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Anthem - Anthem Silver Pathway X 2500
Indiana, 2017
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$7,150
Deductible
$2,500
Emergency Room Care: $500 Copay after deductible + 10% Coinsurance after deductible
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) | $2,500 |
|---|---|
| Deductible (Family) | $5,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,150 |
| Out of Pocket Maximum (Family) | $14,300 |
Doctor Visits
| Primary Care Visit | $40 Copay before deductible + 10% Coinsurance after deductible |
|---|---|
| Specialist Visit | 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible + 10% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | $300 Copay after deductible + 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 10% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 10% 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 | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $500 Copay after deductible + 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 10% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 10% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 10% Coinsurance after deductible |
| Outpatient Facility | 10% Coinsurance after deductible |
| Outpatient Surgery | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% 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
| Deductible (Individual) | $2,500 |
|---|---|
| Deductible (Family) | $5,000 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | $30 Copay before deductible + 10% Coinsurance after deductible |
|---|---|
| Specialists | 10% Coinsurance after deductible |
| Emergency Room | $500 Copay after deductible + 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% 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
| Deductible (Individual) | $750 |
|---|---|
| Deductible (Family) | $1,500 |
| Out of Pocket Maximum (Individual) | $2,000 |
| Out of Pocket Maximum (Family) | $4,000 |
Doctor Visits
| Primary Care Physician | $25 Copay before deductible + 10% Coinsurance after deductible |
|---|---|
| Specialists | 10% Coinsurance after deductible |
| Emergency Room | $250 Copay after deductible + 10% Coinsurance after deductible |
| Inpatient Facility | $250 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance 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
| Deductible (Individual) | $200 |
|---|---|
| Deductible (Family) | $400 |
| Out of Pocket Maximum (Individual) | $750 |
| Out of Pocket Maximum (Family) | $1,500 |
Doctor Visits
| Primary Care Physician | $10 Copay before deductible + 10% Coinsurance after deductible |
|---|---|
| Specialists | 10% Coinsurance after deductible |
| Emergency Room | $150 Copay after deductible + 10% Coinsurance after deductible |
| Inpatient Facility | $150 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance after deductible |
Other Plans in Indiana
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Anthem Bronze Pathway X 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway X POS 5000 | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway X 5850 | Deductible $5,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Pathway X 3500 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $6,150 |
| Plan Anthem Bronze Pathway X 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Anthem Silver Pathway X for HSA | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $4,500 |
| Plan Anthem Bronze Pathway X 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Core Pathway X 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,600 |
| Plan Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Pathway X 4350 | Deductible $4,350 | Coinsurance Not applicable | Out of Pocket $5,700 |
| Plan Anthem Bronze Pathway X 4950 | Deductible $4,950 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Catastrophic Pathway X 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway X 20 for HSA | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Anthem Bronze Pathway X 6500 | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $7,150 |