Obamacare 2021 Rates for Ashtabula County

Obamacare > Rates > Ohio > Ashtabula 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 Ashtabula County, OH.

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, 43 Plans and 2021 Rates for Ashtabula County, Ohio

Below, you’ll find a summary of the 43 plans for Ashtabula County, Ohio 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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Oscar Insurance Corporation of Ohio

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #1 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Simple

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,300 $14,600 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 		$320,27
$363,50
$409,29
$571,98
$869,19 		$565,27
$608,50
$654,29
$816,98 		$810,27
$853,50
$899,29
$1 061,98 		$1 055,27
$1 098,50
$1 144,29
$1 306,98 		$245,00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640,54
$727,00
$818,58
$1 143,96
$1 738,38 		$885,54
$972,00
$1 063,58
$1 388,96 		$1 130,54
$1 217,00
$1 308,58
$1 633,96 		$1 375,54
$1 462,00
$1 553,58
$1 878,96 		$245,00
Toc - Plan #2 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic PCP Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$329,37
$373,83
$420,93
$588,25
$893,90 		$581,33
$625,79
$672,89
$840,21 		$833,29
$877,75
$924,85
$1 092,17 		$1 085,25
$1 129,71
$1 176,81
$1 344,13 		$251,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$658,74
$747,66
$841,86
$1 176,50
$1 787,80 		$910,70
$999,62
$1 093,82
$1 428,46 		$1 162,66
$1 251,58
$1 345,78
$1 680,42 		$1 414,62
$1 503,54
$1 597,74
$1 932,38 		$251,96
Toc - Plan #3 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$322,30
$365,80
$411,88
$575,61
$874,69 		$568,85
$612,35
$658,43
$822,16 		$815,40
$858,90
$904,98
$1 068,71 		$1 061,95
$1 105,45
$1 151,53
$1 315,26 		$246,55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$644,60
$731,60
$823,76
$1 151,22
$1 749,38 		$891,15
$978,15
$1 070,31
$1 397,77 		$1 137,70
$1 224,70
$1 316,86
$1 644,32 		$1 384,25
$1 471,25
$1 563,41
$1 890,87 		$246,55
Toc - Plan #4 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$383,62
$435,40
$490,26
$685,13
$1 041,13 		$677,08
$728,86
$783,72
$978,59 		$970,54
$1 022,32
$1 077,18
$1 272,05 		$1 264,00
$1 315,78
$1 370,64
$1 565,51 		$293,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767,24
$870,80
$980,52
$1 370,26
$2 082,26 		$1 060,70
$1 164,26
$1 273,98
$1 663,72 		$1 354,16
$1 457,72
$1 567,44
$1 957,18 		$1 647,62
$1 751,18
$1 860,90
$2 250,64 		$293,46
Toc - Plan #5 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$383,20
$434,92
$489,72
$684,38
$1 039,99 		$676,34
$728,06
$782,86
$977,52 		$969,48
$1 021,20
$1 076,00
$1 270,66 		$1 262,62
$1 314,34
$1 369,14
$1 563,80 		$293,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$766,40
$869,84
$979,44
$1 368,76
$2 079,98 		$1 059,54
$1 162,98
$1 272,58
$1 661,90 		$1 352,68
$1 456,12
$1 565,72
$1 955,04 		$1 645,82
$1 749,26
$1 858,86
$2 248,18 		$293,14
Toc - Plan #6 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Saver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 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 		$375,83
$426,56
$480,30
$671,22
$1 019,98 		$663,33
$714,06
$767,80
$958,72 		$950,83
$1 001,56
$1 055,30
$1 246,22 		$1 238,33
$1 289,06
$1 342,80
$1 533,72 		$287,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$751,66
$853,12
$960,60
$1 342,44
$2 039,96 		$1 039,16
$1 140,62
$1 248,10
$1 629,94 		$1 326,66
$1 428,12
$1 535,60
$1 917,44 		$1 614,16
$1 715,62
$1 823,10
$2 204,94 		$287,50
Toc - Plan #7 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 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 		$389,07
$441,59
$497,22
$694,87
$1 055,92 		$686,70
$739,22
$794,85
$992,50 		$984,33
$1 036,85
$1 092,48
$1 290,13 		$1 281,96
$1 334,48
$1 390,11
$1 587,76 		$297,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$778,14
$883,18
$994,44
$1 389,74
$2 111,84 		$1 075,77
$1 180,81
$1 292,07
$1 687,37 		$1 373,40
$1 478,44
$1 589,70
$1 985,00 		$1 671,03
$1 776,07
$1 887,33
$2 282,63 		$297,63
Toc - Plan #8 Oscar Insurance Corporation of Ohio
Catastrophic

(HMO) Oscar Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$224,90
$255,25
$287,41
$401,65
$610,34 		$396,94
$427,29
$459,45
$573,69 		$568,98
$599,33
$631,49
$745,73 		$741,02
$771,37
$803,53
$917,77 		$172,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$449,80
$510,50
$574,82
$803,30
$1 220,68 		$621,84
$682,54
$746,86
$975,34 		$793,88
$854,58
$918,90
$1 147,38 		$965,92
$1 026,62
$1 090,94
$1 319,42 		$172,04
Toc - Plan #9 Oscar Insurance Corporation of Ohio
Gold

(HMO) Oscar Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$445,58
$505,72
$569,44
$795,78
$1 209,27 		$786,44
$846,58
$910,30
$1 136,64 		$1 127,30
$1 187,44
$1 251,16
$1 477,50 		$1 468,16
$1 528,30
$1 592,02
$1 818,36 		$340,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$891,16
$1 011,44
$1 138,88
$1 591,56
$2 418,54 		$1 232,02
$1 352,30
$1 479,74
$1 932,42 		$1 572,88
$1 693,16
$1 820,60
$2 273,28 		$1 913,74
$2 034,02
$2 161,46
$2 614,14 		$340,86
Toc - Plan #10 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Oscar Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 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 		$344,86
$391,41
$440,72
$615,90
$935,92 		$608,67
$655,22
$704,53
$879,71 		$872,48
$919,03
$968,34
$1 143,52 		$1 136,29
$1 182,84
$1 232,15
$1 407,33 		$263,81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$689,72
$782,82
$881,44
$1 231,80
$1 871,84 		$953,53
$1 046,63
$1 145,25
$1 495,61 		$1 217,34
$1 310,44
$1 409,06
$1 759,42 		$1 481,15
$1 574,25
$1 672,87
$2 023,23 		$263,81
Toc - Plan #11 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$392,62
$445,61
$501,75
$701,20
$1 065,54 		$692,97
$745,96
$802,10
$1 001,55 		$993,32
$1 046,31
$1 102,45
$1 301,90 		$1 293,67
$1 346,66
$1 402,80
$1 602,25 		$300,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785,24
$891,22
$1 003,50
$1 402,40
$2 131,08 		$1 085,59
$1 191,57
$1 303,85
$1 702,75 		$1 385,94
$1 491,92
$1 604,20
$2 003,10 		$1 686,29
$1 792,27
$1 904,55
$2 303,45 		$300,35
Toc - Plan #12 Oscar Insurance Corporation of Ohio
Silver

(HMO) Oscar Silver Classic $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$419,86
$476,53
$536,56
$749,85
$1 139,46 		$741,04
$797,71
$857,74
$1 071,03 		$1 062,22
$1 118,89
$1 178,92
$1 392,21 		$1 383,40
$1 440,07
$1 500,10
$1 713,39 		$321,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$839,72
$953,06
$1 073,12
$1 499,70
$2 278,92 		$1 160,90
$1 274,24
$1 394,30
$1 820,88 		$1 482,08
$1 595,42
$1 715,48
$2 142,06 		$1 803,26
$1 916,60
$2 036,66
$2 463,24 		$321,18

ADVERTISEMENT

Molina Healthcare

Local: 1-888-296-7677 | Toll Free: 1-888-296-7677

Toc - Plan #13 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 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 		$305,28
$346,49
$390,15
$545,23
$828,53 		$538,82
$580,03
$623,69
$778,77 		$772,36
$813,57
$857,23
$1 012,31 		$1 005,90
$1 047,11
$1 090,77
$1 245,85 		$233,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$610,56
$692,98
$780,30
$1 090,46
$1 657,06 		$844,10
$926,52
$1 013,84
$1 324,00 		$1 077,64
$1 160,06
$1 247,38
$1 557,54 		$1 311,18
$1 393,60
$1 480,92
$1 791,08 		$233,54
Toc - Plan #14 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$260,95
$296,18
$333,50
$466,06
$708,22 		$460,58
$495,81
$533,13
$665,69 		$660,21
$695,44
$732,76
$865,32 		$859,84
$895,07
$932,39
$1 064,95 		$199,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$521,90
$592,36
$667,00
$932,12
$1 416,44 		$721,53
$791,99
$866,63
$1 131,75 		$921,16
$991,62
$1 066,26
$1 331,38 		$1 120,79
$1 191,25
$1 265,89
$1 531,01 		$199,63
Toc - Plan #15 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 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 		$212,67
$241,39
$271,80
$379,84
$577,20 		$375,37
$404,09
$434,50
$542,54 		$538,07
$566,79
$597,20
$705,24 		$700,77
$729,49
$759,90
$867,94 		$162,70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$425,34
$482,78
$543,60
$759,68
$1 154,40 		$588,04
$645,48
$706,30
$922,38 		$750,74
$808,18
$869,00
$1 085,08 		$913,44
$970,88
$1 031,70
$1 247,78 		$162,70
Toc - Plan #16 Molina Healthcare
Silver

