Anthem Indiana 2026 Carrier Hub
Anthem Blue Cross and Blue Shield Indiana
Anthem is the one Indiana carrier that shows up in all three markets at once - individual ACA coverage, Medicare Supplement, and employer group health. This hub is the starting point. Pick the lane that matches your situation and go from there.
Choose your Anthem lane
The Anthem product you need depends entirely on where your coverage comes from. These three pages cover the full 2026 lineup.
Under 65 / Individual
Anthem ACA and Individual Plans
Bronze, Silver, Gold, and HSA-compatible designs on and off the Indiana marketplace. Anthem is the only carrier writing statewide PPO coverage in Indiana's individual market for 2026.
Compare 2026 ACA plans →
Age 65+ / Medicare
Anthem Medicare Supplement
Anthem Medigap Plans F, G, and N paired with Original Medicare, plus the 2026 Part A, Part B, and Part D numbers that decide how much of the gap you are actually filling.
See 2026 Medicare options →
Employers
Anthem Group Health
Small group, level funded, and large group plans built on Blue Access PPO. Anthem is Indiana's largest small group carrier and usually the only single network that reaches every county.
Review group options →Anthem Indiana 2026 at a glance
- 5Carriers on Indiana's 2026 individual marketplace
- Only PPOAnthem is Indiana's sole individual-market PPO carrier for 2026
- 7-9%Approximate average 2026 Indiana marketplace rate increase
- 2-50Employee range for Anthem Indiana small group and level funded plans
Why the network matters more than the brand. "My doctor takes Anthem" is not the same as "my doctor is in the network attached to this specific Anthem plan in my county." Anthem writes several different networks in Indiana across ACA, Medicare, and group. Always verify the exact network name on the plan document before you enroll.
How the three Anthem markets differ
| Market | Who it is for | 2026 product lanes | Network shape | When you can enroll |
|---|---|---|---|---|
| ACA / Individual | Under 65, no employer coverage, self-employed, early retirees | Bronze, Silver, Gold, HSA-compatible Bronze; on-exchange and off-exchange | County-based HMO plus statewide PPO | Open Enrollment each fall, or a qualifying Special Enrollment Period |
| Medicare Supplement | Age 65+ or Medicare-eligible by disability, already on Parts A and B | Medigap Plan F (legacy only), Plan G, Plan N; High-Deductible G | Any provider that accepts Original Medicare, nationwide | Medigap Open Enrollment at 65, guaranteed issue windows, or anytime with underwriting |
| Group / Employer | Indiana businesses covering employees | Fully insured PPO, HMO, EPO, HDHP; level funded; Anthem Balanced Funding for larger groups | Blue Access PPO statewide, plus narrower HMO and EPO options | Any month with a valid effective date, plus the group's annual renewal |
Where Anthem is genuinely strong in Indiana
Statewide reach that holds up outside the metros
Anthem's Blue Access PPO contracts the major Indiana systems - IU Health and Franciscan in central Indiana, Parkview in Fort Wayne, and Deaconess in Evansville. That breadth matters most in rural and small-metro counties, where narrower HMO networks from other carriers can leave real gaps.
One carrier across all three markets
If you are aging into Medicare off an Anthem group plan, or moving from an Anthem individual plan onto an employer plan, staying inside the same carrier family often means less provider disruption. It is not automatic, though - the networks are separate products and need to be checked individually.
Both exchange and direct paths on the individual side
Anthem sells Indiana individual coverage both on HealthCare.gov and directly off-exchange. That is useful when your income is too high for meaningful premium tax credits, because the off-exchange version can price better. When you do qualify for subsidies, the exchange version almost always wins.
Level funding available to genuinely small groups
Anthem offers claims-based level funded arrangements to Indiana small groups, not just to 100-life employers. A 15-person business can get claims-based pricing and a potential year-end surplus return without taking on full self-funded risk.
Common questions about Anthem in Indiana
Is Anthem the biggest health insurer in Indiana?
