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Providers for Zip Code 53095

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2019 Marketplace Rates For Washington County, Wisconsin

Thursday, April 25th, 2024


The health insurance rates listed below are for calendar year 2019.

2019 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

(click here for 2018)

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

Obamacare Providers, Plans and 2019 Rates for Washington County

Washington County is in “Rating Area 12” of Wisconsin.

Currently, there are 26 plans offered in Rating Area 12.

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 West Bend, WI area accept this insurance coverage as within the plan's "network".
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Children's Community Health Plan

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672

TTY: 1-844-531-4856

Plan: (EPO) Together Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $7,000 : Family: $14,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $370.97
$421.04
$474.09
$662.54
$1,006.80		 $741.94
$842.08
$948.18
$1,325.08
$2,013.60		 $1,025.73
$1,125.87
$1,231.97
$1,608.87		 $1,309.52
$1,409.66
$1,515.76
$1,892.66		 $1,593.31
$1,693.45
$1,799.55
$2,176.45		 $654.76
$704.83
$757.88
$946.33		 $938.55
$988.62
$1,041.67
$1,230.12		 $1,222.34
$1,272.41
$1,325.46
$1,513.91		 $338.69

Plan: (EPO) Together Standard Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $514.52
$583.97
$657.55
$918.92
$1,396.39		 $1,029.04
$1,167.94
$1,315.10
$1,837.84
$2,792.78		 $1,422.64
$1,561.54
$1,708.70
$2,231.44		 $1,816.24
$1,955.14
$2,102.30
$2,625.04		 $2,209.84
$2,348.74
$2,495.90
$3,018.64		 $908.12
$977.57
$1,051.15
$1,312.52		 $1,301.72
$1,371.17
$1,444.75
$1,706.12		 $1,695.32
$1,764.77
$1,838.35
$2,099.72		 $469.75

Plan: (EPO) Together Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $4,700 : Family: $9,400
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $477.99
$542.51
$610.86
$853.68
$1,297.25		 $955.98
$1,085.02
$1,221.72
$1,707.36
$2,594.50		 $1,321.64
$1,450.68
$1,587.38
$2,073.02		 $1,687.30
$1,816.34
$1,953.04
$2,438.68		 $2,052.96
$2,182.00
$2,318.70
$2,804.34		 $843.65
$908.17
$976.52
$1,219.34		 $1,209.31
$1,273.83
$1,342.18
$1,585.00		 $1,574.97
$1,639.49
$1,707.84
$1,950.66		 $436.40

Plan: (EPO) Together Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

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
Gold 21
30
40
50
60		 $508.35
$576.97
$649.66
$907.89
$1,379.63		 $1,016.70
$1,153.94
$1,299.32
$1,815.78
$2,759.26		 $1,405.58
$1,542.82
$1,688.20
$2,204.66		 $1,794.46
$1,931.70
$2,077.08
$2,593.54		 $2,183.34
$2,320.58
$2,465.96
$2,982.42		 $897.23
$965.85
$1,038.54
$1,296.77		 $1,286.11
$1,354.73
$1,427.42
$1,685.65		 $1,674.99
$1,743.61
$1,816.30
$2,074.53		 $464.11

Plan: (EPO) Together Bronze HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

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

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
Bronze 21
30
40
50
60		 $395.16
$448.49
$505.00
$705.73
$1,072.43		 $790.32
$896.98
$1,010.00
$1,411.46
$2,144.86		 $1,092.61
$1,199.27
$1,312.29
$1,713.75		 $1,394.90
$1,501.56
$1,614.58
$2,016.04		 $1,697.19
$1,803.85
$1,916.87
$2,318.33		 $697.45
$750.78
$807.29
$1,008.02		 $999.74
$1,053.07
$1,109.58
$1,310.31		 $1,302.03
$1,355.36
$1,411.87
$1,612.60		 $360.77

Plan: (EPO) Together Silver Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $498.57
$565.87
$637.16
$890.43
$1,353.10		 $997.14
$1,131.74
$1,274.32
$1,780.86
$2,706.20		 $1,378.54
$1,513.14
$1,655.72
$2,162.26		 $1,759.94
$1,894.54
$2,037.12
$2,543.66		 $2,141.34
$2,275.94
$2,418.52
$2,925.06		 $879.97
$947.27
$1,018.56
$1,271.83		 $1,261.37
$1,328.67
$1,399.96
$1,653.23		 $1,642.77
$1,710.07
$1,781.36
$2,034.63		 $455.19

