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Ambetter Balanced Care 11 (2019)
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Ambetter Balanced Care 11 (2019)

Overview
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Ambetter Balanced Care 11 (2019) is an individual health health plan issued by Celtic Insurance Company and is available for the year 2019. This health plan is offered by the federal government through HealthCare.gov and the Affordable Care Act (ACA).

Where Do I Need to Live to Quality for this Plan?

This plan is available for qualifying individuals who live in Lauderdale county, Tennessee.

What Type of Health Plan Is This?

This plan is an EPO plan, which is also known as an "Exclusive Provider Organization." An EPO is a managed care plan where services are covered so long as the the hospitals, dentists, and other health providers in the plan's network are used.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
Celtic Insurance Company
Plan ID
70111TN0110004
Coverage area
Lauderdale County, Tennessee
Phone
Local Phone: 1-312-332-5401
Toll-Free: 1-800-779-7989
TTY:
Plan type
EPO
Coverage type
Medical deductible
$6,000
Out-of-pocket maximum
$7,900
Generic drug co-pay
$20
Preferred brand drug co-pay
$50
Primary care physician visit cost
$30
Specialist doctor visit cost
$60
Doctor Visits
Primary Care Visit $30
Specialist Visit $60
Emergency Room Visit 40% Coinsurance after deductible
Inpatient Facility Visit 40% Coinsurance after deductible
Inpatient Physician Visit 40% Coinsurance after deductible
Prescription Drugs
Generic Drugs $20
Preferred Brand Drugs $50
Non-preferred Brand Drugs 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $6,000
Medical Maximum Out Of Pocket (Individual) $7,900
Medical Deductible (Family) $12,000
Medical Maximum Out Of Pocket (Family) $15,800
Drug Deductible
Drug Deductible (Individual) Included in Medical
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) Included in Medical
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 99.95%
Premium Child Age 0-14 298
Premium Child Age 18 356
Premium Adult Individual Age 21 389
Premium Adult Individual Age 27 408
Premium Adult Individual Age 30 442
Premium Adult Individual Age 40 498
Premium Adult Individual Age 50 696
Premium Adult Individual Age 60 1,058
Premium Couple 21 779
Premium Couple 30 885
Premium Couple 40 996
Premium Couple 50 1,392
Premium Couple 60 2,116
Couple+1 child, Age 21 1,078
Couple+1 child, Age 30 1,183
Couple+1 child, Age 40 1,294
Couple+1 child, Age 50 1,691
Couple+2 children, Age 21 1,376
Couple+2 children, Age 30 1,481
Couple+2 children, Age 40 1,593
Couple+2 children, Age 50 1,989
Couple+3 or more Children, Age 21 1,674
Couple+3 or more Children, Age 30 1,780
Couple+3 or more Children, Age 40 1,891
Couple+3 or more Children, Age 50 2,287
Individual+1 child, Age 21 688
Individual+1 child, Age 30 740
Individual+1 child, Age 40 796
Individual+1 child, Age 50 994
Individual+2 children, Age 21 986
Individual+2 children, Age 30 1,039
Individual+2 children, Age 40 1,094
Individual+2 children, Age 50 1,293
Individual+3 or more children, Age 21 1,284
Individual+3 or more children, Age 30 1,337
Individual+3 or more children, Age 40 1,393
Individual+3 or more children, Age 50 1,591
Reference
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  • HealthCare.gov. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov
  • The 'metal' categories: Bronze, Silver, Gold & Platinum. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plans-categories
  • Health insurance plan & network types: HMOs, PPOs, and more. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plan-types