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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