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Harvard - Silver HMO
Maine, 2017
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$7,150
Deductible
$2,000
Emergency Room Care: $500 Copay 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) | $2,000 |
|---|---|
| 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 | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 30% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 30% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 30% 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 | 30% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | $750 Copay after deductible |
| Outpatient Surgery | No charge after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | 30% Coinsurance after deductible |
| Specialty Drugs | 30% 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) | $2,000 |
|---|---|
| Deductible (Family) | $4,000 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $500 Copay after deductible |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 30% Coinsurance after deductible |
| Specialty Drugs | 30% 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) | $600 |
|---|---|
| Deductible (Family) | $1,200 |
| Out of Pocket Maximum (Individual) | $2,000 |
| Out of Pocket Maximum (Family) | $4,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $250 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 | 30% Coinsurance after deductible |
| Specialty Drugs | 30% 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) | $300 |
|---|---|
| Deductible (Family) | $600 |
| Out of Pocket Maximum (Individual) | $750 |
| Out of Pocket Maximum (Family) | $1,500 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $150 Copay after deductible |
| Inpatient Facility | 10% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 30% Coinsurance after deductible |
| Specialty Drugs | 30% Coinsurance after deductible |
Other Plans in Maine
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Gold HMO 1000 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan Maine's Choice Sebago Silver HMO | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Maine's Choice Casco Silver HMO | Deductible $1,700 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Best Buy HSA HMO 5400 | Deductible $5,400 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Maine's Choice Gold HMO | Deductible $750 | Coinsurance Not applicable | Out of Pocket $3,500 |
| Plan Bronze HMO 6000 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Maine's Choice Pemaquid Silver HMO | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $6,700 |