Plan: (EPO) Together Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $304.60
$345.71
$389.27
$544.00
$826.66		 $609.20
$691.42
$778.54
$1,088.00
$1,653.32		 $842.21
$924.43
$1,011.55
$1,321.01		 $1,075.22
$1,157.44
$1,244.56
$1,554.02		 $1,308.23
$1,390.45
$1,477.57
$1,787.03		 $537.61
$578.72
$622.28
$777.01		 $770.62
$811.73
$855.29
$1,010.02		 $1,003.63
$1,044.74
$1,088.30
$1,243.03		 $278.09
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Molina Healthcare of Wisconsin, Inc.

Local: 1-888-560-2043 | Toll Free: 1-888-560-2043

Plan: (HMO) Molina Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $2,925 : Family: $5,850
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		 $498.02
$565.25
$636.47
$889.46
$1,351.62		 $996.04
$1,130.50
$1,272.94
$1,778.92
$2,703.24		 $1,377.02
$1,511.48
$1,653.92
$2,159.90		 $1,758.00
$1,892.46
$2,034.90
$2,540.88		 $2,138.98
$2,273.44
$2,415.88
$2,921.86		 $879.00
$946.23
$1,017.45
$1,270.44		 $1,259.98
$1,327.21
$1,398.43
$1,651.42		 $1,640.96
$1,708.19
$1,779.41
$2,032.40		 $454.69

Plan: (HMO) Molina Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $5,350 : Family: $10,700
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $439.94
$499.33
$562.25
$785.74
$1,194.00		 $879.88
$998.66
$1,124.50
$1,571.48
$2,388.00		 $1,216.44
$1,335.22
$1,461.06
$1,908.04		 $1,553.00
$1,671.78
$1,797.62
$2,244.60		 $1,889.56
$2,008.34
$2,134.18
$2,581.16		 $776.50
$835.89
$898.81
$1,122.30		 $1,113.06
$1,172.45
$1,235.37
$1,458.86		 $1,449.62
$1,509.01
$1,571.93
$1,795.42		 $401.67
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Network Health Plan

Local: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400

TTY: 1-800-947-3529

Plan: (HMO) Prestige Bronze 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

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
Bronze 21
30
40
50
60		 $392.21
$445.16
$501.24
$700.48
$1,064.45		 $784.42
$890.32
$1,002.48
$1,400.96
$2,128.90		 $1,084.46
$1,190.36
$1,302.52
$1,701.00		 $1,384.50
$1,490.40
$1,602.56
$2,001.04		 $1,684.54
$1,790.44
$1,902.60
$2,301.08		 $692.25
$745.20
$801.28
$1,000.52		 $992.29
$1,045.24
$1,101.32
$1,300.56		 $1,292.33
$1,345.28
$1,401.36
$1,600.60		 $358.09

Plan: (HMO) Prestige Silver 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

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		 $565.71
$642.08
$722.97
$1,010.35
$1,535.32		 $1,131.42
$1,284.16
$1,445.94
$2,020.70
$3,070.64		 $1,564.19
$1,716.93
$1,878.71
$2,453.47		 $1,996.96
$2,149.70
$2,311.48
$2,886.24		 $2,429.73
$2,582.47
$2,744.25
$3,319.01		 $998.48
$1,074.85
$1,155.74
$1,443.12		 $1,431.25
$1,507.62
$1,588.51
$1,875.89		 $1,864.02
$1,940.39
$2,021.28
$2,308.66		 $516.49

Plan: (HMO) Prestige Bronze Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $7,000 : Family: $14,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $381.40
$432.89
$487.43
$681.18
$1,035.12		 $762.80
$865.78
$974.86
$1,362.36
$2,070.24		 $1,054.57
$1,157.55
$1,266.63
$1,654.13		 $1,346.34
$1,449.32
$1,558.40
$1,945.90		 $1,638.11
$1,741.09
$1,850.17
$2,237.67		 $673.17
$724.66
$779.20
$972.95		 $964.94
$1,016.43
$1,070.97
$1,264.72		 $1,256.71
$1,308.20
$1,362.74
$1,556.49		 $348.22

Plan: (HMO) Prestige Silver Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $549.35
$623.51
$702.07
$981.13
$1,490.92		 $1,098.70
$1,247.02
$1,404.14
$1,962.26
$2,981.84		 $1,518.95
$1,667.27
$1,824.39
$2,382.51		 $1,939.20
$2,087.52
$2,244.64
$2,802.76		 $2,359.45
$2,507.77
$2,664.89
$3,223.01		 $969.60
$1,043.76
$1,122.32
$1,401.38		 $1,389.85
$1,464.01
$1,542.57
$1,821.63		 $1,810.10
$1,884.26
$1,962.82
$2,241.88		 $501.56

Plan: (HMO) Prestige Gold Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $566.85
$643.37
$724.43
$1,012.38
$1,538.41		 $1,133.70
$1,286.74
$1,448.86
$2,024.76
$3,076.82		 $1,567.34
$1,720.38
$1,882.50
$2,458.40		 $2,000.98
$2,154.02
$2,316.14
$2,892.04		 $2,434.62
$2,587.66
$2,749.78
$3,325.68		 $1,000.49
$1,077.01
$1,158.07
$1,446.02		 $1,434.13
$1,510.65
$1,591.71
$1,879.66		 $1,867.77
$1,944.29
$2,025.35
$2,313.30		 $517.53

Plan: (HMO) Prestige Bronze 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $401.88
$456.13
$513.59
$717.74
$1,090.68		 $803.76
$912.26
$1,027.18
$1,435.48
$2,181.36		 $1,111.20
$1,219.70
$1,334.62
$1,742.92		 $1,418.64
$1,527.14
$1,642.06
$2,050.36		 $1,726.08
$1,834.58
$1,949.50
$2,357.80		 $709.32
$763.57
$821.03
$1,025.18		 $1,016.76
$1,071.01
$1,128.47
$1,332.62		 $1,324.20
$1,378.45
$1,435.91
$1,640.06		 $366.91

Plan: (HMO) Prestige Bronze 50 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $2,700 : Family: $5,400
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

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
Expanded Bronze 21
30
40
50
60		 $413.47
$469.29
$528.42
$738.46
$1,122.16		 $826.94
$938.58
$1,056.84
$1,476.92
$2,244.32		 $1,143.25
$1,254.89
$1,373.15
$1,793.23		 $1,459.56
$1,571.20
$1,689.46
$2,109.54		 $1,775.87
$1,887.51
$2,005.77
$2,425.85		 $729.78
$785.60
$844.73
$1,054.77		 $1,046.09
$1,101.91
$1,161.04
$1,371.08		 $1,362.40
$1,418.22
$1,477.35
$1,687.39		 $377.50

Plan: (HMO) Prestige Gold 50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,300 : Family: $8,600

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
Gold 21
30
40
50
60		 $588.16
$667.56
$751.67
$1,050.45
$1,596.26		 $1,176.32
$1,335.12
$1,503.34
$2,100.90
$3,192.52		 $1,626.27
$1,785.07
$1,953.29
$2,550.85		 $2,076.22
$2,235.02
$2,403.24
$3,000.80		 $2,526.17
$2,684.97
$2,853.19
$3,450.75		 $1,038.11
$1,117.51
$1,201.62
$1,500.40		 $1,488.06
$1,567.46
$1,651.57
$1,950.35		 $1,938.01
$2,017.41
$2,101.52
$2,400.30		 $536.99

Plan: (HMO) Prestige Gold 0 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $2,700 : Family: $5,400
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		 $603.88
$685.40
$771.75
$1,078.52
$1,638.91		 $1,207.76
$1,370.80
$1,543.50
$2,157.04
$3,277.82		 $1,669.73
$1,832.77
$2,005.47
$2,619.01		 $2,131.70
$2,294.74
$2,467.44
$3,080.98		 $2,593.67
$2,756.71
$2,929.41
$3,542.95		 $1,065.85
$1,147.37
$1,233.72
$1,540.49		 $1,527.82
$1,609.34
$1,695.69
$2,002.46		 $1,989.79
$2,071.31
$2,157.66
$2,464.43		 $551.34
ADVERTISEMENT

Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442

TTY: 1-855-643-5001

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Gold 2000/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $454.39
$515.72
$580.69
$811.52
$1,233.18		 $908.78
$1,031.44
$1,161.38
$1,623.04
$2,466.36		 $1,256.38
$1,379.04
$1,508.98
$1,970.64		 $1,603.98
$1,726.64
$1,856.58
$2,318.24		 $1,951.58
$2,074.24
$2,204.18
$2,665.84		 $801.99
$863.32
$928.29
$1,159.12		 $1,149.59
$1,210.92
$1,275.89
$1,506.72		 $1,497.19
$1,558.52
$1,623.49
$1,854.32		 $414.85

