Obamacare 2021 Rates for Spartanburg County

Obamacare > Rates > South Carolina > Spartanburg 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 Spartanburg County, SC.

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, 41 Plans and 2021 Rates for Spartanburg County, South Carolina

Below, you’ll find a summary of the 41 plans for Spartanburg County, South 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

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |

ADVERTISEMENT

ADVERTISEMENT

Bright Health

Local: 1-855-521-9353 | Toll Free: 1-855-521-9353 | TTY: 1-855-521-9353
Toc - Plan #1 Bright Health
Gold

(HMO) Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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 		$449,46
$510,14
$574,41
$802,74
$1 219,84 		$793,30
$853,98
$918,25
$1 146,58 		$1 137,14
$1 197,82
$1 262,09
$1 490,42 		$1 480,98
$1 541,66
$1 605,93
$1 834,26 		$343,84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$898,92
$1 020,28
$1 148,82
$1 605,48
$2 439,68 		$1 242,76
$1 364,12
$1 492,66
$1 949,32 		$1 586,60
$1 707,96
$1 836,50
$2 293,16 		$1 930,44
$2 051,80
$2 180,34
$2 637,00 		$343,84
Toc - Plan #2 Bright Health
Silver

(HMO) Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$392,99
$446,04
$502,24
$701,88
$1 066,57 		$693,63
$746,68
$802,88
$1 002,52 		$994,27
$1 047,32
$1 103,52
$1 303,16 		$1 294,91
$1 347,96
$1 404,16
$1 603,80 		$300,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785,98
$892,08
$1 004,48
$1 403,76
$2 133,14 		$1 086,62
$1 192,72
$1 305,12
$1 704,40 		$1 387,26
$1 493,36
$1 605,76
$2 005,04 		$1 687,90
$1 794,00
$1 906,40
$2 305,68 		$300,64
Toc - Plan #3 Bright Health
Silver

(HMO) Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$394,64
$447,92
$504,35
$704,83
$1 071,05 		$696,54
$749,82
$806,25
$1 006,73 		$998,44
$1 051,72
$1 108,15
$1 308,63 		$1 300,34
$1 353,62
$1 410,05
$1 610,53 		$301,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789,28
$895,84
$1 008,70
$1 409,66
$2 142,10 		$1 091,18
$1 197,74
$1 310,60
$1 711,56 		$1 393,08
$1 499,64
$1 612,50
$2 013,46 		$1 694,98
$1 801,54
$1 914,40
$2 315,36 		$301,90
Toc - Plan #4 Bright Health
Silver

(HMO) Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$397,96
$451,68
$508,59
$710,76
$1 080,06 		$702,40
$756,12
$813,03
$1 015,20 		$1 006,84
$1 060,56
$1 117,47
$1 319,64 		$1 311,28
$1 365,00
$1 421,91
$1 624,08 		$304,44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795,92
$903,36
$1 017,18
$1 421,52
$2 160,12 		$1 100,36
$1 207,80
$1 321,62
$1 725,96 		$1 404,80
$1 512,24
$1 626,06
$2 030,40 		$1 709,24
$1 816,68
$1 930,50
$2 334,84 		$304,44
Toc - Plan #5 Bright Health
Expanded Bronze

(HMO) Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$298,23
$338,49
$381,13
$532,63
$809,39 		$526,37
$566,63
$609,27
$760,77 		$754,51
$794,77
$837,41
$988,91 		$982,65
$1 022,91
$1 065,55
$1 217,05 		$228,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$596,46
$676,98
$762,26
$1 065,26
$1 618,78 		$824,60
$905,12
$990,40
$1 293,40 		$1 052,74
$1 133,26
$1 218,54
$1 521,54 		$1 280,88
$1 361,40
$1 446,68
$1 749,68 		$228,14
Toc - Plan #6 Bright Health
Expanded Bronze

(HMO) Bronze $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$307,05
$348,50
$392,41
$548,40
$833,34 		$541,94
$583,39
$627,30
$783,29 		$776,83
$818,28
$862,19
$1 018,18 		$1 011,72
$1 053,17
$1 097,08
$1 253,07 		$234,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$614,10
$697,00
$784,82
$1 096,80
$1 666,68 		$848,99
$931,89
$1 019,71
$1 331,69 		$1 083,88
$1 166,78
$1 254,60
$1 566,58 		$1 318,77
$1 401,67
$1 489,49
$1 801,47 		$234,89
Toc - Plan #7 Bright Health
Expanded Bronze

