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Ambetter Balanced Care 4 (2019)
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Ambetter Balanced Care 4 (2019)

Overview
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Ambetter Balanced Care 4 (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 Osceola county, Florida.

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
21663FL0130009
Coverage area
Osceola County, Florida
Phone
Local Phone: 1-877-687-1169
Toll-Free: 1-877-687-1169
TTY: 1-800-955-8770
Plan type
EPO
Coverage type
Medical deductible
$7,050
Out-of-pocket maximum
$7,050
Generic drug co-pay
$15
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 No Charge after Deductible
Inpatient Facility Visit No Charge after Deductible
Inpatient Physician Visit No Charge after Deductible
Prescription Drugs
Generic Drugs $15
Preferred Brand Drugs $50
Non-preferred Brand Drugs No Charge after Deductible
Specialty Drugs No Charge after Deductible
Medical Deductible
Medical Deductible (Individual) $7,050
Medical Maximum Out Of Pocket (Individual) $7,050
Medical Deductible (Family) $14,100
Medical Maximum Out Of Pocket (Family) $14,100
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 100.00%
Premium Child Age 0-14 310
Premium Child Age 18 370
Premium Adult Individual Age 21 405
Premium Adult Individual Age 27 424
Premium Adult Individual Age 30 460
Premium Adult Individual Age 40 518
Premium Adult Individual Age 50 724
Premium Adult Individual Age 60 1,100
Premium Couple 21 811
Premium Couple 30 920
Premium Couple 40 1,036
Premium Couple 50 1,448
Premium Couple 60 2,201
Couple+1 child, Age 21 1,121
Couple+1 child, Age 30 1,230
Couple+1 child, Age 40 1,346
Couple+1 child, Age 50 1,758
Couple+2 children, Age 21 1,431
Couple+2 children, Age 30 1541
Couple+2 children, Age 40 1,656
Couple+2 children, Age 50 2069
Couple+3 or more Children, Age 21 1,741
Couple+3 or more Children, Age 30 1,851
Couple+3 or more Children, Age 40 1,967
Couple+3 or more Children, Age 50 2,379
Individual+1 child, Age 21 715
Individual+1 child, Age 30 770
Individual+1 child, Age 40 828
Individual+1 child, Age 50 1,034
Individual+2 children, Age 21 1026
Individual+2 children, Age 30 1,080
Individual+2 children, Age 40 1,138
Individual+2 children, Age 50 1,344
Individual+3 or more children, Age 21 1,336
Individual+3 or more children, Age 30 1,390
Individual+3 or more children, Age 40 1,448
Individual+3 or more children, Age 50 1,654
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