(HMO) Constant Care Silver 4 250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 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 		$258,50
$293,39
$330,36
$461,68
$701,56 		$456,25
$491,14
$528,11
$659,43 		$654,00
$688,89
$725,86
$857,18 		$851,75
$886,64
$923,61
$1 054,93 		$197,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$517,00
$586,78
$660,72
$923,36
$1 403,12 		$714,75
$784,53
$858,47
$1 121,11 		$912,50
$982,28
$1 056,22
$1 318,86 		$1 110,25
$1 180,03
$1 253,97
$1 516,61 		$197,75
Toc - Plan #17 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

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 		$222,75
$252,82
$284,68
$397,83
$604,55 		$393,15
$423,22
$455,08
$568,23 		$563,55
$593,62
$625,48
$738,63 		$733,95
$764,02
$795,88
$909,03 		$170,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$445,50
$505,64
$569,36
$795,66
$1 209,10 		$615,90
$676,04
$739,76
$966,06 		$786,30
$846,44
$910,16
$1 136,46 		$956,70
$1 016,84
$1 080,56
$1 306,86 		$170,40
Toc - Plan #18 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

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 		$216,59
$245,83
$276,80
$386,83
$587,83 		$382,28
$411,52
$442,49
$552,52 		$547,97
$577,21
$608,18
$718,21 		$713,66
$742,90
$773,87
$883,90 		$165,69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$433,18
$491,66
$553,60
$773,66
$1 175,66 		$598,87
$657,35
$719,29
$939,35 		$764,56
$823,04
$884,98
$1 105,04 		$930,25
$988,73
$1 050,67
$1 270,73 		$165,69
Toc - Plan #19 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 +Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 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 		$307,97
$349,54
$393,58
$550,03
$835,82 		$543,56
$585,13
$629,17
$785,62 		$779,15
$820,72
$864,76
$1 021,21 		$1 014,74
$1 056,31
$1 100,35
$1 256,80 		$235,59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$615,94
$699,08
$787,16
$1 100,06
$1 671,64 		$851,53
$934,67
$1 022,75
$1 335,65 		$1 087,12
$1 170,26
$1 258,34
$1 571,24 		$1 322,71
$1 405,85
$1 493,93
$1 806,83 		$235,59
Toc - Plan #20 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 250 +Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$263,64
$299,23
$336,93
$470,85
$715,51 		$465,32
$500,91
$538,61
$672,53 		$667,00
$702,59
$740,29
$874,21 		$868,68
$904,27
$941,97
$1 075,89 		$201,68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$527,28
$598,46
$673,86
$941,70
$1 431,02 		$728,96
$800,14
$875,54
$1 143,38 		$930,64
$1 001,82
$1 077,22
$1 345,06 		$1 132,32
$1 203,50
$1 278,90
$1 546,74 		$201,68
Toc - Plan #21 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 1 +Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 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 		$215,36
$244,43
$275,23
$384,63
$584,48 		$380,11
$409,18
$439,98
$549,38 		$544,86
$573,93
$604,73
$714,13 		$709,61
$738,68
$769,48
$878,88 		$164,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$430,72
$488,86
$550,46
$769,26
$1 168,96 		$595,47
$653,61
$715,21
$934,01 		$760,22
$818,36
$879,96
$1 098,76 		$924,97
$983,11
$1 044,71
$1 263,51 		$164,75
Toc - Plan #22 Molina Healthcare
Silver

(HMO) Constant Care Silver 2 250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 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 		$260,39
$295,55
$332,78
$465,06
$706,70 		$459,59
$494,75
$531,98
$664,26 		$658,79
$693,95
$731,18
$863,46 		$857,99
$893,15
$930,38
$1 062,66 		$199,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$520,78
$591,10
$665,56
$930,12
$1 413,40 		$719,98
$790,30
$864,76
$1 129,32 		$919,18
$989,50
$1 063,96
$1 328,52 		$1 118,38
$1 188,70
$1 263,16
$1 527,72 		$199,20
Toc - Plan #23 Molina Healthcare
Bronze

