More Information
Health Insurance Tools
Health Exchange Guides
- What is a Health Insurance Exchange?
- Understanding the ACA Subsidies
- Cost Sharing Reductions
- Minimum Essential Coverage
- What Is An Insurance Rating Area?
- The Individual Mandate and Penalties
- Inpatient vs Outpatient Care and Coverage
- Copay vs Coinsurance
- Average Cost of Health Insurance
- How Age Affects Your Health Insurance Costs
Visualizations and Data
Other Insurance Research
Health - HMO 3500a Elite Silver
Illinois, 2019
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$7,900
Deductible
$3,500
Emergency Room Care: 20% 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) | $7,900 |
| Out of Pocket Maximum (Family) | $15,800 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | 20% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 20% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 20% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 20% Coinsurance after deductible |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Not available |
| Diabetes | Available |
| Heart Disease | Not available |
| High Blood Pressure / High Cholesterol | Available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 20% Coinsurance after deductible |
| Outpatient Facility | 20% Coinsurance after deductible |
| Outpatient Surgery | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | $10 Copay after deductible |
|---|---|
| Preferred Brand Rx | $40 Copay after deductible |
| Non Preferred Brand Rx | $80 Copay after deductible |
| Specialty Drugs | 50% 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) | $6,300 |
| Out of Pocket Maximum (Family) | $12,600 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | 20% Coinsurance after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | $10 Copay after deductible |
|---|---|
| Preferred Brand Rx | $40 Copay after deductible |
| Non Preferred Brand Rx | $80 Copay after deductible |
| Specialty Drugs | 50% 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) | $1,250 |
|---|---|
| Deductible (Family) | $2,500 |
| Out of Pocket Maximum (Individual) | $2,500 |
| Out of Pocket Maximum (Family) | $5,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | 0% Coinsurance after deductible |
| Inpatient Facility | 0% Coinsurance after deductible |
| Inpatient Physician | 0% 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) | $250 |
|---|---|
| Deductible (Family) | $500 |
| Out of Pocket Maximum (Individual) | $1,500 |
| Out of Pocket Maximum (Family) | $3,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | |
| Emergency Room | 0% Coinsurance after deductible |
| Inpatient Facility | 0% Coinsurance after deductible |
| Inpatient Physician | 0% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in Illinois
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan POS HSA 6650 Elite Bronze | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan POS 7250 Riverside Silver | Deductible $7,250 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3150 OSF Silver | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 5000c OSF Silver | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,300 |
| Plan HMO 3500a OSF Silver | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan POS 5000a Elite Bronze | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 5000c Elite Silver | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,300 |
| Plan POS 5000a OSF Bronze | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 4000b Elite Silver | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,500 |
| Plan HMO 7900 Elite Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3800 Elite Bronze | Deductible $3,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 2000 Methodist Gold | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,000 |
| Plan POS 7250 Elite Silver | Deductible $7,250 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 5000c Methodist Silver | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,300 |
| Plan POS 6000a Methodist Bronze | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan POS 5000a Methodist Bronze | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3500a Methodist Silver | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 4000b OSF Silver | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,500 |
| Plan HMO 4000b Methodist Silver | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,500 |
| Plan POS HSA 6650 Methodist Bronze | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan POS 6000a OSF Bronze | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3150 Methodist Silver | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan POS 7250 OSF Silver | Deductible $7,250 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3800 OSF Bronze | Deductible $3,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 2000 Elite Gold | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,000 |
| Plan HMO 3150 Elite Silver | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 3800 Methodist Bronze | Deductible $3,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan HMO 2000 OSF Gold | Deductible $2,000 | Coinsurance Not applicable | Out of Pocket $6,000 |
| Plan POS 7250 Methodist Silver | Deductible $7,250 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan POS 6000a Elite Bronze | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan POS HSA 6650 OSF Bronze | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $6,650 |