Obamacare 2021 Rates for Santa Cruz County

Obamacare > Rates > Arizona > Santa Cruz County

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

The health insurance rates listed below are for calendar year 2021.

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

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

Obamacare Providers, 29 Plans and 2021 Rates for Santa Cruz County, Arizona

Below, you’ll find a summary of the 29 plans for Santa Cruz County, Arizona and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Blue Cross Blue Shield of Arizona

Local: 1-844-341-5837 | Toll Free: 1-844-341-5837 | TTY: 1-602-864-4823
Toc - Plan #1 Blue Cross Blue Shield of Arizona
Silver

(HMO) Blue TrueHealth Silver - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361,35
$410,13
$461,80
$645,36
$980,68 		$637,78
$686,56
$738,23
$921,79 		$914,21
$962,99
$1 014,66
$1 198,22 		$1 190,64
$1 239,42
$1 291,09
$1 474,65 		$276,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722,70
$820,26
$923,60
$1 290,72
$1 961,36 		$999,13
$1 096,69
$1 200,03
$1 567,15 		$1 275,56
$1 373,12
$1 476,46
$1 843,58 		$1 551,99
$1 649,55
$1 752,89
$2 120,01 		$276,43
Toc - Plan #2 Blue Cross Blue Shield of Arizona
Gold

(HMO) Blue EverydayHealth Gold - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 Annual Deductible
$6,750 $13,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$420,94
$477,77
$537,96
$751,80
$1 142,42 		$742,96
$799,79
$859,98
$1 073,82 		$1 064,98
$1 121,81
$1 182,00
$1 395,84 		$1 387,00
$1 443,83
$1 504,02
$1 717,86 		$322,02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$841,88
$955,54
$1 075,92
$1 503,60
$2 284,84 		$1 163,90
$1 277,56
$1 397,94
$1 825,62 		$1 485,92
$1 599,58
$1 719,96
$2 147,64 		$1 807,94
$1 921,60
$2 041,98
$2 469,66 		$322,02
Toc - Plan #3 Blue Cross Blue Shield of Arizona
Silver

(HMO) Blue EverydayHealth Silver - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$354,87
$402,78
$453,53
$633,80
$963,12 		$626,35
$674,26
$725,01
$905,28 		$897,83
$945,74
$996,49
$1 176,76 		$1 169,31
$1 217,22
$1 267,97
$1 448,24 		$271,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$709,74
$805,56
$907,06
$1 267,60
$1 926,24 		$981,22
$1 077,04
$1 178,54
$1 539,08 		$1 252,70
$1 348,52
$1 450,02
$1 810,56 		$1 524,18
$1 620,00
$1 721,50
$2 082,04 		$271,48
Toc - Plan #4 Blue Cross Blue Shield of Arizona
Expanded Bronze

(HMO) Blue EverydayHealth Bronze - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$266,28
$302,23
$340,31
$475,58
$722,69 		$469,99
$505,94
$544,02
$679,29 		$673,70
$709,65
$747,73
$883,00 		$877,41
$913,36
$951,44
$1 086,71 		$203,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$532,56
$604,46
$680,62
$951,16
$1 445,38 		$736,27
$808,17
$884,33
$1 154,87 		$939,98
$1 011,88
$1 088,04
$1 358,58 		$1 143,69
$1 215,59
$1 291,75
$1 562,29 		$203,71
Toc - Plan #5 Blue Cross Blue Shield of Arizona
Expanded Bronze

(HMO) Blue Portfolio HSA Bronze - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287,60
$326,42
$367,55
$513,64
$780,53 		$507,61
$546,43
$587,56
$733,65 		$727,62
$766,44
$807,57
$953,66 		$947,63
$986,45
$1 027,58
$1 173,67 		$220,01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$575,20
$652,84
$735,10
$1 027,28
$1 561,06 		$795,21
$872,85
$955,11
$1 247,29 		$1 015,22
$1 092,86
$1 175,12
$1 467,30 		$1 235,23
$1 312,87
$1 395,13
$1 687,31 		$220,01
Toc - Plan #6 Blue Cross Blue Shield of Arizona
Catastrophic

(HMO) Blue SimpleHealth - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$238,50
$270,70
$304,81
$425,97
$647,29 		$420,96
$453,16
$487,27
$608,43 		$603,42
$635,62
$669,73
$790,89 		$785,88
$818,08
$852,19
$973,35 		$182,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$477,00
$541,40
$609,62
$851,94
$1 294,58 		$659,46
$723,86
$792,08
$1 034,40 		$841,92
$906,32
$974,54
$1 216,86 		$1 024,38
$1 088,78
$1 157,00
$1 399,32 		$182,46
Toc - Plan #7 Blue Cross Blue Shield of Arizona
Expanded Bronze

