Montana - Access Care Silver

Montana, 2017

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,850

  • Deductible

    $2,250

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $2,250
Deductible (Family) $4,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,850
Out of Pocket Maximum (Family) $13,700

Doctor Visits

Primary Care Visit $35 Copay after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient $35 Copay after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% 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) $1,450
Deductible (Family) $2,900
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Physician $30 Copay after deductible
Specialists 40% Coinsurance after deductible
Emergency Room 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% 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) $550
Deductible (Family) $1,100
Out of Pocket Maximum (Individual) $2,100
Out of Pocket Maximum (Family) $4,200

Doctor Visits

Primary Care Physician $10 Copay after deductible
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance 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
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) $50
Deductible (Family) $100
Out of Pocket Maximum (Individual) $1,350
Out of Pocket Maximum (Family) $2,700

Doctor Visits

Primary Care Physician $10 Copay after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance 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
Specialty Drugs

Other Plans in Montana

Plan Access Care Bronze Plus Deductible $5,750 Coinsurance Not applicable Out of Pocket $6,550
Plan Connected Care Bronze Plus Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Access Care Bronze Deductible $5,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Access Care Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Connected Care Gold Deductible $750 Coinsurance Not applicable Out of Pocket $5,750
Plan Connected Care Bronze Deductible $5,550 Coinsurance Not applicable Out of Pocket $7,150
Plan Access Care Gold Deductible $800 Coinsurance Not applicable Out of Pocket $4,750
Plan Connected Care Silver Deductible $2,150 Coinsurance Not applicable Out of Pocket $7,150
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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) $2,250
Deductible (Family) $4,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,850
Out of Pocket Maximum (Family) $13,700

Doctor Visits

Primary Care Visit $35 Copay after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient $35 Copay after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% 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) $1,450
Deductible (Family) $2,900
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Physician $30 Copay after deductible
Specialists 40% Coinsurance after deductible
Emergency Room 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% 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) $550
Deductible (Family) $1,100
Out of Pocket Maximum (Individual) $2,100
Out of Pocket Maximum (Family) $4,200

Doctor Visits

Primary Care Physician $10 Copay after deductible
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance 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
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) $50
Deductible (Family) $100
Out of Pocket Maximum (Individual) $1,350
Out of Pocket Maximum (Family) $2,700

Doctor Visits

Primary Care Physician $10 Copay after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance 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
Specialty Drugs

Other Plans in Montana

Plan Access Care Bronze Plus Deductible $5,750 Coinsurance Not applicable Out of Pocket $6,550
Plan Connected Care Bronze Plus Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Access Care Bronze Deductible $5,250 Coinsurance Not applicable Out of Pocket $7,150
Plan Access Care Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Connected Care Gold Deductible $750 Coinsurance Not applicable Out of Pocket $5,750
Plan Connected Care Bronze Deductible $5,550 Coinsurance Not applicable Out of Pocket $7,150
Plan Access Care Gold Deductible $800 Coinsurance Not applicable Out of Pocket $4,750
Plan Connected Care Silver Deductible $2,150 Coinsurance Not applicable Out of Pocket $7,150