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Providers for Zip Code 78577

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Pharr, TX

Thursday, April 18th, 2024


The health insurance rates listed below are for calendar year 2016.

2016 Rates and Providers

(click here for 2014)

(click here for 2015)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Pharr, TX.

Obamacare Providers, Plans and 2016 Rates for Hidalgo County

Hidalgo County is in “Rating Area 15” of Texas.

Currently, there are 4 providers offering 33 plans to Rating Area 15. †

Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

The table below shows premiums for the following scenarios for:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Pharr, TX area accept this insurance coverage as within the plan's "network".
ADVERTISEMENT

Celtic Insurance Company

Local: 1-877-687-1196 | Toll Free: 1-800-735-2989

Plan: (EPO) Ambetter Secure Care 1 (2016) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $197.25
$223.87
$252.07
$352.27
$535.31		 $394.50
$447.74
$504.14
$704.54
$1070.62		 $519.75
$572.99
$629.39
$829.79		 $645.00
$698.24
$754.64
$955.04		 $770.25
$823.49
$879.89
$1080.29		 $322.50
$349.12
$377.32
$477.52		 $447.75
$474.37
$502.57
$602.77		 $573.00
$599.62
$627.82
$728.02		 $125.25

Plan: (EPO) Ambetter Balanced Care 1 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $153.05
$173.70
$195.58
$273.33
$415.35		 $306.10
$347.40
$391.16
$546.66
$830.70		 $403.28
$444.58
$488.34
$643.84		 $500.46
$541.76
$585.52
$741.02		 $597.64
$638.94
$682.70
$838.20		 $250.23
$270.88
$292.76
$370.51		 $347.41
$368.06
$389.94
$467.69		 $444.59
$465.24
$487.12
$564.87		 $97.18

Plan: (EPO) Ambetter Balanced Care 2 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $151.38
$171.81
$193.45
$270.35
$410.83		 $302.76
$343.62
$386.90
$540.70
$821.66		 $398.88
$439.74
$483.02
$636.82		 $495.00
$535.86
$579.14
$732.94		 $591.12
$631.98
$675.26
$829.06		 $247.50
$267.93
$289.57
$366.47		 $343.62
$364.05
$385.69
$462.59		 $439.74
$460.17
$481.81
$558.71		 $96.12

Plan: (EPO) Ambetter Balanced Care 10 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $158.04
$179.37
$201.97
$282.25
$428.90		 $316.08
$358.74
$403.94
$564.50
$857.80		 $416.43
$459.09
$504.29
$664.85		 $516.78
$559.44
$604.64
$765.20		 $617.13
$659.79
$704.99
$865.55		 $258.39
$279.72
$302.32
$382.60		 $358.74
$380.07
$402.67
$482.95		 $459.09
$480.42
$503.02
$583.30		 $100.35

Plan: (EPO) Ambetter Essential Care 1 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $132.92
$150.85
$169.85
$237.37
$360.71		 $265.84
$301.70
$339.70
$474.74
$721.42		 $350.24
$386.10
$424.10
$559.14		 $434.64
$470.50
$508.50
$643.54		 $519.04
$554.90
$592.90
$727.94		 $217.32
$235.25
$254.25
$321.77		 $301.72
$319.65
$338.65
$406.17		 $386.12
$404.05
$423.05
$490.57		 $84.40

Plan: (EPO) Ambetter Essential Care 5 (2016) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $137.31
$155.83
$175.46
$245.21
$372.62		 $274.62
$311.66
$350.92
$490.42
$745.24		 $361.80
$398.84
$438.10
$577.60		 $448.98
$486.02
$525.28
$664.78		 $536.16
$573.20
$612.46
$751.96		 $224.49
$243.01
$262.64
$332.39		 $311.67
$330.19
$349.82
$419.57		 $398.85
$417.37
$437.00
$506.75		 $87.18

Plan: (EPO) Ambetter Balanced Care 1 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $156.87
$178.04
$200.47
$280.16
$425.73		 $313.74
$356.08
$400.94
$560.32
$851.46		 $413.35
$455.69
$500.55
$659.93		 $512.96
$555.30
$600.16
$759.54		 $612.57
$654.91
$699.77
$859.15		 $256.48
$277.65
$300.08
$379.77		 $356.09
$377.26
$399.69
$479.38		 $455.70
$476.87
$499.30
$578.99		 $99.61

