Healthy - Anthem Silver Pathway X 5500

Missouri, 2018

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,500

  • Deductible

    $5,500

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) $5,500
Deductible (Family) $11,000
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 25% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible + 25% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay after deductible + 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 25% Coinsurance after deductible
X-Ray and Diagnostic Imaging 25% 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 25% Coinsurance after deductible
Rehabilitative Speech Therapy 25% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 25% Coinsurance after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
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) $3,100
Deductible (Family) $6,200
Out of Pocket Maximum (Individual) $5,350
Out of Pocket Maximum (Family) $10,700

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
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) $1,000
Deductible (Family) $2,000
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $250 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $200 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $700
Out of Pocket Maximum (Family) $1,400

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $150 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $100 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Missouri

Plan Anthem Bronze Pathway X 20 for HSA Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,650
Plan Anthem Bronze Pathway X 6350 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 3250 Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,450
Plan Anthem Silver Pathway X 4500 Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,800
Plan Anthem Silver Pathway X 2900 Deductible $2,900 Coinsurance Not applicable Out of Pocket $5,500
Plan Anthem Bronze Pathway X 5450 Deductible $5,450 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 1850 Deductible $1,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Bronze Pathway X 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Anthem Silver Pathway X 3850 Deductible $3,850 Coinsurance Not applicable Out of Pocket $5,900
Plan Anthem Silver Pathway X 2250 Deductible $2,250 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Bronze Pathway X 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Catastrophic Pathway X 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Gold Pathway X 1250 Deductible $1,250 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X for HSA Deductible $2,950 Coinsurance Not applicable Out of Pocket $6,000
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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) $5,500
Deductible (Family) $11,000
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 25% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible + 25% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay after deductible + 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 25% Coinsurance after deductible
X-Ray and Diagnostic Imaging 25% 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 25% Coinsurance after deductible
Rehabilitative Speech Therapy 25% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 25% Coinsurance after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
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) $3,100
Deductible (Family) $6,200
Out of Pocket Maximum (Individual) $5,350
Out of Pocket Maximum (Family) $10,700

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
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) $1,000
Deductible (Family) $2,000
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $250 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $200 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $700
Out of Pocket Maximum (Family) $1,400

Doctor Visits

Primary Care Physician
Specialists 25% Coinsurance after deductible
Emergency Room $150 Copay after deductible + 25% Coinsurance after deductible
Inpatient Facility $100 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Missouri

Plan Anthem Bronze Pathway X 20 for HSA Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,650
Plan Anthem Bronze Pathway X 6350 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 3250 Deductible $3,250 Coinsurance Not applicable Out of Pocket $6,450
Plan Anthem Silver Pathway X 4500 Deductible $4,500 Coinsurance Not applicable Out of Pocket $6,800
Plan Anthem Silver Pathway X 2900 Deductible $2,900 Coinsurance Not applicable Out of Pocket $5,500
Plan Anthem Bronze Pathway X 5450 Deductible $5,450 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X 1850 Deductible $1,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Bronze Pathway X 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan Anthem Silver Pathway X 3850 Deductible $3,850 Coinsurance Not applicable Out of Pocket $5,900
Plan Anthem Silver Pathway X 2250 Deductible $2,250 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Bronze Pathway X 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Catastrophic Pathway X 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Gold Pathway X 1250 Deductible $1,250 Coinsurance Not applicable Out of Pocket $7,350
Plan Anthem Silver Pathway X for HSA Deductible $2,950 Coinsurance Not applicable Out of Pocket $6,000