Anthem - Anthem Bronze Pathway X HMO 5000

Kentucky, 2017

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $5,000

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) $5,000
Deductible (Family) $10,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $50 Copay before deductible + 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible + 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible + 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 $50 Copay before deductible + 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay before deductible + 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 40% Coinsurance after deductible
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Kentucky

Plan Anthem Bronze Pathway X PPO 6100 Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,100
Plan Anthem Bronze Pathway X PPO 0 for HSA Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Anthem Bronze Pathway X PPO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X HMO 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $5,850
Plan Anthem Gold Pathway X HMO 1450 Deductible $1,450 Coinsurance Not applicable Out of Pocket $4,100
Plan Anthem Silver Pathway X PPO for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $4,300
Plan Anthem Silver Pathway X PPO 2000 Deductible $2,000 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 PPO 4900 Deductible $4,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,750
Plan Anthem Silver Pathway X PPO 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $5,700
Plan Anthem Catastrophic Pathway X PPO 7150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
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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) $5,000
Deductible (Family) $10,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $50 Copay before deductible + 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible + 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible + 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 $50 Copay before deductible + 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay before deductible + 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx 40% Coinsurance after deductible
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Kentucky

Plan Anthem Bronze Pathway X PPO 6100 Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan Deductible $3,750 Coinsurance Not applicable Out of Pocket $6,100
Plan Anthem Bronze Pathway X PPO 0 for HSA Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Anthem Bronze Pathway X PPO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X HMO 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $5,850
Plan Anthem Gold Pathway X HMO 1450 Deductible $1,450 Coinsurance Not applicable Out of Pocket $4,100
Plan Anthem Silver Pathway X PPO for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $4,300
Plan Anthem Silver Pathway X PPO 2000 Deductible $2,000 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 PPO 4900 Deductible $4,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,750
Plan Anthem Silver Pathway X PPO 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $5,700
Plan Anthem Catastrophic Pathway X PPO 7150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150