(HMO) Core Care Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-296-7677

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 		$210,80
$239,26
$269,40
$376,49
$572,11 		$372,06
$400,52
$430,66
$537,75 		$533,32
$561,78
$591,92
$699,01 		$694,58
$723,04
$753,18
$860,27 		$161,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$421,60
$478,52
$538,80
$752,98
$1 144,22 		$582,86
$639,78
$700,06
$914,24 		$744,12
$801,04
$861,32
$1 075,50 		$905,38
$962,30
$1 022,58
$1 236,76 		$161,26

ADVERTISEMENT

CareSource

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502 | TTY: 1-800-750-0750
Toc - Plan #24 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 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 		$235,26
$267,02
$300,66
$420,17
$638,48 		$415,23
$446,99
$480,63
$600,14 		$595,20
$626,96
$660,60
$780,11 		$775,17
$806,93
$840,57
$960,08 		$179,97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$470,52
$534,04
$601,32
$840,34
$1 276,96 		$650,49
$714,01
$781,29
$1 020,31 		$830,46
$893,98
$961,26
$1 200,28 		$1 010,43
$1 073,95
$1 141,23
$1 380,25 		$179,97
Toc - Plan #25 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

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 		$299,14
$339,52
$382,30
$534,26
$811,86 		$527,98
$568,36
$611,14
$763,10 		$756,82
$797,20
$839,98
$991,94 		$985,66
$1 026,04
$1 068,82
$1 220,78 		$228,84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$598,28
$679,04
$764,60
$1 068,52
$1 623,72 		$827,12
$907,88
$993,44
$1 297,36 		$1 055,96
$1 136,72
$1 222,28
$1 526,20 		$1 284,80
$1 365,56
$1 451,12
$1 755,04 		$228,84
Toc - Plan #26 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$403,32
$457,76
$515,43
$720,32
$1 094,59 		$711,85
$766,29
$823,96
$1 028,85 		$1 020,38
$1 074,82
$1 132,49
$1 337,38 		$1 328,91
$1 383,35
$1 441,02
$1 645,91 		$308,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806,64
$915,52
$1 030,86
$1 440,64
$2 189,18 		$1 115,17
$1 224,05
$1 339,39
$1 749,17 		$1 423,70
$1 532,58
$1 647,92
$2 057,70 		$1 732,23
$1 841,11
$1 956,45
$2 366,23 		$308,53
Toc - Plan #27 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 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 		$314,82
$357,31
$402,33
$562,26
$854,40 		$555,65
$598,14
$643,16
$803,09 		$796,48
$838,97
$883,99
$1 043,92 		$1 037,31
$1 079,80
$1 124,82
$1 284,75 		$240,83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$629,64
$714,62
$804,66
$1 124,52
$1 708,80 		$870,47
$955,45
$1 045,49
$1 365,35 		$1 111,30
$1 196,28
$1 286,32
$1 606,18 		$1 352,13
$1 437,11
$1 527,15
$1 847,01 		$240,83
Toc - Plan #28 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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 		$212,13
$240,76
$271,10
$378,86
$575,71 		$374,41
$403,04
$433,38
$541,14 		$536,69
$565,32
$595,66
$703,42 		$698,97
$727,60
$757,94
$865,70 		$162,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$424,26
$481,52
$542,20
$757,72
$1 151,42 		$586,54
$643,80
$704,48
$920,00 		$748,82
$806,08
$866,76
$1 082,28 		$911,10
$968,36
$1 029,04
$1 244,56 		$162,28
Toc - Plan #29 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 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 		$323,22
$366,85
$413,07
$577,26
$877,20 		$570,48
$614,11
$660,33
$824,52 		$817,74
$861,37
$907,59
$1 071,78 		$1 065,00
$1 108,63
$1 154,85
$1 319,04 		$247,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$646,44
$733,70
$826,14
$1 154,52
$1 754,40 		$893,70
$980,96
$1 073,40
$1 401,78 		$1 140,96
$1 228,22
$1 320,66
$1 649,04 		$1 388,22
$1 475,48
$1 567,92
$1 896,30 		$247,26
Toc - Plan #30 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

