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Providers for Zip Code 69153

Obamacare 2016 Marketplace Rates For Keith County, Nebraska

Tuesday, October 17th, 2017


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 Keith County, Nebraska.

Obamacare Providers, Plans and 2016 Rates for Keith County

Keith County is in “Rating Area 4” of Nebraska.

Currently, there are 3 providers offering 31 plans to Rating Area 4.

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 Ogallala, NE area accept this insurance coverage as within the plan's "network".

Coventry Health Care of Nebraska Inc.

Local: 1-402-995-7900 | Toll Free: 1-855-449-2889

Plan: (POS) Coventry Gold $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Nebraska Inc.)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

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
$369.73
$419.64
$472.51
$660.33
$1003.44
$739.46
$839.28
$945.02
$1320.66
$2006.88
$974.24
$1074.06
$1179.80
$1555.44
$1209.02
$1308.84
$1414.58
$1790.22
$1443.80
$1543.62
$1649.36
$2025.00
$604.51
$654.42
$707.29
$895.11
$839.29
$889.20
$942.07
$1129.89
$1074.07
$1123.98
$1176.85
$1364.67
$234.78

Plan: (POS) Coventry Silver $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Nebraska Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
$285.06
$323.55
$364.31
$509.12
$773.66
$570.12
$647.10
$728.62
$1018.24
$1547.32
$751.14
$828.12
$909.64
$1199.26
$932.16
$1009.14
$1090.66
$1380.28
$1113.18
$1190.16
$1271.68
$1561.30
$466.08
$504.57
$545.33
$690.14
$647.10
$685.59
$726.35
$871.16
$828.12
$866.61
$907.37
$1052.18
$181.02

Plan: (POS) Coventry Bronze $15 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Nebraska Inc.)

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
Bronze 21
30
40
50
60
$235.74
$267.57
$301.28
$421.03
$639.80
$471.48
$535.14
$602.56
$842.06
$1279.60
$621.18
$684.84
$752.26
$991.76
$770.88
$834.54
$901.96
$1141.46
$920.58
$984.24
$1051.66
$1291.16
$385.44
$417.27
$450.98
$570.73
$535.14
$566.97
$600.68
$720.43
$684.84
$716.67
$750.38
$870.13
$149.70

Plan: (POS) Coventry Bronze HSA Eligible

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Nebraska Inc.)

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
$222.92
$253.02
$284.90
$398.14
$605.02
$445.84
$506.04
$569.80
$796.28
$1210.04
$587.40
$647.60
$711.36
$937.84
$728.96
$789.16
$852.92
$1079.40
$870.52
$930.72
$994.48
$1220.96
$364.48
$394.58
$426.46
$539.70
$506.04
$536.14
$568.02
$681.26
$647.60
$677.70
$709.58
$822.82
$141.56

Medica Insurance Company

Local: | Toll Free:

Plan: (PPO) Medica Insure Gold Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $300 : Family: $900
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

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
$365.45
$414.77
$467.03
$652.68
$991.80
$730.90
$829.54
$934.06
$1305.36
$1983.60
$962.95
$1061.59
$1166.11
$1537.41
$1195.00
$1293.64
$1398.16
$1769.46
$1427.05
$1525.69
$1630.21
$2001.51
$597.50
$646.82
$699.08
$884.73
$829.55
$878.87
$931.13
$1116.78
$1061.60
$1110.92
$1163.18
$1348.83
$232.05

Plan: (PPO) Medica Insure Silver Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $2,600 : Family: $7,800
Out of Pocket Maximum per year: Individual: $5,750 : Family: $11,500

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
$305.26
$346.46
$390.11
$545.18
$828.45
$610.52
$692.92
$780.22
$1090.36
$1656.90
$804.35
$886.75
$974.05
$1284.19
$998.18
$1080.58
$1167.88
$1478.02
$1192.01
$1274.41
$1361.71
$1671.85
$499.09
$540.29
$583.94
$739.01
$692.92
$734.12
$777.77
$932.84
$886.75
$927.95
$971.60
$1126.67
$193.83

Plan: (PPO) Medica Insure Bronze Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica 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
Bronze 21
30
40
50
60
$264.33
$300.01
$337.80
$472.08
$717.37
$528.66
$600.02
$675.60
$944.16
$1434.74
$696.50
$767.86
$843.44
$1112.00
$864.34
$935.70
$1011.28
$1279.84
$1032.18
$1103.54
$1179.12
$1447.68
$432.17
$467.85
$505.64
$639.92
$600.01
$635.69
$673.48
$807.76
$767.85
$803.53
$841.32
$975.60
$167.84

Plan: (PPO) Medica Insure Gold H S A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $1,300 : Family: $3,900
Out of Pocket Maximum per year: Individual: $2,600 : Family: $7,050

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
$350.36
$397.64
$447.74
$625.72
$950.84
$700.72
$795.28
$895.48
$1251.44
$1901.68
$923.19
$1017.75
$1117.95
$1473.91
$1145.66
$1240.22
$1340.42
$1696.38
$1368.13
$1462.69
$1562.89
$1918.85
$572.83
$620.11
$670.21
$848.19
$795.30
$842.58
$892.68
$1070.66
$1017.77
$1065.05
$1115.15
$1293.13
$222.47

Plan: (PPO) Medica Insure Silver H S A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $1,300 : Family: $3,900
Out of Pocket Maximum per year: Individual: $5,450 : 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
Silver 21
30
40
50
60
$299.31
$339.70
$382.50
$534.54
$812.29
$598.62
$679.40
$765.00
$1069.08
$1624.58
$788.67
$869.45
$955.05
$1259.13
$978.72
$1059.50
$1145.10
$1449.18
$1168.77
$1249.55
$1335.15
$1639.23
$489.36
$529.75
$572.55
$724.59
$679.41
$719.80
$762.60
$914.64
$869.46
$909.85
$952.65
$1104.69
$190.05

Plan: (PPO) Medica Insure Bronze H S A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $6,300 : Family: $12,700
Out of Pocket Maximum per year: Individual: $6,300 : 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
$251.65
$285.61
$321.60
$449.43
$682.96
$503.30
$571.22
$643.20
$898.86
$1365.92
$663.09
$731.01
$802.99
$1058.65
$822.88
$890.80
$962.78
$1218.44
$982.67
$1050.59
$1122.57
$1378.23
$411.44
$445.40
$481.39
$609.22
$571.23
$605.19
$641.18
$769.01
$731.02
$764.98
$800.97
$928.80
$159.79

Plan: (PPO) Medica Insure Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica 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
$185.65
$210.71
$237.25
$331.56
$503.84
$371.30
$421.42
$474.50
$663.12
$1007.68
$489.18
$539.30
$592.38
$781.00
$607.06
$657.18
$710.26
$898.88
$724.94
$775.06
$828.14
$1016.76
$303.53
$328.59
$355.13
$449.44
$421.41
$446.47
$473.01
$567.32
$539.29
$564.35
$590.89
$685.20
$117.88

Plan: (PPO) Medica Insure Gold Copay 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $2,400 : Family: $7,200
Out of Pocket Maximum per year: Individual: $2,400 : Family: $7,200

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
$364.83
$414.07
$466.24
$651.57
$990.12
$729.66
$828.14
$932.48
$1303.14
$1980.24
$961.32
$1059.80
$1164.14
$1534.80
$1192.98
$1291.46
$1395.80
$1766.46
$1424.64
$1523.12
$1627.46
$1998.12
$596.49
$645.73
$697.90
$883.23
$828.15
$877.39
$929.56
$1114.89
$1059.81
$1109.05
$1161.22
$1346.55
$231.66

Plan: (PPO) Medica Insure Gold Copay Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

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
$399.76
$453.72
$510.89
$713.96
$1084.93
$799.52
$907.44
$1021.78
$1427.92
$2169.86
$1053.36
$1161.28
$1275.62
$1681.76
$1307.20
$1415.12
$1529.46
$1935.60
$1561.04
$1668.96
$1783.30
$2189.44
$653.60
$707.56
$764.73
$967.80
$907.44
$961.40
$1018.57
$1221.64
$1161.28
$1215.24
$1272.41
$1475.48
$253.84

Plan: (PPO) Medica Insure Silver Copay Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Medica Insurance Company)