Plan: (EPO) Ambetter Balanced Care 2 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $155.17
$176.10
$198.29
$277.11
$421.10		 $310.34
$352.20
$396.58
$554.22
$842.20		 $408.86
$450.72
$495.10
$652.74		 $507.38
$549.24
$593.62
$751.26		 $605.90
$647.76
$692.14
$849.78		 $253.69
$274.62
$296.81
$375.63		 $352.21
$373.14
$395.33
$474.15		 $450.73
$471.66
$493.85
$572.67		 $98.52

Plan: (EPO) Ambetter Balanced Care 10 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $161.99
$183.85
$207.02
$289.30
$439.62		 $323.98
$367.70
$414.04
$578.60
$879.24		 $426.84
$470.56
$516.90
$681.46		 $529.70
$573.42
$619.76
$784.32		 $632.56
$676.28
$722.62
$887.18		 $264.85
$286.71
$309.88
$392.16		 $367.71
$389.57
$412.74
$495.02		 $470.57
$492.43
$515.60
$597.88		 $102.86

Plan: (EPO) Ambetter Essential Care 1 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $136.24
$154.62
$174.10
$243.30
$369.72		 $272.48
$309.24
$348.20
$486.60
$739.44		 $358.98
$395.74
$434.70
$573.10		 $445.48
$482.24
$521.20
$659.60		 $531.98
$568.74
$607.70
$746.10		 $222.74
$241.12
$260.60
$329.80		 $309.24
$327.62
$347.10
$416.30		 $395.74
$414.12
$433.60
$502.80		 $86.50

Plan: (EPO) Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $140.74
$159.73
$179.85
$251.34
$381.93		 $281.48
$319.46
$359.70
$502.68
$763.86		 $370.84
$408.82
$449.06
$592.04		 $460.20
$498.18
$538.42
$681.40		 $549.56
$587.54
$627.78
$770.76		 $230.10
$249.09
$269.21
$340.70		 $319.46
$338.45
$358.57
$430.06		 $408.82
$427.81
$447.93
$519.42		 $89.36
ADVERTISEMENT

Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683

TTY: 1-800-735-2989

Plan: (HMO) Blue Advantage Bronze HMO? 006

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,000 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,000 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $146.26
$166.01
$186.93
$261.23
$396.96		 $292.52
$332.02
$373.86
$522.46
$793.92		 $385.40
$424.90
$466.74
$615.34		 $478.28
$517.78
$559.62
$708.22		 $571.16
$610.66
$652.50
$801.10		 $239.14
$258.89
$279.81
$354.11		 $332.02
$351.77
$372.69
$446.99		 $424.90
$444.65
$465.57
$539.87		 $92.88

Plan: (HMO) Blue Advantage Gold HMO? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $500 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,250 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $228.30
$259.12
$291.77
$407.75
$619.62		 $456.60
$518.24
$583.54
$815.50
$1239.24		 $601.57
$663.21
$728.51
$960.47		 $746.54
$808.18
$873.48
$1105.44		 $891.51
$953.15
$1018.45
$1250.41		 $373.27
$404.09
$436.74
$552.72		 $518.24
$549.06
$581.71
$697.69		 $663.21
$694.03
$726.68
$842.66		 $144.97

Plan: (HMO) Blue Advantage Silver HMO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $2,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $197.10
$223.71
$251.90
$352.03
$534.94		 $394.20
$447.42
$503.80
$704.06
$1069.88		 $519.36
$572.58
$628.96
$829.22		 $644.52
$697.74
$754.12
$954.38		 $769.68
$822.90
$879.28
$1079.54		 $322.26
$348.87
$377.06
$477.19		 $447.42
$474.03
$502.22
$602.35		 $572.58
$599.19
$627.38
$727.51		 $125.16

Plan: (HMO) Blue Advantage Silver HMO? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,500 : Family: $10,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $10,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $186.44
$211.61
$238.27
$332.98
$506.00		 $372.88
$423.22
$476.54
$665.96
$1012.00		 $491.27
$541.61
$594.93
$784.35		 $609.66
$660.00
$713.32
$902.74		 $728.05
$778.39
$831.71
$1021.13		 $304.83
$330.00
$356.66
$451.37		 $423.22
$448.39
$475.05
$569.76		 $541.61
$566.78
$593.44
$688.15		 $118.39

Plan: (HMO) Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,750 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $141.83
$160.97
$181.26
$253.30
$384.92		 $283.66
$321.94
$362.52
$506.60
$769.84		 $373.72
$412.00
$452.58
$596.66		 $463.78
$502.06
$542.64
$686.72		 $553.84
$592.12
$632.70
$776.78		 $231.89
$251.03
$271.32
$343.36		 $321.95
$341.09
$361.38
$433.42		 $412.01
$431.15
$451.44
$523.48		 $90.06

Plan: (HMO) Blue Advantage Security HMO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $133.41
$151.42
$170.49
$238.26
$362.06		 $266.82
$302.84
$340.98
$476.52
$724.12		 $351.53
$387.55
$425.69
$561.23		 $436.24
$472.26
$510.40
$645.94		 $520.95
$556.97
$595.11
$730.65		 $218.12
$236.13
$255.20
$322.97		 $302.83
$320.84
$339.91
$407.68		 $387.54
$405.55
$424.62
$492.39		 $84.71

Plan: (HMO) Blue Advantage Plus Gold? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $2,750 : Family: $8,250
Out of Pocket Maximum per year: Individual: $3,500 : Family: $10,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $263.89
$299.52
$337.26
$471.32
$716.21		 $527.78
$599.04
$674.52
$942.64
$1432.42		 $695.35
$766.61
$842.09
$1110.21		 $862.92
$934.18
$1009.66
$1277.78		 $1030.49
$1101.75
$1177.23
$1445.35		 $431.46
$467.09
$504.83
$638.89		 $599.03
$634.66
$672.40
$806.46		 $766.60
$802.23
$839.97
$974.03		 $167.57

Plan: (HMO) Blue Advantage Plus Silver? 102 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,250 : Family: $9,750
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $210.69
$239.13
$269.26
$376.28
$571.80		 $421.38
$478.26
$538.52
$752.56
$1143.60		 $555.17
$612.05
$672.31
$886.35		 $688.96
$745.84
$806.10
$1020.14		 $822.75
$879.63
$939.89
$1153.93		 $344.48
$372.92
$403.05
$510.07		 $478.27
$506.71
$536.84
$643.86		 $612.06
$640.50
$670.63
$777.65		 $133.79

Plan: (HMO) Blue Advantage Plus Bronze? 103 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,800 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $162.24
$184.14
$207.34
$289.76
$440.32		 $324.48
$368.28
$414.68
$579.52
$880.64		 $427.50
$471.30
$517.70
$682.54		 $530.52
$574.32
$620.72
$785.56		 $633.54
$677.34
$723.74
$888.58		 $265.26
$287.16
$310.36
$392.78		 $368.28
$390.18
$413.38
$495.80		 $471.30
$493.20
$516.40
$598.82		 $103.02

Plan: (HMO) Blue Advantage Plus Bronze? 104

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $4,500 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,450 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $167.15
$189.72
$213.62
$298.54
$453.66		 $334.30
$379.44
$427.24
$597.08
$907.32		 $440.44
$485.58
$533.38
$703.22		 $546.58
$591.72
$639.52
$809.36		 $652.72
$697.86
$745.66
$915.50		 $273.29
$295.86
$319.76
$404.68		 $379.43
$402.00
$425.90
$510.82		 $485.57
$508.14
$532.04
$616.96		 $106.14

Plan: (HMO) Blue Cross Blue Shield Premier? 101, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $252.35
$286.42
$322.50
$450.69
$684.87		 $504.70
$572.84
$645.00
$901.38
$1369.74		 $664.94
$733.08
$805.24
$1061.62		 $825.18
$893.32
$965.48
$1221.86		 $985.42
$1053.56
$1125.72
$1382.10		 $412.59
$446.66
$482.74
$610.93		 $572.83
$606.90
$642.98
$771.17		 $733.07
$767.14
$803.22
$931.41		 $160.24

Plan: (HMO) Blue Cross Blue Shield Solution? 102, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $206.09
$233.92
$263.39
$368.08
$559.34		 $412.18
$467.84
$526.78
$736.16
$1118.68		 $543.05
$598.71
$657.65
$867.03		 $673.92
$729.58
$788.52
$997.90		 $804.79
$860.45
$919.39
$1128.77		 $336.96
$364.79
$394.26
$498.95		 $467.83
$495.66
$525.13
$629.82		 $598.70
$626.53
$656.00
$760.69		 $130.87

