Obamacare 2021 Rates for Guilford County

Obamacare > Rates > North Carolina > Guilford 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 Guilford County, NC.

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, 51 Plans and 2021 Rates for Guilford County, North Carolina

Below, you’ll find a summary of the 51 plans for Guilford County, North Carolina 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 and Blue Shield of NC

Local: 1-800-324-4973 | Toll Free: 1-800-324-4973

Toc - Plan #1 Blue Cross and Blue Shield of NC
Gold

(PPO) Blue Advantage Gold 2500 (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$469,37
$532,73
$599,85
$838,29
$1 273,87 		$828,44
$891,80
$958,92
$1 197,36 		$1 187,51
$1 250,87
$1 317,99
$1 556,43 		$1 546,58
$1 609,94
$1 677,06
$1 915,50 		$359,07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$938,74
$1 065,46
$1 199,70
$1 676,58
$2 547,74 		$1 297,81
$1 424,53
$1 558,77
$2 035,65 		$1 656,88
$1 783,60
$1 917,84
$2 394,72 		$2 015,95
$2 142,67
$2 276,91
$2 753,79 		$359,07
Toc - Plan #2 Blue Cross and Blue Shield of NC
Silver

(PPO) Blue Advantage Silver 4000 (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$499,00
$566,37
$637,72
$891,21
$1 354,29 		$880,74
$948,11
$1 019,46
$1 272,95 		$1 262,48
$1 329,85
$1 401,20
$1 654,69 		$1 644,22
$1 711,59
$1 782,94
$2 036,43 		$381,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$998,00
$1 132,74
$1 275,44
$1 782,42
$2 708,58 		$1 379,74
$1 514,48
$1 657,18
$2 164,16 		$1 761,48
$1 896,22
$2 038,92
$2 545,90 		$2 143,22
$2 277,96
$2 420,66
$2 927,64 		$381,74
Toc - Plan #3 Blue Cross and Blue Shield of NC
Expanded Bronze

(PPO) Blue Advantage Bronze 7000 (broad network, HSA eligible)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$338,01
$383,64
$431,98
$603,69
$917,36 		$596,59
$642,22
$690,56
$862,27 		$855,17
$900,80
$949,14
$1 120,85 		$1 113,75
$1 159,38
$1 207,72
$1 379,43 		$258,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676,02
$767,28
$863,96
$1 207,38
$1 834,72 		$934,60
$1 025,86
$1 122,54
$1 465,96 		$1 193,18
$1 284,44
$1 381,12
$1 724,54 		$1 451,76
$1 543,02
$1 639,70
$1 983,12 		$258,58
Toc - Plan #4 Blue Cross and Blue Shield of NC
Catastrophic

(PPO) Blue Advantage Catastrophic (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$234,56
$266,23
$299,77
$418,92
$636,60 		$414,00
$445,67
$479,21
$598,36 		$593,44
$625,11
$658,65
$777,80 		$772,88
$804,55
$838,09
$957,24 		$179,44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$469,12
$532,46
$599,54
$837,84
$1 273,20 		$648,56
$711,90
$778,98
$1 017,28 		$828,00
$891,34
$958,42
$1 196,72 		$1 007,44
$1 070,78
$1 137,86
$1 376,16 		$179,44
Toc - Plan #5 Blue Cross and Blue Shield of NC
Silver

(PPO) Blue Advantage Silver 6300 (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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 		$479,82
$544,60
$613,21
$856,96
$1 302,23 		$846,88
$911,66
$980,27
$1 224,02 		$1 213,94
$1 278,72
$1 347,33
$1 591,08 		$1 581,00
$1 645,78
$1 714,39
$1 958,14 		$367,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$959,64
$1 089,20
$1 226,42
$1 713,92
$2 604,46 		$1 326,70
$1 456,26
$1 593,48
$2 080,98 		$1 693,76
$1 823,32
$1 960,54
$2 448,04 		$2 060,82
$2 190,38
$2 327,60
$2 815,10 		$367,06
Toc - Plan #6 Blue Cross and Blue Shield of NC
Expanded Bronze

(PPO) Blue Advantage Bronze 7550 (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 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 		$360,59
$409,27
$460,83
$644,01
$978,64 		$636,44
$685,12
$736,68
$919,86 		$912,29
$960,97
$1 012,53
$1 195,71 		$1 188,14
$1 236,82
$1 288,38
$1 471,56 		$275,85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$721,18
$818,54
$921,66
$1 288,02
$1 957,28 		$997,03
$1 094,39
$1 197,51
$1 563,87 		$1 272,88
$1 370,24
$1 473,36
$1 839,72 		$1 548,73
$1 646,09
$1 749,21
$2 115,57 		$275,85
Toc - Plan #7 Blue Cross and Blue Shield of NC
Bronze

(PPO) Blue Advantage Bronze 8550 (broad network)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$328,10
$372,39
$419,31
$585,99
$890,46 		$579,10
$623,39
$670,31
$836,99 		$830,10
$874,39
$921,31
$1 087,99 		$1 081,10
$1 125,39
$1 172,31
$1 338,99 		$251,00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656,20
$744,78
$838,62
$1 171,98
$1 780,92 		$907,20
$995,78
$1 089,62
$1 422,98 		$1 158,20
$1 246,78
$1 340,62
$1 673,98 		$1 409,20
$1 497,78
$1 591,62
$1 924,98 		$251,00
Toc - Plan #8 Blue Cross and Blue Shield of NC
Gold

(POS) Blue Local Gold 2500 (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$331,41
$376,15
$423,54
$591,90
$899,45 		$584,94
$629,68
$677,07
$845,43 		$838,47
$883,21
$930,60
$1 098,96 		$1 092,00
$1 136,74
$1 184,13
$1 352,49 		$253,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$662,82
$752,30
$847,08
$1 183,80
$1 798,90 		$916,35
$1 005,83
$1 100,61
$1 437,33 		$1 169,88
$1 259,36
$1 354,14
$1 690,86 		$1 423,41
$1 512,89
$1 607,67
$1 944,39 		$253,53
Toc - Plan #9 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 4000 (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$348,99
$396,10
$446,01
$623,30
$947,16 		$615,97
$663,08
$712,99
$890,28 		$882,95
$930,06
$979,97
$1 157,26 		$1 149,93
$1 197,04
$1 246,95
$1 424,24 		$266,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$697,98
$792,20
$892,02
$1 246,60
$1 894,32 		$964,96
$1 059,18
$1 159,00
$1 513,58 		$1 231,94
$1 326,16
$1 425,98
$1 780,56 		$1 498,92
$1 593,14
$1 692,96
$2 047,54 		$266,98
Toc - Plan #10 Blue Cross and Blue Shield of NC
Silver

(POS) Blue Local Silver 6300 (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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 		$334,12
$379,23
$427,01
$596,74
$906,80 		$589,72
$634,83
$682,61
$852,34 		$845,32
$890,43
$938,21
$1 107,94 		$1 100,92
$1 146,03
$1 193,81
$1 363,54 		$255,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$668,24
$758,46
$854,02
$1 193,48
$1 813,60 		$923,84
$1 014,06
$1 109,62
$1 449,08 		$1 179,44
$1 269,66
$1 365,22
$1 704,68 		$1 435,04
$1 525,26
$1 620,82
$1 960,28 		$255,60
Toc - Plan #11 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Local Bronze 7550 (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 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 		$248,53
$282,08
$317,62
$443,87
$674,51 		$438,66
$472,21
$507,75
$634,00 		$628,79
$662,34
$697,88
$824,13 		$818,92
$852,47
$888,01
$1 014,26 		$190,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$497,06
$564,16
$635,24
$887,74
$1 349,02 		$687,19
$754,29
$825,37
$1 077,87 		$877,32
$944,42
$1 015,50
$1 268,00 		$1 067,45
$1 134,55
$1 205,63
$1 458,13 		$190,13
Toc - Plan #12 Blue Cross and Blue Shield of NC
Expanded Bronze

(POS) Blue Local Bronze 7000 (local network with Wake Forest Baptist Health, HSA eligible)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$233,09
$264,56
$297,89
$416,30
$632,61 		$411,40
$442,87
$476,20
$594,61 		$589,71
$621,18
$654,51
$772,92 		$768,02
$799,49
$832,82
$951,23 		$178,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$466,18
$529,12
$595,78
$832,60
$1 265,22 		$644,49
$707,43
$774,09
$1 010,91 		$822,80
$885,74
$952,40
$1 189,22 		$1 001,11
$1 064,05
$1 130,71
$1 367,53 		$178,31
Toc - Plan #13 Blue Cross and Blue Shield of NC
Bronze