(HMO) Blue AdvanceHealth Bronze - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$247,73
$281,17
$316,59
$442,44
$672,32 		$437,24
$470,68
$506,10
$631,95 		$626,75
$660,19
$695,61
$821,46 		$816,26
$849,70
$885,12
$1 010,97 		$189,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$495,46
$562,34
$633,18
$884,88
$1 344,64 		$684,97
$751,85
$822,69
$1 074,39 		$874,48
$941,36
$1 012,20
$1 263,90 		$1 063,99
$1 130,87
$1 201,71
$1 453,41 		$189,51
Toc - Plan #8 Blue Cross Blue Shield of Arizona
Silver

(HMO) Blue AdvanceHealth Silver - Neighborhood Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-341-5837

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$329,05
$373,47
$420,52
$587,68
$893,03 		$580,77
$625,19
$672,24
$839,40 		$832,49
$876,91
$923,96
$1 091,12 		$1 084,21
$1 128,63
$1 175,68
$1 342,84 		$251,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$658,10
$746,94
$841,04
$1 175,36
$1 786,06 		$909,82
$998,66
$1 092,76
$1 427,08 		$1 161,54
$1 250,38
$1 344,48
$1 678,80 		$1 413,26
$1 502,10
$1 596,20
$1 930,52 		$251,72

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Ambetter from Arizona Complete Health

Local: 1-888-926-5057 | Toll Free: 1-888-926-5057 | TTY: 1-888-926-5180
Toc - Plan #9 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 9 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$311,64
$353,71
$398,28
$556,59
$845,79 		$550,04
$592,11
$636,68
$794,99 		$788,44
$830,51
$875,08
$1 033,39 		$1 026,84
$1 068,91
$1 113,48
$1 271,79 		$238,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$623,28
$707,42
$796,56
$1 113,18
$1 691,58 		$861,68
$945,82
$1 034,96
$1 351,58 		$1 100,08
$1 184,22
$1 273,36
$1 589,98 		$1 338,48
$1 422,62
$1 511,76
$1 828,38 		$238,40
Toc - Plan #10 Ambetter from Arizona Complete Health
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$249,35
$283,01
$318,66
$445,33
$676,72 		$440,10
$473,76
$509,41
$636,08 		$630,85
$664,51
$700,16
$826,83 		$821,60
$855,26
$890,91
$1 017,58 		$190,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$498,70
$566,02
$637,32
$890,66
$1 353,44 		$689,45
$756,77
$828,07
$1 081,41 		$880,20
$947,52
$1 018,82
$1 272,16 		$1 070,95
$1 138,27
$1 209,57
$1 462,91 		$190,75
Toc - Plan #11 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 4 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$290,17
$329,34
$370,84
$518,24
$787,52 		$512,15
$551,32
$592,82
$740,22 		$734,13
$773,30
$814,80
$962,20 		$956,11
$995,28
$1 036,78
$1 184,18 		$221,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$580,34
$658,68
$741,68
$1 036,48
$1 575,04 		$802,32
$880,66
$963,66
$1 258,46 		$1 024,30
$1 102,64
$1 185,64
$1 480,44 		$1 246,28
$1 324,62
$1 407,62
$1 702,42 		$221,98
Toc - Plan #12 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 11 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$281,46
$319,45
$359,70
$502,68
$763,87 		$496,77
$534,76
$575,01
$717,99 		$712,08
$750,07
$790,32
$933,30 		$927,39
$965,38
$1 005,63
$1 148,61 		$215,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$562,92
$638,90
$719,40
$1 005,36
$1 527,74 		$778,23
$854,21
$934,71
$1 220,67 		$993,54
$1 069,52
$1 150,02
$1 435,98 		$1 208,85
$1 284,83
$1 365,33
$1 651,29 		$215,31
Toc - Plan #13 Ambetter from Arizona Complete Health
Bronze

(HMO) Ambetter Essential Care 1 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$241,66
$274,28
$308,84
$431,60
$655,86 		$426,53
$459,15
$493,71
$616,47 		$611,40
$644,02
$678,58
$801,34 		$796,27
$828,89
$863,45
$986,21 		$184,87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$483,32
$548,56
$617,68
$863,20
$1 311,72 		$668,19
$733,43
$802,55
$1 048,07 		$853,06
$918,30
$987,42
$1 232,94 		$1 037,93
$1 103,17
$1 172,29
$1 417,81 		$184,87
Toc - Plan #14 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 12 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$276,56
$313,89
$353,44
$493,93
$750,57 		$488,13
$525,46
$565,01
$705,50 		$699,70
$737,03
$776,58
$917,07 		$911,27
$948,60
$988,15
$1 128,64 		$211,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$553,12
$627,78
$706,88
$987,86
$1 501,14 		$764,69
$839,35
$918,45
$1 199,43 		$976,26
$1 050,92
$1 130,02
$1 411,00 		$1 187,83
$1 262,49
$1 341,59
$1 622,57 		$211,57
Toc - Plan #15 Ambetter from Arizona Complete Health
Gold

