Obamacare 2021 Rates for Sheridan County

Obamacare > Rates > Montana > Sheridan 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 Sheridan County, MT.

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, 22 Plans and 2021 Rates for Sheridan County, Montana

Below, you’ll find a summary of the 22 plans for Sheridan County, Montana 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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PacificSource Health Plans

Local: 1-406-442-6589 | Toll Free: 1-877-590-1596 | TTY: 1-800-253-4091

Toc - Plan #1 PacificSource Health Plans
Expanded Bronze

(PPO) Voyager Bronze HSA 6900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

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
$322,00
$366,00
$412,00
$576,00
$875,00
$569,00
$613,00
$659,00
$823,00
$816,00
$860,00
$906,00
$1 070,00
$1 063,00
$1 107,00
$1 153,00
$1 317,00
$247,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$644,00
$732,00
$824,00
$1 152,00
$1 750,00
$891,00
$979,00
$1 071,00
$1 399,00
$1 138,00
$1 226,00
$1 318,00
$1 646,00
$1 385,00
$1 473,00
$1 565,00
$1 893,00
$247,00
Toc - Plan #2 PacificSource Health Plans
Silver

(PPO) Voyager Silver HSA 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$443,00
$502,00
$566,00
$791,00
$1 201,00
$782,00
$841,00
$905,00
$1 130,00
$1 121,00
$1 180,00
$1 244,00
$1 469,00
$1 460,00
$1 519,00
$1 583,00
$1 808,00
$339,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$886,00
$1 004,00
$1 132,00
$1 582,00
$2 402,00
$1 225,00
$1 343,00
$1 471,00
$1 921,00
$1 564,00
$1 682,00
$1 810,00
$2 260,00
$1 903,00
$2 021,00
$2 149,00
$2 599,00
$339,00
Toc - Plan #3 PacificSource Health Plans
Gold

(PPO) Voyager Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,000 $10,000 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
$476,00
$540,00
$608,00
$850,00
$1 292,00
$840,00
$904,00
$972,00
$1 214,00
$1 204,00
$1 268,00
$1 336,00
$1 578,00
$1 568,00
$1 632,00
$1 700,00
$1 942,00
$364,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$952,00
$1 080,00
$1 216,00
$1 700,00
$2 584,00
$1 316,00
$1 444,00
$1 580,00
$2 064,00
$1 680,00
$1 808,00
$1 944,00
$2 428,00
$2 044,00
$2 172,00
$2 308,00
$2 792,00
$364,00
Toc - Plan #4 PacificSource Health Plans
Expanded Bronze

(PPO) Voyager Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

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
$329,00
$374,00
$421,00
$588,00
$894,00
$581,00
$626,00
$673,00
$840,00
$833,00
$878,00
$925,00
$1 092,00
$1 085,00
$1 130,00
$1 177,00
$1 344,00
$252,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658,00
$748,00
$842,00
$1 176,00
$1 788,00
$910,00
$1 000,00
$1 094,00
$1 428,00
$1 162,00
$1 252,00
$1 346,00
$1 680,00
$1 414,00
$1 504,00
$1 598,00
$1 932,00
$252,00
Toc - Plan #5 PacificSource Health Plans
Silver

(PPO) Voyager Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-590-1596

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
$428,00
$486,00
$547,00
$765,00
$1 162,00
$756,00
$814,00
$875,00
$1 093,00
$1 084,00
$1 142,00
$1 203,00
$1 421,00
$1 412,00
$1 470,00
$1 531,00
$1 749,00
$328,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856,00
$972,00
$1 094,00
$1 530,00
$2 324,00
$1 184,00
$1 300,00
$1 422,00
$1 858,00
$1 512,00
$1 628,00
$1 750,00
$2 186,00
$1 840,00
$1 956,00
$2 078,00
$2 514,00
$328,00

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Blue Cross and Blue Shield of Montana