Anthem has the broadest statewide reach in both Indiana's individual and small group markets, and for 2026 it is the only carrier offering PPO plans on the individual market. Ambetter from MHS, CareSource, Cigna, and UnitedHealthcare also write individual coverage, but generally as HMO or EPO products in a narrower set of counties.
Does Anthem Indiana sell Medicare Advantage as well as Medicare Supplement?
Anthem offers both product types in Indiana, but they solve different problems. Medicare Supplement pairs with Original Medicare and gives you nationwide provider access with predictable cost sharing. Medicare Advantage replaces how your Parts A and B benefits are delivered, adds a network, and usually bundles drug coverage. Our Medicare page walks through the tradeoff and the 2026 numbers on both sides.
Can I keep the same Anthem doctors if I switch from a group plan to an individual plan?
Sometimes, but do not assume it. Anthem group plans in Indiana commonly run on Blue Access PPO, while individual plans are frequently county-based HMO products with a tighter network. Pull the provider directory for the specific individual plan and check each doctor and hospital by name before you drop group coverage.
Is Anthem Blue Cross and Blue Shield the same company as BCBS in other states?
Anthem is an independent licensee of the Blue Cross and Blue Shield Association. It operates the Blue plan in Indiana and about a dozen other states, but each Blue plan is a separate company with its own networks, plan designs, and rates. Your BlueCard access travels with you nationally; your Indiana plan design does not.
Do I pay more for an Anthem plan by going through an agent?
No. Insurance rates in Indiana are filed with the state and are identical whether you buy direct from Anthem, through HealthCare.gov, or through a licensed agent. Using an agency costs you nothing extra and gives you someone to call when a claim or a renewal goes sideways.
Not sure which Anthem lane you belong in?
Tell us your age, your county, and whether coverage is coming from you or an employer. We will point you at the right page - or just quote it for you.
Last reviewed against official carrier, CMS, and Indiana Department of Insurance materials on August 3, 2026. Availability, premiums, provider networks, formularies, and exact cost sharing vary by county and by the specific plan document. Indiana Health Agents Inc. is an independent agency and is not affiliated with or endorsed by Anthem Blue Cross and Blue Shield, the Indiana Department of Insurance, or the federal Medicare program.
2026 Anthem Plans
Anthem Gold Plans
| Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan (1GFE) | |
| Network name | Pathway X HMO/POS |
| Plan includes out-of-network coverage? | No |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $1,000 |
| Individual CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | $7,150 |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (percentage may vary for some covered services) | 10% |
| Preventive care1 | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $30 copay |
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 10% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 10% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance |
| Urgent care | Deductible, then $50 copay and 10% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 10% coinsurance |
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 10% coinsurance |
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
| Retail pharmacy tier 14: level 1 / level 2 | $10 copay / $20 copay |
| Retail pharmacy tier 24: level 1 / level 2 | $40 copay / $50 copay |
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance |
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance |
| Physical and occupational therapy (limits apply) | Deductible, then 10% coinsurance |
| Speech therapy (limits apply) | Deductible, then 10% coinsurance |
| Office visit: chiropractic (limits apply) | Deductible, then 10% coinsurance |
Anthem Silver Plans
| Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan (1GFA) | Anthem Silver Pathway X 2500 (1GF6) |
Anthem Silver Pathway X for HSA (1GF2)
|
|
| Network name | Pathway X HMO/POS | Pathway X HMO/POS |
Pathway X HMO/POS
|
| Plan includes out-of-network coverage? | No | No | No |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $2,000 | $2,500 | $3,000 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 | $7,150 | $4,500 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max (percentage may vary for some covered services) | 20% | 10% | 10% |
| Preventive care1 | No additional cost to you. | No additional cost to you. |
No additional cost to you.
