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Ambetter - Ambetter Secure Care 1 (2019) with 3 Free PCP Visits
North Carolina, 2019
Plan Type
HMO
Metal Tier
Gold
Out of Pocket Maximum
$6,350
Deductible
$1,000
Emergency Room Care: $250 Copay 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) | $1,000 |
|---|---|
| Deductible (Family) | $2,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,350 |
| Out of Pocket Maximum (Family) | $12,700 |
Doctor Visits
| Primary Care Visit | 20% Coinsurance after deductible |
|---|---|
| Specialist Visit | 20% Coinsurance after deductible |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | $250 Copay 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 | 20% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 20% Coinsurance after deductible |
| Outpatient Facility | 20% Coinsurance after deductible |
| Outpatient Surgery | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | $25 Copay after deductible |
| Non Preferred Brand Rx | $75 Copay after deductible |
| Specialty Drugs | 30% Coinsurance after deductible |
Other Plans in North Carolina
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Ambetter Balanced Care 3 (2019) | 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 Essential Care 2 (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 5 (2019) | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |