CareSource Marketplace Low Premium Silver, state_name

CareSource Marketplace Low Premium Silver 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).

This plan is available for qualifying individuals who live in Raleigh county, West Virginia.

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.

You can purchase this plan at HealthCare.gov.

Issuer

CareSource West Virginia Co.

Plan ID

50328WV0010021

Coverage area

Raleigh County, West Virginia

Phone

Local Phone:
Toll-Free:
TTY:

Plan type

HMO

Coverage type

Silver

Medical deductible

$6,400

Out-of-pocket maximum

$7,900

Generic drug co-pay

$20

Preferred brand drug co-pay

$50

Primary care physician visit cost

$25

Specialist doctor visit cost

$50

Primary Care Visit	$25
Specialist Visit	$50
Emergency Room Visit	$500 Copay after deductible
Inpatient Facility Visit	$500 Copay per Stay after deductible
Inpatient Physician Visit	$500 Copay after deductible

Generic Drugs	$20
Preferred Brand Drugs	$50
Non-preferred Brand Drugs	15% Coinsurance after deductible
Specialty Drugs	15% Coinsurance after deductible

Medical Deductible (Individual)	$6,400
Medical Maximum Out Of Pocket (Individual)	$7,900
Medical Deductible (Family)	$12,800
Medical Maximum Out Of Pocket (Family)	$15,800

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

EHB Percent of Total Premium	100.00%
Premium Child Age 0-14	325
Premium Child Age 18	388
Premium Adult Individual Age 21	424
Premium Adult Individual Age 27	445
Premium Adult Individual Age 30	482
Premium Adult Individual Age 40	543
Premium Adult Individual Age 50	759
Premium Adult Individual Age 60	1,153
Premium Couple 21	849
Premium Couple 30	964
Premium Couple 40	1,086
Premium Couple 50	1518
Premium Couple 60	2,306
Couple+1 child, Age 21	1,175
Couple+1 child, Age 30	1,289
Couple+1 child, Age 40	1,411
Couple+1 child, Age 50	1,843
Couple+2 children, Age 21	1,500
Couple+2 children, Age 30	1,614
Couple+2 children, Age 40	1,736
Couple+2 children, Age 50	2,168
Couple+3 or more Children, Age 21	1,825
Couple+3 or more Children, Age 30	1,940
Couple+3 or more Children, Age 40	2,061
Couple+3 or more Children, Age 50	2,493
Individual+1 child, Age 21	750
Individual+1 child, Age 30	807
Individual+1 child, Age 40	868
Individual+1 child, Age 50	1,084
Individual+2 children, Age 21	1,075
Individual+2 children, Age 30	1,132
Individual+2 children, Age 40	1,193
Individual+2 children, Age 50	1,409
Individual+3 or more children, Age 21	1,400
Individual+3 or more children, Age 30	1,457
Individual+3 or more children, Age 40	1,518
Individual+3 or more children, Age 50	1,734

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

State:
North Dakota
Metal Level:
Bronze
Plan Type:
HMO
Primary Care Visit: $80
Generic Drugs: $30
Medical Deductible (Individual): $6,850
Medical Maximum Out Of Pocket (Individual): $7,900