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 		$311,66
$353,73
$398,30
$556,62
$845,84 		$550,08
$592,15
$636,72
$795,04 		$788,50
$830,57
$875,14
$1 033,46 		$1 026,92
$1 068,99
$1 113,56
$1 271,88 		$238,42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$623,32
$707,46
$796,60
$1 113,24
$1 691,68 		$861,74
$945,88
$1 035,02
$1 351,66 		$1 100,16
$1 184,30
$1 273,44
$1 590,08 		$1 338,58
$1 422,72
$1 511,86
$1 828,50 		$238,42
Toc - Plan #31 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$420,82
$477,63
$537,80
$751,58
$1 142,10 		$742,75
$799,56
$859,73
$1 073,51 		$1 064,68
$1 121,49
$1 181,66
$1 395,44 		$1 386,61
$1 443,42
$1 503,59
$1 717,37 		$321,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$841,64
$955,26
$1 075,60
$1 503,16
$2 284,20 		$1 163,57
$1 277,19
$1 397,53
$1 825,09 		$1 485,50
$1 599,12
$1 719,46
$2 147,02 		$1 807,43
$1 921,05
$2 041,39
$2 468,95 		$321,93
Toc - Plan #32 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$7,900 $15,800 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 		$328,32
$372,64
$419,59
$586,37
$891,05 		$579,48
$623,80
$670,75
$837,53 		$830,64
$874,96
$921,91
$1 088,69 		$1 081,80
$1 126,12
$1 173,07
$1 339,85 		$251,16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656,64
$745,28
$839,18
$1 172,74
$1 782,10 		$907,80
$996,44
$1 090,34
$1 423,90 		$1 158,96
$1 247,60
$1 341,50
$1 675,06 		$1 410,12
$1 498,76
$1 592,66
$1 926,22 		$251,16
Toc - Plan #33 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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 		$221,71
$251,64
$283,35
$395,98
$601,72 		$391,32
$421,25
$452,96
$565,59 		$560,93
$590,86
$622,57
$735,20 		$730,54
$760,47
$792,18
$904,81 		$169,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$443,42
$503,28
$566,70
$791,96
$1 203,44 		$613,03
$672,89
$736,31
$961,57 		$782,64
$842,50
$905,92
$1 131,18 		$952,25
$1 012,11
$1 075,53
$1 300,79 		$169,61
Toc - Plan #34 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-479-9502

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 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 		$337,67
$383,25
$431,53
$603,07
$916,42 		$595,98
$641,56
$689,84
$861,38 		$854,29
$899,87
$948,15
$1 119,69 		$1 112,60
$1 158,18
$1 206,46
$1 378,00 		$258,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$675,34
$766,50
$863,06
$1 206,14
$1 832,84 		$933,65
$1 024,81
$1 121,37
$1 464,45 		$1 191,96
$1 283,12
$1 379,68
$1 722,76 		$1 450,27
$1 541,43
$1 637,99
$1 981,07 		$258,31

ADVERTISEMENT

MedMutual

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Toc - Plan #35 MedMutual
Gold

(HMO) Market HMO 2000 - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$466,89
$529,92
$596,69
$833,87
$1 267,14 		$824,06
$887,09
$953,86
$1 191,04 		$1 181,23
$1 244,26
$1 311,03
$1 548,21 		$1 538,40
$1 601,43
$1 668,20
$1 905,38 		$357,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$933,78
$1 059,84
$1 193,38
$1 667,74
$2 534,28 		$1 290,95
$1 417,01
$1 550,55
$2 024,91 		$1 648,12
$1 774,18
$1 907,72
$2 382,08 		$2 005,29
$2 131,35
$2 264,89
$2 739,25 		$357,17
Toc - Plan #36 MedMutual
Silver

(HMO) Market HMO 3000 - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$363,76
$412,87
$464,89
$649,68
$987,25 		$642,04
$691,15
$743,17
$927,96 		$920,32
$969,43
$1 021,45
$1 206,24 		$1 198,60
$1 247,71
$1 299,73
$1 484,52 		$278,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$727,52
$825,74
$929,78
$1 299,36
$1 974,50 		$1 005,80
$1 104,02
$1 208,06
$1 577,64 		$1 284,08
$1 382,30
$1 486,34
$1 855,92 		$1 562,36
$1 660,58
$1 764,62
$2 134,20 		$278,28
Toc - Plan #37 MedMutual
Silver

