Coventry Silver $15 Copay PPO Plan MO

Plan Information
Company Coventry Health Care
State MO
Metal Tier Silver
Plan Type PPO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $3,750 Data Not Available
Deductible (Family) $7,500 Data Not Available
Coinsurance Data Not Available Data Not Available
Out of Pocket Maximum (Individual) $6,350 Data Not Available
Out of Pocket Maximum (Family) $12,700 Data Not Available
Services In Network Out of Network
Primary Care Visit $15 Data Not Available
Specialist Visit $75 Data Not Available
In Patient Hospital Services $500 Copay per Stay and 30% Coin Data Not Available
Emergency Room Services $500 Data Not Available
Mental / Behavioral Health Data Not Available Data Not Available
Imaging (CT/PET Scans, MRIs) Data Not Available Data Not Available
Rehabilitative Speech Therapy Data Not Available Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available Data Not Available
Preventative Care Data Not Available Data Not Available
Laboratory Outpatient and Professional Services Data Not Available Data Not Available
X-ray and Diagnostic Imaging Data Not Available Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $15
Preferred Brand Rx $45 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $3,750.00
Deductible (Family) $7,500.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $75
Emergency Room $500
Inpatient Facility $500 Copay per Stay and 30% Coin
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $15.00
Preferred Brand Rx $45 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,750.00
Deductible (Family) $3,500.00
Out of Pocket Maximum (Individual) $2,250.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $50
Emergency Room $100
Inpatient Facility No Charge after deductible
Inpatient Physician No Charge after Deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $35
Non Preferred Brand Rx $75
Specialty Drugs 30%

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $0.00
Deductible (Family) $0.00
Out of Pocket Maximum (Individual) $1,500.0
Out of Pocket Maximum (Family) $3,000.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $25
Emergency Room $100
Inpatient Facility 10%
Inpatient Physician 10%
Prescription Drugs In Network Out of Network
Generic Rx $5.00
Preferred Brand Rx $30
Non Preferred Brand Rx $55
Specialty Drugs 20%

Other Plans

Other plans that are available in the state.

Plan Name
Bronze $10 Copay PPO Exchange
Bronze $15 Copay PPO KC Exchange
Bronze Deductible Only HSA Eligible PPO Exchange
Bronze Deductible Only HSA Eligible PPO KC Exchange
Catastrophic 100% PPO Exchange
Catastrophic 100% PPO KC Exchange
Gold $0 Copay PPO KC Exchange
Gold $5 Copay PPO Exchange
Silver $10 Copay PPO Exchange
Silver $10 Copay PPO KC Exchange
Silver Integrated $10 Copay PPO Exchange
Silver Integrated $10 Copay PPO KC Exchange
Bronze $10 Copay PPO Carelink from Coventry
Bronze $15 Copay PPO Plan
Bronze Deductible Only PPO HSA Eligible Carelink fromCoventry
Bronze Deductible Only PPO HSA Eligible Plan
Catastrophic 100% PPO Carelink from Coventry
Catastrophic 100% PPO Plan
Gold $10 Copay PPO Plan
Gold $5 Copay PPO Carelink from Coventry
Silver $10 Copay PPO Carelink from Coventry
Silver $15 Copay PPO Plan
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.