Plan: (HMO) Blue Cross Blue Shield Basic? 103, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,250 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $158.91
$180.37
$203.09
$283.82
$431.30		 $317.82
$360.74
$406.18
$567.64
$862.60		 $418.73
$461.65
$507.09
$668.55		 $519.64
$562.56
$608.00
$769.46		 $620.55
$663.47
$708.91
$870.37		 $259.82
$281.28
$304.00
$384.73		 $360.73
$382.19
$404.91
$485.64		 $461.64
$483.10
$505.82
$586.55		 $100.91
ADVERTISEMENT

Prominence HealthFirst of Texas, Inc.

Local: 1-775-770-9310 | Toll Free: 1-800-863-7515

TTY: 1-800-326-6868

Plan: (HMO) Bronze 5

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-863-7515 - Provider Directory for This Plan: (Prominence HealthFirst of Texas, Inc.)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $190.70
$216.44
$243.70
$340.58
$517.54		 $381.40
$432.88
$487.40
$681.16
$1035.08		 $502.49
$553.97
$608.49
$802.25		 $623.58
$675.06
$729.58
$923.34		 $744.67
$796.15
$850.67
$1044.43		 $311.79
$337.53
$364.79
$461.67		 $432.88
$458.62
$485.88
$582.76		 $553.97
$579.71
$606.97
$703.85		 $121.09

Plan: (HMO) Bronze 6

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-863-7515 - Provider Directory for This Plan: (Prominence HealthFirst of Texas, Inc.)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $186.78
$211.98
$238.69
$333.57
$506.89		 $373.56
$423.96
$477.38
$667.14
$1013.78		 $492.16
$542.56
$595.98
$785.74		 $610.76
$661.16
$714.58
$904.34		 $729.36
$779.76
$833.18
$1022.94		 $305.38
$330.58
$357.29
$452.17		 $423.98
$449.18
$475.89
$570.77		 $542.58
$567.78
$594.49
$689.37		 $118.60

Plan: (HMO) Silver 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-863-7515 - Provider Directory for This Plan: (Prominence HealthFirst of Texas, Inc.)

Deductible: Individual: $3,000 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,200 : Family: $12,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $212.93
$241.66
$272.11
$380.27
$577.86		 $425.86
$483.32
$544.22
$760.54
$1155.72		 $561.06
$618.52
$679.42
$895.74		 $696.26
$753.72
$814.62
$1030.94		 $831.46
$888.92
$949.82
$1166.14		 $348.13
$376.86
$407.31
$515.47		 $483.33
$512.06
$542.51
$650.67		 $618.53
$647.26
$677.71
$785.87		 $135.20

Plan: (HMO) Silver 50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-863-7515 - Provider Directory for This Plan: (Prominence HealthFirst of Texas, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $194.81
$221.10
$248.96
$347.91
$528.69		 $389.62
$442.20
$497.92
$695.82
$1057.38		 $513.32
$565.90
$621.62
$819.52		 $637.02
$689.60
$745.32
$943.22		 $760.72
$813.30
$869.02
$1066.92		 $318.51
$344.80
$372.66
$471.61		 $442.21
$468.50
$496.36
$595.31		 $565.91
$592.20
$620.06
$719.01		 $123.70

Plan: (HMO) Gold 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-863-7515 - Provider Directory for This Plan: (Prominence HealthFirst of Texas, Inc.)

Deductible: Individual: $500 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $245.24
$278.33
$313.40
$437.98
$665.55		 $490.48
$556.66
$626.80
$875.96
$1331.10		 $646.20
$712.38
$782.52
$1031.68		 $801.92
$868.10
$938.24
$1187.40		 $957.64
$1023.82
$1093.96
$1343.12		 $400.96
$434.05
$469.12
$593.70		 $556.68
$589.77
$624.84
$749.42		 $712.40
$745.49
$780.56
$905.14		 $155.72
ADVERTISEMENT

