Ambetter Essential Care 5 (2020) + Vision + Adult Dental Plan Details for 2021- HealthPocket

Ambetter Essential Care 5 (2020) + Vision + Adult Dental

$431.71/mo

Apply For This Plan

Zip Code63129
Applicant11/30/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Essential Care 5 (2020) + Vision + Adult Dental
Plan IDhhs-99723MO0110019
Plan Year2020
Insurance ProviderAmbetter
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$7,400
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist Visit$75 Copay
Laboratory Outpatient and Professional Services$35 Copay
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$14800 per group
Out-of-Pocket Maximum - Family$16300 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs50.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://providersearch.ambetterhealth.com/
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?Not Covered
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care$35 Copay
Delivery and all inpatient services for maternity care50.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$35 Copay
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Substance use disorder outpatient services$35 Copay
Substance use disorder inpatient services50.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareIncluded
Adult Dental Coverage - Basic Dental CareIncluded
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareIncluded

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
Eyeglasses for Adults
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $342
Select by Medica Bronze Copay $5 Preferred Primary Care
$7,500.00Select
from $521
Ambetter Balanced Care 124 (2021)
$7,450.00Select
from $523
Cox HealthPlans Silver Connect 5
$7,350.00Select
from $527
Cigna Connect 7300
$7,300.00Select
from $541
Ambetter Balanced Care 124 (2021) + Vision + Adult Dental
$7,450.00Select
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Stephen, Staten
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Wendi, Carns
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Steven, Lauter
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Amanda, Carter
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Brigid, Maltagliati
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Infectious Disease
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Elise, Finnerty
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Kristine, Binder
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Mary, Schaus
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Karla, Mckeirnan
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Danielle, Sellers
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Cory, Heslin
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Allison, Arehart
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Elizabeth, Miotti
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Laura, Flanigan
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Taylor, Barker
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Maureen, Moore
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Jaime, Mathieu
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Nick, Livasy
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Marina, Clements
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Jennifer, Marr
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Susan, Grogan
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Stephen Staten, MD
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  • Phone Number
    (314) 543-5996
  • Office Locations
    4438 Telegraph Rd
    Saint Louis, MO 63129
4438 Telegraph Rd Saint Louis MO, 63129

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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 Benefytt Technologies, Inc. family of companies.