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Silver 4000/75

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $453.02
$514.17
$578.95
$809.08
$1,229.48		 $906.04
$1,028.34
$1,157.90
$1,618.16
$2,458.96		 $1,252.60
$1,374.90
$1,504.46
$1,964.72		 $1,599.16
$1,721.46
$1,851.02
$2,311.28		 $1,945.72
$2,068.02
$2,197.58
$2,657.84		 $799.58
$860.73
$925.51
$1,155.64		 $1,146.14
$1,207.29
$1,272.07
$1,502.20		 $1,492.70
$1,553.85
$1,618.63
$1,848.76		 $413.60

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Silver 3000/75/Copay40

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $467.07
$530.12
$596.91
$834.17
$1,267.61		 $934.14
$1,060.24
$1,193.82
$1,668.34
$2,535.22		 $1,291.44
$1,417.54
$1,551.12
$2,025.64		 $1,648.74
$1,774.84
$1,908.42
$2,382.94		 $2,006.04
$2,132.14
$2,265.72
$2,740.24		 $824.37
$887.42
$954.21
$1,191.47		 $1,181.67
$1,244.72
$1,311.51
$1,548.77		 $1,538.97
$1,602.02
$1,668.81
$1,906.07		 $426.43

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Catastrophic 7900/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $228.64
$259.49
$292.18
$408.33
$620.49		 $457.28
$518.98
$584.36
$816.66
$1,240.98		 $632.18
$693.88
$759.26
$991.56		 $807.08
$868.78
$934.16
$1,166.46		 $981.98
$1,043.68
$1,109.06
$1,341.36		 $403.54
$434.39
$467.08
$583.23		 $578.44
$609.29
$641.98
$758.13		 $753.34
$784.19
$816.88
$933.03		 $208.74

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Bronze 7900/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $296.66
$336.70
$379.12
$529.82
$805.11		 $593.32
$673.40
$758.24
$1,059.64
$1,610.22		 $820.26
$900.34
$985.18
$1,286.58		 $1,047.20
$1,127.28
$1,212.12
$1,513.52		 $1,274.14
$1,354.22
$1,439.06
$1,740.46		 $523.60
$563.64
$606.06
$756.76		 $750.54
$790.58
$833.00
$983.70		 $977.48
$1,017.52
$1,059.94
$1,210.64		 $270.84

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - HSA Silver 3500/75

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

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		 $483.61
$548.88
$618.03
$863.70
$1,312.48		 $967.22
$1,097.76
$1,236.06
$1,727.40
$2,624.96		 $1,337.17
$1,467.71
$1,606.01
$2,097.35		 $1,707.12
$1,837.66
$1,975.96
$2,467.30		 $2,077.07
$2,207.61
$2,345.91
$2,837.25		 $853.56
$918.83
$987.98
$1,233.65		 $1,223.51
$1,288.78
$1,357.93
$1,603.60		 $1,593.46
$1,658.73
$1,727.88
$1,973.55		 $441.52

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - HSA Bronze 6650/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

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		 $318.67
$361.67
$407.24
$569.12
$864.83		 $637.34
$723.34
$814.48
$1,138.24
$1,729.66		 $881.11
$967.11
$1,058.25
$1,382.01		 $1,124.88
$1,210.88
$1,302.02
$1,625.78		 $1,368.65
$1,454.65
$1,545.79
$1,869.55		 $562.44
$605.44
$651.01
$812.89		 $806.21
$849.21
$894.78
$1,056.66		 $1,049.98
$1,092.98
$1,138.55
$1,300.43		 $290.93

Plan: (EPO) Envision Aurora Bellin ThedaCare CHHS - Silver 6000/75

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $380.75
$432.14
$486.59
$680.00
$1,033.33		 $761.50
$864.28
$973.18
$1,360.00
$2,066.66		 $1,052.77
$1,155.55
$1,264.45
$1,651.27		 $1,344.04
$1,446.82
$1,555.72
$1,942.54		 $1,635.31
$1,738.09
$1,846.99
$2,233.81		 $672.02
$723.41
$777.86
$971.27		 $963.29
$1,014.68
$1,069.13
$1,262.54		 $1,254.56
$1,305.95
$1,360.40
$1,553.81		 $347.62

‡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 Washington County here.

 

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