80
$1,423.36
$1,512.84
$1,607.62
$1,944.32
$253.52
Toc - Plan #6 Harvard Pilgrim Health Care
Silver

(HMO) NH Local Choice HMO Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309.82
$351.65
$395.95
$553.34
$840.86
$546.83
$588.66
$632.96
$790.35
$783.84
$825.67
$869.97
$1,027.36
$1,020.85
$1,062.68
$1,106.98
$1,264.37
$237.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619.64
$703.30
$791.90
$1,106.68
$1,681.72
$856.65
$940.31
$1,028.91
$1,343.69
$1,093.66
$1,177.32
$1,265.92
$1,580.70
$1,330.67
$1,414.33
$1,502.93
$1,817.71
$237.01
Toc - Plan #7 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$270.89
$307.46
$346.19
$483.80
$735.18
$478.12
$514.69
$553.42
$691.03
$685.35
$721.92
$760.65
$898.26
$892.58
$929.15
$967.88
$1,105.49
$207.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541.78
$614.92
$692.38
$967.60
$1,470.36
$749.01
$822.15
$899.61
$1,174.83
$956.24
$1,029.38
$1,106.84
$1,382.06
$1,163.47
$1,236.61
$1,314.07
$1,589.29
$207.23
Toc - Plan #8 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 7200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$254.00
$288.29
$324.61
$453.64
$689.35
$448.31
$482.60
$518.92
$647.95
$642.62
$676.91
$713.23
$842.26
$836.93
$871.22
$907.54
$1,036.57
$194.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$508.00
$576.58
$649.22
$907.28
$1,378.70
$702.31
$770.89
$843.53
$1,101.59
$896.62
$965.20
$1,037.84
$1,295.90
$1,090.93
$1,159.51
$1,232.15
$1,490.21
$194.31
Toc - Plan #9 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO Bronze 8000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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
$247.43
$280.83
$316.22
$441.91
$671.53
$436.71
$470.11
$505.50
$631.19
$625.99
$659.39
$694.78
$820.47
$815.27
$848.67
$884.06
$1,009.75
$189.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$494.86
$561.66
$632.44
$883.82
$1,343.06
$684.14
$750.94
$821.72
$1,073.10
$873.42
$940.22
$1,011.00
$1,262.38
$1,062.70
$1,129.50
$1,200.28
$1,451.66
$189.28
Toc - Plan #10 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local Choice HMO HSA Bronze 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$252.59
$286.69
$322.81
$451.13
$685.53
$445.82
$479.92
$516.04
$644.36
$639.05
$673.15
$709.27
$837.59
$832.28
$866.38
$902.50
$1,030.82
$193.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$505.18
$573.38
$645.62
$902.26
$1,371.06
$698.41
$766.61
$838.85
$1,095.49
$891.64
$959.84
$1,032.08
$1,288.72
$1,084.87
$1,153.07
$1,225.31
$1,481.95
$193.23
Toc - Plan #11 Harvard Pilgrim Health Care
Gold

(HMO) NH Local HMO Gold 1500 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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
$355.80
$403.83
$454.71
$635.45
$965.63
$627.98
$676.01
$726.89
$907.63
$900.16
$948.19
$999.07
$1,179.81
$1,172.34
$1,220.37
$1,271.25
$1,451.99
$272.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$711.60
$807.66
$909.42
$1,270.90
$1,931.26
$983.78
$1,079.84
$1,181.60
$1,543.08
$1,255.96
$1,352.02
$1,453.78
$1,815.26
$1,528.14
$1,624.20
$1,725.96
$2,087.44
$272.18
Toc - Plan #12 Harvard Pilgrim Health Care
Silver

(HMO) NH Local HMO Silver 5900 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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
$301.38
$342.06
$385.16
$538.26
$817.94
$531.93
$572.61
$615.71
$768.81
$762.48
$803.16
$846.26
$999.36
$993.03
$1,033.71
$1,076.81
$1,229.91
$230.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$602.76
$684.12
$770.32
$1,076.52
$1,635.88
$833.31
$914.67
$1,000.87
$1,307.07
$1,063.86
$1,145.22
$1,231.42
$1,537.62
$1,294.41
$1,375.77
$1,461.97
$1,768.17
$230.55
Toc - Plan #13 Harvard Pilgrim Health Care
Expanded Bronze