Molina Healthcare of Texas

Local: 1-888-560-2025 | Toll Free: 1-888-560-2025

Plan: (HMO) Molina Marketplace Gold Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2025 - Provider Directory for This Plan: (Molina Healthcare of Texas)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $250.71
$284.55
$320.40
$447.76
$680.42		 $501.42
$569.10
$640.80
$895.52
$1360.84		 $660.62
$728.30
$800.00
$1054.72		 $819.82
$887.50
$959.20
$1213.92		 $979.02
$1046.70
$1118.40
$1373.12		 $409.91
$443.75
$479.60
$606.96		 $569.11
$602.95
$638.80
$766.16		 $728.31
$762.15
$798.00
$925.36		 $159.20

Plan: (HMO) Molina Marketplace Silver Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2025 - Provider Directory for This Plan: (Molina Healthcare of Texas)

Deductible: Individual: $0 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $210.56
$238.98
$269.09
$376.06
$571.45		 $421.12
$477.96
$538.18
$752.12
$1142.90		 $554.82
$611.66
$671.88
$885.82		 $688.52
$745.36
$805.58
$1019.52		 $822.22
$879.06
$939.28
$1153.22		 $344.26
$372.68
$402.79
$509.76		 $477.96
$506.38
$536.49
$643.46		 $611.66
$640.08
$670.19
$777.16		 $133.70

Plan: (HMO) Molina Marketplace Choice Gold Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2025 - Provider Directory for This Plan: (Molina Healthcare of Texas)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $248.91
$282.51
$318.10
$444.55
$675.53		 $497.82
$565.02
$636.20
$889.10
$1351.06		 $655.88
$723.08
$794.26
$1047.16		 $813.94
$881.14
$952.32
$1205.22		 $972.00
$1039.20
$1110.38
$1363.28		 $406.97
$440.57
$476.16
$602.61		 $565.03
$598.63
$634.22
$760.67		 $723.09
$756.69
$792.28
$918.73		 $158.06

Plan: (HMO) Molina Marketplace Choice Silver Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2025 - Provider Directory for This Plan: (Molina Healthcare of Texas)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $207.79
$235.85
$265.56
$371.12
$563.95		 $415.58
$471.70
$531.12
$742.24
$1127.90		 $547.53
$603.65
$663.07
$874.19		 $679.48
$735.60
$795.02
$1006.14		 $811.43
$867.55
$926.97
$1138.09		 $339.74
$367.80
$397.51
$503.07		 $471.69
$499.75
$529.46
$635.02		 $603.64
$631.70
$661.41
$766.97		 $131.95

Plan: (HMO) Molina Marketplace Choice Bronze Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2025 - Provider Directory for This Plan: (Molina Healthcare of Texas)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $175.01
$198.64
$223.66
$312.57
$474.98		 $350.02
$397.28
$447.32
$625.14
$949.96		 $461.15
$508.41
$558.45
$736.27		 $572.28
$619.54
$669.58
$847.40		 $683.41
$730.67
$780.71
$958.53		 $286.14
$309.77
$334.79
$423.70		 $397.27
$420.90
$445.92
$534.83		 $508.40
$532.03
$557.05
$645.96		 $111.13
ADVERTISEMENT

Humana Insurance Company

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 1-800-325-2028

Plan: (EPO) Humana Basic 6850/Rio Grande EPOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $143.66
$163.05
$183.60
$256.58
$389.89		 $287.32
$326.10
$367.20
$513.16
$779.78		 $378.54
$417.32
$458.42
$604.38		 $469.76
$508.54
$549.64
$695.60		 $560.98
$599.76
$640.86
$786.82		 $234.88
$254.27
$274.82
$347.80		 $326.10
$345.49
$366.04
$439.02		 $417.32
$436.71
$457.26
$530.24		 $91.22

Plan: (EPO) Humana Bronze 6450/Rio Grande EPOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Insurance Company)

Deductible: Individual: $6,450 : Family: $12,900
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $192.99
$219.04
$246.64
$344.68
$523.77		 $385.98
$438.08
$493.28
$689.36
$1047.54		 $508.53
$560.63
$615.83
$811.91		 $631.08
$683.18
$738.38
$934.46		 $753.63
$805.73
$860.93
$1057.01		 $315.54
$341.59
$369.19
$467.23		 $438.09
$464.14
$491.74
$589.78		 $560.64
$586.69
$614.29
$712.33		 $122.55

Plan: (EPO) Humana Bronze 4850/Rio Grande EPOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Insurance Company)

