Ambetter Ambetter Silver 5 + Vision + Adult Dental (Mississippi)

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Company Ambetter from Magnolia Health Plan
Plan Year 2014
State Mississippi
Metal Tier Silver
Plan Type HMO
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Cost Sharing Benefits (In Network)

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.

Deductible (Individual) $3,000
Deductible (Family) $6,000
Coinsurance Data Not Available
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $50
Specialist Visit $75
In Patient Hospital Services $1000 Copay per Day
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-ray and Diagnostic Imaging Data Not Available

Other

Mental / Behavioral Health Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

Prescription Drugs

Generic Rx $10
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs $250 Copay 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

Deductible (Individual) $3,000.00
Deductible (Family) $6,000.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Primary Care Physician $20
Specialists $30
Emergency Room $150 Copay after deductible
Inpatient Facility $1000 Copay per Day
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx $50 Copay after deductible
Specialty Drugs $250 Copay 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) $500.00
Deductible (Family) $1,000.00
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 $10
Specialists $20
Emergency Room $100 Copay after deductible
Inpatient Facility $250 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx $40 Copay after deductible
Specialty Drugs $250 Copay after deductible

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) $2,250.0
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $5
Specialists $10
Emergency Room $100 Copay after deductible
Inpatient Facility $100 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx $40 Copay after deductible
Specialty Drugs $100 Copay after deductible

Other Plans

Other plans that are available in the state.

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