(POS) Blue Local Bronze 8550 (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$225,39
$255,82
$288,05
$402,55
$611,71 		$397,81
$428,24
$460,47
$574,97 		$570,23
$600,66
$632,89
$747,39 		$742,65
$773,08
$805,31
$919,81 		$172,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$450,78
$511,64
$576,10
$805,10
$1 223,42 		$623,20
$684,06
$748,52
$977,52 		$795,62
$856,48
$920,94
$1 149,94 		$968,04
$1 028,90
$1 093,36
$1 322,36 		$172,42
Toc - Plan #14 Blue Cross and Blue Shield of NC
Catastrophic

(POS) Blue Local Catastrophic (local network with Wake Forest Baptist Health)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-324-4973

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 		$164,24
$186,41
$209,90
$293,33
$445,75 		$289,88
$312,05
$335,54
$418,97 		$415,52
$437,69
$461,18
$544,61 		$541,16
$563,33
$586,82
$670,25 		$125,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$328,48
$372,82
$419,80
$586,66
$891,50 		$454,12
$498,46
$545,44
$712,30 		$579,76
$624,10
$671,08
$837,94 		$705,40
$749,74
$796,72
$963,58 		$125,64

ADVERTISEMENT

UnitedHealthcare

Local: 1-800-980-5357 | Toll Free: 1-800-980-5357 | TTY: 1-800-980-5357
Toc - Plan #15 UnitedHealthcare
Gold

(HMO) Balance Gold 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$571,46
$648,61
$730,33
$1 020,63
$1 550,95 		$1 008,63
$1 085,78
$1 167,50
$1 457,80 		$1 445,80
$1 522,95
$1 604,67
$1 894,97 		$1 882,97
$1 960,12
$2 041,84
$2 332,14 		$437,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 142,92
$1 297,22
$1 460,66
$2 041,26
$3 101,90 		$1 580,09
$1 734,39
$1 897,83
$2 478,43 		$2 017,26
$2 171,56
$2 335,00
$2 915,60 		$2 454,43
$2 608,73
$2 772,17
$3 352,77 		$437,17
Toc - Plan #16 UnitedHealthcare
Silver

(HMO) Balance Plus Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$506,23
$574,57
$646,97
$904,13
$1 373,92 		$893,50
$961,84
$1 034,24
$1 291,40 		$1 280,77
$1 349,11
$1 421,51
$1 678,67 		$1 668,04
$1 736,38
$1 808,78
$2 065,94 		$387,27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 012,46
$1 149,14
$1 293,94
$1 808,26
$2 747,84 		$1 399,73
$1 536,41
$1 681,21
$2 195,53 		$1 787,00
$1 923,68
$2 068,48
$2 582,80 		$2 174,27
$2 310,95
$2 455,75
$2 970,07 		$387,27
Toc - Plan #17 UnitedHealthcare
Silver

(HMO) Balance Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$508,71
$577,39
$650,14
$908,56
$1 380,65 		$897,88
$966,56
$1 039,31
$1 297,73 		$1 287,05
$1 355,73
$1 428,48
$1 686,90 		$1 676,22
$1 744,90
$1 817,65
$2 076,07 		$389,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 017,42
$1 154,78
$1 300,28
$1 817,12
$2 761,30 		$1 406,59
$1 543,95
$1 689,45
$2 206,29 		$1 795,76
$1 933,12
$2 078,62
$2 595,46 		$2 184,93
$2 322,29
$2 467,79
$2 984,63 		$389,17
Toc - Plan #18 UnitedHealthcare
Silver

(HMO) Value Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$510,84
$579,80
$652,86
$912,36
$1 386,42 		$901,63
$970,59
$1 043,65
$1 303,15 		$1 292,42
$1 361,38
$1 434,44
$1 693,94 		$1 683,21
$1 752,17
$1 825,23
$2 084,73 		$390,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 021,68
$1 159,60
$1 305,72
$1 824,72
$2 772,84 		$1 412,47
$1 550,39
$1 696,51
$2 215,51 		$1 803,26
$1 941,18
$2 087,30
$2 606,30 		$2 194,05
$2 331,97
$2 478,09
$2 997,09 		$390,79
Toc - Plan #19 UnitedHealthcare
Expanded Bronze

