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Applicant Info
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Zip Code	33186 (edit)
Applicant	2/16/1984 Male (edit)
Coverage Start	2/17/2019 (edit)

Insurance Type	ACA (Obamacare)
Plan Name	myBlue Gold 1605
Plan ID	hhs-30252FL0070009
Plan Year	2019
Insurance Provider	Blue Cross Blue Shield of Florida
Metal Level	Gold
Plan Type	HMO
Deductible	$940
Out-of-Pocket Maximum	$4,700
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$90 Copay
Specialist Visit	$120 Copay
Laboratory Outpatient and Professional Services	Not Applicable
X-rays and Diagnostic Imaging	20.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	20.00% Coinsurance after deductible
Deductible - Family	$1880 per group
Out-of-Pocket Maximum - Family	$9400 per group

Prescription drug coverage
Generic Drugs	$15 Copay
Preferred Brand Drugs	15.00% 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://providersearch.floridablue.com/providersearch/pub/index.htm
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Yes - All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.
Does this plan cover services outside plan service area?	Yes - Accident and emergency services.
Does this plan cover services outside the country?	Yes - Accident and emergency services.

Hospital services
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	20.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	$120 Copay
Delivery and all inpatient services for maternity care	20.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$60 Copay
Mental/Behavioral Health Inpatient Services	20.00% Coinsurance after deductible
Substance use disorder outpatient services	$60 Copay
Substance use disorder inpatient services	20.00% Coinsurance after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, 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 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 Dental Anesthesia Diabetes Care Management Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Bone Marrow Transplant Congenital Anomaly, including Cleft Lip/Palate Nutrition/Formulas Off Label Prescription Drugs Osteoporosis
More Limited Benefits	Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Abortion for Which Public Funding is Prohibited

+ See All Coverage Details

Premium

Plan Name

Deductible

from $1,111

BlueOptions Platinum 1418

$1,000.00

from $408

Ambetter Secure Care 3 (2019) with 3 Free PCP Visits

$1,000.00

from $422

myBlue Gold 1605

$940.00

from $483

Ambetter Secure Care 3 (2019) with 3 Free PCP Visits

$1,000.00

from $508

Gym Access IND Platinum HMO BC 5841

$800.00

Last Name

Location/Distance

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Sheldon Cohen, M.D.

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

9000 Sw 137th Ave Miami FL, 33186

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.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.