Anthem - Anthem Silver Pathway X PPO 2000

Kentucky, 2017

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $2,000

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) $2,000
Deductible (Family) $4,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $35 Copay before deductible + 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible + 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $300 Copay after deductible + 50% 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 Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $500 Copay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient $35 Copay before deductible + 20% Coinsurance after deductible
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy $35 Copay before deductible + 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 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) $1,700
Deductible (Family) $3,400
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician $35 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $200 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician $15 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $100 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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) $175
Deductible (Family) $350
Out of Pocket Maximum (Individual) $900
Out of Pocket Maximum (Family) $1,800

Doctor Visits

Primary Care Physician $10 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $75 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $150 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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 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 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 Bronze Pathway X HMO 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
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) $2,000
Deductible (Family) $4,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $35 Copay before deductible + 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible + 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $300 Copay after deductible + 50% 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 Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $500 Copay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient $35 Copay before deductible + 20% Coinsurance after deductible
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy $35 Copay before deductible + 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 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) $1,700
Deductible (Family) $3,400
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician $35 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $200 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician $15 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $100 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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) $175
Deductible (Family) $350
Out of Pocket Maximum (Individual) $900
Out of Pocket Maximum (Family) $1,800

Doctor Visits

Primary Care Physician $10 Copay before deductible + 20% Coinsurance after deductible
Specialists 20% Coinsurance after deductible
Emergency Room $75 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $150 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 20% 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 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 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 Bronze Pathway X HMO 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
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