Obamacare 2021 Rates for Perry County

Obamacare > Rates > Tennessee > Perry 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 Perry County, TN.

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, 32 Plans and 2021 Rates for Perry County, Tennessee

Below, you’ll find a summary of the 32 plans for Perry County, Tennessee 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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BlueCross BlueShield of Tennessee

Local: 1-423-535-5600 | Toll Free: 1-800-565-9140

Toc - Plan #1 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B07S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,950 $11,900 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 		$363,70
$412,80
$464,81
$649,57
$987,08 		$641,93
$691,03
$743,04
$927,80 		$920,16
$969,26
$1 021,27
$1 206,03 		$1 198,39
$1 247,49
$1 299,50
$1 484,26 		$278,23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$727,40
$825,60
$929,62
$1 299,14
$1 974,16 		$1 005,63
$1 103,83
$1 207,85
$1 577,37 		$1 283,86
$1 382,06
$1 486,08
$1 855,60 		$1 562,09
$1 660,29
$1 764,31
$2 133,83 		$278,23
Toc - Plan #2 BlueCross BlueShield of Tennessee
Bronze

(EPO) Bronze B08S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

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 		$295,51
$335,40
$377,66
$527,78
$802,01 		$521,58
$561,47
$603,73
$753,85 		$747,65
$787,54
$829,80
$979,92 		$973,72
$1 013,61
$1 055,87
$1 205,99 		$226,07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$591,02
$670,80
$755,32
$1 055,56
$1 604,02 		$817,09
$896,87
$981,39
$1 281,63 		$1 043,16
$1 122,94
$1 207,46
$1 507,70 		$1 269,23
$1 349,01
$1 433,53
$1 733,77 		$226,07
Toc - Plan #3 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B10S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$6,600 $13,200 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 		$340,93
$386,96
$435,71
$608,90
$925,28 		$601,74
$647,77
$696,52
$869,71 		$862,55
$908,58
$957,33
$1 130,52 		$1 123,36
$1 169,39
$1 218,14
$1 391,33 		$260,81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$681,86
$773,92
$871,42
$1 217,80
$1 850,56 		$942,67
$1 034,73
$1 132,23
$1 478,61 		$1 203,48
$1 295,54
$1 393,04
$1 739,42 		$1 464,29
$1 556,35
$1 653,85
$2 000,23 		$260,81
Toc - Plan #4 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S01S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,800 $15,600 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 		$602,42
$683,75
$769,89
$1 075,92
$1 634,97 		$1 063,27
$1 144,60
$1 230,74
$1 536,77 		$1 524,12
$1 605,45
$1 691,59
$1 997,62 		$1 984,97
$2 066,30
$2 152,44
$2 458,47 		$460,85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 204,84
$1 367,50
$1 539,78
$2 151,84
$3 269,94 		$1 665,69
$1 828,35
$2 000,63
$2 612,69 		$2 126,54
$2 289,20
$2 461,48
$3 073,54 		$2 587,39
$2 750,05
$2 922,33
$3 534,39 		$460,85
Toc - Plan #5 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S04S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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 		$506,28
$574,63
$647,03
$904,22
$1 374,04 		$893,58
$961,93
$1 034,33
$1 291,52 		$1 280,88
$1 349,23
$1 421,63
$1 678,82 		$1 668,18
$1 736,53
$1 808,93
$2 066,12 		$387,30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 012,56
$1 149,26
$1 294,06
$1 808,44
$2 748,08 		$1 399,86
$1 536,56
$1 681,36
$2 195,74 		$1 787,16
$1 923,86
$2 068,66
$2 583,04 		$2 174,46
$2 311,16
$2 455,96
$2 970,34 		$387,30
Toc - Plan #6 BlueCross BlueShield of Tennessee
Gold

(EPO) Gold G06S, Network S

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$6,350 $12,700 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 		$652,62
$740,72
$834,05
$1 165,58
$1 771,21 		$1 151,87
$1 239,97
$1 333,30
$1 664,83 		$1 651,12
$1 739,22
$1 832,55
$2 164,08 		$2 150,37
$2 238,47
$2 331,80
$2 663,33 		$499,25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 305,24
$1 481,44
$1 668,10
$2 331,16
$3 542,42 		$1 804,49
$1 980,69
$2 167,35
$2 830,41 		$2 303,74
$2 479,94
$2 666,60
$3 329,66 		$2 802,99
$2 979,19
$3 165,85
$3 828,91 		$499,25

