HMSA Platinum HMO

Individual Health Insurance (Obamacare)

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HMSA Platinum HMO

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Monthly Cost



Benefits & Coverage

Plan Name
HMSA Platinum HMO
Plan Year
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$10 Copay
Specialist Visit
$20 Copay
Laboratory Outpatient and Professional Services
$10 Copay
X-rays and Diagnostic Imaging
$10 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$100 Copay
Deductible - Family
$0 per group
Out-of-Pocket Maximum - Family
$14300 per group

Prescription drug coverage

Generic Drugs
$7 Copay
Preferred Brand Drugs
$30 Copay
Non-Preferred Brand Drugs
$75 Copay
Specialty Drugs
20.00% Coinsurance

Access to doctors and hospitals

Provider directory URL
Does this plan have access to a national provider network?
Is a referral required to see a Specialist?
Yes - Refer to plan for details
Does this plan cover services outside plan service area?
Yes - Covered for certain services
Does this plan cover services outside the country?
Yes - Covered for certain services

Hospital services

Emergency Room Services
$250 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
$300 Copay per Day
Inpatient Physician and Surgical Services
10.00% Coinsurance
Emergency Transportation or Ambulance Service
10.00% Coinsurance


Prenatal and Postnatal Care
10.00% Coinsurance
Delivery and all inpatient services for maternity care
10.00% Coinsurance

Mental Health

Mental/Behavioral Health Outpatient Services
$10 Copay
Mental/Behavioral Health Inpatient Services
No Charge
Substance use disorder outpatient services
$10 Copay
Substance use disorder inpatient services
No Charge

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
Does this plan offer a wellness program?

Vision Coverage

Routine Eye Exam for Children
Eye Glasses for Children
Routine Eye Exam for Adults

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
Bariatric Surgery
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
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Non-Emergency Care When Traveling Outside the U.S.
Applied Behavior Analysis Based Therapies
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Well Baby Visits and Care
Autism Spectrum Disorders
Prescription Drugs Other
Gender Identity Serivces
Orthodontic Services for the Treatment of Orofacial Anomlies
More Limited Benefits
Skilled Nursing Facility
Infertility Treatment
Home Health Care Services
Chiropractic Care
More Excluded Benefits
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Treatment for Temporomandibular Joint Disorders

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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Similar Plans

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Platinum plan frequently asked questions (FAQ)

  • What is the Platinum Plan?

    ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. A Platinum Plan is designed to incur the lowest out-of-pocket expenses for enrollees. A typical platinum plan enrollee pays approximately 10% of the costs of covered healthcare services with the plan paying the remainder. In comparison, a typical Bronze Plan enrollee pays 40% of covered medical expenses.

  • How are Platinum 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 Platinum Plan pays 90% of covered medical costs for a typical enrollee while the other Obamacare health plans pay a lower percentage of these costs.

  • How much does a Platinum Plan cost?

    The monthly premium for a Platinum 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 Platinum Plan premiums in your area.

  • When Can I Enroll in a Platinum 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.

Read More



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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.

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