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Blue - Blue Focus Silver POS? 206 - Two $25 PCP Visits
Montana, 2018
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$7,350
Deductible
$3,500
Emergency Room Care: $1000 Copay after deductible + 50% Coinsurance 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) | $7,350 |
| Out of Pocket Maximum (Family) | $14,700 |
Doctor Visits
| Primary Care Visit | 50% Coinsurance after deductible |
|---|---|
| Specialist Visit | 50% Coinsurance after deductible |
| Inpatient Facility | $850 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
| Emergency Room Services | $1000 Copay after deductible + 50% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 50% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 50% 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 | Available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $850 Copay per stay after deductible + 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 50% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 50% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 50% Coinsurance after deductible |
| Outpatient Facility | 50% Coinsurance after deductible |
| Outpatient Surgery | 50% 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) | $1,500 |
|---|---|
| Deductible (Family) | $3,000 |
| Out of Pocket Maximum (Individual) | $5,850 |
| Out of Pocket Maximum (Family) | $11,700 |
Doctor Visits
| Primary Care Physician | 50% Coinsurance after deductible |
|---|---|
| Specialists | 50% Coinsurance after deductible |
| Emergency Room | $1000 Copay after deductible + 50% Coinsurance after deductible |
| Inpatient Facility | $850 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 50% 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) | $100 |
|---|---|
| Deductible (Family) | $200 |
| Out of Pocket Maximum (Individual) | $2,450 |
| Out of Pocket Maximum (Family) | $4,900 |
Doctor Visits
| Primary Care Physician | 30% Coinsurance after deductible |
|---|---|
| Specialists | 30% Coinsurance after deductible |
| Emergency Room | $500 Copay after deductible + 30% Coinsurance after deductible |
| Inpatient Facility | $250 Copay per stay after deductible + 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) | $0 |
|---|---|
| Deductible (Family) | $0 |
| Out of Pocket Maximum (Individual) | $1,000 |
| Out of Pocket Maximum (Family) | $2,000 |
Doctor Visits
| Primary Care Physician | 15% Coinsurance after deductible |
|---|---|
| Specialists | 15% Coinsurance after deductible |
| Emergency Room | $500 Copay after deductible + 15% Coinsurance after deductible |
| Inpatient Facility | $250 Copay per stay after deductible + 15% Coinsurance after deductible |
| Inpatient Physician | 15% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | No charge |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in Montana
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Focus Bronze POS? 205 - Two $40 PCP Visits | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Gold PPO?204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Bronze POS? 205 - Two $40 PCP Visits | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Gold POS? 207 | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Silver POS? 206 - Two $25 PCP Visits | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Gold POS? 207 | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |