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CareSource Marketplace Gold Dental and Vision
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CareSource Marketplace Gold Dental and Vision

Overview
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CareSource Marketplace Gold Dental and Vision is an individual health health plan issued by CareSource West Virginia Co. 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 Wetzel county, West Virginia.

What Type of Health Plan Is This?

This plan is an HMO plan, which is also known as a "Health Maintenance Organization." An HMO is a type of insurance plan that generally limits coverage to care from doctors who contract with the HMO. Out-of-network doctors are usually not covered.

You may be required to live or work in a particular service area in order to be eligible for the HMO's coverage. In an HMO, you will usually need to have a primary care doctor (PCP) and you need referrals in order to see specialists.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
CareSource West Virginia Co.
Plan ID
50328WV0020022
Coverage area
Wetzel County, West Virginia
Phone
Local Phone:
Toll-Free:
TTY:
Plan type
HMO
Coverage type
Medical deductible
$2,000
Out-of-pocket maximum
$6,500
Generic drug co-pay
$10
Preferred brand drug co-pay
$50
Primary care physician visit cost
No Charge
Specialist doctor visit cost
$35
Doctor Visits
Primary Care Visit No Charge
Specialist Visit $35
Emergency Room Visit 20% Coinsurance after deductible
Inpatient Facility Visit 20% Coinsurance after deductible
Inpatient Physician Visit 20% Coinsurance after deductible
Prescription Drugs
Generic Drugs $10
Preferred Brand Drugs $50
Non-preferred Brand Drugs $200
Specialty Drugs 40% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $2,000
Medical Maximum Out Of Pocket (Individual) $6,500
Medical Deductible (Family) $4,000
Medical Maximum Out Of Pocket (Family) $13,000
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 97.27%
Premium Child Age 0-14 449
Premium Child Age 18 536
Premium Adult Individual Age 21 588
Premium Adult Individual Age 27 616
Premium Adult Individual Age 30 667
Premium Adult Individual Age 40 751
Premium Adult Individual Age 50 1,050
Premium Adult Individual Age 60 1,595
Premium Couple 21 1,176
Premium Couple 30 1,334
Premium Couple 40 1,503
Premium Couple 50 2,100
Premium Couple 60 3,191
Couple+1 child, Age 21 1,625
Couple+1 child, Age 30 1,784
Couple+1 child, Age 40 1,952
Couple+1 child, Age 50 2,550
Couple+2 children, Age 21 2,075
Couple+2 children, Age 30 2,234
Couple+2 children, Age 40 2,402
Couple+2 children, Age 50 3,000
Couple+3 or more Children, Age 21 2,525
Couple+3 or more Children, Age 30 2,684
Couple+3 or more Children, Age 40 2,852
Couple+3 or more Children, Age 50 3,450
Individual+1 child, Age 21 1,037
Individual+1 child, Age 30 1,117
Individual+1 child, Age 40 1,201
Individual+1 child, Age 50 1,500
Individual+2 children, Age 21 1,487
Individual+2 children, Age 30 1,567
Individual+2 children, Age 40 1,651
Individual+2 children, Age 50 1,949
Individual+3 or more children, Age 21 1,937
Individual+3 or more children, Age 30 2,017
Individual+3 or more children, Age 40 2,101
Individual+3 or more children, Age 50 2,399
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