(HMO) Bronze 7000 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$346,21
$392,95
$442,46
$618,33
$939,61 		$611,06
$657,80
$707,31
$883,18 		$875,91
$922,65
$972,16
$1 148,03 		$1 140,76
$1 187,50
$1 237,01
$1 412,88 		$264,85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692,42
$785,90
$884,92
$1 236,66
$1 879,22 		$957,27
$1 050,75
$1 149,77
$1 501,51 		$1 222,12
$1 315,60
$1 414,62
$1 766,36 		$1 486,97
$1 580,45
$1 679,47
$2 031,21 		$264,85
Toc - Plan #8 Bright Health
Catastrophic

(HMO) Catastrophic 3 $0 PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$176,62
$200,46
$225,72
$315,44
$479,34 		$311,73
$335,57
$360,83
$450,55 		$446,84
$470,68
$495,94
$585,66 		$581,95
$605,79
$631,05
$720,77 		$135,11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$353,24
$400,92
$451,44
$630,88
$958,68 		$488,35
$536,03
$586,55
$765,99 		$623,46
$671,14
$721,66
$901,10 		$758,57
$806,25
$856,77
$1 036,21 		$135,11
Toc - Plan #9 Bright Health
Silver

(HMO) Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$394,06
$447,26
$503,61
$703,80
$1 069,49 		$695,52
$748,72
$805,07
$1 005,26 		$996,98
$1 050,18
$1 106,53
$1 306,72 		$1 298,44
$1 351,64
$1 407,99
$1 608,18 		$301,46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$788,12
$894,52
$1 007,22
$1 407,60
$2 138,98 		$1 089,58
$1 195,98
$1 308,68
$1 709,06 		$1 391,04
$1 497,44
$1 610,14
$2 010,52 		$1 692,50
$1 798,90
$1 911,60
$2 311,98 		$301,46
Toc - Plan #10 Bright Health
Expanded Bronze

(HMO) Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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 		$332,53
$377,42
$424,98
$593,90
$902,49 		$586,92
$631,81
$679,37
$848,29 		$841,31
$886,20
$933,76
$1 102,68 		$1 095,70
$1 140,59
$1 188,15
$1 357,07 		$254,39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$665,06
$754,84
$849,96
$1 187,80
$1 804,98 		$919,45
$1 009,23
$1 104,35
$1 442,19 		$1 173,84
$1 263,62
$1 358,74
$1 696,58 		$1 428,23
$1 518,01
$1 613,13
$1 950,97 		$254,39

ADVERTISEMENT

BlueCross BlueShield of South Carolina

Local: 1-855-404-6752 | Toll Free: 1-855-404-6752 | TTY: 1-855-889-4325
Toc - Plan #11 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$4,500 $9,000 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 		$438,95
$498,21
$560,98
$783,96
$1 191,31 		$774,75
$834,01
$896,78
$1 119,76 		$1 110,55
$1 169,81
$1 232,58
$1 455,56 		$1 446,35
$1 505,61
$1 568,38
$1 791,36 		$335,80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$877,90
$996,42
$1 121,96
$1 567,92
$2 382,62 		$1 213,70
$1 332,22
$1 457,76
$1 903,72 		$1 549,50
$1 668,02
$1 793,56
$2 239,52 		$1 885,30
$2 003,82
$2 129,36
$2 575,32 		$335,80
Toc - Plan #12 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 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 		$457,71
$519,50
$584,96
$817,47
$1 242,23 		$807,86
$869,65
$935,11
$1 167,62 		$1 158,01
$1 219,80
$1 285,26
$1 517,77 		$1 508,16
$1 569,95
$1 635,41
$1 867,92 		$350,15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$915,42
$1 039,00
$1 169,92
$1 634,94
$2 484,46 		$1 265,57
$1 389,15
$1 520,07
$1 985,09 		$1 615,72
$1 739,30
$1 870,22
$2 335,24 		$1 965,87
$2 089,45
$2 220,37
$2 685,39 		$350,15
Toc - Plan #13 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,400 $6,800 Annual Deductible
$6,600 $13,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$436,08
$494,95
$557,30
$778,83
$1 183,51 		$769,68
$828,55
$890,90
$1 112,43 		$1 103,28
$1 162,15
$1 224,50
$1 446,03 		$1 436,88
$1 495,75
$1 558,10
$1 779,63 		$333,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$872,16
$989,90
$1 114,60
$1 557,66
$2 367,02 		$1 205,76
$1 323,50
$1 448,20
$1 891,26 		$1 539,36
$1 657,10
$1 781,80
$2 224,86 		$1 872,96
$1 990,70
$2 115,40
$2 558,46 		$333,60
Toc - Plan #14 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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 		$275,51
$312,71
$352,11
$492,07
$747,74 		$486,28
$523,48
$562,88
$702,84 		$697,05
$734,25
$773,65
$913,61 		$907,82
$945,02
$984,42
$1 124,38 		$210,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$551,02
$625,42
$704,22
$984,14
$1 495,48 		$761,79
$836,19
$914,99
$1 194,91 		$972,56
$1 046,96
$1 125,76
$1 405,68 		$1 183,33
$1 257,73
$1 336,53
$1 616,45 		$210,77
Toc - Plan #15 BlueCross BlueShield of South Carolina
Bronze

(EPO) BlueEssentials Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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 		$274,93
$312,05
$351,36
$491,02
$746,16 		$485,25
$522,37
$561,68
$701,34 		$695,57
$732,69
$772,00
$911,66 		$905,89
$943,01
$982,32
$1 121,98 		$210,32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$549,86
$624,10
$702,72
$982,04
$1 492,32 		$760,18
$834,42
$913,04
$1 192,36 		$970,50
$1 044,74
$1 123,36
$1 402,68 		$1 180,82
$1 255,06
$1 333,68
$1 613,00 		$210,32
Toc - Plan #16 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$5,600 $11,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$428,57
$486,43
$547,71
$765,43
$1 163,14 		$756,43
$814,29
$875,57
$1 093,29 		$1 084,29
$1 142,15
$1 203,43
$1 421,15 		$1 412,15
$1 470,01
$1 531,29
$1 749,01 		$327,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857,14
$972,86
$1 095,42
$1 530,86
$2 326,28 		$1 185,00
$1 300,72
$1 423,28
$1 858,72 		$1 512,86
$1 628,58
$1 751,14
$2 186,58 		$1 840,72
$1 956,44
$2 079,00
$2 514,44 		$327,86
Toc - Plan #17 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials HD Gold 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$3,000 $6,000 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 		$436,87
$495,85
$558,32
$780,26
$1 185,67 		$771,08
$830,06
$892,53
$1 114,47 		$1 105,29
$1 164,27
$1 226,74
$1 448,68 		$1 439,50
$1 498,48
$1 560,95
$1 782,89 		$334,21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$873,74
$991,70
$1 116,64
$1 560,52
$2 371,34 		$1 207,95
$1 325,91
$1 450,85
$1 894,73 		$1 542,16
$1 660,12
$1 785,06
$2 228,94 		$1 876,37
$1 994,33
$2 119,27
$2 563,15 		$334,21
Toc - Plan #18 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials HD Silver 6

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$4,300 $8,600 Annual Deductible
$4,300 $8,600 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 		$460,87
$523,09
$588,99
$823,12
$1 250,81 		$813,44
$875,66
$941,56
$1 175,69 		$1 166,01
$1 228,23
$1 294,13
$1 528,26 		$1 518,58
$1 580,80
$1 646,70
$1 880,83 		$352,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$921,74
$1 046,18
$1 177,98
$1 646,24
$2 501,62 		$1 274,31
$1 398,75
$1 530,55
$1 998,81 		$1 626,88
$1 751,32
$1 883,12
$2 351,38 		$1 979,45
$2 103,89
$2 235,69
$2 703,95 		$352,57
Toc - Plan #19 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287,43
$326,24
$367,34
$513,36
$780,10 		$507,32
$546,13
$587,23
$733,25 		$727,21
$766,02
$807,12
$953,14 		$947,10
$985,91
$1 027,01
$1 173,03 		$219,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$574,86
$652,48
$734,68
$1 026,72
$1 560,20 		$794,75
$872,37
$954,57
$1 246,61 		$1 014,64
$1 092,26
$1 174,46
$1 466,50 		$1 234,53
$1 312,15
$1 394,35
$1 686,39 		$219,89
Toc - Plan #20 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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 		$277,66
$315,14
$354,85
$495,90
$753,57 		$490,07
$527,55
$567,26
$708,31 		$702,48
$739,96
$779,67
$920,72 		$914,89
$952,37
$992,08
$1 133,13 		$212,41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$555,32
$630,28
$709,70
$991,80
$1 507,14 		$767,73
$842,69
$922,11
$1 204,21 		$980,14
$1 055,10
$1 134,52
$1 416,62 		$1 192,55
$1 267,51
$1 346,93
$1 629,03 		$212,41
Toc - Plan #21 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287,57
$326,39
$367,51
$513,60
$780,46 		$507,56
$546,38
$587,50
$733,59 		$727,55
$766,37
$807,49
$953,58 		$947,54
$986,36
$1 027,48
$1 173,57 		$219,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$575,14
$652,78
$735,02
$1 027,20
$1 560,92 		$795,13
$872,77
$955,01
$1 247,19 		$1 015,12
$1 092,76
$1 175,00
$1 467,18 		$1 235,11
$1 312,75
$1 394,99
$1 687,17 		$219,99
Toc - Plan #22 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,400 $14,800 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 		$422,13
$479,12
$539,48
$753,92
$1 145,66 		$745,06
$802,05
$862,41
$1 076,85 		$1 067,99
$1 124,98
$1 185,34
$1 399,78 		$1 390,92
$1 447,91
$1 508,27
$1 722,71 		$322,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$844,26
$958,24
$1 078,96
$1 507,84
$2 291,32 		$1 167,19
$1 281,17
$1 401,89
$1 830,77 		$1 490,12
$1 604,10
$1 724,82
$2 153,70 		$1 813,05
$1 927,03
$2 047,75
$2 476,63 		$322,93
Toc - Plan #23 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 8

