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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 Hamilton 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
Hamilton 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 0-14 309
Premium Child Age 18 369
Premium Adult Individual Age 21 404
Premium Adult Individual Age 27 423
Premium Adult Individual Age 30 458
Premium Adult Individual Age 40 516
Premium Adult Individual Age 50 721
Premium Adult Individual Age 60 1,096
Premium Couple 21 808
Premium Couple 30 917
Premium Couple 40 1,033
Premium Couple 50 1,443
Premium Couple 60 2,193
Couple+1 child, Age 21 1,117
Couple+1 child, Age 30 1,226
Couple+1 child, Age 40 1,342
Couple+1 child, Age 50 1,752
Couple+2 children, Age 21 1,426
Couple+2 children, Age 30 1,535
Couple+2 children, Age 40 1,651
Couple+2 children, Age 50 2,062
Couple+3 or more Children, Age 21 1736
Couple+3 or more Children, Age 30 1,845
Couple+3 or more Children, Age 40 1,960
Couple+3 or more Children, Age 50 2,371
Individual+1 child, Age 21 713
Individual+1 child, Age 30 767
Individual+1 child, Age 40 825
Individual+1 child, Age 50 1,031
Individual+2 children, Age 21 1,022
Individual+2 children, Age 30 1,077
Individual+2 children, Age 40 1,134
Individual+2 children, Age 50 1,340
Individual+3 or more children, Age 21 1,331
Individual+3 or more children, Age 30 1,386
Individual+3 or more children, Age 40 1,444
Individual+3 or more children, Age 50 1,649
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