(HMO) NH Local HMO Bronze 7500 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-907-4742

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
$257.75
$292.55
$329.41
$460.34
$699.54
$454.93
$489.73
$526.59
$657.52
$652.11
$686.91
$723.77
$854.70
$849.29
$884.09
$920.95
$1,051.88
$197.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$515.50
$585.10
$658.82
$920.68
$1,399.08
$712.68
$782.28
$856.00
$1,117.86
$909.86
$979.46
$1,053.18
$1,315.04
$1,107.04
$1,176.64
$1,250.36
$1,512.22
$197.18

ADVERTISEMENT

Ambetter from NH Healthy Families

Local: 1-844-265-1278 | Toll Free: 1-844-265-1278 | TTY: 1-855-742-0123

Toc - Plan #14 Ambetter from NH Healthy Families
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$310.20
$352.07
$396.43
$554.01
$841.87
$547.50
$589.37
$633.73
$791.31
$784.80
$826.67
$871.03
$1,028.61
$1,022.10
$1,063.97
$1,108.33
$1,265.91
$237.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$620.40
$704.14
$792.86
$1,108.02
$1,683.74
$857.70
$941.44
$1,030.16
$1,345.32
$1,095.00
$1,178.74
$1,267.46
$1,582.62
$1,332.30
$1,416.04
$1,504.76
$1,819.92
$237.30
Toc - Plan #15 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$230.76
$261.91
$294.90
$412.13
$626.27
$407.29
$438.44
$471.43
$588.66
$583.82
$614.97
$647.96
$765.19
$760.35
$791.50
$824.49
$941.72
$176.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$461.52
$523.82
$589.80
$824.26
$1,252.54
$638.05
$700.35
$766.33
$1,000.79
$814.58
$876.88
$942.86
$1,177.32
$991.11
$1,053.41
$1,119.39
$1,353.85
$176.53
Toc - Plan #16 Ambetter from NH Healthy Families
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$281.78
$319.81
$360.10
$503.24
$764.73
$497.33
$535.36
$575.65
$718.79
$712.88
$750.91
$791.20
$934.34
$928.43
$966.46
$1,006.75
$1,149.89
$215.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$563.56
$639.62
$720.20
$1,006.48
$1,529.46
$779.11
$855.17
$935.75
$1,222.03
$994.66
$1,070.72
$1,151.30
$1,437.58
$1,210.21
$1,286.27
$1,366.85
$1,653.13
$215.55
Toc - Plan #17 Ambetter from NH Healthy Families
Silver

(EPO) Elite Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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
$292.11
$331.54
$373.31
$521.70
$792.77
$515.57
$555.00
$596.77
$745.16
$739.03
$778.46
$820.23
$968.62
$962.49
$1,001.92
$1,043.69
$1,192.08
$223.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$584.22
$663.08
$746.62
$1,043.40
$1,585.54
$807.68
$886.54
$970.08
$1,266.86
$1,031.14
$1,110.00
$1,193.54
$1,490.32
$1,254.60
$1,333.46
$1,417.00
$1,713.78
$223.46
Toc - Plan #18 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$264.83
$300.57
$338.44
$472.97
$718.72
$467.42
$503.16
$541.03
$675.56
$670.01
$705.75
$743.62
$878.15
$872.60
$908.34
$946.21
$1,080.74
$202.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$529.66
$601.14
$676.88
$945.94
$1,437.44
$732.25
$803.73
$879.47
$1,148.53
$934.84
$1,006.32
$1,082.06
$1,351.12
$1,137.43
$1,208.91
$1,284.65
$1,553.71
$202.59
Toc - Plan #19 Ambetter from NH Healthy Families
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$276.22
$313.50
$353.00
$493.31
$749.64
$487.52
$524.80
$564.30
$704.61
$698.82
$736.10
$775.60
$915.91
$910.12
$947.40
$986.90
$1,127.21
$211.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$552.44
$627.00
$706.00
$986.62
$1,499.28
$763.74
$838.30
$917.30
$1,197.92
$975.04
$1,049.60
$1,128.60
$1,409.22
$1,186.34
$1,260.90
$1,339.90
$1,620.52
$211.30
Toc - Plan #20 Ambetter from NH Healthy Families
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$296.32
$336.31
$378.68
$529.21
$804.18
$523.00
$562.99
$605.36
$755.89
$749.68
$789.67
$832.04
$982.57
$976.36
$1,016.35
$1,058.72
$1,209.25
$226.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$592.64
$672.62
$757.36
$1,058.42
$1,608.36
$819.32
$899.30
$984.04
$1,285.10
$1,046.00
$1,125.98
$1,210.72
$1,511.78
$1,272.68
$1,352.66
$1,437.40
$1,738.46
$226.68
Toc - Plan #21 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$225.72
$256.18
$288.46
$403.12
$612.57
$398.39
$428.85
$461.13
$575.79
$571.06
$601.52
$633.80
$748.46
$743.73
$774.19
$806.47
$921.13
$172.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$451.44
$512.36
$576.92
$806.24
$1,225.14
$624.11
$685.03
$749.59
$978.91
$796.78
$857.70
$922.26
$1,151.58
$969.45
$1,030.37
$1,094.93
$1,324.25
$172.67
Toc - Plan #22 Ambetter from NH Healthy Families
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$271.23
$307.83
$346.62
$484.40
$736.09
$478.71
$515.31
$554.10
$691.88
$686.19
$722.79
$761.58
$899.36
$893.67
$930.27
$969.06
$1,106.84
$207.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$542.46
$615.66
$693.24
$968.80
$1,472.18
$749.94
$823.14
$900.72
$1,176.28
$957.42
$1,030.62
$1,108.20
$1,383.76
$1,164.90
$1,238.10
$1,315.68
$1,591.24
$207.48
Toc - Plan #23 Ambetter from NH Healthy Families
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$297.05
$337.14
$379.62
$530.51
$806.17
$524.29
$564.38
$606.86
$757.75
$751.53
$791.62
$834.10
$984.99
$978.77
$1,018.86
$1,061.34
$1,212.23
$227.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$594.10
$674.28
$759.24
$1,061.02
$1,612.34
$821.34
$901.52
$986.48
$1,288.26
$1,048.58
$1,128.76
$1,213.72
$1,515.50
$1,275.82
$1,356.00
$1,440.96
$1,742.74
$227.24
Toc - Plan #24 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$243.10
$275.91
$310.67
$434.16
$659.75
$429.06
$461.87
$496.63
$620.12
$615.02
$647.83
$682.59
$806.08
$800.98
$833.79
$868.55
$992.04
$185.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$486.20
$551.82
$621.34
$868.32
$1,319.50
$672.16
$737.78
$807.30
$1,054.28
$858.12
$923.74
$993.26
$1,240.24
$1,044.08
$1,109.70
$1,179.22
$1,426.20
$185.96
Toc - Plan #25 Ambetter from NH Healthy Families
Silver