(HMO) Balance Bronze 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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 		$354,50
$402,36
$453,06
$633,15
$962,13 		$625,70
$673,56
$724,26
$904,35 		$896,90
$944,76
$995,46
$1 175,55 		$1 168,10
$1 215,96
$1 266,66
$1 446,75 		$271,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$709,00
$804,72
$906,12
$1 266,30
$1 924,26 		$980,20
$1 075,92
$1 177,32
$1 537,50 		$1 251,40
$1 347,12
$1 448,52
$1 808,70 		$1 522,60
$1 618,32
$1 719,72
$2 079,90 		$271,20
Toc - Plan #20 UnitedHealthcare
Expanded Bronze

(HMO) Value Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5357

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$363,72
$412,82
$464,84
$649,61
$987,14 		$641,97
$691,07
$743,09
$927,86 		$920,22
$969,32
$1 021,34
$1 206,11 		$1 198,47
$1 247,57
$1 299,59
$1 484,36 		$278,25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$727,44
$825,64
$929,68
$1 299,22
$1 974,28 		$1 005,69
$1 103,89
$1 207,93
$1 577,47 		$1 283,94
$1 382,14
$1 486,18
$1 855,72 		$1 562,19
$1 660,39
$1 764,43
$2 133,97 		$278,25

ADVERTISEMENT

Bright Health

Local: 1-855-521-9349 | Toll Free: 1-855-521-9349

Toc - Plan #21 Bright Health
Gold

(HMO) Gold 2500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$409,96
$465,30
$523,93
$732,19
$1 112,63 		$723,58
$778,92
$837,55
$1 045,81 		$1 037,20
$1 092,54
$1 151,17
$1 359,43 		$1 350,82
$1 406,16
$1 464,79
$1 673,05 		$313,62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$819,92
$930,60
$1 047,86
$1 464,38
$2 225,26 		$1 133,54
$1 244,22
$1 361,48
$1 778,00 		$1 447,16
$1 557,84
$1 675,10
$2 091,62 		$1 760,78
$1 871,46
$1 988,72
$2 405,24 		$313,62
Toc - Plan #22 Bright Health
Silver

(HMO) Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$328,33
$372,65
$419,61
$586,40
$891,09 		$579,50
$623,82
$670,78
$837,57 		$830,67
$874,99
$921,95
$1 088,74 		$1 081,84
$1 126,16
$1 173,12
$1 339,91 		$251,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656,66
$745,30
$839,22
$1 172,80
$1 782,18 		$907,83
$996,47
$1 090,39
$1 423,97 		$1 159,00
$1 247,64
$1 341,56
$1 675,14 		$1 410,17
$1 498,81
$1 592,73
$1 926,31 		$251,17
Toc - Plan #23 Bright Health
Silver

(HMO) Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,500 $15,000 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 		$330,58
$375,21
$422,48
$590,42
$897,20 		$583,48
$628,11
$675,38
$843,32 		$836,38
$881,01
$928,28
$1 096,22 		$1 089,28
$1 133,91
$1 181,18
$1 349,12 		$252,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$661,16
$750,42
$844,96
$1 180,84
$1 794,40 		$914,06
$1 003,32
$1 097,86
$1 433,74 		$1 166,96
$1 256,22
$1 350,76
$1 686,64 		$1 419,86
$1 509,12
$1 603,66
$1 939,54 		$252,90
Toc - Plan #24 Bright Health
Silver

(HMO) Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$333,58
$378,61
$426,32
$595,78
$905,34 		$588,77
$633,80
$681,51
$850,97 		$843,96
$888,99
$936,70
$1 106,16 		$1 099,15
$1 144,18
$1 191,89
$1 361,35 		$255,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$667,16
$757,22
$852,64
$1 191,56
$1 810,68 		$922,35
$1 012,41
$1 107,83
$1 446,75 		$1 177,54
$1 267,60
$1 363,02
$1 701,94 		$1 432,73
$1 522,79
$1 618,21
$1 957,13 		$255,19
Toc - Plan #25 Bright Health
Expanded Bronze

