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) |
$6,800 |
Deductible (Family) |
$13,600 |
Coinsurance |
Not applicable |
Out of Pocket Maximum (Individual) |
$6,800 |
Out of Pocket Maximum (Family) |
$13,600 |
Doctor Visits
Primary Care Visit |
No charge after deductible |
Specialist Visit |
No charge after deductible |
Inpatient Facility |
No charge after deductible |
Inpatient Physician |
No charge after deductible |
Emergency Room Services |
No charge after deductible |
Tests and Imaging
Imaging (CT/PET Scans, MRIs) |
No charge after deductible |
Laboratory Outpatient and Professional Services |
No charge after deductible |
X-Ray and Diagnostic Imaging |
No charge 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 |
Not available |
Pregnancy |
Available |
Weight Loss |
Not available |
Other
Mental / Behavioral Health Inpatient |
No charge after deductible |
Mental / Behavioral Health Outpatient |
No charge after deductible |
Rehabilitative Speech Therapy |
No charge after deductible |
Rehabilitative Occupational & Physical Therapy |
No charge after deductible |
Outpatient Facility |
No charge after deductible |
Outpatient Surgery |
No charge after deductible |
Prescription Drugs
Generic Rx |
Data Not Available |
Preferred Brand Rx |
No charge after deductible |
Non Preferred Brand Rx |
No charge after deductible |
Specialty Drugs
| No charge after deductible |
Other Plans in Texas
Plan
Ambetter Balanced Care 4 (2018)
|
Deductible
$7,050 |
Coinsurance Not applicable |
Out of Pocket
$7,050 |
Plan
Ambetter Balanced Care 5 (2018)
|
Deductible
$7,350 |
Coinsurance Not applicable |
Out of Pocket
$7,350 |
Plan
Ambetter Balanced Care 10 (2018)
|
Deductible
$5,000 |
Coinsurance Not applicable |
Out of Pocket
$6,700 |
Plan
Ambetter Balanced Care 2 (2018)
|
Deductible
$6,500 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Balanced Care 2 (2018) + Vision
|
Deductible
$6,500 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Balanced Care 10 (2018) + Vision
|
Deductible
$5,000 |
Coinsurance Not applicable |
Out of Pocket
$6,700 |
Plan
Ambetter Balanced Care 1 (2018)
|
Deductible
$5,500 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Balanced Care 3 (2018)
|
Deductible
$3,000 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Essential Care 1 (2018)
|
Deductible
$6,800 |
Coinsurance Not applicable |
Out of Pocket
$6,800 |
Plan
Ambetter Balanced Care 1 (2018) + Vision
|
Deductible
$5,500 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Secure Care 1 (2018) with 3 Free PCP Visits
|
Deductible
$1,000 |
Coinsurance Not applicable |
Out of Pocket
$6,350 |
Plan
Ambetter Balanced Care 3 (2018) + Vision
|
Deductible
$3,000 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Ambetter Balanced Care 12 (2018)
|
Deductible
$3,500 |
Coinsurance Not applicable |
Out of Pocket
$7,350 |