(EPO) Elite Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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
$307.73
$349.26
$393.27
$549.59
$835.15
$543.14
$584.67
$628.68
$785.00
$778.55
$820.08
$864.09
$1,020.41
$1,013.96
$1,055.49
$1,099.50
$1,255.82
$235.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$615.46
$698.52
$786.54
$1,099.18
$1,670.30
$850.87
$933.93
$1,021.95
$1,334.59
$1,086.28
$1,169.34
$1,257.36
$1,570.00
$1,321.69
$1,404.75
$1,492.77
$1,805.41
$235.41
Toc - Plan #26 Ambetter from NH Healthy Families
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$326.79
$370.89
$417.62
$583.63
$886.88
$576.78
$620.88
$667.61
$833.62
$826.77
$870.87
$917.60
$1,083.61
$1,076.76
$1,120.86
$1,167.59
$1,333.60
$249.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$653.58
$741.78
$835.24
$1,167.26
$1,773.76
$903.57
$991.77
$1,085.23
$1,417.25
$1,153.56
$1,241.76
$1,335.22
$1,667.24
$1,403.55
$1,491.75
$1,585.21
$1,917.23
$249.99
Toc - Plan #27 Ambetter from NH Healthy Families
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$296.84
$336.91
$379.35
$530.15
$805.61
$523.92
$563.99
$606.43
$757.23
$751.00
$791.07
$833.51
$984.31
$978.08
$1,018.15
$1,060.59
$1,211.39
$227.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$593.68
$673.82
$758.70
$1,060.30
$1,611.22
$820.76
$900.90
$985.78
$1,287.38
$1,047.84
$1,127.98
$1,212.86
$1,514.46
$1,274.92
$1,355.06
$1,439.94
$1,741.54
$227.08
Toc - Plan #28 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$278.99
$316.64
$356.53
$498.25
$757.14
$492.41
$530.06
$569.95
$711.67
$705.83
$743.48
$783.37
$925.09
$919.25
$956.90
$996.79
$1,138.51
$213.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$557.98
$633.28
$713.06
$996.50
$1,514.28
$771.40
$846.70
$926.48
$1,209.92
$984.82
$1,060.12
$1,139.90
$1,423.34
$1,198.24
$1,273.54
$1,353.32
$1,636.76
$213.42
Toc - Plan #29 Ambetter from NH Healthy Families
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$312.16
$354.29
$398.93
$557.50
$847.17
$550.95
$593.08
$637.72
$796.29
$789.74
$831.87
$876.51
$1,035.08
$1,028.53
$1,070.66
$1,115.30
$1,273.87
$238.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$624.32
$708.58
$797.86
$1,115.00
$1,694.34
$863.11
$947.37
$1,036.65
$1,353.79
$1,101.90
$1,186.16
$1,275.44
$1,592.58
$1,340.69
$1,424.95
$1,514.23
$1,831.37
$238.79
Toc - Plan #30 Ambetter from NH Healthy Families
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$290.99
$330.26
$371.87
$519.69
$789.71
$513.59
$552.86
$594.47
$742.29
$736.19
$775.46
$817.07
$964.89
$958.79
$998.06
$1,039.67
$1,187.49
$222.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$581.98
$660.52
$743.74
$1,039.38
$1,579.42
$804.58
$883.12
$966.34
$1,261.98
$1,027.18
$1,105.72
$1,188.94
$1,484.58
$1,249.78
$1,328.32
$1,411.54
$1,707.18
$222.60
Toc - Plan #31 Ambetter from NH Healthy Families
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$237.79
$269.88
$303.88
$424.67
$645.32
$419.69
$451.78
$485.78
$606.57
$601.59
$633.68
$667.68
$788.47
$783.49
$815.58
$849.58
$970.37
$181.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$475.58
$539.76
$607.76
$849.34
$1,290.64
$657.48
$721.66
$789.66
$1,031.24
$839.38
$903.56
$971.56
$1,213.14
$1,021.28
$1,085.46
$1,153.46
$1,395.04
$181.90
Toc - Plan #32 Ambetter from NH Healthy Families
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$285.73
$324.29
$365.15
$510.30
$775.44
$504.31
$542.87
$583.73
$728.88
$722.89
$761.45
$802.31
$947.46
$941.47
$980.03
$1,020.89
$1,166.04
$218.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$571.46
$648.58
$730.30
$1,020.60
$1,550.88
$790.04
$867.16
$948.88
$1,239.18
$1,008.62
$1,085.74
$1,167.46
$1,457.76
$1,227.20
$1,304.32
$1,386.04
$1,676.34
$218.58
Toc - Plan #33 Ambetter from NH Healthy Families
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-265-1278

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
$312.93
$355.16
$399.91
$558.88
$849.27
$552.31
$594.54
$639.29
$798.26
$791.69
$833.92
$878.67
$1,037.64
$1,031.07
$1,073.30
$1,118.05
$1,277.02
$239.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$625.86
$710.32
$799.82
$1,117.76
$1,698.54
$865.24
$949.70
$1,039.20
$1,357.14
$1,104.62
$1,189.08
$1,278.58
$1,596.52
$1,344.00
$1,428.46
$1,517.96
$1,835.90
$239.38