Deductible: Individual: $2,500 : Family: $7,500
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
$352.22
$399.76
$450.13
$629.05
$955.90
$704.44
$799.52
$900.26
$1258.10
$1911.80
$928.09
$1023.17
$1123.91
$1481.75
$1151.74
$1246.82
$1347.56
$1705.40
$1375.39
$1470.47
$1571.21
$1929.05
$575.87
$623.41
$673.78
$852.70
$799.52
$847.06
$897.43
$1076.35
$1023.17
$1070.71
$1121.08
$1300.00
$223.65

Blue Cross and Blue Shield of Nebraska

Local: 1-888-592-8960 | Toll Free: 1-888-592-8960

TTY: 1-800-821-4791

Plan: (PPO) BlueEssentials 3500 HSA Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

Deductible: Individual: $3,500 : Family: $7,000
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
$254.60
$288.98
$325.38
$454.72
$691.00
$509.20
$577.96
$650.76
$909.44
$1382.00
$670.87
$739.63
$812.43
$1071.11
$832.54
$901.30
$974.10
$1232.78
$994.21
$1062.97
$1135.77
$1394.45
$416.27
$450.65
$487.05
$616.39
$577.94
$612.32
$648.72
$778.06
$739.61
$773.99
$810.39
$939.73
$161.67

Plan: (PPO) BlueEssentials 6450 Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

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
$240.51
$272.98
$307.38
$429.56
$652.75
$481.02
$545.96
$614.76
$859.12
$1305.50
$633.75
$698.69
$767.49
$1011.85
$786.48
$851.42
$920.22
$1164.58
$939.21
$1004.15
$1072.95
$1317.31
$393.24
$425.71
$460.11
$582.29
$545.97
$578.44
$612.84
$735.02
$698.70
$731.17
$765.57
$887.75
$152.73

Plan: (PPO) BlueEssentials 4500 Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

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
Bronze 21
30
40
50
60
$280.55
$318.42
$358.54
$501.06
$761.40
$561.10
$636.84
$717.08
$1002.12
$1522.80
$739.25
$814.99
$895.23
$1180.27
$917.40
$993.14
$1073.38
$1358.42
$1095.55
$1171.29
$1251.53
$1536.57
$458.70
$496.57
$536.69
$679.21
$636.85
$674.72
$714.84
$857.36
$815.00
$852.87
$892.99
$1035.51
$178.15

Plan: (PPO) BlueEssentials 2700 HSA Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

Deductible: Individual: $2,700 : Family: $5,400
Out of Pocket Maximum per year: Individual: $5,600 : Family: $11,200

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
$326.42
$370.49
$417.16
$582.98
$885.90
$652.84
$740.98
$834.32
$1165.96
$1771.80
$860.12
$948.26
$1041.60
$1373.24
$1067.40
$1155.54
$1248.88
$1580.52
$1274.68
$1362.82
$1456.16
$1787.80
$533.70
$577.77
$624.44
$790.26
$740.98
$785.05
$831.72
$997.54
$948.26
$992.33
$1039.00
$1204.82
$207.28

Plan: (PPO) BlueEssentials 3000 Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

Deductible: Individual: $3,000 : 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
$370.56
$420.58
$473.57
$661.82
$1005.70
$741.12
$841.16
$947.14
$1323.64
$2011.40
$976.43
$1076.47
$1182.45
$1558.95
$1211.74
$1311.78
$1417.76
$1794.26
$1447.05
$1547.09
$1653.07
$2029.57
$605.87
$655.89
$708.88
$897.13
$841.18
$891.20
$944.19
$1132.44
$1076.49
$1126.51
$1179.50
$1367.75
$235.31

Plan: (PPO) BlueEssentials 1500 Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,350 : Family: $8,700

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
$428.59
$486.45
$547.74
$765.47
$1163.20
$857.18
$972.90
$1095.48
$1530.94
$2326.40
$1129.34
$1245.06
$1367.64
$1803.10
$1401.50
$1517.22
$1639.80
$2075.26
$1673.66
$1789.38
$1911.96
$2347.42
$700.75
$758.61
$819.90
$1037.63
$972.91
$1030.77
$1092.06
$1309.79
$1245.07
$1302.93
$1364.22
$1581.95
$272.16

Plan: (PPO) BlueEssentials 6850 Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8960 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Nebraska)

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
$166.79
$189.31
$213.16
$297.89
$452.68
$333.58
$378.62
$426.32
$595.78
$905.36
$439.49
$484.53
$532.23
$701.69
$545.40
$590.44
$638.14
$807.60
$651.31
$696.35
$744.05
$913.51
$272.70
$295.22
$319.07
$403.80
$378.61
$401.13
$424.98
$509.71
$484.52
$507.04
$530.89
$615.62
$105.91

UnitedHealthcare of the Midlands, Inc.

