Celtic - Ambetter Balanced Care 12 (2017)

Indiana, 2017

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $3,500

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

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) $3,500
Deductible (Family) $7,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $400 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility 20% Coinsurance after deductible
Outpatient Surgery 20% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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
Deductible (Family) $6,000
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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

Deductible (Individual) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $2,000
Out of Pocket Maximum (Family) $4,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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

Deductible (Individual) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $1,250
Out of Pocket Maximum (Family) $2,500

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $100 Copay after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Indiana

Plan Ambetter Balanced Care 10 (2017) + Vision + Adult Dental Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Essential Care 1 (2017) + Vision Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Essential Care 1 (2017) Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Balanced Care 2 (2017) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 10 (2017) + Vision Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Essential Care 1 (2017) + Vision + Adult Dental Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Balanced Care 2 (2017) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2017) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 10 (2017) Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2017) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Balanced Care 1 (2017) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2017) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
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Cost Sharing Benefits (In Network)

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) $3,500
Deductible (Family) $7,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $400 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility 20% Coinsurance after deductible
Outpatient Surgery 20% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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
Deductible (Family) $6,000
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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

Deductible (Individual) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $2,000
Out of Pocket Maximum (Family) $4,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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

Deductible (Individual) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $1,250
Out of Pocket Maximum (Family) $2,500

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $100 Copay after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Indiana

Plan Ambetter Balanced Care 10 (2017) + Vision + Adult Dental Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Essential Care 1 (2017) + Vision Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Essential Care 1 (2017) Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Balanced Care 2 (2017) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 10 (2017) + Vision Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Essential Care 1 (2017) + Vision + Adult Dental Deductible $6,800 Coinsurance Not applicable Out of Pocket $6,800
Plan Ambetter Balanced Care 2 (2017) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2017) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 10 (2017) Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2017) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Balanced Care 1 (2017) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2017) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500