Celtic - Ambetter Balanced Care 5 (2019)

Indiana, 2019

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $7,350

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $7,350
Deductible (Family) $14,700
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $5,350
Deductible (Family) $10,700
Out of Pocket Maximum (Individual) $5,350
Out of Pocket Maximum (Family) $10,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $1,950
Deductible (Family) $3,900
Out of Pocket Maximum (Individual) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $675
Deductible (Family) $1,350
Out of Pocket Maximum (Individual) $675
Out of Pocket Maximum (Family) $1,350

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Indiana

Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2019) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Essential Care 2 HSA (2019) Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 2 (2019) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2019) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Balanced Care 2 (2019) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
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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) $7,350
Deductible (Family) $14,700
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient Data Not Available
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 Data Not Available
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $5,350
Deductible (Family) $10,700
Out of Pocket Maximum (Individual) $5,350
Out of Pocket Maximum (Family) $10,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $1,950
Deductible (Family) $3,900
Out of Pocket Maximum (Individual) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge 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) $675
Deductible (Family) $1,350
Out of Pocket Maximum (Individual) $675
Out of Pocket Maximum (Family) $1,350

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Indiana

Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2019) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Essential Care 2 HSA (2019) Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 2 (2019) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2019) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Balanced Care 2 (2019) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500