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Ambetter - Ambetter Balanced Care 2 (2017)
Mississippi, 2017
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$6,500
Deductible
$6,500
Emergency Room Care: No charge 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) | $6,500 |
|---|---|
| Deductible (Family) | $13,000 |
| 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 | No charge after deductible |
| Inpatient Physician | No charge after deductible |
| Emergency Room Services | No charge after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | No charge after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | No charge after deductible |
| X-Ray and Diagnostic Imaging | No charge 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 | No charge after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | No charge after deductible |
| Rehabilitative Occupational & Physical Therapy | No charge after deductible |
| Outpatient Facility | No charge 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 | No charge after deductible |
| Specialty Drugs | No charge 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) | $5,000 |
|---|---|
| Deductible (Family) | $10,000 |
| Out of Pocket Maximum (Individual) | $5,000 |
| Out of Pocket Maximum (Family) | $10,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | No charge after deductible |
| Specialty Drugs | No charge 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) | $1,750 |
|---|---|
| Deductible (Family) | $3,500 |
| Out of Pocket Maximum (Individual) | $1,750 |
| Out of Pocket Maximum (Family) | $3,500 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | No charge after deductible |
| Specialty Drugs | No charge 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) | $575 |
|---|---|
| Deductible (Family) | $1,150 |
| Out of Pocket Maximum (Individual) | $575 |
| Out of Pocket Maximum (Family) | $1,150 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | No charge after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | No charge after deductible |
| Specialty Drugs | No charge after deductible |
Other Plans in Mississippi
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Ambetter Balanced Care 3 (2017) | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 1 (2017) + Vision | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 3 (2017) + Vision + Adult Dental | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 1 (2017) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 3 (2017) + Vision | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 1 (2017) + Vision + Adult Dental | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 10 (2017) | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 12 (2017) | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Ambetter Balanced Care 10 (2017) + Vision + Adult Dental | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Balanced Care 2 (2017) + Vision | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Essential Care 1 (2017) + Vision | Deductible $6,800 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $6,350 |
| Plan Ambetter Essential Care 1 (2017) + Vision + Adult Dental | Deductible $6,800 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Ambetter Balanced Care 10 (2017) + Vision | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan Ambetter Essential Care 1 (2017) | Deductible $6,800 | Coinsurance Not applicable | Out of Pocket $6,800 |
| Plan Ambetter Balanced Care 2 (2017) + Vision + Adult Dental | Deductible $6,500 | Coinsurance Not applicable | Out of Pocket $6,500 |