More Information
Health Insurance Tools
Health Exchange Guides
- What is a Health Insurance Exchange?
- Understanding the ACA Subsidies
- Cost Sharing Reductions
- Minimum Essential Coverage
- What Is An Insurance Rating Area?
- The Individual Mandate and Penalties
- Inpatient vs Outpatient Care and Coverage
- Copay vs Coinsurance
- Average Cost of Health Insurance
- How Age Affects Your Health Insurance Costs
Visualizations and Data
Other Insurance Research
Blue - Blue Local 3500 (local network with Carolinas HealthCare System)
North Carolina, 2017
Plan Type
POS
Metal Tier
Silver
Out of Pocket Maximum
$7,150
Deductible
$3,500
Emergency Room Care: $600 Copay 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) | $3,500 |
|---|---|
| Deductible (Family) | $7,000 |
| 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 | $0 Copay per stay + 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
| Emergency Room Services | $600 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 | Not available |
| Pain Management | Not 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 | 30% Coinsurance after deductible |
| Outpatient Surgery | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | $10 Copay after deductible |
|---|---|
| Preferred Brand Rx | $40 Copay after deductible |
| Non Preferred Brand Rx | $80 Copay after deductible |
| Specialty Drugs | 25% 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) | $2,800 |
|---|---|
| Deductible (Family) | $5,600 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $600 Copay after deductible |
| Inpatient Facility | $0 Copay per stay + 30% Coinsurance after deductible |
| Inpatient Physician | 30% 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) | $800 |
|---|---|
| Deductible (Family) | $1,600 |
| Out of Pocket Maximum (Individual) | $2,350 |
| Out of Pocket Maximum (Family) | $4,700 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $500 Copay after deductible |
| Inpatient Facility | $0 Copay per stay + 30% Coinsurance after deductible |
| Inpatient Physician | 30% 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) | $450 |
|---|---|
| Deductible (Family) | $900 |
| Out of Pocket Maximum (Individual) | $800 |
| Out of Pocket Maximum (Family) | $1,600 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $300 Copay after deductible |
| Inpatient Facility | $0 Copay per stay + 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in North Carolina
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Advantage 5500 (broad network, HSA eligible) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Local 7150 (local network with Duke Medicine and WakeMed) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 3500 (local network with Duke Medicine and WakeMed) | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 7150 (local network with Carolinas HealthCare System) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 7150 (limited network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 3500 (limited network) | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Advantage 5000 (broad network) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 5000 (limited network) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value Catastrophic (limited network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 7150 (limited network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Select 1500 (tiered network) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $6,000 |
| Plan Blue Local 1500 (local network with Duke Medicine and WakeMed) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 5000 (local network with Duke Medicine and WakeMed) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Advantage Catastrophic (broad network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 5500 (local network with Duke Medicine and WakeMed, HSA eligible) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Value 1500 (limited network) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 5500 (local network with Carolinas HealthCare System, HSA eligible) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Value 3500 (limited network) | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 5500 (limited network, HSA eligible) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Value 5500 (limited network, HSA eligible) | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Select 1500 (tiered network) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $6,000 |
| Plan Blue Value 1500 (limited network) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Select 5000 (tiered network) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Advantage 1500 (broad network) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Select 5000 (tiered network) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Value 5000 (limited network) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Advantage 3500 (broad network) | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 5000 (local network with Carolinas HealthCare System) | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Advantage 7150 (broad network) | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan Blue Local 1500 (local network with Carolinas HealthCare System) | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,150 |