Obamacare 2021 Rates for Buffalo County

Obamacare > Rates > Wisconsin > Buffalo 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 Buffalo County, WI.

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, 38 Plans and 2021 Rates for Buffalo County, Wisconsin

Below, you’ll find a summary of the 38 plans for Buffalo County, Wisconsin 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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Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973
Toc - Plan #1 Quartz
Silver

(HMO) Quartz One Silver I302 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$451,72
$512,70
$577,29
$806,76
$1 225,96 		$797,28
$858,26
$922,85
$1 152,32 		$1 142,84
$1 203,82
$1 268,41
$1 497,88 		$1 488,40
$1 549,38
$1 613,97
$1 843,44 		$345,56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$903,44
$1 025,40
$1 154,58
$1 613,52
$2 451,92 		$1 249,00
$1 370,96
$1 500,14
$1 959,08 		$1 594,56
$1 716,52
$1 845,70
$2 304,64 		$1 940,12
$2 062,08
$2 191,26
$2 650,20 		$345,56
Toc - Plan #2 Quartz
Silver

(HMO) Quartz One Silver I303 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$434,96
$493,68
$555,87
$776,83
$1 180,47 		$767,70
$826,42
$888,61
$1 109,57 		$1 100,44
$1 159,16
$1 221,35
$1 442,31 		$1 433,18
$1 491,90
$1 554,09
$1 775,05 		$332,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$869,92
$987,36
$1 111,74
$1 553,66
$2 360,94 		$1 202,66
$1 320,10
$1 444,48
$1 886,40 		$1 535,40
$1 652,84
$1 777,22
$2 219,14 		$1 868,14
$1 985,58
$2 109,96
$2 551,88 		$332,74
Toc - Plan #3 Quartz
Gold

(HMO) Quartz One Gold I402 Maintenance with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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 		$399,37
$453,28
$510,39
$713,27
$1 083,88 		$704,88
$758,79
$815,90
$1 018,78 		$1 010,39
$1 064,30
$1 121,41
$1 324,29 		$1 315,90
$1 369,81
$1 426,92
$1 629,80 		$305,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$798,74
$906,56
$1 020,78
$1 426,54
$2 167,76 		$1 104,25
$1 212,07
$1 326,29
$1 732,05 		$1 409,76
$1 517,58
$1 631,80
$2 037,56 		$1 715,27
$1 823,09
$1 937,31
$2 343,07 		$305,51
Toc - Plan #4 Quartz
Gold

(HMO) Quartz One Gold I401 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$403,97
$458,50
$516,27
$721,48
$1 096,36 		$713,00
$767,53
$825,30
$1 030,51 		$1 022,03
$1 076,56
$1 134,33
$1 339,54 		$1 331,06
$1 385,59
$1 443,36
$1 648,57 		$309,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$807,94
$917,00
$1 032,54
$1 442,96
$2 192,72 		$1 116,97
$1 226,03
$1 341,57
$1 751,99 		$1 426,00
$1 535,06
$1 650,60
$2 061,02 		$1 735,03
$1 844,09
$1 959,63
$2 370,05 		$309,03
Toc - Plan #5 Quartz
Silver

(HMO) Quartz One Silver I301 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,400 $8,800 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 		$450,89
$511,76
$576,24
$805,29
$1 223,71 		$795,82
$856,69
$921,17
$1 150,22 		$1 140,75
$1 201,62
$1 266,10
$1 495,15 		$1 485,68
$1 546,55
$1 611,03
$1 840,08 		$344,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$901,78
$1 023,52
$1 152,48
$1 610,58
$2 447,42 		$1 246,71
$1 368,45
$1 497,41
$1 955,51 		$1 591,64
$1 713,38
$1 842,34
$2 300,44 		$1 936,57
$2 058,31
$2 187,27
$2 645,37 		$344,93
Toc - Plan #6 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 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 		$311,58
$353,64
$398,20
$556,48
$845,62 		$549,94
$592,00
$636,56
$794,84 		$788,30
$830,36
$874,92
$1 033,20 		$1 026,66
$1 068,72
$1 113,28
$1 271,56 		$238,36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$623,16
$707,28
$796,40
$1 112,96
$1 691,24 		$861,52
$945,64
$1 034,76
$1 351,32 		$1 099,88
$1 184,00
$1 273,12
$1 589,68 		$1 338,24
$1 422,36
$1 511,48
$1 828,04 		$238,36
Toc - Plan #7 Quartz
Gold

