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Celtic - Ambetter Essential Care 1 (2018) + Vision
Texas, 2018
Plan Type
EPO
Metal Tier
Bronze
Out of Pocket Maximum
$6,800
Deductible
$6,800
Emergency Room Care: No charge 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) | $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 | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| 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 |