(HMO) Ambetter Secure Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$404,98
$459,65
$517,56
$723,29
$1 099,10 		$714,79
$769,46
$827,37
$1 033,10 		$1 024,60
$1 079,27
$1 137,18
$1 342,91 		$1 334,41
$1 389,08
$1 446,99
$1 652,72 		$309,81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$809,96
$919,30
$1 035,12
$1 446,58
$2 198,20 		$1 119,77
$1 229,11
$1 344,93
$1 756,39 		$1 429,58
$1 538,92
$1 654,74
$2 066,20 		$1 739,39
$1 848,73
$1 964,55
$2 376,01 		$309,81
Toc - Plan #16 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 25 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287,97
$326,85
$368,03
$514,32
$781,56 		$508,27
$547,15
$588,33
$734,62 		$728,57
$767,45
$808,63
$954,92 		$948,87
$987,75
$1 028,93
$1 175,22 		$220,30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$575,94
$653,70
$736,06
$1 028,64
$1 563,12 		$796,24
$874,00
$956,36
$1 248,94 		$1 016,54
$1 094,30
$1 176,66
$1 469,24 		$1 236,84
$1 314,60
$1 396,96
$1 689,54 		$220,30
Toc - Plan #17 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 26 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$288,60
$327,56
$368,83
$515,44
$783,27 		$509,38
$548,34
$589,61
$736,22 		$730,16
$769,12
$810,39
$957,00 		$950,94
$989,90
$1 031,17
$1 177,78 		$220,78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$577,20
$655,12
$737,66
$1 030,88
$1 566,54 		$797,98
$875,90
$958,44
$1 251,66 		$1 018,76
$1 096,68
$1 179,22
$1 472,44 		$1 239,54
$1 317,46
$1 400,00
$1 693,22 		$220,78
Toc - Plan #18 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 28 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$298,75
$339,08
$381,80
$533,57
$810,80 		$527,29
$567,62
$610,34
$762,11 		$755,83
$796,16
$838,88
$990,65 		$984,37
$1 024,70
$1 067,42
$1 219,19 		$228,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$597,50
$678,16
$763,60
$1 067,14
$1 621,60 		$826,04
$906,70
$992,14
$1 295,68 		$1 054,58
$1 135,24
$1 220,68
$1 524,22 		$1 283,12
$1 363,78
$1 449,22
$1 752,76 		$228,54
Toc - Plan #19 Ambetter from Arizona Complete Health
Expanded Bronze

(HMO) Ambetter Essential Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$249,16
$282,80
$318,43
$445,00
$676,22 		$439,77
$473,41
$509,04
$635,61 		$630,38
$664,02
$699,65
$826,22 		$820,99
$854,63
$890,26
$1 016,83 		$190,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$498,32
$565,60
$636,86
$890,00
$1 352,44 		$688,93
$756,21
$827,47
$1 080,61 		$879,54
$946,82
$1 018,08
$1 271,22 		$1 070,15
$1 137,43
$1 208,69
$1 461,83 		$190,61
Toc - Plan #20 Ambetter from Arizona Complete Health
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$261,26
$296,52
$333,88
$466,60
$709,05 		$461,12
$496,38
$533,74
$666,46 		$660,98
$696,24
$733,60
$866,32 		$860,84
$896,10
$933,46
$1 066,18 		$199,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$522,52
$593,04
$667,76
$933,20
$1 418,10 		$722,38
$792,90
$867,62
$1 133,06 		$922,24
$992,76
$1 067,48
$1 332,92 		$1 122,10
$1 192,62
$1 267,34
$1 532,78 		$199,86
Toc - Plan #21 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 9 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326,52
$370,61
$417,30
$583,17
$886,19 		$576,31
$620,40
$667,09
$832,96 		$826,10
$870,19
$916,88
$1 082,75 		$1 075,89
$1 119,98
$1 166,67
$1 332,54 		$249,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$653,04
$741,22
$834,60
$1 166,34
$1 772,38 		$902,83
$991,01
$1 084,39
$1 416,13 		$1 152,62
$1 240,80
$1 334,18
$1 665,92 		$1 402,41
$1 490,59
$1 583,97
$1 915,71 		$249,79
Toc - Plan #22 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 4 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$304,03
$345,07
$388,55
$543,00
$825,13 		$536,61
$577,65
$621,13
$775,58 		$769,19
$810,23
$853,71
$1 008,16 		$1 001,77
$1 042,81
$1 086,29
$1 240,74 		$232,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$608,06
$690,14
$777,10
$1 086,00
$1 650,26 		$840,64
$922,72
$1 009,68
$1 318,58 		$1 073,22
$1 155,30
$1 242,26
$1 551,16 		$1 305,80
$1 387,88
$1 474,84
$1 783,74 		$232,58
Toc - Plan #23 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$294,90
$334,71
$376,88
$526,69
$800,36 		$520,50
$560,31
$602,48
$752,29 		$746,10
$785,91
$828,08
$977,89 		$971,70
$1 011,51
$1 053,68
$1 203,49 		$225,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$589,80
$669,42
$753,76
$1 053,38
$1 600,72 		$815,40
$895,02
$979,36
$1 278,98 		$1 041,00
$1 120,62
$1 204,96
$1 504,58 		$1 266,60
$1 346,22
$1 430,56
$1 730,18 		$225,60
Toc - Plan #24 Ambetter from Arizona Complete Health
Bronze