Local: 1-855-258-8471 | Toll Free: 1-855-258-8471 | TTY: 1-406-444-4212

Toc - Plan #6 Blue Cross and Blue Shield of Montana
Gold

(PPO) Blue Preferred Gold PPO_ 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 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
$445,70
$505,87
$569,61
$796,02
$1 209,63
$786,66
$846,83
$910,57
$1 136,98
$1 127,62
$1 187,79
$1 251,53
$1 477,94
$1 468,58
$1 528,75
$1 592,49
$1 818,90
$340,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$891,40
$1 011,74
$1 139,22
$1 592,04
$2 419,26
$1 232,36
$1 352,70
$1 480,18
$1 933,00
$1 573,32
$1 693,66
$1 821,14
$2 273,96
$1 914,28
$2 034,62
$2 162,10
$2 614,92
$340,96
Toc - Plan #7 Blue Cross and Blue Shield of Montana
Silver

(PPO) Blue Preferred Silver PPO_ 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$800 $1,600 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
$436,05
$494,92
$557,27
$778,79
$1 183,44
$769,63
$828,50
$890,85
$1 112,37
$1 103,21
$1 162,08
$1 224,43
$1 445,95
$1 436,79
$1 495,66
$1 558,01
$1 779,53
$333,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$872,10
$989,84
$1 114,54
$1 557,58
$2 366,88
$1 205,68
$1 323,42
$1 448,12
$1 891,16
$1 539,26
$1 657,00
$1 781,70
$2 224,74
$1 872,84
$1 990,58
$2 115,28
$2 558,32
$333,58
Toc - Plan #8 Blue Cross and Blue Shield of Montana
Expanded Bronze

(PPO) Blue Preferred Bronze PPO_ 201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$3,200 $6,400 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
$339,04
$384,81
$433,29
$605,52
$920,15
$598,40
$644,17
$692,65
$864,88
$857,76
$903,53
$952,01
$1 124,24
$1 117,12
$1 162,89
$1 211,37
$1 383,60
$259,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678,08
$769,62
$866,58
$1 211,04
$1 840,30
$937,44
$1 028,98
$1 125,94
$1 470,40
$1 196,80
$1 288,34
$1 385,30
$1 729,76
$1 456,16
$1 547,70
$1 644,66
$1 989,12
$259,36
Toc - Plan #9 Blue Cross and Blue Shield of Montana
Expanded Bronze

(PPO) Blue Preferred Bronze PPO_ 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$350,02
$397,28
$447,33
$625,14
$949,97
$617,79
$665,05
$715,10
$892,91
$885,56
$932,82
$982,87
$1 160,68
$1 153,33
$1 200,59
$1 250,64
$1 428,45
$267,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$700,04
$794,56
$894,66
$1 250,28
$1 899,94
$967,81
$1 062,33
$1 162,43
$1 518,05
$1 235,58
$1 330,10
$1 430,20
$1 785,82
$1 503,35
$1 597,87
$1 697,97
$2 053,59
$267,77
Toc - Plan #10 Blue Cross and Blue Shield of Montana
Catastrophic

(PPO) Blue Preferred Security PPO_ 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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
$292,70
$332,21
$374,07
$522,76
$794,39
$516,61
$556,12
$597,98
$746,67
$740,52
$780,03
$821,89
$970,58
$964,43
$1 003,94
$1 045,80
$1 194,49
$223,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$585,40
$664,42
$748,14
$1 045,52
$1 588,78
$809,31
$888,33
$972,05
$1 269,43
$1 033,22
$1 112,24
$1 195,96
$1 493,34
$1 257,13
$1 336,15
$1 419,87
$1 717,25
$223,91
Toc - Plan #11 Blue Cross and Blue Shield of Montana
Silver

