Anthem Bronze Pathway 4950

Individual Health Insurance (Obamacare)

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Anthem Bronze Pathway 4950

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Monthly Cost

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Benefits & Coverage

Plan Name
Anthem Bronze Pathway 4950
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
50.00% Coinsurance after deductible
Specialist Visit
50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
50.00% Coinsurance after deductible
Deductible - Family
$9900 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
50.00% Coinsurance after deductible
Preferred Brand Drugs
50.00% Coinsurance after deductible
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://www.anthem.com/health-insurance/provider-directory/searchcriteria
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?
Yes - BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only
Does this plan cover services outside the country?
No - Urgent/Emergency Coverage Only

Hospital services

Emergency Room Services
$500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)
$1500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
50.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care
$1500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services
50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
$1500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services
50.00% Coinsurance after deductible
Substance use disorder inpatient services
$1500 Copay per Stay after deductible, 50.00% 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 Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Not Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Included
Child Dental Coverage - Basic Dental Care
Included
Child Dental Coverage - Orthodontia
Included
Child Dental Coverage - Major Dental Care
Included

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
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Applied Behavior Analysis Based Therapies
Dental Anesthesia
Inherited Metabolic Disorder - PKU
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
Bone Marrow Testing
Clinical Trials
Newborn Services Other
More Limited Benefits
Skilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded Benefits
Acupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

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Bronze plan frequently asked questions (FAQ)

  • What is a bronze plan?

    Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.

  • How are Bronze 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 Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.

  • How much does a Bronze Plan cost?

    The monthly premium for a Bronze 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 Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.

  • When Can I Enroll in a Bronze Plan?

    The annual enrollment period for the 2016 plan year will begin on November 1, 2015 and continue through January 31, 2016.

    In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2016. See our Open Enrollment article for more information.

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