(HMO) Market HMO 4000 HSA - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$362,35
$411,27
$463,09
$647,17
$983,43 		$639,55
$688,47
$740,29
$924,37 		$916,75
$965,67
$1 017,49
$1 201,57 		$1 193,95
$1 242,87
$1 294,69
$1 478,77 		$277,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$724,70
$822,54
$926,18
$1 294,34
$1 966,86 		$1 001,90
$1 099,74
$1 203,38
$1 571,54 		$1 279,10
$1 376,94
$1 480,58
$1 848,74 		$1 556,30
$1 654,14
$1 757,78
$2 125,94 		$277,20
Toc - Plan #38 MedMutual
Expanded Bronze

(HMO) Market HMO 5850 HSA - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$5,850 $11,700 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 		$299,52
$339,96
$382,79
$534,94
$812,90 		$528,65
$569,09
$611,92
$764,07 		$757,78
$798,22
$841,05
$993,20 		$986,91
$1 027,35
$1 070,18
$1 222,33 		$229,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$599,04
$679,92
$765,58
$1 069,88
$1 625,80 		$828,17
$909,05
$994,71
$1 299,01 		$1 057,30
$1 138,18
$1 223,84
$1 528,14 		$1 286,43
$1 367,31
$1 452,97
$1 757,27 		$229,13
Toc - Plan #39 MedMutual
Expanded Bronze

(HMO) Market HMO 7000 HSA - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

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 		$279,51
$317,25
$357,22
$499,21
$758,60 		$493,34
$531,08
$571,05
$713,04 		$707,17
$744,91
$784,88
$926,87 		$921,00
$958,74
$998,71
$1 140,70 		$213,83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$559,02
$634,50
$714,44
$998,42
$1 517,20 		$772,85
$848,33
$928,27
$1 212,25 		$986,68
$1 062,16
$1 142,10
$1 426,08 		$1 200,51
$1 275,99
$1 355,93
$1 639,91 		$213,83
Toc - Plan #40 MedMutual
Bronze

(HMO) Market HMO 8500 - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$268,81
$305,10
$343,54
$480,09
$729,54 		$474,45
$510,74
$549,18
$685,73 		$680,09
$716,38
$754,82
$891,37 		$885,73
$922,02
$960,46
$1 097,01 		$205,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$537,62
$610,20
$687,08
$960,18
$1 459,08 		$743,26
$815,84
$892,72
$1 165,82 		$948,90
$1 021,48
$1 098,36
$1 371,46 		$1 154,54
$1 227,12
$1 304,00
$1 577,10 		$205,64
Toc - Plan #41 MedMutual
Catastrophic

(HMO) Market HMO Young Adult Essentials - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

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 		$168,50
$191,24
$215,34
$300,94
$457,30 		$297,40
$320,14
$344,24
$429,84 		$426,30
$449,04
$473,14
$558,74 		$555,20
$577,94
$602,04
$687,64 		$128,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$337,00
$382,48
$430,68
$601,88
$914,60 		$465,90
$511,38
$559,58
$730,78 		$594,80
$640,28
$688,48
$859,68 		$723,70
$769,18
$817,38
$988,58 		$128,90
Toc - Plan #42 MedMutual
Silver

(HMO) Market HMO 6500 - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$376,72
$427,58
$481,45
$672,83
$1 022,43 		$664,91
$715,77
$769,64
$961,02 		$953,10
$1 003,96
$1 057,83
$1 249,21 		$1 241,29
$1 292,15
$1 346,02
$1 537,40 		$288,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$753,44
$855,16
$962,90
$1 345,66
$2 044,86 		$1 041,63
$1 143,35
$1 251,09
$1 633,85 		$1 329,82
$1 431,54
$1 539,28
$1 922,04 		$1 618,01
$1 719,73
$1 827,47
$2 210,23 		$288,19
Toc - Plan #43 MedMutual
Expanded Bronze

(HMO) Market HMO $0 Deductible - NE Ohio

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$311,64
$353,71
$398,27
$556,58
$845,78 		$550,04
$592,11
$636,67
$794,98 		$788,44
$830,51
$875,07
$1 033,38 		$1 026,84
$1 068,91
$1 113,47
$1 271,78 		$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
$796,54
$1 113,16
$1 691,56 		$861,68
$945,82
$1 034,94
$1 351,56 		$1 100,08
$1 184,22
$1 273,34
$1 589,96 		$1 338,48
$1 422,62
$1 511,74
$1 828,36 		$238,40

‡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 Ashtabula County here.

Ashtabula County is in “Rating Area 11” of Ohio.

Currently, there are 43 plans offered in Rating Area 11.

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2021 Obamacare Plans for Ashtabula County, OH

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