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

Local: 1-855-748-1804 | Toll Free: 1-855-748-1804

Toc - Plan #34 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced 6000/35% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$214.95
$243.97
$274.71
$383.90
$583.37
$379.39
$408.41
$439.15
$548.34
$543.83
$572.85
$603.59
$712.78
$708.27
$737.29
$768.03
$877.22
$164.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$429.90
$487.94
$549.42
$767.80
$1,166.74
$594.34
$652.38
$713.86
$932.24
$758.78
$816.82
$878.30
$1,096.68
$923.22
$981.26
$1,042.74
$1,261.12
$164.44
Toc - Plan #35 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced 6000/30% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$218.36
$247.84
$279.06
$389.99
$592.63
$385.41
$414.89
$446.11
$557.04
$552.46
$581.94
$613.16
$724.09
$719.51
$748.99
$780.21
$891.14
$167.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$436.72
$495.68
$558.12
$779.98
$1,185.26
$603.77
$662.73
$725.17
$947.03
$770.82
$829.78
$892.22
$1,114.08
$937.87
$996.83
$1,059.27
$1,281.13
$167.05
Toc - Plan #36 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced 3500/15% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$271.76
$308.45
$347.31
$485.36
$737.56
$479.66
$516.35
$555.21
$693.26
$687.56
$724.25
$763.11
$901.16
$895.46
$932.15
$971.01
$1,109.06
$207.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$543.52
$616.90
$694.62
$970.72
$1,475.12
$751.42
$824.80
$902.52
$1,178.62
$959.32
$1,032.70
$1,110.42
$1,386.52
$1,167.22
$1,240.60
$1,318.32
$1,594.42
$207.90
Toc - Plan #37 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced 4000/0% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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
$290.66
$329.90
$371.46
$519.12
$788.85
$513.01
$552.25
$593.81
$741.47
$735.36
$774.60
$816.16
$963.82
$957.71
$996.95
$1,038.51
$1,186.17
$222.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$581.32
$659.80
$742.92
$1,038.24
$1,577.70
$803.67
$882.15
$965.27
$1,260.59
$1,026.02
$1,104.50
$1,187.62
$1,482.94
$1,248.37
$1,326.85
$1,409.97
$1,705.29
$222.35
Toc - Plan #38 Anthem Blue Cross and Blue Shield
Catastrophic

(HMO) Anthem Catastrophic Pathway X Enhanced 9450/0%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$172.95
$196.30
$221.03
$308.89
$469.39
$305.26
$328.61
$353.34
$441.20
$437.57
$460.92
$485.65
$573.51
$569.88
$593.23
$617.96
$705.82
$132.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$345.90
$392.60
$442.06
$617.78
$938.78
$478.21
$524.91
$574.37
$750.09
$610.52
$657.22
$706.68
$882.40
$742.83
$789.53
$838.99
$1,014.71
$132.31
Toc - Plan #39 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X Enhanced 6500/40% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$208.16
$236.26
$266.03
$371.77
$564.95
$367.40
$395.50
$425.27
$531.01
$526.64
$554.74
$584.51
$690.25
$685.88
$713.98
$743.75
$849.49
$159.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$416.32
$472.52
$532.06
$743.54
$1,129.90
$575.56
$631.76
$691.30
$902.78
$734.80
$791.00
$850.54
$1,062.02
$894.04
$950.24
$1,009.78
$1,221.26
$159.24
Toc - Plan #40 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced 1200/20% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 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
$281.88
$319.93
$360.24
$503.44
$765.02
$497.52
$535.57
$575.88
$719.08
$713.16
$751.21
$791.52
$934.72
$928.80
$966.85
$1,007.16
$1,150.36
$215.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$563.76
$639.86
$720.48
$1,006.88
$1,530.04
$779.40
$855.50
$936.12
$1,222.52
$995.04
$1,071.14
$1,151.76
$1,438.16
$1,210.68
$1,286.78
$1,367.40
$1,653.80
$215.64
Toc - Plan #41 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced 5500/35% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$216.71
$245.97
$276.96
$387.04
$588.15
$382.49
$411.75
$442.74
$552.82
$548.27
$577.53
$608.52
$718.60
$714.05
$743.31
$774.30
$884.38
$165.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$433.42
$491.94
$553.92
$774.08
$1,176.30
$599.20
$657.72
$719.70
$939.86
$764.98
$823.50
$885.48
$1,105.64
$930.76
$989.28
$1,051.26
$1,271.42
$165.78
Toc - Plan #42 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced 5500/20% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,200 $18,400 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
$262.51
$297.95
$335.49
$468.84
$712.45
$463.33
$498.77
$536.31
$669.66
$664.15
$699.59
$737.13
$870.48
$864.97
$900.41
$937.95
$1,071.30
$200.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$525.02
$595.90
$670.98
$937.68
$1,424.90
$725.84
$796.72
$871.80
$1,138.50
$926.66
$997.54
$1,072.62
$1,339.32
$1,127.48
$1,198.36
$1,273.44
$1,540.14
$200.82
Toc - Plan #43 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced 4500/20% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$6,150 $12,300 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
$262.47
$297.90
$335.44
$468.77
$712.34
$463.26
$498.69
$536.23
$669.56
$664.05
$699.48
$737.02
$870.35
$864.84
$900.27
$937.81
$1,071.14
$200.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$524.94
$595.80
$670.88
$937.54
$1,424.68
$725.73
$796.59
$871.67
$1,138.33
$926.52
$997.38
$1,072.46
$1,339.12
$1,127.31
$1,198.17
$1,273.25
$1,539.91
$200.79
Toc - Plan #44 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced 700/40% ($0 Preferred Virtual Care + $0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