(HMO) Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

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 		$232,86
$264,30
$297,59
$415,89
$631,98 		$411,00
$442,44
$475,73
$594,03 		$589,14
$620,58
$653,87
$772,17 		$767,28
$798,72
$832,01
$950,31 		$178,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$465,72
$528,60
$595,18
$831,78
$1 263,96 		$643,86
$706,74
$773,32
$1 009,92 		$822,00
$884,88
$951,46
$1 188,06 		$1 000,14
$1 063,02
$1 129,60
$1 366,20 		$178,14
Toc - Plan #26 Bright Health
Expanded Bronze

(HMO) Bronze $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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 		$242,50
$275,24
$309,92
$433,11
$658,15 		$428,02
$460,76
$495,44
$618,63 		$613,54
$646,28
$680,96
$804,15 		$799,06
$831,80
$866,48
$989,67 		$185,52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$485,00
$550,48
$619,84
$866,22
$1 316,30 		$670,52
$736,00
$805,36
$1 051,74 		$856,04
$921,52
$990,88
$1 237,26 		$1 041,56
$1 107,04
$1 176,40
$1 422,78 		$185,52
Toc - Plan #27 Bright Health
Expanded Bronze

(HMO) Bronze 7000 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

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 		$276,58
$313,92
$353,47
$493,97
$750,64 		$488,16
$525,50
$565,05
$705,55 		$699,74
$737,08
$776,63
$917,13 		$911,32
$948,66
$988,21
$1 128,71 		$211,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$553,16
$627,84
$706,94
$987,94
$1 501,28 		$764,74
$839,42
$918,52
$1 199,52 		$976,32
$1 051,00
$1 130,10
$1 411,10 		$1 187,90
$1 262,58
$1 341,68
$1 622,68 		$211,58
Toc - Plan #28 Bright Health
Catastrophic

(HMO) Catastrophic 3 $0 PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

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 		$158,25
$179,62
$202,25
$282,64
$429,50 		$279,31
$300,68
$323,31
$403,70 		$400,37
$421,74
$444,37
$524,76 		$521,43
$542,80
$565,43
$645,82 		$121,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$316,50
$359,24
$404,50
$565,28
$859,00 		$437,56
$480,30
$525,56
$686,34 		$558,62
$601,36
$646,62
$807,40 		$679,68
$722,42
$767,68
$928,46 		$121,06
Toc - Plan #29 Bright Health
Expanded Bronze

(HMO) Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$266,03
$301,95
$339,99
$475,13
$722,01 		$469,55
$505,47
$543,51
$678,65 		$673,07
$708,99
$747,03
$882,17 		$876,59
$912,51
$950,55
$1 085,69 		$203,52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$532,06
$603,90
$679,98
$950,26
$1 444,02 		$735,58
$807,42
$883,50
$1 153,78 		$939,10
$1 010,94
$1 087,02
$1 357,30 		$1 142,62
$1 214,46
$1 290,54
$1 560,82 		$203,52
Toc - Plan #30 Bright Health
Silver

(HMO) Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9349

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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 		$329,66
$374,16
$421,30
$588,77
$894,69 		$581,85
$626,35
$673,49
$840,96 		$834,04
$878,54
$925,68
$1 093,15 		$1 086,23
$1 130,73
$1 177,87
$1 345,34 		$252,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$659,32
$748,32
$842,60
$1 177,54
$1 789,38 		$911,51
$1 000,51
$1 094,79
$1 429,73 		$1 163,70
$1 252,70
$1 346,98
$1 681,92 		$1 415,89
$1 504,89
$1 599,17
$1 934,11 		$252,19

ADVERTISEMENT

Ambetter of North Carolina

Local: 1-833-863-1310 | Toll Free: 1-833-863-1310

Toc - Plan #31 Ambetter of North Carolina
Bronze

(HMO) Ambetter Essential Care 1 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$336,40
$381,81
$429,91
$600,80
$912,97 		$593,74
$639,15
$687,25
$858,14 		$851,08
$896,49
$944,59
$1 115,48 		$1 108,42
$1 153,83
$1 201,93
$1 372,82 		$257,34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$672,80
$763,62
$859,82
$1 201,60
$1 825,94 		$930,14
$1 020,96
$1 117,16
$1 458,94 		$1 187,48
$1 278,30
$1 374,50
$1 716,28 		$1 444,82
$1 535,64
$1 631,84
$1 973,62 		$257,34
Toc - Plan #32 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$365,85
$415,23
$467,54
$653,39
$992,89 		$645,72
$695,10
$747,41
$933,26 		$925,59
$974,97
$1 027,28
$1 213,13 		$1 205,46
$1 254,84
$1 307,15
$1 493,00 		$279,87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$731,70
$830,46
$935,08
$1 306,78
$1 985,78 		$1 011,57
$1 110,33
$1 214,95
$1 586,65 		$1 291,44
$1 390,20
$1 494,82
$1 866,52 		$1 571,31
$1 670,07
$1 774,69
$2 146,39 		$279,87
Toc - Plan #33 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 11 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$457,25
$518,97
$584,35
$816,63
$1 240,95 		$807,04
$868,76
$934,14
$1 166,42 		$1 156,83
$1 218,55
$1 283,93
$1 516,21 		$1 506,62
$1 568,34
$1 633,72
$1 866,00 		$349,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$914,50
$1 037,94
$1 168,70
$1 633,26
$2 481,90 		$1 264,29
$1 387,73
$1 518,49
$1 983,05 		$1 614,08
$1 737,52
$1 868,28
$2 332,84 		$1 963,87
$2 087,31
$2 218,07
$2 682,63 		$349,79
Toc - Plan #34 Ambetter of North Carolina
Gold