Local: 1-800-725-1147 | Toll Free: 1-800-725-1147

Plan: (HMO) Gold Compass 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$378.45
$429.54
$483.65
$675.91
$1027.10
$756.90
$859.08
$967.30
$1351.82
$2054.20
$997.21
$1099.39
$1207.61
$1592.13
$1237.52
$1339.70
$1447.92
$1832.44
$1477.83
$1580.01
$1688.23
$2072.75
$618.76
$669.85
$723.96
$916.22
$859.07
$910.16
$964.27
$1156.53
$1099.38
$1150.47
$1204.58
$1396.84
$240.31

Plan: (HMO) Gold Compass 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$374.66
$425.23
$478.81
$669.13
$1016.82
$749.32
$850.46
$957.62
$1338.26
$2033.64
$987.23
$1088.37
$1195.53
$1576.17
$1225.14
$1326.28
$1433.44
$1814.08
$1463.05
$1564.19
$1671.35
$2051.99
$612.57
$663.14
$716.72
$907.04
$850.48
$901.05
$954.63
$1144.95
$1088.39
$1138.96
$1192.54
$1382.86
$237.91

Plan: (HMO) Silver Compass HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$315.90
$358.54
$403.72
$564.19
$857.35
$631.80
$717.08
$807.44
$1128.38
$1714.70
$832.40
$917.68
$1008.04
$1328.98
$1033.00
$1118.28
$1208.64
$1529.58
$1233.60
$1318.88
$1409.24
$1730.18
$516.50
$559.14
$604.32
$764.79
$717.10
$759.74
$804.92
$965.39
$917.70
$960.34
$1005.52
$1165.99
$200.60

Plan: (HMO) Silver Compass 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$331.38
$376.11
$423.50
$591.84
$899.36
$662.76
$752.22
$847.00
$1183.68
$1798.72
$873.18
$962.64
$1057.42
$1394.10
$1083.60
$1173.06
$1267.84
$1604.52
$1294.02
$1383.48
$1478.26
$1814.94
$541.80
$586.53
$633.92
$802.26
$752.22
$796.95
$844.34
$1012.68
$962.64
$1007.37
$1054.76
$1223.10
$210.42

Plan: (HMO) Silver Compass 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$333.90
$378.98
$426.73
$596.35
$906.22
$667.80
$757.96
$853.46
$1192.70
$1812.44
$879.83
$969.99
$1065.49
$1404.73
$1091.86
$1182.02
$1277.52
$1616.76
$1303.89
$1394.05
$1489.55
$1828.79
$545.93
$591.01
$638.76
$808.38
$757.96
$803.04
$850.79
$1020.41
$969.99
$1015.07
$1062.82
$1232.44
$212.03

Plan: (HMO) Bronze Compass HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$275.46
$312.65
$352.04
$491.98
$747.61
$550.92
$625.30
$704.08
$983.96
$1495.22
$725.84
$800.22
$879.00
$1158.88
$900.76
$975.14
$1053.92
$1333.80
$1075.68
$1150.06
$1228.84
$1508.72
$450.38
$487.57
$526.96
$666.90
$625.30
$662.49
$701.88
$841.82
$800.22
$837.41
$876.80
$1016.74
$174.92

Plan: (HMO) Bronze Compass 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-725-1147 - Provider Directory for This Plan: (UnitedHealthcare of the Midlands, Inc.)

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
$290.31
$329.50
$371.02
$518.49
$787.90
$580.62
$659.00
$742.04
$1036.98
$1575.80
$764.97
$843.35
$926.39
$1221.33
$949.32
$1027.70
$1110.74
$1405.68
$1133.67
$1212.05
$1295.09
$1590.03
$474.66
$513.85
$555.37
$702.84
$659.01
$698.20
$739.72
$887.19
$843.36
$882.55
$924.07
$1071.54
$184.35

†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 Keith County here.