Anthem Silver Pathway 4000 Plan Details for 2021- HealthPocket

Anthem Silver Pathway 4000

$424.88/mo

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Zip Code53215
Applicant10/27/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Silver Pathway 4000
Plan IDhhs-79475WI0340106
Plan Year2021
Insurance ProviderAnthem BCBS
Metal LevelSilver
Plan TypeHMO
Deductible$4,000
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$45 Copay
Specialist Visit$75 Copay
Laboratory Outpatient and Professional Services20.00% Coinsurance after deductible
X-rays and Diagnostic Imaging20.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$500 Copay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family$8000 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$55 Copay
Non-Preferred Brand Drugs40.00% Coinsurance after deductible
Specialty Drugs40.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=WI
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?No - TRAD/PAR network
Does this plan cover services outside the country?No - Urgent/Emergency Coverage Only

Hospital services

Emergency Room Services$500 Copay after deductible, 20.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$750 Copay per Stay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service20.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care20.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care$750 Copay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services20.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services$750 Copay per Stay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services20.00% Coinsurance after deductible
Substance use disorder inpatient services$750 Copay per Stay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Medical Management Programs

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

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

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

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
Hospice Services
Chiropractic Care
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Radiation
Reconstructive Surgery
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
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Dental Check-Up for Children
Accidental Dental
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Private-Duty Nursing
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Allergy Testing
Nutritional Counseling
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $291Select Bronze 4000 Ded/8500 MOOP$4,000.00Select
from $335Bronze 4000 Ded/8500 MOOP$4,000.00Select
from $409Select Silver Simple Choice 4550X Ded/7900 MOOP$4,000.00Select
from $480Silver Simple Choice 4550X Ded/7900 MOOP$4,000.00Select
from $489Medica Individual Choice Silver Copay$3,900.00Select
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  • Phone Number
    (414) 672-1353
  • Office Locations
    2906 S 20th St
    Milwaukee, WI 53215
2906 S 20th St Milwaukee WI, 53215
  • 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.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.