Deductible: Individual: $4,850 : Family: $9,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $210.15
$238.52
$268.57
$375.33
$570.35		 $420.30
$477.04
$537.14
$750.66
$1140.70		 $553.75
$610.49
$670.59
$884.11		 $687.20
$743.94
$804.04
$1017.56		 $820.65
$877.39
$937.49
$1151.01		 $343.60
$371.97
$402.02
$508.78		 $477.05
$505.42
$535.47
$642.23		 $610.50
$638.87
$668.92
$775.68		 $133.45

Plan: (EPO) Humana Silver 3800/Rio Grande EPOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Insurance Company)

Deductible: Individual: $3,800 : Family: $7,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $227.58
$258.30
$290.85
$406.46
$617.65		 $455.16
$516.60
$581.70
$812.92
$1235.30		 $599.67
$661.11
$726.21
$957.43		 $744.18
$805.62
$870.72
$1101.94		 $888.69
$950.13
$1015.23
$1246.45		 $372.09
$402.81
$435.36
$550.97		 $516.60
$547.32
$579.87
$695.48		 $661.11
$691.83
$724.38
$839.99		 $144.51

Plan: (EPO) Humana Gold 2250/Rio Grande EPOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Insurance Company)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $268.70
$304.97
$343.40
$479.90
$729.25		 $537.40
$609.94
$686.80
$959.80
$1458.50		 $708.02
$780.56
$857.42
$1130.42		 $878.64
$951.18
$1028.04
$1301.04		 $1049.26
$1121.80
$1198.66
$1471.66		 $439.32
$475.59
$514.02
$650.52		 $609.94
$646.21
$684.64
$821.14		 $780.56
$816.83
$855.26
$991.76		 $170.62
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Allegian Insurance Company

Local: 1-888-371-1249 | Toll Free: 1-888-371-1249

TTY: 1-866-489-9042

Plan: (HMO) Allegian Choice Gold HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $215.16
$244.19
$274.96
$384.25
$583.91		 $430.32
$488.38
$549.92
$768.50
$1167.82		 $566.94
$625.00
$686.54
$905.12		 $703.56
$761.62
$823.16
$1041.74		 $840.18
$898.24
$959.78
$1178.36		 $351.78
$380.81
$411.58
$520.87		 $488.40
$517.43
$548.20
$657.49		 $625.02
$654.05
$684.82
$794.11		 $136.62

Plan: (HMO) Allegian Choice Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $178.06
$202.08
$227.54
$317.99
$483.22		 $356.12
$404.16
$455.08
$635.98
$966.44		 $469.18
$517.22
$568.14
$749.04		 $582.24
$630.28
$681.20
$862.10		 $695.30
$743.34
$794.26
$975.16		 $291.12
$315.14
$340.60
$431.05		 $404.18
$428.20
$453.66
$544.11		 $517.24
$541.26
$566.72
$657.17		 $113.06

Plan: (HMO) Allegian Choice Bronze HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $132.72
$150.63
$169.60
$237.02
$360.18		 $265.44
$301.26
$339.20
$474.04
$720.36		 $349.71
$385.53
$423.47
$558.31		 $433.98
$469.80
$507.74
$642.58		 $518.25
$554.07
$592.01
$726.85		 $216.99
$234.90
$253.87
$321.29		 $301.26
$319.17
$338.14
$405.56		 $385.53
$403.44
$422.41
$489.83		 $84.27
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All Savers Insurance Company

Local: 1-877-887-0443 | Toll Free: 1-877-887-0443

Plan: (EPO) Gold Compass Balanced 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $205.36
$233.07
$262.44
$366.75
$557.32		 $410.72
$466.14
$524.88
$733.50
$1114.64		 $541.12
$596.54
$655.28
$863.90		 $671.52
$726.94
$785.68
$994.30		 $801.92
$857.34
$916.08
$1124.70		 $335.76
$363.47
$392.84
$497.15		 $466.16
$493.87
$523.24
$627.55		 $596.56
$624.27
$653.64
$757.95		 $130.40

Plan: (EPO) Gold Compass Balanced 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $204.30
$231.86
$261.08
$364.86
$554.43		 $408.60
$463.72
$522.16
$729.72
$1108.86		 $538.32
$593.44
$651.88
$859.44		 $668.04
$723.16
$781.60
$989.16		 $797.76
$852.88
$911.32
$1118.88		 $334.02
$361.58
$390.80
$494.58		 $463.74
$491.30
$520.52
$624.30		 $593.46
$621.02
$650.24
$754.02		 $129.72