Annual Out of Pocket Expenses:

Individual Family
$700 $1,400 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
$276.76
$314.12
$353.70
$494.29
$751.13
$488.48
$525.84
$565.42
$706.01
$700.20
$737.56
$777.14
$917.73
$911.92
$949.28
$988.86
$1,129.45
$211.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$553.52
$628.24
$707.40
$988.58
$1,502.26
$765.24
$839.96
$919.12
$1,200.30
$976.96
$1,051.68
$1,130.84
$1,412.02
$1,188.68
$1,263.40
$1,342.56
$1,623.74
$211.72
Toc - Plan #45 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X Enhanced 7500/50% ($0 Preferred Virtual Care + $0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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
$213.45
$242.27
$272.79
$381.22
$579.30
$376.74
$405.56
$436.08
$544.51
$540.03
$568.85
$599.37
$707.80
$703.32
$732.14
$762.66
$871.09
$163.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$426.90
$484.54
$545.58
$762.44
$1,158.60
$590.19
$647.83
$708.87
$925.73
$753.48
$811.12
$872.16
$1,089.02
$916.77
$974.41
$1,035.45
$1,252.31
$163.29
Toc - Plan #46 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X Enhanced 5900/40% ($0 Preferred Virtual Care + $0 Select Drugs) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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
$253.15
$287.33
$323.53
$452.13
$687.05
$446.81
$480.99
$517.19
$645.79
$640.47
$674.65
$710.85
$839.45
$834.13
$868.31
$904.51
$1,033.11
$193.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$506.30
$574.66
$647.06
$904.26
$1,374.10
$699.96
$768.32
$840.72
$1,097.92
$893.62
$961.98
$1,034.38
$1,291.58
$1,087.28
$1,155.64
$1,228.04
$1,485.24
$193.66
Toc - Plan #47 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X Enhanced 1500/25% ($0 Preferred Virtual Care + $0 Select Drug) Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1804

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
$287.28
$326.06
$367.14
$513.08
$779.68
$507.05
$545.83
$586.91
$732.85
$726.82
$765.60
$806.68
$952.62
$946.59
$985.37
$1,026.45
$1,172.39
$219.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$574.56
$652.12
$734.28
$1,026.16
$1,559.36
$794.33
$871.89
$954.05
$1,245.93
$1,014.10
$1,091.66
$1,173.82
$1,465.70
$1,233.87
$1,311.43
$1,393.59
$1,685.47
$219.77

‡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 Belknap County here.

Belknap County is in “Rating Area 1” of New Hampshire.

Currently, there are 47 plans offered in Rating Area 1.

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2024 Obamacare Plans for Belknap County, NH

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