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
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 |