|
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $35 copay per visit for the first 3 visits, then deductible and 20% coinsurance | $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance |
Deductible, then 10% coinsurance
|
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance |
Deductible, then $300 copay and 50% coinsurance
|
| Urgent care | Deductible, then $50 copay and 20% coinsurance | Deductible, then $50 copay and 10% coinsurance |
Deductible, then $50 copay and 10% coinsurance
|
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 20% coinsurance | Deductible, then $500 copay and 10% coinsurance |
Deductible, then $500 copay and 10% coinsurance
|
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance |
Deductible, then $500 copay and 50% coinsurance
|
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
|
| Retail pharmacy tier 14: level 1 / level 2 | $10 copay / $20 copay | $15 copay / $25 copay |
10% coinsurance / 20% coinsurance
|
| Retail pharmacy tier 24: level 1 / level 2 | $50 copay / $60 copay | $50 copay / $60 copay |
10% coinsurance / 20% coinsurance
|
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance |
40% coinsurance / 50% coinsurance
|
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance |
40% coinsurance / 50% coinsurance
|
| Physical and occupational therapy (limits apply) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Speech therapy (limits apply) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Office visit: chiropractic (limits apply) | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance |
Deductible, then 10% coinsurance
|
| Anthem Silver Pathway X 3500 (1GEY) | Anthem Silver Pathway X 4350 (1XA2) |
Anthem Silver Core Pathway X 5300 (2EQD)
|
|
| Network name | Pathway X HMO/POS | Pathway X HMO/POS |
Pathway X HMO/POS
|
| Plan includes out-of-network coverage? | No | No | No |
| Individual deductible | $3,500 | $4,350 | $5,300 |
| Individual out-of-pocket limit | $6,150 | $5,700 | $6,600 |
| Coinsurance (percentage may vary for some covered services) | 0% | 30% | 25% |
| Preventive care1 | No additional cost to you. | No additional cost to you. |
No additional cost to you.
|
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $45 copay | $25 copay | $30 copay |
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance | $50 copay |
Deductible, then 25% coinsurance
|
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 0% coinsurance | Deductible, then 30% coinsurance |
Deductible, then 25% coinsurance
|
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance |
Deductible, then $300 copay and 50% coinsurance
|
| Urgent care | Deductible, then $50 copay | $90 copay |
Deductible, then $50 copay and 25% coinsurance
|
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay | Deductible, then 30% coinsurance |
Deductible, then $500 copay and 25% coinsurance
|
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance |
Deductible, then $500 copay and 50% coinsurance
|
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance | Deductible, then 30% coinsurance |
Deductible, then 25% coinsurance
|
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1: No deductible Tier 2, 3, 4: $1,000 Combined pharmacy deductible |
Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies
|
| Retail Pharmacy tier 14: level 1 / level 2 | $15 copay / $25 copay | $10 copay / $20 copay |
$10 copay / $20 copay
|
| Retail pharmacy tier 24: level 1 / level 2 | $50 copay / $60 copay | $40 copay / $50 copay |
$40 copay / $50 copay
|
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance |
40% coinsurance / 50% coinsurance
|
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance |
40% coinsurance / 50% coinsurance
|
| Physical and occupational therapy (limits apply) | Deductible, then 0% coinsurance | Deductible, then 30% coinsurance |
Deductible, then 25% coinsurance
|
| Speech therapy (limits apply) | Deductible, then 0% coinsurance | Deductible, then 30% coinsurance |
Deductible, then 25% coinsurance
|
| Office visit: chiropractic (limits apply) | Deductible, then 0% coinsurance | Deductible, then 30% coinsurance |
Deductible, then 25% coinsurance
|
Anthem Bronze Plans
| Anthem Bronze Pathway X POS 5000 (1GEV) | Anthem Bronze Pathway X 4950 (1XAE) | Anthem Bronze Pathway X 20% for HSA (1GEW) | ||
| Network name | Pathway X HMO/POS | Pathway X HMO/POS | Pathway X HMO/POS | |
| Plan includes out-of-network coverage? | Yes | No | No | |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $5,000 / $15,000 Network / Non-network | $4,950 | $5,200 | |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 / $30,000 Network / Non-network | $7,150 | $6,550 | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max (percentage may vary for some covered services) | 40% / 60% Network / Non-network | 50% | 20% | |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. | |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $50 copay per visit for the first 2 visits, then deductible and 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $500 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | |
| Urgent care | Deductible, then $50 copay and 40% coinsurance | Deductible, then $75 copay and 50% coinsurance | Deductible, then $50 copay and 20% coinsurance | |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 40% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 20% coinsurance | |
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then 50% coinsurance | Deductible, then $1,500 copay and 50% coinsurance | Deductible, then 20% coinsurance | |
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies | |
| Retail pharmacy tier 14: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 20% coinsurance / 30% coinsurance | |
| Retail pharmacy tier 24: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance | 20% coinsurance / 30% coinsurance | |
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | |
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | |
| Physical and occupational therapy (limits apply) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Speech therapy (limits apply) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Office visit: chiropractic (limits apply) | Deductible, then 40% coinsurance | Deductible, then 50% coinsurance | Deductible, then 20% coinsurance | |
| Anthem Bronze Pathway X 5300 (1GEX) | Anthem Bronze Pathway X 5850 (1XAB) | Anthem Bronze Pathway X 6500 (1GET) | ||
| Network name | Pathway X HMO/POS | Pathway X HMO/POS | Pathway X HMO/POS | |
| Plan includes out-of-network coverage? | No | No | No | |
| Individual deductible | $5,300 | $5,850 | $6,500 | |
| Individual out-of-pocket limit | $7,150 | $7,150 | $7,150 | |
| Coinsurance (percentage may vary for some covered services) | 20% | 35% | 30% | |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. | |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $45 copay per visit for the first 2 visits, then deductible and 20% coinsurance | Deductible, then 35% coinsurance | $50 copay per visit for the first 2 visits, then deductible and 30% coinsurance | |
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $500 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance | Deductible, then $400 copay and 50% coinsurance | |
| Urgent care | Deductible, then $50 copay and 20% coinsurance | Deductible, then $75 copay and 35% coinsurance | Deductible, then $50 copay and 30% coinsurance | |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 20% coinsurance | Deductible, then $500 copay and 35% coinsurance | Deductible, then $450 copay and 30% coinsurance | |
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then 20% coinsurance | Deductible, then $1,000 copay and 50% coinsurance | Deductible, then 30% coinsurance | |
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies | Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies | |
| Retail Pharmacy tier 14: level 1 / level 2 | 20% coinsurance / 30% coinsurance | 35% coinsurance / 45% coinsurance | $20 copay / $30 copay | |
| Retail pharmacy tier 24: level 1 / level 2 | 20% coinsurance / 30% coinsurance | 35% coinsurance / 45% coinsurance | $80 copay / $90 copay | |
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | |
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | |
| Physical and occupational therapy (limits apply) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Speech therapy (limits apply) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Office visit: chiropractic (limits apply) | Deductible, then 20% coinsurance | Deductible, then 35% coinsurance | Deductible, then 30% coinsurance | |
| Anthem Bronze Pathway X 0% for HSA (1GES) |
Anthem Bronze Pathway X 7150 (1XAG)
|
|||
| Network name | Pathway X HMO/POS |
Pathway X HMO/POS
|
||
| Plan includes out-of-network coverage? | No | No | ||
| Individual deductible | $6,550 | $7,150 | ||
| Individual out-of-pocket limit | $6,550 | $7,150 | ||
| Coinsurance (percentage may vary for some covered services) | 0% | 0% | ||
| Preventive care1 | No additional cost to you. |
No additional cost to you.
|
||
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Urgent care | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
|
||
| Retail pharmacy tier 14: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
0% coinsurance / 0% coinsurance
|
||
| Retail pharmacy tier 24: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
0% coinsurance / 0% coinsurance
|
||
| Retail pharmacy tier 3: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
0% coinsurance / 0% coinsurance
|
||
| Retail pharmacy tier 4: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
0% coinsurance / 0% coinsurance
|
||
| Physical and occupational therapy (limits apply) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Speech therapy (limits apply) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
||
| Office visit: chiropractic (limits apply) | Deductible, then 0% coinsurance |
Deductible, then 0% coinsurance
|
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