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CareSource - CareSource Marketplace Standard Silver
West Virginia, 2019
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$7,700
Deductible
$5,700
Emergency Room Care: $500 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) | $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 | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| 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 |