(HMO) Quartz One Gold I405 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$399,91
$453,90
$511,08
$714,24
$1 085,35 		$705,84
$759,83
$817,01
$1 020,17 		$1 011,77
$1 065,76
$1 122,94
$1 326,10 		$1 317,70
$1 371,69
$1 428,87
$1 632,03 		$305,93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$799,82
$907,80
$1 022,16
$1 428,48
$2 170,70 		$1 105,75
$1 213,73
$1 328,09
$1 734,41 		$1 411,68
$1 519,66
$1 634,02
$2 040,34 		$1 717,61
$1 825,59
$1 939,95
$2 346,27 		$305,93
Toc - Plan #8 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$312,69
$354,90
$399,62
$558,46
$848,64 		$551,90
$594,11
$638,83
$797,67 		$791,11
$833,32
$878,04
$1 036,88 		$1 030,32
$1 072,53
$1 117,25
$1 276,09 		$239,21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$625,38
$709,80
$799,24
$1 116,92
$1 697,28 		$864,59
$949,01
$1 038,45
$1 356,13 		$1 103,80
$1 188,22
$1 277,66
$1 595,34 		$1 343,01
$1 427,43
$1 516,87
$1 834,55 		$239,21
Toc - Plan #9 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,450 $4,900 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 		$325,54
$369,49
$416,04
$581,41
$883,51 		$574,58
$618,53
$665,08
$830,45 		$823,62
$867,57
$914,12
$1 079,49 		$1 072,66
$1 116,61
$1 163,16
$1 328,53 		$249,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$651,08
$738,98
$832,08
$1 162,82
$1 767,02 		$900,12
$988,02
$1 081,12
$1 411,86 		$1 149,16
$1 237,06
$1 330,16
$1 660,90 		$1 398,20
$1 486,10
$1 579,20
$1 909,94 		$249,04
Toc - Plan #10 Quartz
Silver

(HMO) Quartz One Silver I302

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$434,07
$492,66
$554,73
$775,23
$1 178,04 		$766,13
$824,72
$886,79
$1 107,29 		$1 098,19
$1 156,78
$1 218,85
$1 439,35 		$1 430,25
$1 488,84
$1 550,91
$1 771,41 		$332,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$868,14
$985,32
$1 109,46
$1 550,46
$2 356,08 		$1 200,20
$1 317,38
$1 441,52
$1 882,52 		$1 532,26
$1 649,44
$1 773,58
$2 214,58 		$1 864,32
$1 981,50
$2 105,64
$2 546,64 		$332,06
Toc - Plan #11 Quartz
Silver

(HMO) Quartz One Silver I303

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$417,96
$474,38
$534,15
$746,47
$1 134,33 		$737,70
$794,12
$853,89
$1 066,21 		$1 057,44
$1 113,86
$1 173,63
$1 385,95 		$1 377,18
$1 433,60
$1 493,37
$1 705,69 		$319,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$835,92
$948,76
$1 068,30
$1 492,94
$2 268,66 		$1 155,66
$1 268,50
$1 388,04
$1 812,68 		$1 475,40
$1 588,24
$1 707,78
$2 132,42 		$1 795,14
$1 907,98
$2 027,52
$2 452,16 		$319,74
Toc - Plan #12 Quartz
Gold

(HMO) Quartz One Gold I402 Maintenance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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 		$383,76
$435,56
$490,44
$685,39
$1 041,52 		$677,33
$729,13
$784,01
$978,96 		$970,90
$1 022,70
$1 077,58
$1 272,53 		$1 264,47
$1 316,27
$1 371,15
$1 566,10 		$293,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767,52
$871,12
$980,88
$1 370,78
$2 083,04 		$1 061,09
$1 164,69
$1 274,45
$1 664,35 		$1 354,66
$1 458,26
$1 568,02
$1 957,92 		$1 648,23
$1 751,83
$1 861,59
$2 251,49 		$293,57
Toc - Plan #13 Quartz
Gold

(HMO) Quartz One Gold I401

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$388,18
$440,58
$496,09
$693,29
$1 053,51 		$685,14
$737,54
$793,05
$990,25 		$982,10
$1 034,50
$1 090,01
$1 287,21 		$1 279,06
$1 331,46
$1 386,97
$1 584,17 		$296,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$776,36
$881,16
$992,18
$1 386,58
$2 107,02 		$1 073,32
$1 178,12
$1 289,14
$1 683,54 		$1 370,28
$1 475,08
$1 586,10
$1 980,50 		$1 667,24
$1 772,04
$1 883,06
$2 277,46 		$296,96
Toc - Plan #14 Quartz
Silver

(HMO) Quartz One Silver I301

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,400 $8,800 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 		$433,27
$491,76
$553,71
$773,81
$1 175,88 		$764,72
$823,21
$885,16
$1 105,26 		$1 096,17
$1 154,66
$1 216,61
$1 436,71 		$1 427,62
$1 486,11
$1 548,06
$1 768,16 		$331,45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$866,54
$983,52
$1 107,42
$1 547,62
$2 351,76 		$1 197,99
$1 314,97
$1 438,87
$1 879,07 		$1 529,44
$1 646,42
$1 770,32
$2 210,52 		$1 860,89
$1 977,87
$2 101,77
$2 541,97 		$331,45
Toc - Plan #15 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 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 		$299,40
$339,82
$382,63
$534,73
$812,57 		$528,44
$568,86
$611,67
$763,77 		$757,48
$797,90
$840,71
$992,81 		$986,52
$1 026,94
$1 069,75
$1 221,85 		$229,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$598,80
$679,64
$765,26
$1 069,46
$1 625,14 		$827,84
$908,68
$994,30
$1 298,50 		$1 056,88
$1 137,72
$1 223,34
$1 527,54 		$1 285,92
$1 366,76
$1 452,38
$1 756,58 		$229,04
Toc - Plan #16 Quartz
Gold

(HMO) Quartz One Gold I405

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$384,28
$436,16
$491,11
$686,32
$1 042,93 		$678,25
$730,13
$785,08
$980,29 		$972,22
$1 024,10
$1 079,05
$1 274,26 		$1 266,19
$1 318,07
$1 373,02
$1 568,23 		$293,97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768,56
$872,32
$982,22
$1 372,64
$2 085,86 		$1 062,53
$1 166,29
$1 276,19
$1 666,61 		$1 356,50
$1 460,26
$1 570,16
$1 960,58 		$1 650,47
$1 754,23
$1 864,13
$2 254,55 		$293,97
Toc - Plan #17 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$300,47
$341,03
$384,00
$536,64
$815,47 		$530,33
$570,89
$613,86
$766,50 		$760,19
$800,75
$843,72
$996,36 		$990,05
$1 030,61
$1 073,58
$1 226,22 		$229,86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600,94
$682,06
$768,00
$1 073,28
$1 630,94 		$830,80
$911,92
$997,86
$1 303,14 		$1 060,66
$1 141,78
$1 227,72
$1 533,00 		$1 290,52
$1 371,64
$1 457,58
$1 762,86 		$229,86
Toc - Plan #18 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,450 $4,900 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 		$312,82
$355,04
$399,78
$558,69
$848,98 		$552,12
$594,34
$639,08
$797,99 		$791,42
$833,64
$878,38
$1 037,29 		$1 030,72
$1 072,94
$1 117,68
$1 276,59 		$239,30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$625,64
$710,08
$799,56
$1 117,38
$1 697,96 		$864,94
$949,38
$1 038,86
$1 356,68 		$1 104,24
$1 188,68
$1 278,16
$1 595,98 		$1 343,54
$1 427,98
$1 517,46
$1 835,28 		$239,30
Toc - Plan #19 Quartz
Gold

(HMO) Quartz One Gold I404 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,650 $13,300 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 		$404,58
$459,20
$517,05
$722,58
$1 098,03 		$714,08
$768,70
$826,55
$1 032,08 		$1 023,58
$1 078,20
$1 136,05
$1 341,58 		$1 333,08
$1 387,70
$1 445,55
$1 651,08 		$309,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$809,16
$918,40
$1 034,10
$1 445,16
$2 196,06 		$1 118,66
$1 227,90
$1 343,60
$1 754,66 		$1 428,16
$1 537,40
$1 653,10
$2 064,16 		$1 737,66
$1 846,90
$1 962,60
$2 373,66 		$309,50
Toc - Plan #20 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I203 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$307,76
$349,30
$393,31
$549,65
$835,25 		$543,19
$584,73
$628,74
$785,08 		$778,62
$820,16
$864,17
$1 020,51 		$1 014,05
$1 055,59
$1 099,60
$1 255,94 		$235,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$615,52
$698,60
$786,62
$1 099,30
$1 670,50 		$850,95
$934,03
$1 022,05
$1 334,73 		$1 086,38
$1 169,46
$1 257,48
$1 570,16 		$1 321,81
$1 404,89
$1 492,91
$1 805,59 		$235,43
Toc - Plan #21 Quartz
Catastrophic