Plan: (EPO) Silver Compass Balanced HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $170.48
$193.49
$217.87
$304.47
$462.67		 $340.96
$386.98
$435.74
$608.94
$925.34		 $449.21
$495.23
$543.99
$717.19		 $557.46
$603.48
$652.24
$825.44		 $665.71
$711.73
$760.49
$933.69		 $278.73
$301.74
$326.12
$412.72		 $386.98
$409.99
$434.37
$520.97		 $495.23
$518.24
$542.62
$629.22		 $108.25

Plan: (EPO) Silver Compass Balanced 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $177.39
$201.32
$226.69
$316.80
$481.41		 $354.78
$402.64
$453.38
$633.60
$962.82		 $467.42
$515.28
$566.02
$746.24		 $580.06
$627.92
$678.66
$858.88		 $692.70
$740.56
$791.30
$971.52		 $290.03
$313.96
$339.33
$429.44		 $402.67
$426.60
$451.97
$542.08		 $515.31
$539.24
$564.61
$654.72		 $112.64

Plan: (EPO) Silver Compass Balanced 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $178.80
$202.93
$228.50
$319.33
$485.25		 $357.60
$405.86
$457.00
$638.66
$970.50		 $471.13
$519.39
$570.53
$752.19		 $584.66
$632.92
$684.06
$865.72		 $698.19
$746.45
$797.59
$979.25		 $292.33
$316.46
$342.03
$432.86		 $405.86
$429.99
$455.56
$546.39		 $519.39
$543.52
$569.09
$659.92		 $113.53

Plan: (EPO) Silver Compass Balanced 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $180.22
$204.54
$230.31
$321.86
$489.09		 $360.44
$409.08
$460.62
$643.72
$978.18		 $474.87
$523.51
$575.05
$758.15		 $589.30
$637.94
$689.48
$872.58		 $703.73
$752.37
$803.91
$987.01		 $294.65
$318.97
$344.74
$436.29		 $409.08
$433.40
$459.17
$550.72		 $523.51
$547.83
$573.60
$665.15		 $114.43

Plan: (EPO) Silver Compass Balanced 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $184.29
$209.16
$235.51
$329.13
$500.14		 $368.58
$418.32
$471.02
$658.26
$1000.28		 $485.60
$535.34
$588.04
$775.28		 $602.62
$652.36
$705.06
$892.30		 $719.64
$769.38
$822.08
$1009.32		 $301.31
$326.18
$352.53
$446.15		 $418.33
$443.20
$469.55
$563.17		 $535.35
$560.22
$586.57
$680.19		 $117.02

Plan: (EPO) Bronze Compass Balanced HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $148.71
$168.78
$190.04
$265.58
$403.57		 $297.42
$337.56
$380.08
$531.16
$807.14		 $391.84
$431.98
$474.50
$625.58		 $486.26
$526.40
$568.92
$720.00		 $580.68
$620.82
$663.34
$814.42		 $243.13
$263.20
$284.46
$360.00		 $337.55
$357.62
$378.88
$454.42		 $431.97
$452.04
$473.30
$548.84		 $94.42

Plan: (EPO) Bronze Compass Balanced 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $156.68
$177.82
$200.22
$279.81
$425.19		 $313.36
$355.64
$400.44
$559.62
$850.38		 $412.84
$455.12
$499.92
$659.10		 $512.32
$554.60
$599.40
$758.58		 $611.80
$654.08
$698.88
$858.06		 $256.16
$277.30
$299.70
$379.29		 $355.64
$376.78
$399.18
$478.77		 $455.12
$476.26
$498.66
$578.25		 $99.48

Plan: (EPO) Gold Compass Balanced 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $202.17
$229.45
$258.36
$361.06
$548.67		 $404.34
$458.90
$516.72
$722.12
$1097.34		 $532.71
$587.27
$645.09
$850.49		 $661.08
$715.64
$773.46
$978.86		 $789.45
$844.01
$901.83
$1107.23		 $330.54
$357.82
$386.73
$489.43		 $458.91
$486.19
$515.10
$617.80		 $587.28
$614.56
$643.47
$746.17		 $128.37

†Source: Our summary of lowest costs and numbers of providers is based on a government report released September 25, 2013. For more detailed information about specific plans and providers, see HealthCare.gov.

‡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 Hidalgo County here.

 

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