Ambetter Gold Plans

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Secure Care 1 – $1,000 deductible with $6,350 maximum out-of-pocket expenses. Three free pcp office visits are allowed although specialist visits must meet the deductible first. A $500 deductible also applies to all prescriptions except generic drugs ($10 copay). There is also a 20% coinsurance once the deductible has been met.

A Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. It’s best for people who know they have a lot of medical costs throughout the year.

Plan Name Secure Care 1 (2017) with 3 Free PCP Visits – Standard
Medical Deductible(Ind/Fam) $1,000/$2,000
Prescription Drug Deductible(Ind/Fam) $500/$1,000
Metal Level Gold
Out-of-pocket Maximum(Ind/Fam) $6,350/$12,700
Annual Well Visit/ Preventive Care No charge
PCP Office Visit 20% after ded.
Specialist Office Visit 20% after ded.
Imaging(CT/PET Scans, MRIs) 20% after ded.
X-rays & Diagnostic Imaging 20% after ded.
Urgent Care 20% after ded.
Emergency Room* $250 after ded.
Emergency Transportation* 20% after ded.
Inpatient Facility Fee 20% after ded.
Inpatient Hospital Physician & Surgical Services 20% after ded.
Outpatient Facility Fee 20% after ded.
Outpatient Surgery Physician/Surgical Services 20% after ded.
Labs & Diagnostics 20% after ded.
Mental/Behavioral Health & Substance Use Disorder Outpatient Services 20% after ded.
Rehabilitation Outpatient Services(Includes Speech, Occupational, Physical Therapy) 20% after ded.
Skilled Nursing Facility 20% after ded.
Pediatric Vision- Routine Eye Exam(1 visit per year) 100% Covered
Pediatric Vision- Eyeglasses(frames, 1 per year) 100% Covered
Pedicatric Vision- Lenses(per pair) 100% Covered
Pharmacy*
(Generic / Preferred / Non-preferred / Specialty)
$10 / $25 after Rx ded. / $75 after Rx ded. / 30% after Rx ded.

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Phone: (312) 726-6565

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