Gold 80 HMO Coinsurance

Individual Health Insurance (Obamacare)

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Gold 80 HMO Coinsurance

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Monthly Cost



Benefits & Coverage

Plan Name
Gold 80 HMO Coinsurance
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
$25 Copay
Specialist Visit
$55 Copay
Laboratory Outpatient and Professional Services
$35 Copay
X-rays and Diagnostic Imaging
$55 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
20.00% Coinsurance
Deductible - Family
$0 per group
Out-of-Pocket Maximum - Family
$12000 per group

Prescription drug coverage

Generic Drugs
$15 Copay
Preferred Brand Drugs
$55 Copay
Non-Preferred Brand Drugs
$55 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 - All
Does this plan cover services outside plan service area?
Not Covered
Does this plan cover services outside the country?
Not Covered

Hospital services

Emergency Room Services
$325 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
20.00% Coinsurance
Inpatient Physician and Surgical Services
20.00% Coinsurance
Emergency Transportation or Ambulance Service
$250 Copay


Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
20.00% Coinsurance

Mental Health

Mental/Behavioral Health Outpatient Services
$25 Copay
Mental/Behavioral Health Inpatient Services
20.00% Coinsurance
Substance use disorder outpatient services
$25 Copay
Substance use disorder inpatient services
20.00% Coinsurance

Medical Management Programs

Does this plan offer a wellness program?
Not Covered

Vision Coverage

Routine Eye Exam for Children
Eye Glasses for Children
Routine Eye Exam for Adults
Not Covered

Child Dental Coverage

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

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
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
Dental Check-Up for Children
Routine Foot Care
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Second Opinion
Abortion for Which Public Funding is Prohibited
Allergy Testing
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Clinical Trials
Coverage for Effects of Diethylstilbestrol
Off Label Prescription Drugs
Organ Transplants
Prescription Drugs Other
Mastectomy-Related Coverage
Delivery and all Inpatient Services Professional Fee
Emergency Room Physician Fee
Mental/Behavioral Health Inpatient Professional Fee
Outpatient Services Office Visit
Substance Use Disorder Inpatient Professional Fee
Deliveray and all Inpatient Services Professional Fee
Emergency Room Professional Fees
More Limited Benefits
Skilled Nursing Facility
Home Health Care Services
More Excluded Benefits
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Chiropractic Care
Non-Emergency Care When Traveling Outside the U.S.
Accidental Dental
Nutritional Counseling

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is not eligible for a tax credit subsidy

Physician Directory

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Gold plan frequently asked questions (FAQ)

  • 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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