(HMO) Ambetter Secure Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$520,26
$590,48
$664,88
$929,17
$1 411,96 		$918,25
$988,47
$1 062,87
$1 327,16 		$1 316,24
$1 386,46
$1 460,86
$1 725,15 		$1 714,23
$1 784,45
$1 858,85
$2 123,14 		$397,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 040,52
$1 180,96
$1 329,76
$1 858,34
$2 823,92 		$1 438,51
$1 578,95
$1 727,75
$2 256,33 		$1 836,50
$1 976,94
$2 125,74
$2 654,32 		$2 234,49
$2 374,93
$2 523,73
$3 052,31 		$397,99
Toc - Plan #35 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 12 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$449,02
$509,63
$573,84
$801,93
$1 218,62 		$792,51
$853,12
$917,33
$1 145,42 		$1 136,00
$1 196,61
$1 260,82
$1 488,91 		$1 479,49
$1 540,10
$1 604,31
$1 832,40 		$343,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$898,04
$1 019,26
$1 147,68
$1 603,86
$2 437,24 		$1 241,53
$1 362,75
$1 491,17
$1 947,35 		$1 585,02
$1 706,24
$1 834,66
$2 290,84 		$1 928,51
$2 049,73
$2 178,15
$2 634,33 		$343,49
Toc - Plan #36 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$361,60
$410,40
$462,11
$645,79
$981,35 		$638,21
$687,01
$738,72
$922,40 		$914,82
$963,62
$1 015,33
$1 199,01 		$1 191,43
$1 240,23
$1 291,94
$1 475,62 		$276,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$723,20
$820,80
$924,22
$1 291,58
$1 962,70 		$999,81
$1 097,41
$1 200,83
$1 568,19 		$1 276,42
$1 374,02
$1 477,44
$1 844,80 		$1 553,03
$1 650,63
$1 754,05
$2 121,41 		$276,61
Toc - Plan #37 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 10 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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 		$346,78
$393,59
$443,17
$619,33
$941,14 		$612,06
$658,87
$708,45
$884,61 		$877,34
$924,15
$973,73
$1 149,89 		$1 142,62
$1 189,43
$1 239,01
$1 415,17 		$265,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$693,56
$787,18
$886,34
$1 238,66
$1 882,28 		$958,84
$1 052,46
$1 151,62
$1 503,94 		$1 224,12
$1 317,74
$1 416,90
$1 769,22 		$1 489,40
$1 583,02
$1 682,18
$2 034,50 		$265,28
Toc - Plan #38 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 29 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 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 		$445,27
$505,37
$569,04
$795,24
$1 208,44 		$785,90
$846,00
$909,67
$1 135,87 		$1 126,53
$1 186,63
$1 250,30
$1 476,50 		$1 467,16
$1 527,26
$1 590,93
$1 817,13 		$340,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$890,54
$1 010,74
$1 138,08
$1 590,48
$2 416,88 		$1 231,17
$1 351,37
$1 478,71
$1 931,11 		$1 571,80
$1 692,00
$1 819,34
$2 271,74 		$1 912,43
$2 032,63
$2 159,97
$2 612,37 		$340,63
Toc - Plan #39 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 25 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$471,24
$534,85
$602,24
$841,62
$1 278,93 		$831,73
$895,34
$962,73
$1 202,11 		$1 192,22
$1 255,83
$1 323,22
$1 562,60 		$1 552,71
$1 616,32
$1 683,71
$1 923,09 		$360,49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$942,48
$1 069,70
$1 204,48
$1 683,24
$2 557,86 		$1 302,97
$1 430,19
$1 564,97
$2 043,73 		$1 663,46
$1 790,68
$1 925,46
$2 404,22 		$2 023,95
$2 151,17
$2 285,95
$2 764,71 		$360,49
Toc - Plan #40 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 27 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$6,500 $13,000 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 		$490,45
$556,65
$626,78
$875,92
$1 331,05 		$865,63
$931,83
$1 001,96
$1 251,10 		$1 240,81
$1 307,01
$1 377,14
$1 626,28 		$1 615,99
$1 682,19
$1 752,32
$2 001,46 		$375,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$980,90
$1 113,30
$1 253,56
$1 751,84
$2 662,10 		$1 356,08
$1 488,48
$1 628,74
$2 127,02 		$1 731,26
$1 863,66
$2 003,92
$2 502,20 		$2 106,44
$2 238,84
$2 379,10
$2 877,38 		$375,18
Toc - Plan #41 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 28 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$490,08
$556,23
$626,31
$875,27
$1 330,05 		$864,98
$931,13
$1 001,21
$1 250,17 		$1 239,88
$1 306,03
$1 376,11
$1 625,07 		$1 614,78
$1 680,93
$1 751,01
$1 999,97 		$374,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$980,16
$1 112,46
$1 252,62
$1 750,54
$2 660,10 		$1 355,06
$1 487,36
$1 627,52
$2 125,44 		$1 729,96
$1 862,26
$2 002,42
$2 500,34 		$2 104,86
$2 237,16
$2 377,32
$2 875,24 		$374,90
Toc - Plan #42 Ambetter of North Carolina
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$351,68
$399,15
$449,44
$628,08
$954,44 		$620,71
$668,18
$718,47
$897,11 		$889,74
$937,21
$987,50
$1 166,14 		$1 158,77
$1 206,24
$1 256,53
$1 435,17 		$269,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$703,36
$798,30
$898,88
$1 256,16
$1 908,88 		$972,39
$1 067,33
$1 167,91
$1 525,19 		$1 241,42
$1 336,36
$1 436,94
$1 794,22 		$1 510,45
$1 605,39
$1 705,97
$2 063,25 		$269,03
Toc - Plan #43 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$382,46
$434,09
$488,78
$683,06
$1 037,98 		$675,04
$726,67
$781,36
$975,64 		$967,62
$1 019,25
$1 073,94
$1 268,22 		$1 260,20
$1 311,83
$1 366,52
$1 560,80 		$292,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$764,92
$868,18
$977,56
$1 366,12
$2 075,96 		$1 057,50
$1 160,76
$1 270,14
$1 658,70 		$1 350,08
$1 453,34
$1 562,72
$1 951,28 		$1 642,66
$1 745,92
$1 855,30
$2 243,86 		$292,58
Toc - Plan #44 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$478,02
$542,54
$610,90
$853,72
$1 297,32 		$843,70
$908,22
$976,58
$1 219,40 		$1 209,38
$1 273,90
$1 342,26
$1 585,08 		$1 575,06
$1 639,58
$1 707,94
$1 950,76 		$365,68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$956,04
$1 085,08
$1 221,80
$1 707,44
$2 594,64 		$1 321,72
$1 450,76
$1 587,48
$2 073,12 		$1 687,40
$1 816,44
$1 953,16
$2 438,80 		$2 053,08
$2 182,12
$2 318,84
$2 804,48 		$365,68
Toc - Plan #45 Ambetter of North Carolina
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$543,89
$617,30
$695,08
$971,37
$1 476,09 		$959,96
$1 033,37
$1 111,15
$1 387,44 		$1 376,03
$1 449,44
$1 527,22
$1 803,51 		$1 792,10
$1 865,51
$1 943,29
$2 219,58 		$416,07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 087,78
$1 234,60
$1 390,16
$1 942,74
$2 952,18 		$1 503,85
$1 650,67
$1 806,23
$2 358,81 		$1 919,92
$2 066,74
$2 222,30
$2 774,88 		$2 335,99
$2 482,81
$2 638,37
$3 190,95 		$416,07
Toc - Plan #46 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$469,41
$532,77
$599,90
$838,36
$1 273,96 		$828,50
$891,86
$958,99
$1 197,45 		$1 187,59
$1 250,95
$1 318,08
$1 556,54 		$1 546,68
$1 610,04
$1 677,17
$1 915,63 		$359,09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$938,82
$1 065,54
$1 199,80
$1 676,72
$2 547,92 		$1 297,91
$1 424,63
$1 558,89
$2 035,81 		$1 657,00
$1 783,72
$1 917,98
$2 394,90 		$2 016,09
$2 142,81
$2 277,07
$2 753,99 		$359,09
Toc - Plan #47 Ambetter of North Carolina
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$378,02
$429,04
$483,10
$675,12
$1 025,92 		$667,20
$718,22
$772,28
$964,30 		$956,38
$1 007,40
$1 061,46
$1 253,48 		$1 245,56
$1 296,58
$1 350,64
$1 542,66 		$289,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$756,04
$858,08
$966,20
$1 350,24
$2 051,84 		$1 045,22
$1 147,26
$1 255,38
$1 639,42 		$1 334,40
$1 436,44
$1 544,56
$1 928,60 		$1 623,58
$1 725,62
$1 833,74
$2 217,78 		$289,18
Toc - Plan #48 Ambetter of North Carolina
Expanded Bronze

