Maine - Community Foundation HMO

Maine, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,450

  • Deductible

    $4,000

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) $4,000
Deductible (Family) $8,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,450
Out of Pocket Maximum (Family) $14,900

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $5,800
Out of Pocket Maximum (Family) $11,600

Doctor Visits

Primary Care Physician 30% Coinsurance after deductible
Specialists 30% Coinsurance after deductible
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $800
Deductible (Family) $1,600
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician 15% Coinsurance after deductible
Specialists 15% Coinsurance after deductible
Emergency Room 15% Coinsurance after deductible
Inpatient Facility 15% Coinsurance after deductible
Inpatient Physician 15% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 15% Coinsurance after deductible
Non Preferred Brand Rx 15% Coinsurance after deductible
Specialty Drugs 15% 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) $400
Deductible (Family) $800
Out of Pocket Maximum (Individual) $1,150
Out of Pocket Maximum (Family) $2,300

Doctor Visits

Primary Care Physician 5% Coinsurance after deductible
Specialists 5% Coinsurance after deductible
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 5% Coinsurance after deductible
Non Preferred Brand Rx 5% Coinsurance after deductible
Specialty Drugs 5% Coinsurance after deductible

Other Plans in Maine

Plan Community Complete HMO Deductible $3,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Edge PPO Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Community Safe Harbor PPO Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Community Advance PPO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Value HMO Deductible $3,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Vital HMO Deductible $2,250 Coinsurance Not applicable Out of Pocket $6,500
Plan Community Reliant HSA PPO Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Community Focus PPO Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Community Best HMO Deductible $4,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Community Choice PPO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Align PPO Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
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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) $4,000
Deductible (Family) $8,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,450
Out of Pocket Maximum (Family) $14,900

Doctor Visits

Primary Care Visit 40% Coinsurance after deductible
Specialist Visit 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $5,800
Out of Pocket Maximum (Family) $11,600

Doctor Visits

Primary Care Physician 30% Coinsurance after deductible
Specialists 30% Coinsurance after deductible
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $800
Deductible (Family) $1,600
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician 15% Coinsurance after deductible
Specialists 15% Coinsurance after deductible
Emergency Room 15% Coinsurance after deductible
Inpatient Facility 15% Coinsurance after deductible
Inpatient Physician 15% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 15% Coinsurance after deductible
Non Preferred Brand Rx 15% Coinsurance after deductible
Specialty Drugs 15% 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) $400
Deductible (Family) $800
Out of Pocket Maximum (Individual) $1,150
Out of Pocket Maximum (Family) $2,300

Doctor Visits

Primary Care Physician 5% Coinsurance after deductible
Specialists 5% Coinsurance after deductible
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 5% Coinsurance after deductible
Non Preferred Brand Rx 5% Coinsurance after deductible
Specialty Drugs 5% Coinsurance after deductible

Other Plans in Maine

Plan Community Complete HMO Deductible $3,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Edge PPO Deductible $1,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Community Safe Harbor PPO Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Community Advance PPO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Value HMO Deductible $3,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Vital HMO Deductible $2,250 Coinsurance Not applicable Out of Pocket $6,500
Plan Community Reliant HSA PPO Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Community Focus PPO Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan Community Best HMO Deductible $4,200 Coinsurance Not applicable Out of Pocket $7,900
Plan Community Choice PPO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Align PPO Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350