(HMO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$253,20
$287,38
$323,59
$452,22
$687,19 		$446,90
$481,08
$517,29
$645,92 		$640,60
$674,78
$710,99
$839,62 		$834,30
$868,48
$904,69
$1 033,32 		$193,70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$506,40
$574,76
$647,18
$904,44
$1 374,38 		$700,10
$768,46
$840,88
$1 098,14 		$893,80
$962,16
$1 034,58
$1 291,84 		$1 087,50
$1 155,86
$1 228,28
$1 485,54 		$193,70
Toc - Plan #25 Ambetter from Arizona Complete Health
Gold

(HMO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$424,32
$481,60
$542,28
$757,83
$1 151,60 		$748,92
$806,20
$866,88
$1 082,43 		$1 073,52
$1 130,80
$1 191,48
$1 407,03 		$1 398,12
$1 455,40
$1 516,08
$1 731,63 		$324,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$848,64
$963,20
$1 084,56
$1 515,66
$2 303,20 		$1 173,24
$1 287,80
$1 409,16
$1 840,26 		$1 497,84
$1 612,40
$1 733,76
$2 164,86 		$1 822,44
$1 937,00
$2 058,36
$2 489,46 		$324,60
Toc - Plan #26 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 25 HSA (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$301,73
$342,46
$385,61
$538,89
$818,89 		$532,55
$573,28
$616,43
$769,71 		$763,37
$804,10
$847,25
$1 000,53 		$994,19
$1 034,92
$1 078,07
$1 231,35 		$230,82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603,46
$684,92
$771,22
$1 077,78
$1 637,78 		$834,28
$915,74
$1 002,04
$1 308,60 		$1 065,10
$1 146,56
$1 232,86
$1 539,42 		$1 295,92
$1 377,38
$1 463,68
$1 770,24 		$230,82
Toc - Plan #27 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$302,39
$343,21
$386,45
$540,06
$820,68 		$533,72
$574,54
$617,78
$771,39 		$765,05
$805,87
$849,11
$1 002,72 		$996,38
$1 037,20
$1 080,44
$1 234,05 		$231,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$604,78
$686,42
$772,90
$1 080,12
$1 641,36 		$836,11
$917,75
$1 004,23
$1 311,45 		$1 067,44
$1 149,08
$1 235,56
$1 542,78 		$1 298,77
$1 380,41
$1 466,89
$1 774,11 		$231,33
Toc - Plan #28 Ambetter from Arizona Complete Health
Silver

(HMO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$313,02
$355,28
$400,04
$559,05
$849,53 		$552,48
$594,74
$639,50
$798,51 		$791,94
$834,20
$878,96
$1 037,97 		$1 031,40
$1 073,66
$1 118,42
$1 277,43 		$239,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$626,04
$710,56
$800,08
$1 118,10
$1 699,06 		$865,50
$950,02
$1 039,54
$1 357,56 		$1 104,96
$1 189,48
$1 279,00
$1 597,02 		$1 344,42
$1 428,94
$1 518,46
$1 836,48 		$239,46
Toc - Plan #29 Ambetter from Arizona Complete Health
Expanded Bronze

(HMO) Ambetter Essential Care 5 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-926-5057

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$261,06
$296,30
$333,64
$466,25
$708,52 		$460,77
$496,01
$533,35
$665,96 		$660,48
$695,72
$733,06
$865,67 		$860,19
$895,43
$932,77
$1 065,38 		$199,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$522,12
$592,60
$667,28
$932,50
$1 417,04 		$721,83
$792,31
$866,99
$1 132,21 		$921,54
$992,02
$1 066,70
$1 331,92 		$1 121,25
$1 191,73
$1 266,41
$1 531,63 		$199,71

‡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 Santa Cruz County here.

Santa Cruz County is in “Rating Area 6” of Arizona.

Currently, there are 29 plans offered in Rating Area 6.

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2021 Obamacare Plans for Santa Cruz County, AZ

Plan Browser: 29 Plans
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