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Matthew - Anthem Silver Pathway X Enhanced HMO 5300 25
New Hampshire, 2018
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$6,750
Deductible
$5,300
Emergency Room Care: 25% 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) | $5,300 |
|---|---|
| Deductible (Family) | $10,600 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,750 |
| Out of Pocket Maximum (Family) | $13,500 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | 25% Coinsurance after deductible |
| Inpatient Facility | 25% Coinsurance after deductible |
| Inpatient Physician | 25% Coinsurance after deductible |
| Emergency Room Services | 25% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 25% 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 | 25% 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) | $3,000 |
|---|---|
| Deductible (Family) | $6,000 |
| Out of Pocket Maximum (Individual) | $5,700 |
| Out of Pocket Maximum (Family) | $11,400 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | 25% Coinsurance after deductible |
| Emergency Room | 25% Coinsurance after deductible |
| Inpatient Facility | 25% 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) | $800 |
|---|---|
| Deductible (Family) | $1,600 |
| Out of Pocket Maximum (Individual) | $1,800 |
| Out of Pocket Maximum (Family) | $3,600 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | 25% Coinsurance after deductible |
| Emergency Room | 25% Coinsurance after deductible |
| Inpatient Facility | 25% 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 | 25% Coinsurance after deductible |
| Inpatient Facility | 25% 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 New Hampshire
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Anthem Silver Pathway X Enhanced HMO 3500 0 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Catastrophic Pathway X Enhanced HMO 7350 0 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Silver Pathway X Enhanced HMO 3800 0 | Deductible $3,800 | Coinsurance Not applicable | Out of Pocket $5,800 |
| Plan Anthem Silver Pathway X Enhanced HMO 6300 30 | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Bronze Pathway X Enhanced HMO 5750 10 | Deductible $5,750 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Silver Pathway X Enhanced HMO 10 for HSA | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Anthem Bronze Pathway X Enhanced HMO 6350 40 | Deductible $6,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Bronze Pathway X Enhanced HMO 25 for HSA | Deductible $5,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Anthem Gold Pathway X Enhanced HMO 1500 10 | Deductible $1,500 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Anthem Silver Pathway X Enhanced HMO 2500 30 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,350 |