Celtic - Ambetter Balanced Care 8 (2019)

New Hampshire, 2019

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $7,650

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) $7,650
Deductible (Family) $15,300
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 $300 Copay per stay after deductible
Inpatient Physician Data Not Available
Emergency Room Services $150 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 $300 Copay per stay after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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) $6,290
Deductible (Family) $12,580
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility $300 Copay per stay after deductible
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $1,300
Deductible (Family) $2,600
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $50 Copay after deductible
Inpatient Facility $150 Copay per stay after deductible
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) $375
Deductible (Family) $750
Out of Pocket Maximum (Individual) $975
Out of Pocket Maximum (Family) $1,950

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $25 Copay after deductible
Inpatient Facility $125 Copay per stay after deductible
Inpatient Physician

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in New Hampshire

Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Secure Care 1 (2019) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
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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) $7,650
Deductible (Family) $15,300
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 $300 Copay per stay after deductible
Inpatient Physician Data Not Available
Emergency Room Services $150 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 $300 Copay per stay after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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) $6,290
Deductible (Family) $12,580
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility $300 Copay per stay after deductible
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $1,300
Deductible (Family) $2,600
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $50 Copay after deductible
Inpatient Facility $150 Copay per stay after deductible
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) $375
Deductible (Family) $750
Out of Pocket Maximum (Individual) $975
Out of Pocket Maximum (Family) $1,950

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $25 Copay after deductible
Inpatient Facility $125 Copay per stay after deductible
Inpatient Physician

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in New Hampshire

Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Secure Care 1 (2019) with 3 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350