CareSource - CareSource Marketplace Standard Silver

West Virginia, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,700

  • Deductible

    $5,700

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) $5,700
Deductible (Family) $11,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,700
Out of Pocket Maximum (Family) $15,400

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician $500 Copay after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $250 Copay after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging $150 Copay after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient $500 Copay 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) $4,900
Deductible (Family) $9,800
Out of Pocket Maximum (Individual) $6,100
Out of Pocket Maximum (Family) $12,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $400 Copay after deductible
Inpatient Facility $400 Copay per stay after deductible
Inpatient Physician $400 Copay 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) $950
Deductible (Family) $1,900
Out of Pocket Maximum (Individual) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $400 Copay after deductible
Inpatient Facility $400 Copay per stay after deductible
Inpatient Physician $400 Copay after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
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) $350
Deductible (Family) $700
Out of Pocket Maximum (Individual) $700
Out of Pocket Maximum (Family) $1,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $200 Copay after deductible
Inpatient Facility $200 Copay per stay after deductible
Inpatient Physician $200 Copay after deductible

Prescription Drugs

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

Other Plans in West Virginia

Plan CareSource Marketplace Gold Dental and Vision Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan CareSource Marketplace Bronze Dental and Vision Deductible $7,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Low Premium Silver Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace HSA Eligible Bronze Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,650
Plan CareSource Marketplace Low Deductible Silver Dental and Vision Deductible $4,400 Coinsurance Not applicable Out of Pocket $7,500
Plan CareSource Marketplace Standard Silver Dental and Vision Deductible $5,700 Coinsurance Not applicable Out of Pocket $7,700
Plan CareSource Marketplace Bronze Deductible $7,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Low Premium Silver Dental and Vision Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Gold Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan CareSource Marketplace Low Deductible Silver Deductible $4,400 Coinsurance Not applicable Out of Pocket $7,500

Health Insurance Tools

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Health Exchange Guides

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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) $5,700
Deductible (Family) $11,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,700
Out of Pocket Maximum (Family) $15,400

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician $500 Copay after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $250 Copay after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging $150 Copay after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient $500 Copay 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) $4,900
Deductible (Family) $9,800
Out of Pocket Maximum (Individual) $6,100
Out of Pocket Maximum (Family) $12,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $400 Copay after deductible
Inpatient Facility $400 Copay per stay after deductible
Inpatient Physician $400 Copay 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) $950
Deductible (Family) $1,900
Out of Pocket Maximum (Individual) $1,950
Out of Pocket Maximum (Family) $3,900

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $400 Copay after deductible
Inpatient Facility $400 Copay per stay after deductible
Inpatient Physician $400 Copay after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
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) $350
Deductible (Family) $700
Out of Pocket Maximum (Individual) $700
Out of Pocket Maximum (Family) $1,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $200 Copay after deductible
Inpatient Facility $200 Copay per stay after deductible
Inpatient Physician $200 Copay after deductible

Prescription Drugs

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

Other Plans in West Virginia

Plan CareSource Marketplace Gold Dental and Vision Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan CareSource Marketplace Bronze Dental and Vision Deductible $7,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Low Premium Silver Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace HSA Eligible Bronze Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,650
Plan CareSource Marketplace Low Deductible Silver Dental and Vision Deductible $4,400 Coinsurance Not applicable Out of Pocket $7,500
Plan CareSource Marketplace Standard Silver Dental and Vision Deductible $5,700 Coinsurance Not applicable Out of Pocket $7,700
Plan CareSource Marketplace Bronze Deductible $7,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Low Premium Silver Dental and Vision Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,900
Plan CareSource Marketplace Gold Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan CareSource Marketplace Low Deductible Silver Deductible $4,400 Coinsurance Not applicable Out of Pocket $7,500