{"state":{"code":"MI","name":"Michigan","fips":26,"exchangeName":["Healthcare.gov"],"exchangeUrl":["http:\/\/www.healthcare.gov"],"exchangeType":["Partnership"]},"year":"2017","plan":{"name":"Physicians - Sparrow PHP Silver 2500 HMO","planType":"HMO","tier":"Silver","oopm":"6500.00","deductible":"2500.00","redirectUrl":"https:\/\/www.healthcare.gov"},"phoneNum":"8558665590"}
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) | $6,500 |
| Out of Pocket Maximum (Family) | $13,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | Data Not Available |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 20% 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 | Not available |
| Diabetes | Available |
| Heart Disease | Not available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Available |
| Weight Loss | Available |
Other
| Mental / Behavioral Health Inpatient | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 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 | Data Not Available |
| Specialty Drugs |
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) | $5,000 |
| Out of Pocket Maximum (Family) | $10,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
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) | $500 |
|---|---|
| Deductible (Family) | $1,000 |
| Out of Pocket Maximum (Individual) | $2,000 |
| Out of Pocket Maximum (Family) | $4,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
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) | $250 |
|---|---|
| Deductible (Family) | $500 |
| Out of Pocket Maximum (Individual) | $1,500 |
| Out of Pocket Maximum (Family) | $3,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | |
| Inpatient Facility | 0% Coinsurance after deductible |
| Inpatient Physician | 0% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in Michigan
| Plan Sparrow PHP Silver 3500 HMO | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Gold 1250 HMO | Deductible $1,250 | Coinsurance Not applicable | Out of Pocket $4,750 |
| Plan Sparrow PHP Bronze 6650 HMO | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver 4000 Exclusive | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $6,600 |
| Plan Sparrow PHP Silver 3000 Exclusive | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,600 |
| Plan Sparrow PHP Gold 500 Basic Exclusive | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver HDHP Exclusive | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $4,000 |
| Plan Sparrow PHP Healthy HMO | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver 5000 Exclusive | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver 3000 HMO | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,600 |
| Plan Sparrow PHP Bronze 6650 Exclusive | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver HDHP HMO | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $4,000 |
| Plan Sparrow PHP Bronze 5500 H.S.A. HMO | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Sparrow PHP Gold 500 Exclusive | Deductible $500 | Coinsurance Not applicable | Out of Pocket $4,200 |
| Plan Sparrow PHP Gold 500 HMO | Deductible $500 | Coinsurance Not applicable | Out of Pocket $4,200 |
| Plan Sparrow PHP Silver 3500 Exclusive | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Gold 1000 HMO | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan Sparrow PHP Silver 5000 HMO | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Silver 2000 Exclusive | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Sparrow PHP Silver 4000 HMO | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $6,600 |
| Plan Sparrow PHP Platinum 250 Exclusive | Deductible $250 | Coinsurance Not applicable | Out of Pocket $1,250 |
| Plan Sparrow PHP Bronze 5500 H.S.A. Exclusive | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Sparrow PHP Silver 2500 Exclusive | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Sparrow PHP Platinum 500-100Percent HMO | Deductible $500 | Coinsurance Not applicable | Out of Pocket $1,800 |
| Plan Sparrow PHP Gold 1400 H.S.A. HMO | Deductible $1,400 | Coinsurance Not applicable | Out of Pocket $3,000 |
| Plan Sparrow PHP Bronze 6550 H.S.A. Exclusive | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Sparrow PHP Gold 1400 H.S.A. Exclusive | Deductible $1,400 | Coinsurance Not applicable | Out of Pocket $3,000 |
| Plan Sparrow PHP Bronze 6550 H.S.A. HMO | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Sparrow PHP Gold 500 Basic HMO | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Sparrow PHP Platinum 250 HMO | Deductible $250 | Coinsurance Not applicable | Out of Pocket $1,250 |
| Plan Sparrow PHP Gold 1250 Exclusive | Deductible $1,250 | Coinsurance Not applicable | Out of Pocket $4,750 |
| Plan Sparrow PHP Platinum 500-100Percent Exclusive | Deductible $500 | Coinsurance Not applicable | Out of Pocket $1,800 |
| Plan Sparrow PHP Silver 2000 HMO | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Sparrow PHP Gold 1000 Exclusive | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $5,000 |