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Healthy - Anthem Silver Pathway for HSA
Missouri, 2017
Plan Type
PPO
Metal Tier
Silver
Out of Pocket Maximum
$6,000
Deductible
$3,000
Emergency Room Care: $500 Copay after deductible + 10% Coinsurance 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) | $3,000 |
|---|---|
| Deductible (Family) | $6,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,000 |
| Out of Pocket Maximum (Family) | $12,000 |
Doctor Visits
| Primary Care Visit | 10% Coinsurance after deductible |
|---|---|
| Specialist Visit | 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 40% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible + 10% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | $500 Copay after deductible + 40% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 10% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 10% 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 per stay after deductible + 40% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 10% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 10% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 10% Coinsurance after deductible |
| Outpatient Facility | 10% Coinsurance after deductible |
| Outpatient Surgery | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | 10% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 10% Coinsurance after deductible |
| 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) | $2,700 |
|---|---|
| Deductible (Family) | $5,400 |
| Out of Pocket Maximum (Individual) | $4,300 |
| Out of Pocket Maximum (Family) | $8,600 |
Doctor Visits
| Primary Care Physician | 10% Coinsurance after deductible |
|---|---|
| Specialists | 10% Coinsurance after deductible |
| Emergency Room | $500 Copay after deductible + 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 40% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | 10% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 10% Coinsurance after deductible |
| 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) | $1,200 |
|---|---|
| Deductible (Family) | $2,400 |
| Out of Pocket Maximum (Individual) | $1,200 |
| Out of Pocket Maximum (Family) | $2,400 |
Doctor Visits
| Primary Care Physician | No charge after deductible |
|---|---|
| Specialists | No charge after deductible |
| Emergency Room | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | 0% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 0% Coinsurance after deductible |
| Non Preferred Brand Rx | 0% Coinsurance after deductible |
| Specialty Drugs | 0% 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) | $500 |
|---|---|
| Deductible (Family) | $1,000 |
| Out of Pocket Maximum (Individual) | $500 |
| Out of Pocket Maximum (Family) | $1,000 |
Doctor Visits
| Primary Care Physician | No charge after deductible |
|---|---|
| Specialists | No charge after deductible |
| Emergency Room | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | 0% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 0% Coinsurance after deductible |
| Non Preferred Brand Rx | 0% Coinsurance after deductible |
| Specialty Drugs | 0% Coinsurance after deductible |
Other Plans in Missouri
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Anthem Silver Pathway 5300 | Deductible $5,300 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Anthem Bronze Pathway 5450 | Deductible $5,450 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan | Deductible $1,850 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Pathway 2500 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway 0 for HSA | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Anthem Catastrophic Pathway 7150 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Pathway 2900 | Deductible $2,900 | Coinsurance Not applicable | Out of Pocket $5,500 |
| Plan Anthem Silver Pathway 4700 | Deductible $4,700 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Anthem Silver Pathway 3250 | Deductible $3,250 | Coinsurance Not applicable | Out of Pocket $6,450 |
| Plan Anthem Bronze Pathway 4950 | Deductible $4,950 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway 6350 | Deductible $6,350 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Silver Pathway 3850 | Deductible $3,850 | Coinsurance Not applicable | Out of Pocket $5,900 |
| Plan Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $6,900 |
| Plan Anthem Silver Pathway 2250 | Deductible $2,250 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Anthem Bronze Pathway 20 for HSA | Deductible $5,250 | Coinsurance Not applicable | Out of Pocket $6,550 |