Ambetter Balanced Care 203 (2021) Plan Details for 2021- HealthPocket

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

+ See All Coverage Details

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 $377	Engage LB600-IN21	$6,500.00	Select
from $382	Gym Access IND Bronze POS HSA 5065	$6,300.00	Select
from $392	AvMed Entrust Bronze 600	$6,500.00	Select

Last Name

Location/Distance

Please select the correct zip

Sheldon, Cohen

Felix, Guzman

Janet, Gersten

Romeo E Rojas Md Pa

Delores Macksoud Md Pa

Susana, Echeverri

Cynthia, Hinkle

Sabrina, Castaneda

Life Line Medical Group Inc

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New Beginnings Medical And Rehabilitation Center Inc

Elizabeth, Deluque

Clarice, Crawford

Adriana, Garcia

Salutem Medical Group, Llc

Paola, Delgado

Vielka, Centeno

Junior, Rodriguez

Rasheeda, Abdullahi

Shaylene, Varela

Julio, Alvarez

Rene, Sanchez

Alexandra, Gonzalez

Dunia, Sardina

Lourdes, Frost-garrote

View All Details

Maria, Morales

View All Details

Sheldon Cohen, M.D.

View All Details

Phone Number
(305) 380-6773
Office Locations
9000 Sw 137th Ave
Miami, FL 33186

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.

Zip Code	33186 (edit)
Applicant	9/18/1986 Male (edit)

Zip Code	33186 (edit)
Applicant	9/18/1986 Male (edit)

Ambetter Balanced Care 203 (2021)

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

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What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

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Health Plans Found

Ambetter Balanced Care 203 (2021)

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

Related Articles

Related Searches

Silver plan frequently asked questions (FAQ)

What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

Apply For This Plan

Health Plans Found

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