(PPO) Blue Preferred Silver PPO_ 308

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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
$408,21
$463,32
$521,69
$729,06
$1 107,88
$720,49
$775,60
$833,97
$1 041,34
$1 032,77
$1 087,88
$1 146,25
$1 353,62
$1 345,05
$1 400,16
$1 458,53
$1 665,90
$312,28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$816,42
$926,64
$1 043,38
$1 458,12
$2 215,76
$1 128,70
$1 238,92
$1 355,66
$1 770,40
$1 440,98
$1 551,20
$1 667,94
$2 082,68
$1 753,26
$1 863,48
$1 980,22
$2 394,96
$312,28
Toc - Plan #12 Blue Cross and Blue Shield of Montana
Bronze

(PPO) Blue Preferred Bronze PPO_ 301

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-258-8471

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
$323,15
$366,78
$412,99
$577,15
$877,03
$570,36
$613,99
$660,20
$824,36
$817,57
$861,20
$907,41
$1 071,57
$1 064,78
$1 108,41
$1 154,62
$1 318,78
$247,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$646,30
$733,56
$825,98
$1 154,30
$1 754,06
$893,51
$980,77
$1 073,19
$1 401,51
$1 140,72
$1 227,98
$1 320,40
$1 648,72
$1 387,93
$1 475,19
$1 567,61
$1 895,93
$247,21

ADVERTISEMENT

Mountain Health CO-OP

Local: 1-406-447-9510 | Toll Free: 1-855-447-2900 | TTY: 1-855-447-2900

Toc - Plan #13 Mountain Health CO-OP
Gold

(PPO) Co-op Plus Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,000 $14,000 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
$394,41
$447,65
$504,05
$704,41
$1 070,42
$696,13
$749,37
$805,77
$1 006,13
$997,85
$1 051,09
$1 107,49
$1 307,85
$1 299,57
$1 352,81
$1 409,21
$1 609,57
$301,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$788,82
$895,30
$1 008,10
$1 408,82
$2 140,84
$1 090,54
$1 197,02
$1 309,82
$1 710,54
$1 392,26
$1 498,74
$1 611,54
$2 012,26
$1 693,98
$1 800,46
$1 913,26
$2 313,98
$301,72
Toc - Plan #14 Mountain Health CO-OP
Silver

(PPO) Co-op Plus Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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
$361,51
$410,31
$462,01
$645,65
$981,13
$638,06
$686,86
$738,56
$922,20
$914,61
$963,41
$1 015,11
$1 198,75
$1 191,16
$1 239,96
$1 291,66
$1 475,30
$276,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$723,02
$820,62
$924,02
$1 291,30
$1 962,26
$999,57
$1 097,17
$1 200,57
$1 567,85
$1 276,12
$1 373,72
$1 477,12
$1 844,40
$1 552,67
$1 650,27
$1 753,67
$2 120,95
$276,55
Toc - Plan #15 Mountain Health CO-OP
Expanded Bronze

(PPO) Co-op Plus Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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
$266,26
$302,21
$340,28
$475,55
$722,64
$469,95
$505,90
$543,97
$679,24
$673,64
$709,59
$747,66
$882,93
$877,33
$913,28
$951,35
$1 086,62
$203,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$532,52
$604,42
$680,56
$951,10
$1 445,28
$736,21
$808,11
$884,25
$1 154,79
$939,90
$1 011,80
$1 087,94
$1 358,48
$1 143,59
$1 215,49
$1 291,63
$1 562,17
$203,69
Toc - Plan #16 Mountain Health CO-OP
Gold

(PPO) Connected Care Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,000 $12,000 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
$405,62
$460,37
$518,38
$724,43
$1 100,84
$715,92
$770,67
$828,68
$1 034,73
$1 026,22
$1 080,97
$1 138,98
$1 345,03
$1 336,52
$1 391,27
$1 449,28
$1 655,33
$310,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811,24
$920,74
$1 036,76
$1 448,86
$2 201,68
$1 121,54
$1 231,04
$1 347,06
$1 759,16
$1 431,84
$1 541,34
$1 657,36
$2 069,46
$1 742,14
$1 851,64
$1 967,66
$2 379,76
$310,30
Toc - Plan #17 Mountain Health CO-OP
Silver

(PPO) Connected Care Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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
$376,70
$427,56
$481,43
$672,79
$1 022,37
$664,88
$715,74
$769,61
$960,97
$953,06
$1 003,92
$1 057,79
$1 249,15
$1 241,24
$1 292,10
$1 345,97
$1 537,33
$288,18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753,40
$855,12
$962,86
$1 345,58
$2 044,74
$1 041,58
$1 143,30
$1 251,04
$1 633,76
$1 329,76
$1 431,48
$1 539,22
$1 921,94
$1 617,94
$1 719,66
$1 827,40
$2 210,12
$288,18
Toc - Plan #18 Mountain Health CO-OP
Expanded Bronze

(PPO) Connected Care Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$275,05
$312,18
$351,51
$491,24
$746,48
$485,46
$522,59
$561,92
$701,65
$695,87
$733,00
$772,33
$912,06
$906,28
$943,41
$982,74
$1 122,47
$210,41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$550,10
$624,36
$703,02
$982,48
$1 492,96
$760,51
$834,77
$913,43
$1 192,89
$970,92
$1 045,18
$1 123,84
$1 403,30
$1 181,33
$1 255,59
$1 334,25
$1 613,71
$210,41
Toc - Plan #19 Mountain Health CO-OP
Expanded Bronze

(PPO) Connected Care Bronze Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 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
$288,55
$327,51
$368,77
$515,35
$783,13
$509,29
$548,25
$589,51
$736,09
$730,03
$768,99
$810,25
$956,83
$950,77
$989,73
$1 030,99
$1 177,57
$220,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$577,10
$655,02
$737,54
$1 030,70
$1 566,26
$797,84
$875,76
$958,28
$1 251,44
$1 018,58
$1 096,50
$1 179,02
$1 472,18
$1 239,32
$1 317,24
$1 399,76
$1 692,92
$220,74
Toc - Plan #20 Mountain Health CO-OP
Silver

(PPO) Connected Care Silver Option 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 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
$369,90
$419,84
$472,73
$660,64
$1 003,91
$652,87
$702,81
$755,70
$943,61
$935,84
$985,78
$1 038,67
$1 226,58
$1 218,81
$1 268,75
$1 321,64
$1 509,55
$282,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$739,80
$839,68
$945,46
$1 321,28
$2 007,82
$1 022,77
$1 122,65
$1 228,43
$1 604,25
$1 305,74
$1 405,62
$1 511,40
$1 887,22
$1 588,71
$1 688,59
$1 794,37
$2 170,19
$282,97
Toc - Plan #21 Mountain Health CO-OP
Catastrophic

(PPO) Connected Care Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

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
$227,92
$258,69
$291,29
$407,07
$618,58
$402,28
$433,05
$465,65
$581,43
$576,64
$607,41
$640,01
$755,79
$751,00
$781,77
$814,37
$930,15
$174,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$455,84
$517,38
$582,58
$814,14
$1 237,16
$630,20
$691,74
$756,94
$988,50
$804,56
$866,10
$931,30
$1 162,86
$978,92
$1 040,46
$1 105,66
$1 337,22
$174,36
Toc - Plan #22 Mountain Health CO-OP
Expanded Bronze

(PPO) Connected Care Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-447-2900

Annual Out of Pocket Expenses:

Individual Family
$8,400 $16,800 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
$280,85
$318,77
$358,93
$501,60
$762,23
$495,70
$533,62
$573,78
$716,45
$710,55
$748,47
$788,63
$931,30
$925,40
$963,32
$1 003,48
$1 146,15
$214,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$561,70
$637,54
$717,86
$1 003,20
$1 524,46
$776,55
$852,39
$932,71
$1 218,05
$991,40
$1 067,24
$1 147,56
$1 432,90
$1 206,25
$1 282,09
$1 362,41
$1 647,75
$214,85

‡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 Sheridan County here.

Sheridan County is in “Rating Area 4” of Montana.

Currently, there are 22 plans offered in Rating Area 4.

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