2019 OptimaFit Gold 1600 10% Direct M Plan Details - HealthPocket

OptimaFit Gold 1600 10% Direct M

$477.55/mo

Apply For This Plan

Zip Code23464
Applicant10/19/1984 Male
Coverage Start10/20/2019
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOptimaFit Gold 1600 10% Direct M
Plan IDqhp-20507VA1410015
Plan Year2019
Insurance ProviderOptima Health
Metal LevelGold
Plan TypeHMO
Deductible$1,600
Out-of-Pocket Maximum$7,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay
Specialist Visit$60 Copay
Laboratory Outpatient and Professional Services10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging10.00% Coinsurance after deductible
Deductible - Family$3200
Out-of-Pocket Maximum - Family$15800

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$55 Copay
Non-Preferred Brand Drugs35% Coinsurance after deductible
Specialty Drugs35% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)10% Coinsurance after deductible
Inpatient Physician and Surgical Services10% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care10.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services10.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services10.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNo Charge
Eye Glasses for ChildrenNo Charge

Exclusions and Limitations

More Included BenefitsTransplant
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
More Excluded BenefitsAbortion for Which Public Funding is Prohibited
Hearing Aids
Bariatric Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Cosmetic Surgery
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
PremiumPlan NameDeductible
from $1,115
HealthyBlue PPO Gold 1750
$1,750.00Select
from $1,391
Gold $5 Copay POS Plan-MOC
$1,750.00Select
from $208
Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan
$1,500.00Select
from $208
Anthem HealthKeepers Silver DirectAccess - cbky
$1,500.00Select
from $226
KP VA Silver 1500/30/Dental
$1,500.00Select
/
Please select the correct zip
Charles, Fayton
View All Details
Reynaldo, Francisco
View All Details
Francisco, Espada
View All Details
Maxine, Beatty
View All Details
Carrie, Williams
View All Details
Michael, Livoti
View All Details
Tamara, Tugung
View All Details
Taylor, Braegelman
View All Details
Atlantic Surgical Assistants, Inc
View All Details
Brenna, Fencil
View All Details
Allison, Taliaferro
View All Details
Amber, Scanlon
View All Details
Talya, Singleton
View All Details
Robyn, Toran
View All Details
Brittany, Wulfsberg
View All Details
Michael, Mascolo
View All Details
Donna, Gorman
View All Details
Theresa, Smith
View All Details
Morgan, Benson
View All Details
Jenna, Duncan
View All Details
Sherri, Hughes
View All Details
Charles Fayton, M.D.
View All Details
  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464
  • What is the Gold Plan?

    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.

  • How are Gold Plans different than other Obamacare health plans?

    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.

  • How much does a Gold Plan cost?

    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.

  • When Can I Enroll in a Gold Plan?

    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.

Read More

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

Close

Health Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).