Celtic - Ambetter Balanced Care 11 (2019)

Missouri, 2019

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $6,000

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) $6,000
Deductible (Family) $12,000
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 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 Data Not Available
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 Available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
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) $2,625
Deductible (Family) $5,250
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility
Inpatient Physician

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,050
Out of Pocket Maximum (Family) $2,100

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 Ambetter Essential Care 1 (2019) Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
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
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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) $6,000
Deductible (Family) $12,000
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 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 Data Not Available
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 Available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
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) $2,625
Deductible (Family) $5,250
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 40% Coinsurance after deductible
Inpatient Facility 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility
Inpatient Physician

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,050
Out of Pocket Maximum (Family) $2,100

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 Ambetter Essential Care 1 (2019) Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
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