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UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 

Toc - Plan #7 UnitedHealthcare
Gold

(EPO) Value Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,350 $4,700 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 		$707,55
$803,07
$904,25
$1 263,69
$1 920,29 		$1 248,83
$1 344,35
$1 445,53
$1 804,97 		$1 790,11
$1 885,63
$1 986,81
$2 346,25 		$2 331,39
$2 426,91
$2 528,09
$2 887,53 		$541,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 415,10
$1 606,14
$1 808,50
$2 527,38
$3 840,58 		$1 956,38
$2 147,42
$2 349,78
$3 068,66 		$2 497,66
$2 688,70
$2 891,06
$3 609,94 		$3 038,94
$3 229,98
$3 432,34
$4 151,22 		$541,28
Toc - Plan #8 UnitedHealthcare
Silver

(EPO) Balance Plus Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$530,37
$601,97
$677,81
$947,23
$1 439,41 		$936,10
$1 007,70
$1 083,54
$1 352,96 		$1 341,83
$1 413,43
$1 489,27
$1 758,69 		$1 747,56
$1 819,16
$1 895,00
$2 164,42 		$405,73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 060,74
$1 203,94
$1 355,62
$1 894,46
$2 878,82 		$1 466,47
$1 609,67
$1 761,35
$2 300,19 		$1 872,20
$2 015,40
$2 167,08
$2 705,92 		$2 277,93
$2 421,13
$2 572,81
$3 111,65 		$405,73
Toc - Plan #9 UnitedHealthcare
Silver

(EPO) Balance Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$529,58
$601,07
$676,80
$945,82
$1 437,27 		$934,71
$1 006,20
$1 081,93
$1 350,95 		$1 339,84
$1 411,33
$1 487,06
$1 756,08 		$1 744,97
$1 816,46
$1 892,19
$2 161,21 		$405,13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 059,16
$1 202,14
$1 353,60
$1 891,64
$2 874,54 		$1 464,29
$1 607,27
$1 758,73
$2 296,77 		$1 869,42
$2 012,40
$2 163,86
$2 701,90 		$2 274,55
$2 417,53
$2 568,99
$3 107,03 		$405,13
Toc - Plan #10 UnitedHealthcare
Silver

(EPO) Value Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$527,60
$598,82
$674,27
$942,29
$1 431,90 		$931,21
$1 002,43
$1 077,88
$1 345,90 		$1 334,82
$1 406,04
$1 481,49
$1 749,51 		$1 738,43
$1 809,65
$1 885,10
$2 153,12 		$403,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 055,20
$1 197,64
$1 348,54
$1 884,58
$2 863,80 		$1 458,81
$1 601,25
$1 752,15
$2 288,19 		$1 862,42
$2 004,86
$2 155,76
$2 691,80 		$2 266,03
$2 408,47
$2 559,37
$3 095,41 		$403,61
Toc - Plan #11 UnitedHealthcare
Expanded Bronze

(EPO) Value Bronze Saver (HSA)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$408,55
$463,71
$522,13
$729,67
$1 108,81 		$721,09
$776,25
$834,67
$1 042,21 		$1 033,63
$1 088,79
$1 147,21
$1 354,75 		$1 346,17
$1 401,33
$1 459,75
$1 667,29 		$312,54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$817,10
$927,42
$1 044,26
$1 459,34
$2 217,62 		$1 129,64
$1 239,96
$1 356,80
$1 771,88 		$1 442,18
$1 552,50
$1 669,34
$2 084,42 		$1 754,72
$1 865,04
$1 981,88
$2 396,96 		$312,54
Toc - Plan #12 UnitedHealthcare
Expanded Bronze

(EPO) Balance Bronze 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$395,50
$448,89
$505,45
$706,36
$1 073,39 		$698,06
$751,45
$808,01
$1 008,92 		$1 000,62
$1 054,01
$1 110,57
$1 311,48 		$1 303,18
$1 356,57
$1 413,13
$1 614,04 		$302,56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791,00
$897,78
$1 010,90
$1 412,72
$2 146,78 		$1 093,56
$1 200,34
$1 313,46
$1 715,28 		$1 396,12
$1 502,90
$1 616,02
$2 017,84 		$1 698,68
$1 805,46
$1 918,58
$2 320,40 		$302,56
Toc - Plan #13 UnitedHealthcare
Expanded Bronze