(HMO) Quartz One Catastrophic I101

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$224,12
$254,38
$286,42
$400,28
$608,26 		$395,57
$425,83
$457,87
$571,73 		$567,02
$597,28
$629,32
$743,18 		$738,47
$768,73
$800,77
$914,63 		$171,45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$448,24
$508,76
$572,84
$800,56
$1 216,52 		$619,69
$680,21
$744,29
$972,01 		$791,14
$851,66
$915,74
$1 143,46 		$962,59
$1 023,11
$1 087,19
$1 314,91 		$171,45
Toc - Plan #22 Quartz
Silver

(HMO) Quartz One Silver I304 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,250 $10,500 Annual Deductible
$5,250 $10,500 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 		$447,73
$508,17
$572,20
$799,64
$1 215,14 		$790,24
$850,68
$914,71
$1 142,15 		$1 132,75
$1 193,19
$1 257,22
$1 484,66 		$1 475,26
$1 535,70
$1 599,73
$1 827,17 		$342,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$895,46
$1 016,34
$1 144,40
$1 599,28
$2 430,28 		$1 237,97
$1 358,85
$1 486,91
$1 941,79 		$1 580,48
$1 701,36
$1 829,42
$2 284,30 		$1 922,99
$2 043,87
$2 171,93
$2 626,81 		$342,51
Toc - Plan #23 Quartz
Gold

(HMO) Quartz One Gold I403 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$410,54
$465,95
$524,66
$733,21
$1 114,19 		$724,60
$780,01
$838,72
$1 047,27 		$1 038,66
$1 094,07
$1 152,78
$1 361,33 		$1 352,72
$1 408,13
$1 466,84
$1 675,39 		$314,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821,08
$931,90
$1 049,32
$1 466,42
$2 228,38 		$1 135,14
$1 245,96
$1 363,38
$1 780,48 		$1 449,20
$1 560,02
$1 677,44
$2 094,54 		$1 763,26
$1 874,08
$1 991,50
$2 408,60 		$314,06

ADVERTISEMENT

Security Health Plan

Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232
Toc - Plan #24 Security Health Plan
Catastrophic

(EPO) Select Protection

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

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 		$240,24
$272,67
$307,02
$429,06
$652,00 		$424,02
$456,45
$490,80
$612,84 		$607,80
$640,23
$674,58
$796,62 		$791,58
$824,01
$858,36
$980,40 		$183,78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$480,48
$545,34
$614,04
$858,12
$1 304,00 		$664,26
$729,12
$797,82
$1 041,90 		$848,04
$912,90
$981,60
$1 225,68 		$1 031,82
$1 096,68
$1 165,38
$1 409,46 		$183,78
Toc - Plan #25 Security Health Plan
Bronze

(EPO) Select $8,550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

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 		$351,23
$398,63
$448,86
$627,28
$953,21 		$619,91
$667,31
$717,54
$895,96 		$888,59
$935,99
$986,22
$1 164,64 		$1 157,27
$1 204,67
$1 254,90
$1 433,32 		$268,68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$702,46
$797,26
$897,72
$1 254,56
$1 906,42 		$971,14
$1 065,94
$1 166,40
$1 523,24 		$1 239,82
$1 334,62
$1 435,08
$1 791,92 		$1 508,50
$1 603,30
$1 703,76
$2 060,60 		$268,68
Toc - Plan #26 Security Health Plan
Silver

(EPO) Select $6,950 - 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$6,950 $13,900 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 		$532,81
$604,73
$680,92
$951,58
$1 446,02 		$940,40
$1 012,32
$1 088,51
$1 359,17 		$1 347,99
$1 419,91
$1 496,10
$1 766,76 		$1 755,58
$1 827,50
$1 903,69
$2 174,35 		$407,59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 065,62
$1 209,46
$1 361,84
$1 903,16
$2 892,04 		$1 473,21
$1 617,05
$1 769,43
$2 310,75 		$1 880,80
$2 024,64
$2 177,02
$2 718,34 		$2 288,39
$2 432,23
$2 584,61
$3 125,93 		$407,59
Toc - Plan #27 Security Health Plan
Silver

(EPO) Select $4,500 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$558,10
$633,43
$713,24
$996,75
$1 514,65 		$985,04
$1 060,37
$1 140,18
$1 423,69 		$1 411,98
$1 487,31
$1 567,12
$1 850,63 		$1 838,92
$1 914,25
$1 994,06
$2 277,57 		$426,94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 116,20
$1 266,86
$1 426,48
$1 993,50
$3 029,30 		$1 543,14
$1 693,80
$1 853,42
$2 420,44 		$1 970,08
$2 120,74
$2 280,36
$2 847,38 		$2 397,02
$2 547,68
$2 707,30
$3 274,32 		$426,94
Toc - Plan #28 Security Health Plan
Bronze

(EPO) Select $7,500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

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 		$356,50
$404,61
$455,59
$636,69
$967,51 		$629,21
$677,32
$728,30
$909,40 		$901,92
$950,03
$1 001,01
$1 182,11 		$1 174,63
$1 222,74
$1 273,72
$1 454,82 		$272,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$713,00
$809,22
$911,18
$1 273,38
$1 935,02 		$985,71
$1 081,93
$1 183,89
$1 546,09 		$1 258,42
$1 354,64
$1 456,60
$1 818,80 		$1 531,13
$1 627,35
$1 729,31
$2 091,51 		$272,71
Toc - Plan #29 Security Health Plan
Silver

(EPO) Select $4,800 - 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$542,29
$615,49
$693,04
$968,52
$1 471,76 		$957,14
$1 030,34
$1 107,89
$1 383,37 		$1 371,99
$1 445,19
$1 522,74
$1 798,22 		$1 786,84
$1 860,04
$1 937,59
$2 213,07 		$414,85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 084,58
$1 230,98
$1 386,08
$1 937,04
$2 943,52 		$1 499,43
$1 645,83
$1 800,93
$2 351,89 		$1 914,28
$2 060,68
$2 215,78
$2 766,74 		$2 329,13
$2 475,53
$2 630,63
$3 181,59 		$414,85
Toc - Plan #30 Security Health Plan
Expanded Bronze

(EPO) Select $6,200 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$388,81
$441,29
$496,89
$694,40
$1 055,20 		$686,24
$738,72
$794,32
$991,83 		$983,67
$1 036,15
$1 091,75
$1 289,26 		$1 281,10
$1 333,58
$1 389,18
$1 586,69 		$297,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$777,62
$882,58
$993,78
$1 388,80
$2 110,40 		$1 075,05
$1 180,01
$1 291,21
$1 686,23 		$1 372,48
$1 477,44
$1 588,64
$1 983,66 		$1 669,91
$1 774,87
$1 886,07
$2 281,09 		$297,43
Toc - Plan #31 Security Health Plan
Gold

(EPO) Select $3,500 - 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$493,12
$559,68
$630,20
$880,70
$1 338,31 		$870,35
$936,91
$1 007,43
$1 257,93 		$1 247,58
$1 314,14
$1 384,66
$1 635,16 		$1 624,81
$1 691,37
$1 761,89
$2 012,39 		$377,23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$986,24
$1 119,36
$1 260,40
$1 761,40
$2 676,62 		$1 363,47
$1 496,59
$1 637,63
$2 138,63 		$1 740,70
$1 873,82
$2 014,86
$2 515,86 		$2 117,93
$2 251,05
$2 392,09
$2 893,09 		$377,23

ADVERTISEMENT

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-947-3529
Toc - Plan #32 Medica
Gold

(EPO) Engage by Medica Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,100 $3,300 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 		$549,97
$624,21
$702,85
$982,24
$1 492,60 		$970,69
$1 044,93
$1 123,57
$1 402,96 		$1 391,41
$1 465,65
$1 544,29
$1 823,68 		$1 812,13
$1 886,37
$1 965,01
$2 244,40 		$420,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 099,94
$1 248,42
$1 405,70
$1 964,48
$2 985,20 		$1 520,66
$1 669,14
$1 826,42
$2 385,20 		$1 941,38
$2 089,86
$2 247,14
$2 805,92 		$2 362,10
$2 510,58
$2 667,86
$3 226,64 		$420,72
Toc - Plan #33 Medica
Silver

(EPO) Engage by Medica Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$3,900 $11,700 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 		$549,53
$623,70
$702,28
$981,44
$1 491,39 		$969,91
$1 044,08
$1 122,66
$1 401,82 		$1 390,29
$1 464,46
$1 543,04
$1 822,20 		$1 810,67
$1 884,84
$1 963,42
$2 242,58 		$420,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 099,06
$1 247,40
$1 404,56
$1 962,88
$2 982,78 		$1 519,44
$1 667,78
$1 824,94
$2 383,26 		$1 939,82
$2 088,16
$2 245,32
$2 803,64 		$2 360,20
$2 508,54
$2 665,70
$3 224,02 		$420,38
Toc - Plan #34 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$391,85
$444,74
$500,78
$699,83
$1 063,46 		$691,61
$744,50
$800,54
$999,59 		$991,37
$1 044,26
$1 100,30
$1 299,35 		$1 291,13
$1 344,02
$1 400,06
$1 599,11 		$299,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$783,70
$889,48
$1 001,56
$1 399,66
$2 126,92 		$1 083,46
$1 189,24
$1 301,32
$1 699,42 		$1 383,22
$1 489,00
$1 601,08
$1 999,18 		$1 682,98
$1 788,76
$1 900,84
$2 298,94 		$299,76
Toc - Plan #35 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$426,78
$484,38
$545,41
$762,21
$1 158,26 		$753,26
$810,86
$871,89
$1 088,69 		$1 079,74
$1 137,34
$1 198,37
$1 415,17 		$1 406,22
$1 463,82
$1 524,85
$1 741,65 		$326,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$853,56
$968,76
$1 090,82
$1 524,42
$2 316,52 		$1 180,04
$1 295,24
$1 417,30
$1 850,90 		$1 506,52
$1 621,72
$1 743,78
$2 177,38 		$1 833,00
$1 948,20
$2 070,26
$2 503,86 		$326,48
Toc - Plan #36 Medica
Catastrophic

(EPO) Engage by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$246,94
$280,27
$315,58
$441,02
$670,18 		$435,84
$469,17
$504,48
$629,92 		$624,74
$658,07
$693,38
$818,82 		$813,64
$846,97
$882,28
$1 007,72 		$188,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$493,88
$560,54
$631,16
$882,04
$1 340,36 		$682,78
$749,44
$820,06
$1 070,94 		$871,68
$938,34
$1 008,96
$1 259,84 		$1 060,58
$1 127,24
$1 197,86
$1 448,74 		$188,90
Toc - Plan #37 Medica
Silver

(EPO) Engage by Medica Silver Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,400 $4,200 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 		$551,76
$626,24
$705,14
$985,43
$1 497,45 		$973,85
$1 048,33
$1 127,23
$1 407,52 		$1 395,94
$1 470,42
$1 549,32
$1 829,61 		$1 818,03
$1 892,51
$1 971,41
$2 251,70 		$422,09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 103,52
$1 252,48
$1 410,28
$1 970,86
$2 994,90 		$1 525,61
$1 674,57
$1 832,37
$2 392,95 		$1 947,70
$2 096,66
$2 254,46
$2 815,04 		$2 369,79
$2 518,75
$2 676,55
$3 237,13 		$422,09
Toc - Plan #38 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 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 		$397,88
$451,58
$508,48
$710,59
$1 079,82 		$702,25
$755,95
$812,85
$1 014,96 		$1 006,62
$1 060,32
$1 117,22
$1 319,33 		$1 310,99
$1 364,69
$1 421,59
$1 623,70 		$304,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795,76
$903,16
$1 016,96
$1 421,18
$2 159,64 		$1 100,13
$1 207,53
$1 321,33
$1 725,55 		$1 404,50
$1 511,90
$1 625,70
$2 029,92 		$1 708,87
$1 816,27
$1 930,07
$2 334,29 		$304,37

‡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 Buffalo County here.

Buffalo County is in “Rating Area 6” of Wisconsin.

Currently, there are 38 plans offered in Rating Area 6.

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