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Celtic - Ambetter Balanced Care 1 (2019) + Vision + Adult Dental
Missouri, 2019
Plan Type
EPO
Metal Tier
Silver
Out of Pocket Maximum
$6,500
Deductible
$5,500
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) | $5,500 |
|---|---|
| Deductible (Family) | $11,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,500 |
| Out of Pocket Maximum (Family) | $13,000 |
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 | 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 | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | 20% Coinsurance after deductible |
| Outpatient Surgery | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | 20% Coinsurance after deductible |
| Specialty Drugs | 20% 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) | $3,750 |
|---|---|
| Deductible (Family) | $7,500 |
| 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 | |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 20% Coinsurance after deductible |
| Specialty Drugs | 20% 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) | $900 |
|---|---|
| Deductible (Family) | $1,800 |
| Out of Pocket Maximum (Individual) | $2,600 |
| Out of Pocket Maximum (Family) | $5,200 |
Doctor Visits
| Primary Care Physician | No charge |
|---|---|
| Specialists | |
| Emergency Room | 20% Coinsurance after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | No charge |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | 20% Coinsurance after deductible |
| Specialty Drugs | 20% 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) | $0 |
|---|---|
| Deductible (Family) | $0 |
| Out of Pocket Maximum (Individual) | $1,075 |
| Out of Pocket Maximum (Family) | $2,150 |
Doctor Visits
| Primary Care Physician | No charge |
|---|---|
| Specialists | |
| Emergency Room | |
| Inpatient Facility | |
| Inpatient Physician |
Prescription Drugs
| Generic Rx | No charge |
|---|---|
| Preferred Brand Rx | |
| Non Preferred Brand Rx | |
| Specialty Drugs |
Other Plans in Missouri
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Ambetter Balanced Care 11 (2019) | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Ambetter Essential Care 1 (2019) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Ambetter Balanced Care 11 (2019) | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Ambetter Balanced Care 3 (2019) + Vision + Adult Dental | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Ambetter Essential Care 1 (2019) | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Ambetter Balanced Care 5 (2019) | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| 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 3 (2019) | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Ambetter Balanced Care 1 (2019) | 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 Balanced Care 3 (2019) | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,750 |
| Plan Ambetter Balanced Care 3 (2019) + Vision + Adult Dental | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,750 |