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CareSource Marketplace Low Premium Silver Dental and Vision
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CareSource Marketplace Low Premium Silver Dental and Vision

Overview
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CareSource Marketplace Low Premium Silver 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 Pleasants 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
50328WV0020021
Coverage area
Pleasants County, West Virginia
Phone
Local Phone:
Toll-Free:
TTY:
Plan type
HMO
Coverage type
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
Doctor Visits
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
Prescription Drugs
Generic Drugs $20
Preferred Brand Drugs $50
Non-preferred Brand Drugs 15% Coinsurance after deductible
Specialty Drugs 15% Coinsurance after deductible
Medical 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
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 96.38%
Premium Child Age 0-14 308
Premium Child Age 18 368
Premium Adult Individual Age 21 403
Premium Adult Individual Age 27 422
Premium Adult Individual Age 30 457
Premium Adult Individual Age 40 515
Premium Adult Individual Age 50 720
Premium Adult Individual Age 60 1,094
Premium Couple 21 806
Premium Couple 30 915
Premium Couple 40 1,030
Premium Couple 50 1440
Premium Couple 60 2,188
Couple+1 child, Age 21 1,114
Couple+1 child, Age 30 1,223
Couple+1 child, Age 40 1,338
Couple+1 child, Age 50 1,748
Couple+2 children, Age 21 1,423
Couple+2 children, Age 30 1,531
Couple+2 children, Age 40 1,647
Couple+2 children, Age 50 2,056
Couple+3 or more Children, Age 21 1,731
Couple+3 or more Children, Age 30 1,840
Couple+3 or more Children, Age 40 1,955
Couple+3 or more Children, Age 50 2,365
Individual+1 child, Age 21 711
Individual+1 child, Age 30 765
Individual+1 child, Age 40 823
Individual+1 child, Age 50 1,028
Individual+2 children, Age 21 1,019
Individual+2 children, Age 30 1,074
Individual+2 children, Age 40 1,132
Individual+2 children, Age 50 1,336
Individual+3 or more children, Age 21 1,328
Individual+3 or more children, Age 30 1,382
Individual+3 or more children, Age 40 1,440
Individual+3 or more children, Age 50 1,645
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