Insurance Type | ACA (Obamacare) |
Plan Name | HealthyBlueHMO Gold $1,750 |
Plan ID | hhs-28137MD0370003 |
Plan Year | 2019 |
Insurance Provider | CareFirst BlueCross BlueShield |
Metal Level | Gold |
Plan Type | HMO |
Deductible | $1,750 |
Out-of-Pocket Maximum | $6,650 |
Personal Score | |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | No Charge |
Specialist Visit | $30 Copay |
Laboratory Outpatient and Professional Services | $15 Copay |
X-rays and Diagnostic Imaging | $65 Copay |
Diagnostic Imaging such as MRIs, CT, and PET scans | $250 Copay |
Deductible - Family | $3500 per group |
Out-of-Pocket Maximum - Family | $13300 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | Not Applicable |
Preferred Brand Drugs | $50 Copay after deductible |
Non-Preferred Brand Drugs | $70 Copay after deductible |
Specialty Drugs | $100 Copay after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | https://member.carefirst.com/mos/#/fappublic/search/standard?sType=M&planName=BlueChoice%20HMO |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Not Covered |
Does this plan cover services outside plan service area? | Yes - Emergency Services Only |
Does this plan cover services outside the country? | Yes - Emergency Services Only |
Hospital services | |
---|---|
Emergency Room Services | $300 Copay after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | $450 Copay per Day after deductible |
Inpatient Physician and Surgical Services | $30 Copay after deductible |
Emergency Transportation or Ambulance Service | $30 Copay after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | Not Applicable |
Delivery and all inpatient services for maternity care | $450 Copay after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | Not Applicable |
Mental/Behavioral Health Inpatient Services | $450 Copay per Day after deductible |
Substance use disorder outpatient services | Not Applicable |
Substance use disorder inpatient services | $450 Copay per Day after deductible |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
Does this plan offer a wellness program? | Included |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Included |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Included |
Child Dental Coverage - Basic Dental Care | Included |
Child Dental Coverage - Orthodontia | Included |
Child Dental Coverage - Major Dental Care | Included |
Adult Dental Coverage | |
---|---|
Adult Dental Coverage - Routine Dental Care | Not Covered |
Adult Dental Coverage - Basic Dental Care | Not Covered |
Adult Dental Coverage - Orthodontia | Not Covered |
Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Acupuncture Bariatric Surgery Infertility Treatment Weight Loss Programs Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Durable Medical Equipment Hospice Services Abortion for Which Public Funding is Prohibited Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care |
More Limited Benefits | Skilled Nursing Facility Hearing Aids Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Cosmetic Surgery Long-Term/Custodial Nursing Home Care Private-Duty Nursing Routine Foot Care |
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.
The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.