(HMO) Ambetter Essential Care 10 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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 		$362,53
$411,46
$463,30
$647,46
$983,88 		$639,86
$688,79
$740,63
$924,79 		$917,19
$966,12
$1 017,96
$1 202,12 		$1 194,52
$1 243,45
$1 295,29
$1 479,45 		$277,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$725,06
$822,92
$926,60
$1 294,92
$1 967,76 		$1 002,39
$1 100,25
$1 203,93
$1 572,25 		$1 279,72
$1 377,58
$1 481,26
$1 849,58 		$1 557,05
$1 654,91
$1 758,59
$2 126,91 		$277,33
Toc - Plan #49 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$492,65
$559,14
$629,59
$879,85
$1 337,01 		$869,52
$936,01
$1 006,46
$1 256,72 		$1 246,39
$1 312,88
$1 383,33
$1 633,59 		$1 623,26
$1 689,75
$1 760,20
$2 010,46 		$376,87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$985,30
$1 118,28
$1 259,18
$1 759,70
$2 674,02 		$1 362,17
$1 495,15
$1 636,05
$2 136,57 		$1 739,04
$1 872,02
$2 012,92
$2 513,44 		$2 115,91
$2 248,89
$2 389,79
$2 890,31 		$376,87
Toc - Plan #50 Ambetter of North Carolina
Silver

(HMO) Ambetter Balanced Care 27 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$6,500 $13,000 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 		$512,72
$581,93
$655,25
$915,70
$1 391,50 		$904,94
$974,15
$1 047,47
$1 307,92 		$1 297,16
$1 366,37
$1 439,69
$1 700,14 		$1 689,38
$1 758,59
$1 831,91
$2 092,36 		$392,22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 025,44
$1 163,86
$1 310,50
$1 831,40
$2 783,00 		$1 417,66
$1 556,08
$1 702,72
$2 223,62 		$1 809,88
$1 948,30
$2 094,94
$2 615,84 		$2 202,10
$2 340,52
$2 487,16
$3 008,06 		$392,22
Toc - Plan #51 Ambetter of North Carolina
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-863-1310

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 		$512,34
$581,49
$654,76
$915,02
$1 390,46 		$904,27
$973,42
$1 046,69
$1 306,95 		$1 296,20
$1 365,35
$1 438,62
$1 698,88 		$1 688,13
$1 757,28
$1 830,55
$2 090,81 		$391,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 024,68
$1 162,98
$1 309,52
$1 830,04
$2 780,92 		$1 416,61
$1 554,91
$1 701,45
$2 221,97 		$1 808,54
$1 946,84
$2 093,38
$2 613,90 		$2 200,47
$2 338,77
$2 485,31
$3 005,83 		$391,93

‡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 Guilford County here.

Guilford County is in “Rating Area 7” of North Carolina.

Currently, there are 51 plans offered in Rating Area 7.

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2021 Obamacare Plans for Guilford County, NC

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