{"state":{"code":"ME","name":"Maine","fips":23,"exchangeName":["Healthcare.gov"],"exchangeUrl":["http:\/\/www.healthcare.gov"],"exchangeType":["Federal"]},"year":"2019","plan":{"name":"Anthem - Anthem Silver X POS 2250","planType":"POS","tier":"Silver","oopm":"7900.00","deductible":"2250.00","redirectUrl":"https:\/\/www.healthcare.gov"},"phoneNum":"8558665590"}
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) | $2,250 |
|---|---|
| Deductible (Family) | $4,500 |
| 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 | 50% Coinsurance after deductible |
| Inpatient Facility | 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
| Emergency Room Services | $250 Copay after deductible + 50% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 50% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 50% 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 | 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 50% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 50% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 50% Coinsurance after deductible |
| Outpatient Facility | 50% Coinsurance after deductible |
| Outpatient Surgery | 50% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | 50% Coinsurance after deductible |
| Non Preferred Brand Rx | 50% Coinsurance 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) | $1,800 |
|---|---|
| Deductible (Family) | $3,600 |
| Out of Pocket Maximum (Individual) | $6,000 |
| Out of Pocket Maximum (Family) | $12,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | 50% Coinsurance after deductible |
| Emergency Room | $250 Copay after deductible + 50% Coinsurance after deductible |
| Inpatient Facility | 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | 50% Coinsurance after deductible |
| Non Preferred Brand Rx | 50% Coinsurance 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) | $625 |
|---|---|
| Deductible (Family) | $1,250 |
| Out of Pocket Maximum (Individual) | $2,000 |
| Out of Pocket Maximum (Family) | $4,000 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | 30% Coinsurance after deductible |
| Emergency Room | $250 Copay after deductible + 30% Coinsurance after deductible |
| Inpatient Facility | 30% Coinsurance after deductible |
| Inpatient Physician | 30% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | 50% Coinsurance after deductible |
| Non Preferred Brand Rx | 50% Coinsurance after deductible |
| Specialty Drugs | 50% 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) | $175 |
|---|---|
| Deductible (Family) | $350 |
| Out of Pocket Maximum (Individual) | $850 |
| Out of Pocket Maximum (Family) | $1,700 |
Doctor Visits
| Primary Care Physician | |
|---|---|
| Specialists | 20% Coinsurance after deductible |
| Emergency Room | $250 Copay after deductible + 20% Coinsurance after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | |
|---|---|
| Preferred Brand Rx | 50% Coinsurance after deductible |
| Non Preferred Brand Rx | 50% Coinsurance after deductible |
| Specialty Drugs | 50% Coinsurance after deductible |
Other Plans in Maine
| Plan Anthem Bronze X POS 6350 | Deductible $6,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Catastrophic X POS 7900 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 5000 Online Plus | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 5000 Online Plus | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X HMO 3850 | Deductible $3,850 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X HMO 6350 | Deductible $6,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X POS 5800 | Deductible $5,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Catastrophic X HMO 7900 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X POS 5800 | Deductible $5,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X HMO 4500 | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X POS 3850 | Deductible $3,850 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 5000 for HSA | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Silver X POS 3850 | Deductible $3,850 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 6350 | Deductible $6,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X HMO 2250 | Deductible $2,250 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 6250 for HSA | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Bronze X POS 5000 for HSA | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Bronze X HMO 5000 for HSA | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Silver X POS 4500 | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X HMO 6250 for HSA | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Gold X POS 1350 | Deductible $1,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X HMO 5000 Online Plus | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Gold X POS 1350 | Deductible $1,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X POS 4500 | Deductible $4,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X HMO 5800 | Deductible $5,800 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Bronze X POS 6250 for HSA | Deductible $6,250 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan Anthem Catastrophic X POS 7900 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Gold X HMO 1350 | Deductible $1,350 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Anthem Silver X POS 2250 | Deductible $2,250 | Coinsurance Not applicable | Out of Pocket $7,900 |