(EPO) Value Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$395,90
$449,34
$505,96
$707,07
$1 074,46 		$698,76
$752,20
$808,82
$1 009,93 		$1 001,62
$1 055,06
$1 111,68
$1 312,79 		$1 304,48
$1 357,92
$1 414,54
$1 615,65 		$302,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791,80
$898,68
$1 011,92
$1 414,14
$2 148,92 		$1 094,66
$1 201,54
$1 314,78
$1 717,00 		$1 397,52
$1 504,40
$1 617,64
$2 019,86 		$1 700,38
$1 807,26
$1 920,50
$2 322,72 		$302,86

ADVERTISEMENT

Ambetter of Tennessee

Local: 1-833-709-4735 | Toll Free: 1-833-709-4735

Toc - Plan #14 Ambetter of Tennessee
Bronze

(EPO) Ambetter Essential Care 1 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$305,58
$346,83
$390,52
$545,76
$829,33 		$539,34
$580,59
$624,28
$779,52 		$773,10
$814,35
$858,04
$1 013,28 		$1 006,86
$1 048,11
$1 091,80
$1 247,04 		$233,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$611,16
$693,66
$781,04
$1 091,52
$1 658,66 		$844,92
$927,42
$1 014,80
$1 325,28 		$1 078,68
$1 161,18
$1 248,56
$1 559,04 		$1 312,44
$1 394,94
$1 482,32
$1 792,80 		$233,76
Toc - Plan #15 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 11 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$410,89
$466,35
$525,11
$733,84
$1 115,14 		$725,22
$780,68
$839,44
$1 048,17 		$1 039,55
$1 095,01
$1 153,77
$1 362,50 		$1 353,88
$1 409,34
$1 468,10
$1 676,83 		$314,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821,78
$932,70
$1 050,22
$1 467,68
$2 230,28 		$1 136,11
$1 247,03
$1 364,55
$1 782,01 		$1 450,44
$1 561,36
$1 678,88
$2 096,34 		$1 764,77
$1 875,69
$1 993,21
$2 410,67 		$314,33
Toc - Plan #16 Ambetter of Tennessee
Gold

(EPO) Ambetter Secure Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$473,50
$537,41
$605,12
$845,65
$1 285,05 		$835,72
$899,63
$967,34
$1 207,87 		$1 197,94
$1 261,85
$1 329,56
$1 570,09 		$1 560,16
$1 624,07
$1 691,78
$1 932,31 		$362,22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$947,00
$1 074,82
$1 210,24
$1 691,30
$2 570,10 		$1 309,22
$1 437,04
$1 572,46
$2 053,52 		$1 671,44
$1 799,26
$1 934,68
$2 415,74 		$2 033,66
$2 161,48
$2 296,90
$2 777,96 		$362,22
Toc - Plan #17 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$332,09
$376,91
$424,40
$593,10
$901,27 		$586,13
$630,95
$678,44
$847,14 		$840,17
$884,99
$932,48
$1 101,18 		$1 094,21
$1 139,03
$1 186,52
$1 355,22 		$254,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$664,18
$753,82
$848,80
$1 186,20
$1 802,54 		$918,22
$1 007,86
$1 102,84
$1 440,24 		$1 172,26
$1 261,90
$1 356,88
$1 694,28 		$1 426,30
$1 515,94
$1 610,92
$1 948,32 		$254,04
Toc - Plan #18 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 12 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$402,88
$457,25
$514,86
$719,52
$1 093,38 		$711,07
$765,44
$823,05
$1 027,71 		$1 019,26
$1 073,63
$1 131,24
$1 335,90 		$1 327,45
$1 381,82
$1 439,43
$1 644,09 		$308,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805,76
$914,50
$1 029,72
$1 439,04
$2 186,76 		$1 113,95
$1 222,69
$1 337,91
$1 747,23 		$1 422,14
$1 530,88
$1 646,10
$2 055,42 		$1 730,33
$1 839,07
$1 954,29
$2 363,61 		$308,19
Toc - Plan #19 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 29 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$399,33
$453,23
$510,33
$713,19
$1 083,76 		$704,81
$758,71
$815,81
$1 018,67 		$1 010,29
$1 064,19
$1 121,29
$1 324,15 		$1 315,77
$1 369,67
$1 426,77
$1 629,63 		$305,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$798,66
$906,46
$1 020,66
$1 426,38
$2 167,52 		$1 104,14
$1 211,94
$1 326,14
$1 731,86 		$1 409,62
$1 517,42
$1 631,62
$2 037,34 		$1 715,10
$1 822,90
$1 937,10
$2 342,82 		$305,48
Toc - Plan #20 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$420,08
$476,78
$536,85
$750,24
$1 140,07 		$741,43
$798,13
$858,20
$1 071,59 		$1 062,78
$1 119,48
$1 179,55
$1 392,94 		$1 384,13
$1 440,83
$1 500,90
$1 714,29 		$321,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$840,16
$953,56
$1 073,70
$1 500,48
$2 280,14 		$1 161,51
$1 274,91
$1 395,05
$1 821,83 		$1 482,86
$1 596,26
$1 716,40
$2 143,18 		$1 804,21
$1 917,61
$2 037,75
$2 464,53 		$321,35
Toc - Plan #21 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 26 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$421,77
$478,70
$539,01
$753,27
$1 144,66 		$744,42
$801,35
$861,66
$1 075,92 		$1 067,07
$1 124,00
$1 184,31
$1 398,57 		$1 389,72
$1 446,65
$1 506,96
$1 721,22 		$322,65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$843,54
$957,40
$1 078,02
$1 506,54
$2 289,32 		$1 166,19
$1 280,05
$1 400,67
$1 829,19 		$1 488,84
$1 602,70
$1 723,32
$2 151,84 		$1 811,49
$1 925,35
$2 045,97
$2 474,49 		$322,65
Toc - Plan #22 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 27 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$439,18
$498,45
$561,25
$784,35
$1 191,90 		$775,14
$834,41
$897,21
$1 120,31 		$1 111,10
$1 170,37
$1 233,17
$1 456,27 		$1 447,06
$1 506,33
$1 569,13
$1 792,23 		$335,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878,36
$996,90
$1 122,50
$1 568,70
$2 383,80 		$1 214,32
$1 332,86
$1 458,46
$1 904,66 		$1 550,28
$1 668,82
$1 794,42
$2 240,62 		$1 886,24
$2 004,78
$2 130,38
$2 576,58 		$335,96
Toc - Plan #23 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 28 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$439,50
$498,82
$561,67
$784,93
$1 192,77 		$775,71
$835,03
$897,88
$1 121,14 		$1 111,92
$1 171,24
$1 234,09
$1 457,35 		$1 448,13
$1 507,45
$1 570,30
$1 793,56 		$336,21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$879,00
$997,64
$1 123,34
$1 569,86
$2 385,54 		$1 215,21
$1 333,85
$1 459,55
$1 906,07 		$1 551,42
$1 670,06
$1 795,76
$2 242,28 		$1 887,63
$2 006,27
$2 131,97
$2 578,49 		$336,21
Toc - Plan #24 Ambetter of Tennessee
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$318,94
$361,98
$407,59
$569,61
$865,57 		$562,92
$605,96
$651,57
$813,59 		$806,90
$849,94
$895,55
$1 057,57 		$1 050,88
$1 093,92
$1 139,53
$1 301,55 		$243,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$637,88
$723,96
$815,18
$1 139,22
$1 731,14 		$881,86
$967,94
$1 059,16
$1 383,20 		$1 125,84
$1 211,92
$1 303,14
$1 627,18 		$1 369,82
$1 455,90
$1 547,12
$1 871,16 		$243,98
Toc - Plan #25 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$428,85
$486,73
$548,06
$765,91
$1 163,88 		$756,91
$814,79
$876,12
$1 093,97 		$1 084,97
$1 142,85
$1 204,18
$1 422,03 		$1 413,03
$1 470,91
$1 532,24
$1 750,09 		$328,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857,70
$973,46
$1 096,12
$1 531,82
$2 327,76 		$1 185,76
$1 301,52
$1 424,18
$1 859,88 		$1 513,82
$1 629,58
$1 752,24
$2 187,94 		$1 841,88
$1 957,64
$2 080,30
$2 516,00 		$328,06
Toc - Plan #26 Ambetter of Tennessee
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$494,19
$560,90
$631,57
$882,61
$1 341,21 		$872,24
$938,95
$1 009,62
$1 260,66 		$1 250,29
$1 317,00
$1 387,67
$1 638,71 		$1 628,34
$1 695,05
$1 765,72
$2 016,76 		$378,05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$988,38
$1 121,80
$1 263,14
$1 765,22
$2 682,42 		$1 366,43
$1 499,85
$1 641,19
$2 143,27 		$1 744,48
$1 877,90
$2 019,24
$2 521,32 		$2 122,53
$2 255,95
$2 397,29
$2 899,37 		$378,05
Toc - Plan #27 Ambetter of Tennessee
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$346,61
$393,39
$442,95
$619,02
$940,66 		$611,76
$658,54
$708,10
$884,17 		$876,91
$923,69
$973,25
$1 149,32 		$1 142,06
$1 188,84
$1 238,40
$1 414,47 		$265,15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$693,22
$786,78
$885,90
$1 238,04
$1 881,32 		$958,37
$1 051,93
$1 151,05
$1 503,19 		$1 223,52
$1 317,08
$1 416,20
$1 768,34 		$1 488,67
$1 582,23
$1 681,35
$2 033,49 		$265,15
Toc - Plan #28 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$420,48
$477,24
$537,37
$750,97
$1 141,17 		$742,14
$798,90
$859,03
$1 072,63 		$1 063,80
$1 120,56
$1 180,69
$1 394,29 		$1 385,46
$1 442,22
$1 502,35
$1 715,95 		$321,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$840,96
$954,48
$1 074,74
$1 501,94
$2 282,34 		$1 162,62
$1 276,14
$1 396,40
$1 823,60 		$1 484,28
$1 597,80
$1 718,06
$2 145,26 		$1 805,94
$1 919,46
$2 039,72
$2 466,92 		$321,66
Toc - Plan #29 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$438,44
$497,62
$560,31
$783,03
$1 189,89 		$773,84
$833,02
$895,71
$1 118,43 		$1 109,24
$1 168,42
$1 231,11
$1 453,83 		$1 444,64
$1 503,82
$1 566,51
$1 789,23 		$335,40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$876,88
$995,24
$1 120,62
$1 566,06
$2 379,78 		$1 212,28
$1 330,64
$1 456,02
$1 901,46 		$1 547,68
$1 666,04
$1 791,42
$2 236,86 		$1 883,08
$2 001,44
$2 126,82
$2 572,26 		$335,40
Toc - Plan #30 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$440,20
$499,62
$562,57
$786,19
$1 194,69 		$776,95
$836,37
$899,32
$1 122,94 		$1 113,70
$1 173,12
$1 236,07
$1 459,69 		$1 450,45
$1 509,87
$1 572,82
$1 796,44 		$336,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$880,40
$999,24
$1 125,14
$1 572,38
$2 389,38 		$1 217,15
$1 335,99
$1 461,89
$1 909,13 		$1 553,90
$1 672,74
$1 798,64
$2 245,88 		$1 890,65
$2 009,49
$2 135,39
$2 582,63 		$336,75
Toc - Plan #31 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$458,37
$520,24
$585,78
$818,63
$1 243,99 		$809,01
$870,88
$936,42
$1 169,27 		$1 159,65
$1 221,52
$1 287,06
$1 519,91 		$1 510,29
$1 572,16
$1 637,70
$1 870,55 		$350,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$916,74
$1 040,48
$1 171,56
$1 637,26
$2 487,98 		$1 267,38
$1 391,12
$1 522,20
$1 987,90 		$1 618,02
$1 741,76
$1 872,84
$2 338,54 		$1 968,66
$2 092,40
$2 223,48
$2 689,18 		$350,64
Toc - Plan #32 Ambetter of Tennessee
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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 		$458,70
$520,62
$586,21
$819,23
$1 244,90 		$809,60
$871,52
$937,11
$1 170,13 		$1 160,50
$1 222,42
$1 288,01
$1 521,03 		$1 511,40
$1 573,32
$1 638,91
$1 871,93 		$350,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$917,40
$1 041,24
$1 172,42
$1 638,46
$2 489,80 		$1 268,30
$1 392,14
$1 523,32
$1 989,36 		$1 619,20
$1 743,04
$1 874,22
$2 340,26 		$1 970,10
$2 093,94
$2 225,12
$2 691,16 		$350,90

‡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 Perry County here.

Perry County is in “Rating Area 8” of Tennessee.

Currently, there are 32 plans offered in Rating Area 8.

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2021 Obamacare Plans for Perry County, TN

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