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,250 $10,500 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 		$445,15
$505,24
$568,90
$795,03
$1 208,12 		$785,69
$845,78
$909,44
$1 135,57 		$1 126,23
$1 186,32
$1 249,98
$1 476,11 		$1 466,77
$1 526,86
$1 590,52
$1 816,65 		$340,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$890,30
$1 010,48
$1 137,80
$1 590,06
$2 416,24 		$1 230,84
$1 351,02
$1 478,34
$1 930,60 		$1 571,38
$1 691,56
$1 818,88
$2 271,14 		$1 911,92
$2 032,10
$2 159,42
$2 611,68 		$340,54
Toc - Plan #24 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 9

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,850 $15,700 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 		$441,60
$501,21
$564,36
$788,69
$1 198,50 		$779,42
$839,03
$902,18
$1 126,51 		$1 117,24
$1 176,85
$1 240,00
$1 464,33 		$1 455,06
$1 514,67
$1 577,82
$1 802,15 		$337,82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$883,20
$1 002,42
$1 128,72
$1 577,38
$2 397,00 		$1 221,02
$1 340,24
$1 466,54
$1 915,20 		$1 558,84
$1 678,06
$1 804,36
$2 253,02 		$1 896,66
$2 015,88
$2 142,18
$2 590,84 		$337,82
Toc - Plan #25 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$443,26
$503,10
$566,49
$791,67
$1 203,02 		$782,36
$842,20
$905,59
$1 130,77 		$1 121,46
$1 181,30
$1 244,69
$1 469,87 		$1 460,56
$1 520,40
$1 583,79
$1 808,97 		$339,10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$886,52
$1 006,20
$1 132,98
$1 583,34
$2 406,04 		$1 225,62
$1 345,30
$1 472,08
$1 922,44 		$1 564,72
$1 684,40
$1 811,18
$2 261,54 		$1 903,82
$2 023,50
$2 150,28
$2 600,64 		$339,10
Toc - Plan #26 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$7,350 $14,700 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 		$450,17
$510,94
$575,31
$804,00
$1 221,75 		$794,55
$855,32
$919,69
$1 148,38 		$1 138,93
$1 199,70
$1 264,07
$1 492,76 		$1 483,31
$1 544,08
$1 608,45
$1 837,14 		$344,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$900,34
$1 021,88
$1 150,62
$1 608,00
$2 443,50 		$1 244,72
$1 366,26
$1 495,00
$1 952,38 		$1 589,10
$1 710,64
$1 839,38
$2 296,76 		$1 933,48
$2 055,02
$2 183,76
$2 641,14 		$344,38
Toc - Plan #27 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$5,500 $11,000 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 		$428,64
$486,51
$547,80
$765,56
$1 163,33 		$756,55
$814,42
$875,71
$1 093,47 		$1 084,46
$1 142,33
$1 203,62
$1 421,38 		$1 412,37
$1 470,24
$1 531,53
$1 749,29 		$327,91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857,28
$973,02
$1 095,60
$1 531,12
$2 326,66 		$1 185,19
$1 300,93
$1 423,51
$1 859,03 		$1 513,10
$1 628,84
$1 751,42
$2 186,94 		$1 841,01
$1 956,75
$2 079,33
$2 514,85 		$327,91
Toc - Plan #28 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials HD Silver 13

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 Annual Deductible
$5,750 $11,500 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 		$434,65
$493,33
$555,49
$776,29
$1 179,65 		$767,16
$825,84
$888,00
$1 108,80 		$1 099,67
$1 158,35
$1 220,51
$1 441,31 		$1 432,18
$1 490,86
$1 553,02
$1 773,82 		$332,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$869,30
$986,66
$1 110,98
$1 552,58
$2 359,30 		$1 201,81
$1 319,17
$1 443,49
$1 885,09 		$1 534,32
$1 651,68
$1 776,00
$2 217,60 		$1 866,83
$1 984,19
$2 108,51
$2 550,11 		$332,51
Toc - Plan #29 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 14

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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 		$420,34
$477,09
$537,19
$750,73
$1 140,80 		$741,90
$798,65
$858,75
$1 072,29 		$1 063,46
$1 120,21
$1 180,31
$1 393,85 		$1 385,02
$1 441,77
$1 501,87
$1 715,41 		$321,56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$840,68
$954,18
$1 074,38
$1 501,46
$2 281,60 		$1 162,24
$1 275,74
$1 395,94
$1 823,02 		$1 483,80
$1 597,30
$1 717,50
$2 144,58 		$1 805,36
$1 918,86
$2 039,06
$2 466,14 		$321,56
Toc - Plan #30 BlueCross BlueShield of South Carolina
Catastrophic

(EPO) BlueEssentials Catastrophic 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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 		$182,67
$207,33
$233,45
$326,25
$495,77 		$322,41
$347,07
$373,19
$465,99 		$462,15
$486,81
$512,93
$605,73 		$601,89
$626,55
$652,67
$745,47 		$139,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$365,34
$414,66
$466,90
$652,50
$991,54 		$505,08
$554,40
$606,64
$792,24 		$644,82
$694,14
$746,38
$931,98 		$784,56
$833,88
$886,12
$1 071,72 		$139,74

ADVERTISEMENT

Molina Healthcare

Local: 1-855-885-3176 | Toll Free: 1-800-659-8331 | TTY: 1-800-659-8331
Toc - Plan #31 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$384,72
$436,66
$491,67
$687,11
$1 044,13 		$679,03
$730,97
$785,98
$981,42 		$973,34
$1 025,28
$1 080,29
$1 275,73 		$1 267,65
$1 319,59
$1 374,60
$1 570,04 		$294,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$769,44
$873,32
$983,34
$1 374,22
$2 088,26 		$1 063,75
$1 167,63
$1 277,65
$1 668,53 		$1 358,06
$1 461,94
$1 571,96
$1 962,84 		$1 652,37
$1 756,25
$1 866,27
$2 257,15 		$294,31
Toc - Plan #32 Molina Healthcare
Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$347,26
$394,14
$443,80
$620,21
$942,47 		$612,92
$659,80
$709,46
$885,87 		$878,58
$925,46
$975,12
$1 151,53 		$1 144,24
$1 191,12
$1 240,78
$1 417,19 		$265,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694,52
$788,28
$887,60
$1 240,42
$1 884,94 		$960,18
$1 053,94
$1 153,26
$1 506,08 		$1 225,84
$1 319,60
$1 418,92
$1 771,74 		$1 491,50
$1 585,26
$1 684,58
$2 037,40 		$265,66
Toc - Plan #33 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$251,02
$284,91
$320,80
$448,32
$681,26 		$443,05
$476,94
$512,83
$640,35 		$635,08
$668,97
$704,86
$832,38 		$827,11
$861,00
$896,89
$1 024,41 		$192,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$502,04
$569,82
$641,60
$896,64
$1 362,52 		$694,07
$761,85
$833,63
$1 088,67 		$886,10
$953,88
$1 025,66
$1 280,70 		$1 078,13
$1 145,91
$1 217,69
$1 472,73 		$192,03
Toc - Plan #34 Molina Healthcare
Silver

(HMO) Constant Care Silver 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$343,32
$389,67
$438,76
$613,17
$931,77 		$605,96
$652,31
$701,40
$875,81 		$868,60
$914,95
$964,04
$1 138,45 		$1 131,24
$1 177,59
$1 226,68
$1 401,09 		$262,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$686,64
$779,34
$877,52
$1 226,34
$1 863,54 		$949,28
$1 041,98
$1 140,16
$1 488,98 		$1 211,92
$1 304,62
$1 402,80
$1 751,62 		$1 474,56
$1 567,26
$1 665,44
$2 014,26 		$262,64
Toc - Plan #35 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$262,44
$297,87
$335,40
$468,72
$712,26 		$463,21
$498,64
$536,17
$669,49 		$663,98
$699,41
$736,94
$870,26 		$864,75
$900,18
$937,71
$1 071,03 		$200,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$524,88
$595,74
$670,80
$937,44
$1 424,52 		$725,65
$796,51
$871,57
$1 138,21 		$926,42
$997,28
$1 072,34
$1 338,98 		$1 127,19
$1 198,05
$1 273,11
$1 539,75 		$200,77
Toc - Plan #36 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$255,30
$289,77
$326,28
$455,97
$692,90 		$450,61
$485,08
$521,59
$651,28 		$645,92
$680,39
$716,90
$846,59 		$841,23
$875,70
$912,21
$1 041,90 		$195,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$510,60
$579,54
$652,56
$911,94
$1 385,80 		$705,91
$774,85
$847,87
$1 107,25 		$901,22
$970,16
$1 043,18
$1 302,56 		$1 096,53
$1 165,47
$1 238,49
$1 497,87 		$195,31
Toc - Plan #37 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$387,96
$440,34
$495,82
$692,90
$1 052,93 		$684,75
$737,13
$792,61
$989,69 		$981,54
$1 033,92
$1 089,40
$1 286,48 		$1 278,33
$1 330,71
$1 386,19
$1 583,27 		$296,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$775,92
$880,68
$991,64
$1 385,80
$2 105,86 		$1 072,71
$1 177,47
$1 288,43
$1 682,59 		$1 369,50
$1 474,26
$1 585,22
$1 979,38 		$1 666,29
$1 771,05
$1 882,01
$2 276,17 		$296,79
Toc - Plan #38 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$350,54
$397,86
$447,98
$626,06
$951,35 		$618,70
$666,02
$716,14
$894,22 		$886,86
$934,18
$984,30
$1 162,38 		$1 155,02
$1 202,34
$1 252,46
$1 430,54 		$268,16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$701,08
$795,72
$895,96
$1 252,12
$1 902,70 		$969,24
$1 063,88
$1 164,12
$1 520,28 		$1 237,40
$1 332,04
$1 432,28
$1 788,44 		$1 505,56
$1 600,20
$1 700,44
$2 056,60 		$268,16
Toc - Plan #39 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$254,05
$288,34
$324,67
$453,73
$689,49 		$448,40
$482,69
$519,02
$648,08 		$642,75
$677,04
$713,37
$842,43 		$837,10
$871,39
$907,72
$1 036,78 		$194,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$508,10
$576,68
$649,34
$907,46
$1 378,98 		$702,45
$771,03
$843,69
$1 101,81 		$896,80
$965,38
$1 038,04
$1 296,16 		$1 091,15
$1 159,73
$1 232,39
$1 490,51 		$194,35
Toc - Plan #40 Molina Healthcare
Silver

(HMO) Constant Care Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$347,06
$393,91
$443,54
$619,84
$941,91 		$612,56
$659,41
$709,04
$885,34 		$878,06
$924,91
$974,54
$1 150,84 		$1 143,56
$1 190,41
$1 240,04
$1 416,34 		$265,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694,12
$787,82
$887,08
$1 239,68
$1 883,82 		$959,62
$1 053,32
$1 152,58
$1 505,18 		$1 225,12
$1 318,82
$1 418,08
$1 770,68 		$1 490,62
$1 584,32
$1 683,58
$2 036,18 		$265,50
Toc - Plan #41 Molina Healthcare
Bronze

(HMO) Core Care Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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 		$248,60
$282,16
$317,70
$443,99
$674,69 		$438,78
$472,34
$507,88
$634,17 		$628,96
$662,52
$698,06
$824,35 		$819,14
$852,70
$888,24
$1 014,53 		$190,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$497,20
$564,32
$635,40
$887,98
$1 349,38 		$687,38
$754,50
$825,58
$1 078,16 		$877,56
$944,68
$1 015,76
$1 268,34 		$1 067,74
$1 134,86
$1 205,94
$1 458,52 		$190,18

‡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 Spartanburg County here.

Spartanburg County is in “Rating Area 42” of South Carolina.

Currently, there are 41 plans offered in Rating Area 42.

Top

2021 Obamacare Plans for Spartanburg County, SC

Plan Browser: 41 Plans
scroll down for more
Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork