Insurance Type | ACA (Obamacare) |
Plan Name | Ambetter Balanced Care 203 (2021) |
Plan ID | hhs-21663FL0170004 |
Plan Year | 2021 |
Insurance Provider | Ambetter |
Metal Level | Silver |
Plan Type | EPO |
Deductible | $6,450 |
Out-of-Pocket Maximum | $8,200 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $15 Copay |
Specialist Visit | 35.00% Coinsurance after deductible |
Laboratory Outpatient and Professional Services | $35 Copay |
X-rays and Diagnostic Imaging | 35.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 35.00% Coinsurance after deductible |
Deductible - Family | $12900 per group |
Out-of-Pocket Maximum - Family | $16400 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $35 Copay |
Preferred Brand Drugs | $75 Copay |
Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
Specialty Drugs | 50.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | https://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 Services | 35.00% Coinsurance after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | 35.00% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 35.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 35.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | $15 Copay |
Delivery and all inpatient services for maternity care | 35.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | 25.00% Coinsurance |
Mental/Behavioral Health Inpatient Services | 35.00% Coinsurance after deductible |
Substance use disorder outpatient services | 25.00% Coinsurance |
Substance use disorder inpatient services | 35.00% Coinsurance after deductible |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Diabetes, Heart Disease, Pregnancy |
Does this plan offer a wellness program? | Not Covered |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Not Covered |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
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 Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Habilitation Services Durable Medical Equipment Hospice Services Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Well Baby Visits and Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Mental/Behavioral Health Emergency Room Mental/Behavioral Health Emergency Transportation/Ambulance Mental/Behavioral Health ER Physician Fee Mental/Behavioral Health Outpatient Other Services Mental/Behavioral Health Urgent Care Substance Use Disorder Emergency Room Substance Use Disorder Emergency Transportation/Ambulance Substance Use Disorder ER Physician Fee Substance Use Disorder Outpatient Other Services Substance Use Disorder Urgent Care Telehealth and Virtual Care |
More Limited Benefits | Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Treatment for Temporomandibular Joint Disorders |
More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Infertility Treatment Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Infusion Therapy Long-Term/Custodial Nursing Home Care |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $337 | Ambetter Balanced Care 203 (2021) + Vision + Adult Dental | $6,450.00 | Select |
from $354 | Gym Access IND Bronze HMO HSA 5065 | $6,300.00 | Select |
from $361 | UHC Bronze-X Value+ Saver ($5 Rx + 3 Free Primary Care & 6 Free Virtual Visits) | $6,350.00 | Select |
from $371 | UHC Bronze-X Value+ ($3 Rx + 6 Free Virtual Visits) | $6,500.00 | Select |
from $377 | Engage LB600-IN21 | $6,500.00 | Select |
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.
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.
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.
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.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.
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