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Celtic - Ambetter Balanced Care 8 (2017)
New Hampshire, 2017
Plan Type
EPO
Metal Tier
Silver
Out of Pocket Maximum
$6,500
Deductible
$3,500
Emergency Room Care: $150 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) | $6,500 |
| Out of Pocket Maximum (Family) | $13,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | $300 Copay per stay after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
| Emergency Room Services | $150 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | Data Not Available |
|---|---|
| Laboratory Outpatient and Professional Services | Data Not Available |
| X-Ray and Diagnostic Imaging | Data Not Available |
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 | $300 Copay per stay after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| 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 | 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) | $3,000 |
|---|---|
| Deductible (Family) | $6,000 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $100 Copay after deductible |
| Inpatient Facility | $250 Copay per stay 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) | $1,000 |
|---|---|
| Deductible (Family) | $2,000 |
| Out of Pocket Maximum (Individual) | $1,750 |
| Out of Pocket Maximum (Family) | $3,500 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | $50 Copay after deductible |
| Inpatient Facility | $150 Copay per stay 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) | $350 |
|---|---|
| Deductible (Family) | $700 |
| Out of Pocket Maximum (Individual) | $950 |
| Out of Pocket Maximum (Family) | $1,900 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | No charge after deductible |
| Inpatient Facility | $125 Copay per stay after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in New Hampshire
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $6,350 |