2018 Gold 1500 Plan Details - HealthPocket

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Zip Code63129
Applicant8/20/1983 Male
Coverage Start8/22/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameGold 1500
Plan IDhhs-96384MO0140004
Insurance ProviderCox HealthPlans
Metal LevelGold
Plan TypePPO
Deductible$1,500
Out-of-Pocket Maximum$6,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay
Specialist Visit$50 Copay
Laboratory Outpatient and Professional Services10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging10.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans10.00% Coinsurance after deductible
Deductible - Family$3000 per group
Out-of-Pocket Maximum - Family$12000 per group

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$45 Copay
Non-Preferred Brand Drugs$75 Copay
Specialty Drugs$100 Copay

Access to doctors and hospitals

Provider directory URLhttps://www.coxhealthplans.com/members-providers
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Out-Of-Network
Does this plan cover services outside the country?Yes - Out-Of-Network

Hospital services

Emergency Room Services$200 Copay
Inpatient Hospital Services (e.g., Hospital Stay)10.00% Coinsurance after deductible
Inpatient Physician and Surgical Services10.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service10.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care10.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care10.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services10.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services10.00% Coinsurance after deductible
Substance use disorder outpatient services10.00% Coinsurance after deductible
Substance use disorder inpatient services10.00% Coinsurance after deductible

Medical Management Programs

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
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
Accidental Dental
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
More Limited BenefitsSkilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold 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 Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold 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 your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold 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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