CareSource Indiana

 

Silver Plans

Silver plans are a good middle of the road option, and also the best value when you qualify for cost-sharing reduction.

Plan Costs

Plan Type	Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.	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	CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max	Primary Care Visit Copay	Retail Clinic Visit Copay	Specialist Visit Copay	Emergency Copay
Individual	$3,300	$6,400	30%	$0	$0	$50	$500 after deductible
Family	$6,600	$12,800	30%	$0	$0	$50	$500 after deductible

Prescription Drug Coverage

Plan Type	Preventive	Generic	Preferred Brand	Non-preferred Brand	Preferred Specialty	Non-preferred Specialty
Individual/ Family	$0	$0	$60	$130	40% Coinsurance (up to $300)	50% Coinsurance (up to $300)

Coinsurance

Service/Supply Examples	Coinsurance after Deductible
Ambulance Services, Dental Services (related to accident or injury), Laboratory Services, Diagnostic Mammogram,X-Rays, Home Health Care Services, Home Infusion Services, Hospice Services, Inpatient Professional Services, Medical Supplies, Durable Medical Equipment and Appliances, Outpatient Services, Therapy Services, etc.	20%

Required Copays

Service	Copay
Outpatient Advanced Imaging (CT/PET Scans, MRI)	$150 after deductible
Inpatient Facility Services	$150 copay per day for 5 days, $0 days 6 and  beyond
Skilled Nursing Facility for Physical Medicine and Rehabilitation	$150 copay per day for 5 days, $0 days 6 and  beyond
Urgent Care Services	$75
Pediatric Vision Services – an annual exam is provided at no charge. Copayments apply ONLY if additional office visits are needed.	$40

Pediatric vision and dental (including orthodontia) is included.

A health plan in the bronze level may be a good choice for you if you don’t expect to have many doctor appointments or need many prescription  drugs.

› Generally, plans in the Bronze category have the lowest premiums (your monthly insurance bill) but the highest deductibles and other out-of-pocket costs.

Plan Costs

Plan Type	Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.	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	CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max	Primary Care Visit Copay	Retail Clinic Visit Copay	Specialist Visit Copay	Emergency Copay
Individual	$6,650	$6,850	40%	$35	$35	$75	$500 after deductible
Family	$13,300	$13,700	40%	$35	$35	$75	$500 after deductible

Prescription Drug Coverage

Plan Type	Preventive	Generic	Preferred Brand	Non-preferred Brand	Preferred Specialty	Non-preferred Specialty
Individual/ Family	$0	$25	$100	$250	40% Coinsurance (up to $300)	50% Coinsurance (up to $300)

Coinsurance Service/Supply Examples Coinsurance after Deductible Ambulance Services, Dental Services (related to accident or injury), Laboratory Services, Diagnostic  Mammogram, X-Rays, Home Health Care Services, Home Infusion Services, Hospice Services, Inpatient Professional Services, Medical Supplies, Durable Medical Equipment and Appliances, Outpatient Services, Therapy Services,   etc. 40%   Required Copays

Service	Copay
Outpatient Advanced Imaging (CT/PET Scans, MRI)	$200 after deductible
Inpatient Facility Services	$250 copay per day for 5 days, $0 days 6 and  beyond
Skilled Nursing Facility for Physical Medicine and Rehabilitation	$100 copay per day for 5 days, $0 days 6 and  beyond
Urgent Care Services	$100
Pediatric Vision Services – an annual exam is provided at no charge. Copayments apply ONLY if additional office visits are  needed.	$75