Obamacare 2021 Rates for Camp County

Obamacare > Rates > Texas > Camp 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 Camp County, TX.

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 Camp County, Texas

Below, you’ll find a summary of the 43 plans for Camp County, Texas 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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Ambetter from Superior HealthPlan

Local: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989

Toc - Plan #1 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 11 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$378,59
$429,69
$483,83
$676,15
$1 027,47
$668,21
$719,31
$773,45
$965,77
$957,83
$1 008,93
$1 063,07
$1 255,39
$1 247,45
$1 298,55
$1 352,69
$1 545,01
$289,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757,18
$859,38
$967,66
$1 352,30
$2 054,94
$1 046,80
$1 149,00
$1 257,28
$1 641,92
$1 336,42
$1 438,62
$1 546,90
$1 931,54
$1 626,04
$1 728,24
$1 836,52
$2 221,16
$289,62
Toc - Plan #2 Ambetter from Superior HealthPlan
Bronze

(EPO) Ambetter Essential Care 1 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$318,74
$361,76
$407,33
$569,25
$865,03
$562,57
$605,59
$651,16
$813,08
$806,40
$849,42
$894,99
$1 056,91
$1 050,23
$1 093,25
$1 138,82
$1 300,74
$243,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$637,48
$723,52
$814,66
$1 138,50
$1 730,06
$881,31
$967,35
$1 058,49
$1 382,33
$1 125,14
$1 211,18
$1 302,32
$1 626,16
$1 368,97
$1 455,01
$1 546,15
$1 869,99
$243,83
Toc - Plan #3 Ambetter from Superior HealthPlan
Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$330,36
$374,95
$422,19
$590,01
$896,57
$583,08
$627,67
$674,91
$842,73
$835,80
$880,39
$927,63
$1 095,45
$1 088,52
$1 133,11
$1 180,35
$1 348,17
$252,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$660,72
$749,90
$844,38
$1 180,02
$1 793,14
$913,44
$1 002,62
$1 097,10
$1 432,74
$1 166,16
$1 255,34
$1 349,82
$1 685,46
$1 418,88
$1 508,06
$1 602,54
$1 938,18
$252,72
Toc - Plan #4 Ambetter from Superior HealthPlan
Gold

(EPO) Ambetter Secure Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$504,09
$572,13
$644,22
$900,29
$1 368,08
$889,71
$957,75
$1 029,84
$1 285,91
$1 275,33
$1 343,37
$1 415,46
$1 671,53
$1 660,95
$1 728,99
$1 801,08
$2 057,15
$385,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 008,18
$1 144,26
$1 288,44
$1 800,58
$2 736,16
$1 393,80
$1 529,88
$1 674,06
$2 186,20
$1 779,42
$1 915,50
$2 059,68
$2 571,82
$2 165,04
$2 301,12
$2 445,30
$2 957,44
$385,62
Toc - Plan #5 Ambetter from Superior HealthPlan
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$344,52
$391,02
$440,28
$615,29
$935,00
$608,07
$654,57
$703,83
$878,84
$871,62
$918,12
$967,38
$1 142,39
$1 135,17
$1 181,67
$1 230,93
$1 405,94
$263,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$689,04
$782,04
$880,56
$1 230,58
$1 870,00
$952,59
$1 045,59
$1 144,11
$1 494,13
$1 216,14
$1 309,14
$1 407,66
$1 757,68
$1 479,69
$1 572,69
$1 671,21
$2 021,23
$263,55
Toc - Plan #6 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,350 $14,700 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
$377,57
$428,53
$482,52
$674,32
$1 024,70
$666,40
$717,36
$771,35
$963,15
$955,23
$1 006,19
$1 060,18
$1 251,98
$1 244,06
$1 295,02
$1 349,01
$1 540,81
$288,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755,14
$857,06
$965,04
$1 348,64
$2 049,40
$1 043,97
$1 145,89
$1 253,87
$1 637,47
$1 332,80
$1 434,72
$1 542,70
$1 926,30
$1 621,63
$1 723,55
$1 831,53
$2 215,13
$288,83
Toc - Plan #7 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 12 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$370,79
$420,84
$473,86
$662,22
$1 006,31
$654,44
$704,49
$757,51
$945,87
$938,09
$988,14
$1 041,16
$1 229,52
$1 221,74
$1 271,79
$1 324,81
$1 513,17
$283,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$741,58
$841,68
$947,72
$1 324,44
$2 012,62
$1 025,23
$1 125,33
$1 231,37
$1 608,09
$1 308,88
$1 408,98
$1 515,02
$1 891,74
$1 592,53
$1 692,63
$1 798,67
$2 175,39
$283,65
Toc - Plan #8 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 29 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$367,54
$417,14
$469,70
$656,40
$997,47
$648,70
$698,30
$750,86
$937,56
$929,86
$979,46
$1 032,02
$1 218,72
$1 211,02
$1 260,62
$1 313,18
$1 499,88
$281,16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735,08
$834,28
$939,40
$1 312,80
$1 994,94
$1 016,24
$1 115,44
$1 220,56
$1 593,96
$1 297,40
$1 396,60
$1 501,72
$1 875,12
$1 578,56
$1 677,76
$1 782,88
$2 156,28
$281,16
Toc - Plan #9 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 25 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$382,87
$434,55
$489,30
$683,79
$1 039,08
$675,76
$727,44
$782,19
$976,68
$968,65
$1 020,33
$1 075,08
$1 269,57
$1 261,54
$1 313,22
$1 367,97
$1 562,46
$292,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$765,74
$869,10
$978,60
$1 367,58
$2 078,16
$1 058,63
$1 161,99
$1 271,49
$1 660,47
$1 351,52
$1 454,88
$1 564,38
$1 953,36
$1 644,41
$1 747,77
$1 857,27
$2 246,25
$292,89
Toc - Plan #10 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 27 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$404,68
$459,30
$517,16
$722,73
$1 098,26
$714,25
$768,87
$826,73
$1 032,30
$1 023,82
$1 078,44
$1 136,30
$1 341,87
$1 333,39
$1 388,01
$1 445,87
$1 651,44
$309,57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$809,36
$918,60
$1 034,32
$1 445,46
$2 196,52
$1 118,93
$1 228,17
$1 343,89
$1 755,03
$1 428,50
$1 537,74
$1 653,46
$2 064,60
$1 738,07
$1 847,31
$1 963,03
$2 374,17
$309,57
Toc - Plan #11 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 28 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$407,97
$463,03
$521,37
$728,62
$1 107,20
$720,06
$775,12
$833,46
$1 040,71
$1 032,15
$1 087,21
$1 145,55
$1 352,80
$1 344,24
$1 399,30
$1 457,64
$1 664,89
$312,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$815,94
$926,06
$1 042,74
$1 457,24
$2 214,40
$1 128,03
$1 238,15
$1 354,83
$1 769,33
$1 440,12
$1 550,24
$1 666,92
$2 081,42
$1 752,21
$1 862,33
$1 979,01
$2 393,51
$312,09
Toc - Plan #12 Ambetter from Superior HealthPlan
Gold

(EPO) Ambetter Secure Care 15 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$1,150 $2,300 Annual Deductible
$4,450 $8,900 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
$514,88
$584,38
$658,01
$919,56
$1 397,36
$908,76
$978,26
$1 051,89
$1 313,44
$1 302,64
$1 372,14
$1 445,77
$1 707,32
$1 696,52
$1 766,02
$1 839,65
$2 101,20
$393,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 029,76
$1 168,76
$1 316,02
$1 839,12
$2 794,72
$1 423,64
$1 562,64
$1 709,90
$2 233,00
$1 817,52
$1 956,52
$2 103,78
$2 626,88
$2 211,40
$2 350,40
$2 497,66
$3 020,76
$393,88
Toc - Plan #13 Ambetter from Superior HealthPlan
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$509,88
$578,70
$651,61
$910,63
$1 383,79
$899,93
$968,75
$1 041,66
$1 300,68
$1 289,98
$1 358,80
$1 431,71
$1 690,73
$1 680,03
$1 748,85
$1 821,76
$2 080,78
$390,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 019,76
$1 157,40
$1 303,22
$1 821,26
$2 767,58
$1 409,81
$1 547,45
$1 693,27
$2 211,31
$1 799,86
$1 937,50
$2 083,32
$2 601,36
$2 189,91
$2 327,55
$2 473,37
$2 991,41
$390,05
Toc - Plan #14 Ambetter from Superior HealthPlan
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$322,40
$365,91
$412,01
$575,78
$874,96
$569,03
$612,54
$658,64
$822,41
$815,66
$859,17
$905,27
$1 069,04
$1 062,29
$1 105,80
$1 151,90
$1 315,67
$246,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$644,80
$731,82
$824,02
$1 151,56
$1 749,92
$891,43
$978,45
$1 070,65
$1 398,19
$1 138,06
$1 225,08
$1 317,28
$1 644,82
$1 384,69
$1 471,71
$1 563,91
$1 891,45
$246,63
Toc - Plan #15 Ambetter from Superior HealthPlan
Expanded Bronze

(EPO) Ambetter Essential Care 10 (2021) + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$334,15
$379,25
$427,04
$596,78
$906,87
$589,77
$634,87
$682,66
$852,40
$845,39
$890,49
$938,28
$1 108,02
$1 101,01
$1 146,11
$1 193,90
$1 363,64
$255,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$668,30
$758,50
$854,08
$1 193,56
$1 813,74
$923,92
$1 014,12
$1 109,70
$1 449,18
$1 179,54
$1 269,74
$1 365,32
$1 704,80
$1 435,16
$1 525,36
$1 620,94
$1 960,42
$255,62
Toc - Plan #16 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$382,94
$434,62
$489,38
$683,91
$1 039,27
$675,88
$727,56
$782,32
$976,85
$968,82
$1 020,50
$1 075,26
$1 269,79
$1 261,76
$1 313,44
$1 368,20
$1 562,73
$292,94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$765,88
$869,24
$978,76
$1 367,82
$2 078,54
$1 058,82
$1 162,18
$1 271,70
$1 660,76
$1 351,76
$1 455,12
$1 564,64
$1 953,70
$1 644,70
$1 748,06
$1 857,58
$2 246,64
$292,94
Toc - Plan #17 Ambetter from Superior HealthPlan
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$348,47
$395,51
$445,34
$622,36
$945,73
$615,05
$662,09
$711,92
$888,94
$881,63
$928,67
$978,50
$1 155,52
$1 148,21
$1 195,25
$1 245,08
$1 422,10
$266,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$696,94
$791,02
$890,68
$1 244,72
$1 891,46
$963,52
$1 057,60
$1 157,26
$1 511,30
$1 230,10
$1 324,18
$1 423,84
$1 777,88
$1 496,68
$1 590,76
$1 690,42
$2 044,46
$266,58
Toc - Plan #18 Ambetter from Superior HealthPlan
Silver

(EPO) Ambetter Balanced Care 5 (2021) + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,350 $14,700 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
$381,90
$433,45
$488,06
$682,06
$1 036,46
$674,05
$725,60
$780,21
$974,21
$966,20
$1 017,75
$1 072,36
$1 266,36
$1 258,35
$1 309,90
$1 364,51
$1 558,51
$292,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$763,80
$866,90
$976,12
$1 364,12
$2 072,92
$1 055,95
$1 159,05
$1 268,27
$1 656,27
$1 348,10
$1 451,20
$1 560,42
$1 948,42
$1 640,25
$1 743,35
$1 852,57
$2 240,57
$292,15
Toc - Plan #19 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$375,05
$425,67
$479,30
$669,82
$1 017,86
$661,96
$712,58
$766,21
$956,73
$948,87
$999,49
$1 053,12
$1 243,64
$1 235,78
$1 286,40
$1 340,03
$1 530,55
$286,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$750,10
$851,34
$958,60
$1 339,64
$2 035,72
$1 037,01
$1 138,25
$1 245,51
$1 626,55
$1 323,92
$1 425,16
$1 532,42
$1 913,46
$1 610,83
$1 712,07
$1 819,33
$2 200,37
$286,91
Toc - Plan #20 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$387,27
$439,54
$494,91
$691,64
$1 051,01
$683,52
$735,79
$791,16
$987,89
$979,77
$1 032,04
$1 087,41
$1 284,14
$1 276,02
$1 328,29
$1 383,66
$1 580,39
$296,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774,54
$879,08
$989,82
$1 383,28
$2 102,02
$1 070,79
$1 175,33
$1 286,07
$1 679,53
$1 367,04
$1 471,58
$1 582,32
$1 975,78
$1 663,29
$1 767,83
$1 878,57
$2 272,03
$296,25
Toc - Plan #21 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$409,32
$464,57
$523,10
$731,03
$1 110,87
$722,44
$777,69
$836,22
$1 044,15
$1 035,56
$1 090,81
$1 149,34
$1 357,27
$1 348,68
$1 403,93
$1 462,46
$1 670,39
$313,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$818,64
$929,14
$1 046,20
$1 462,06
$2 221,74
$1 131,76
$1 242,26
$1 359,32
$1 775,18
$1 444,88
$1 555,38
$1 672,44
$2 088,30
$1 758,00
$1 868,50
$1 985,56
$2 401,42
$313,12
Toc - Plan #22 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$412,65
$468,35
$527,36
$736,98
$1 119,92
$728,32
$784,02
$843,03
$1 052,65
$1 043,99
$1 099,69
$1 158,70
$1 368,32
$1 359,66
$1 415,36
$1 474,37
$1 683,99
$315,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825,30
$936,70
$1 054,72
$1 473,96
$2 239,84
$1 140,97
$1 252,37
$1 370,39
$1 789,63
$1 456,64
$1 568,04
$1 686,06
$2 105,30
$1 772,31
$1 883,71
$2 001,73
$2 420,97
$315,67
Toc - Plan #23 Ambetter from Superior HealthPlan
Gold

(EPO) Ambetter Secure Care 15 (2021) + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$1,150 $2,300 Annual Deductible
$4,450 $8,900 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
$520,79
$591,09
$665,56
$930,12
$1 413,40
$919,19
$989,49
$1 063,96
$1 328,52
$1 317,59
$1 387,89
$1 462,36
$1 726,92
$1 715,99
$1 786,29
$1 860,76
$2 125,32
$398,40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 041,58
$1 182,18
$1 331,12
$1 860,24
$2 826,80
$1 439,98
$1 580,58
$1 729,52
$2 258,64
$1 838,38
$1 978,98
$2 127,92
$2 657,04
$2 236,78
$2 377,38
$2 526,32
$3 055,44
$398,40
Toc - Plan #24 Ambetter from Superior HealthPlan
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$528,16
$599,45
$674,97
$943,27
$1 433,39
$932,19
$1 003,48
$1 079,00
$1 347,30
$1 336,22
$1 407,51
$1 483,03
$1 751,33
$1 740,25
$1 811,54
$1 887,06
$2 155,36
$404,03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 056,32
$1 198,90
$1 349,94
$1 886,54
$2 866,78
$1 460,35
$1 602,93
$1 753,97
$2 290,57
$1 864,38
$2 006,96
$2 158,00
$2 694,60
$2 268,41
$2 410,99
$2 562,03
$3 098,63
$404,03
Toc - Plan #25 Ambetter from Superior HealthPlan
Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$333,95
$379,03
$426,78
$596,42
$906,32
$589,42
$634,50
$682,25
$851,89
$844,89
$889,97
$937,72
$1 107,36
$1 100,36
$1 145,44
$1 193,19
$1 362,83
$255,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$667,90
$758,06
$853,56
$1 192,84
$1 812,64
$923,37
$1 013,53
$1 109,03
$1 448,31
$1 178,84
$1 269,00
$1 364,50
$1 703,78
$1 434,31
$1 524,47
$1 619,97
$1 959,25
$255,47
Toc - Plan #26 Ambetter from Superior HealthPlan
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346,13
$392,85
$442,34
$618,17
$939,37
$610,91
$657,63
$707,12
$882,95
$875,69
$922,41
$971,90
$1 147,73
$1 140,47
$1 187,19
$1 236,68
$1 412,51
$264,78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692,26
$785,70
$884,68
$1 236,34
$1 878,74
$957,04
$1 050,48
$1 149,46
$1 501,12
$1 221,82
$1 315,26
$1 414,24
$1 765,90
$1 486,60
$1 580,04
$1 679,02
$2 030,68
$264,78
Toc - Plan #27 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$396,66
$450,20
$506,92
$708,43
$1 076,52
$700,10
$753,64
$810,36
$1 011,87
$1 003,54
$1 057,08
$1 113,80
$1 315,31
$1 306,98
$1 360,52
$1 417,24
$1 618,75
$303,44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$793,32
$900,40
$1 013,84
$1 416,86
$2 153,04
$1 096,76
$1 203,84
$1 317,28
$1 720,30
$1 400,20
$1 507,28
$1 620,72
$2 023,74
$1 703,64
$1 810,72
$1 924,16
$2 327,18
$303,44
Toc - Plan #28 Ambetter from Superior HealthPlan
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$360,97
$409,68
$461,30
$644,67
$979,63
$637,10
$685,81
$737,43
$920,80
$913,23
$961,94
$1 013,56
$1 196,93
$1 189,36
$1 238,07
$1 289,69
$1 473,06
$276,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721,94
$819,36
$922,60
$1 289,34
$1 959,26
$998,07
$1 095,49
$1 198,73
$1 565,47
$1 274,20
$1 371,62
$1 474,86
$1 841,60
$1 550,33
$1 647,75
$1 750,99
$2 117,73
$276,13
Toc - Plan #29 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$7,350 $14,700 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
$395,59
$448,99
$505,56
$706,51
$1 073,61
$698,21
$751,61
$808,18
$1 009,13
$1 000,83
$1 054,23
$1 110,80
$1 311,75
$1 303,45
$1 356,85
$1 413,42
$1 614,37
$302,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791,18
$897,98
$1 011,12
$1 413,02
$2 147,22
$1 093,80
$1 200,60
$1 313,74
$1 715,64
$1 396,42
$1 503,22
$1 616,36
$2 018,26
$1 699,04
$1 805,84
$1 918,98
$2 320,88
$302,62
Toc - Plan #30 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$388,49
$440,93
$496,48
$693,83
$1 054,34
$685,68
$738,12
$793,67
$991,02
$982,87
$1 035,31
$1 090,86
$1 288,21
$1 280,06
$1 332,50
$1 388,05
$1 585,40
$297,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$776,98
$881,86
$992,96
$1 387,66
$2 108,68
$1 074,17
$1 179,05
$1 290,15
$1 684,85
$1 371,36
$1 476,24
$1 587,34
$1 982,04
$1 668,55
$1 773,43
$1 884,53
$2 279,23
$297,19
Toc - Plan #31 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$401,15
$455,29
$512,65
$716,43
$1 088,69
$708,02
$762,16
$819,52
$1 023,30
$1 014,89
$1 069,03
$1 126,39
$1 330,17
$1 321,76
$1 375,90
$1 433,26
$1 637,04
$306,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$802,30
$910,58
$1 025,30
$1 432,86
$2 177,38
$1 109,17
$1 217,45
$1 332,17
$1 739,73
$1 416,04
$1 524,32
$1 639,04
$2 046,60
$1 722,91
$1 831,19
$1 945,91
$2 353,47
$306,87
Toc - Plan #32 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$423,99
$481,22
$541,85
$757,24
$1 150,69
$748,34
$805,57
$866,20
$1 081,59
$1 072,69
$1 129,92
$1 190,55
$1 405,94
$1 397,04
$1 454,27
$1 514,90
$1 730,29
$324,35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$847,98
$962,44
$1 083,70
$1 514,48
$2 301,38
$1 172,33
$1 286,79
$1 408,05
$1 838,83
$1 496,68
$1 611,14
$1 732,40
$2 163,18
$1 821,03
$1 935,49
$2 056,75
$2 487,53
$324,35
Toc - Plan #33 Ambetter from Superior HealthPlan
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

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
$427,45
$485,14
$546,26
$763,40
$1 160,06
$754,44
$812,13
$873,25
$1 090,39
$1 081,43
$1 139,12
$1 200,24
$1 417,38
$1 408,42
$1 466,11
$1 527,23
$1 744,37
$326,99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$854,90
$970,28
$1 092,52
$1 526,80
$2 320,12
$1 181,89
$1 297,27
$1 419,51
$1 853,79
$1 508,88
$1 624,26
$1 746,50
$2 180,78
$1 835,87
$1 951,25
$2 073,49
$2 507,77
$326,99
Toc - Plan #34 Ambetter from Superior HealthPlan
Gold

(EPO) Ambetter Secure Care 15 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses:

Individual Family
$1,150 $2,300 Annual Deductible
$4,450 $8,900 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
$539,46
$612,28
$689,42
$963,46
$1 464,07
$952,14
$1 024,96
$1 102,10
$1 376,14
$1 364,82
$1 437,64
$1 514,78
$1 788,82
$1 777,50
$1 850,32
$1 927,46
$2 201,50
$412,68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 078,92
$1 224,56
$1 378,84
$1 926,92
$2 928,14
$1 491,60
$1 637,24
$1 791,52
$2 339,60
$1 904,28
$2 049,92
$2 204,20
$2 752,28
$2 316,96
$2 462,60
$2 616,88
$3 164,96
$412,68

ADVERTISEMENT

Blue Cross and Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683 | TTY: 1-800-735-2989

Toc - Plan #35 Blue Cross and Blue Shield of Texas
Gold

(HMO) Blue Advantage Gold HMO_ 206

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$750 $2,250 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
$396,26
$449,75
$506,41
$707,71
$1 075,44
$699,40
$752,89
$809,55
$1 010,85
$1 002,54
$1 056,03
$1 112,69
$1 313,99
$1 305,68
$1 359,17
$1 415,83
$1 617,13
$303,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$792,52
$899,50
$1 012,82
$1 415,42
$2 150,88
$1 095,66
$1 202,64
$1 315,96
$1 718,56
$1 398,80
$1 505,78
$1 619,10
$2 021,70
$1 701,94
$1 808,92
$1 922,24
$2 324,84
$303,14
Toc - Plan #36 Blue Cross and Blue Shield of Texas
Catastrophic

(HMO) Blue Advantage Security HMO_ 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

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
$270,03
$306,49
$345,10
$482,28
$732,87
$476,61
$513,07
$551,68
$688,86
$683,19
$719,65
$758,26
$895,44
$889,77
$926,23
$964,84
$1 102,02
$206,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$540,06
$612,98
$690,20
$964,56
$1 465,74
$746,64
$819,56
$896,78
$1 171,14
$953,22
$1 026,14
$1 103,36
$1 377,72
$1 159,80
$1 232,72
$1 309,94
$1 584,30
$206,58
Toc - Plan #37 Blue Cross and Blue Shield of Texas
Silver

(HMO) Blue Advantage Silver HMO_ 205

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$1,900 $5,700 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
$395,27
$448,63
$505,15
$705,94
$1 072,75
$697,65
$751,01
$807,53
$1 008,32
$1 000,03
$1 053,39
$1 109,91
$1 310,70
$1 302,41
$1 355,77
$1 412,29
$1 613,08
$302,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790,54
$897,26
$1 010,30
$1 411,88
$2 145,50
$1 092,92
$1 199,64
$1 312,68
$1 714,26
$1 395,30
$1 502,02
$1 615,06
$2 016,64
$1 697,68
$1 804,40
$1 917,44
$2 319,02
$302,38
Toc - Plan #38 Blue Cross and Blue Shield of Texas
Expanded Bronze

(HMO) Blue Advantage Bronze HMO_ 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$6,000 $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
$297,45
$337,60
$380,14
$531,24
$807,27
$525,00
$565,15
$607,69
$758,79
$752,55
$792,70
$835,24
$986,34
$980,10
$1 020,25
$1 062,79
$1 213,89
$227,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$594,90
$675,20
$760,28
$1 062,48
$1 614,54
$822,45
$902,75
$987,83
$1 290,03
$1 050,00
$1 130,30
$1 215,38
$1 517,58
$1 277,55
$1 357,85
$1 442,93
$1 745,13
$227,55
Toc - Plan #39 Blue Cross and Blue Shield of Texas
Bronze

(HMO) Blue Advantage Bronze HMO_ 301

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

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
$294,66
$334,44
$376,58
$526,27
$799,71
$520,08
$559,86
$602,00
$751,69
$745,50
$785,28
$827,42
$977,11
$970,92
$1 010,70
$1 052,84
$1 202,53
$225,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$589,32
$668,88
$753,16
$1 052,54
$1 599,42
$814,74
$894,30
$978,58
$1 277,96
$1 040,16
$1 119,72
$1 204,00
$1 503,38
$1 265,58
$1 345,14
$1 429,42
$1 728,80
$225,42
Toc - Plan #40 Blue Cross and Blue Shield of Texas
Gold

(HMO) Blue Advantage Plus Gold_ 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$750 $2,250 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
$438,55
$497,76
$560,47
$783,26
$1 190,24
$774,04
$833,25
$895,96
$1 118,75
$1 109,53
$1 168,74
$1 231,45
$1 454,24
$1 445,02
$1 504,23
$1 566,94
$1 789,73
$335,49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$877,10
$995,52
$1 120,94
$1 566,52
$2 380,48
$1 212,59
$1 331,01
$1 456,43
$1 902,01
$1 548,08
$1 666,50
$1 791,92
$2 237,50
$1 883,57
$2 001,99
$2 127,41
$2 572,99
$335,49
Toc - Plan #41 Blue Cross and Blue Shield of Texas
Silver

(HMO) Blue Advantage Plus Silver_ 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$1,250 $3,750 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
$435,03
$493,76
$555,97
$776,97
$1 180,68
$767,83
$826,56
$888,77
$1 109,77
$1 100,63
$1 159,36
$1 221,57
$1 442,57
$1 433,43
$1 492,16
$1 554,37
$1 775,37
$332,80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$870,06
$987,52
$1 111,94
$1 553,94
$2 361,36
$1 202,86
$1 320,32
$1 444,74
$1 886,74
$1 535,66
$1 653,12
$1 777,54
$2 219,54
$1 868,46
$1 985,92
$2 110,34
$2 552,34
$332,80
Toc - Plan #42 Blue Cross and Blue Shield of Texas
Expanded Bronze

(HMO) Blue Advantage Plus Bronze_ 303

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$4,900 $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
$329,35
$373,82
$420,92
$588,23
$893,87
$581,31
$625,78
$672,88
$840,19
$833,27
$877,74
$924,84
$1 092,15
$1 085,23
$1 129,70
$1 176,80
$1 344,11
$251,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658,70
$747,64
$841,84
$1 176,46
$1 787,74
$910,66
$999,60
$1 093,80
$1 428,42
$1 162,62
$1 251,56
$1 345,76
$1 680,38
$1 414,58
$1 503,52
$1 597,72
$1 932,34
$251,96
Toc - Plan #43 Blue Cross and Blue Shield of Texas
Bronze

(HMO) Blue Advantage Plus Bronze_ 305

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses:

Individual Family
$5,000 $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
$307,39
$348,89
$392,84
$549,00
$834,25
$542,54
$584,04
$627,99
$784,15
$777,69
$819,19
$863,14
$1 019,30
$1 012,84
$1 054,34
$1 098,29
$1 254,45
$235,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$614,78
$697,78
$785,68
$1 098,00
$1 668,50
$849,93
$932,93
$1 020,83
$1 333,15
$1 085,08
$1 168,08
$1 255,98
$1 568,30
$1 320,23
$1 403,23
$1 491,13
$1 803,45
$235,15

‡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 Camp County here.

Camp County is in “Rating Area 26” of Texas.

Currently, there are 43 plans offered in Rating Area 26.

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2021 Obamacare Plans for Camp County, TX

Plan Browser: 43 Plans
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