Ambetter Balanced Care 11 (2020) Plan Details for 2020- HealthPocket

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Zip Code79936
Applicant1/25/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Balanced Care 11 (2020)
Plan IDqhp-29418TX0140020
Plan Year2020
Insurance ProviderCeltic Insurance Company
Metal LevelSilver
Plan TypeEPO
Deductible$6,000
Out-of-Pocket Maximum$8,100
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 ServicesNot Applicable
X-rays and Diagnostic Imaging40% Coinsurance after deductible
Deductible - Family$12000
Out-of-Pocket Maximum - Family$16200

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://ambetter.superiorhealthplan.com/findadoc

Hospital services

Emergency Room Services40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient Services40% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
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
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsLong-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $241
Oscar Saver Bronze
$6,000.00Select
from $274
Blue Advantage Bronze HMO℠ 204 - Two $40 PCP Visits
$6,000.00Select
from $279
CHP TX Bronze HSA - Two Free PCP Visits
$6,000.00Select
from $295
Saver Bronze (Free 24/7 Telemedicine + Free Preventive Care)
$6,000.00Select
from $308
Ambetter Balanced Care 11 (2020) + Adult Vision
$6,000.00Select
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  • Phone Number
    (915) 855-7900
  • Office Locations
    1418 George Dieter Dr
    El Paso, TX 79936
1418 George Dieter Dr El Paso TX, 79936
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver 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 the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver 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.

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).