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Gold Plan HSA M1
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Gold Plan HSA M1

Overview
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Gold Plan HSA M1 is an individual health health plan issued by USAble Mutual 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 White county, Arkansas.

What Type of Health Plan Is This?

This plan is a PPO plan, which is also known as a "Preferred Provider Organization." In this type of insurance plan, you can choose to receive care from doctors, hospitals, and other providers who are in-network or out-of-network. You pay less if you use in-network providers. In a PPO plan, you can visit any doctor without getting a referral.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
USAble Mutual Insurance Company
Plan ID
75293AR1210005
Coverage area
White County, Arkansas
Phone
Local Phone: 1-800-800-4298
Toll-Free: 1-800-800-4298
TTY: 1-800-800-4298
Plan type
PPO
Coverage type
Medical deductible
$3,000
Out-of-pocket maximum
$3,000
Generic drug co-pay
No Charge after Deductible
Preferred brand drug co-pay
No Charge after Deductible
Primary care physician visit cost
No Charge after Deductible
Specialist doctor visit cost
No Charge after Deductible
Doctor Visits
Primary Care Visit No Charge after Deductible
Specialist Visit No Charge after Deductible
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 No Charge after Deductible
Preferred Brand Drugs No Charge after Deductible
Non-preferred Brand Drugs No Charge after Deductible
Specialty Drugs No Charge after Deductible
Medical Deductible
Medical Deductible (Individual) $3,000
Medical Maximum Out Of Pocket (Individual) $3,000
Medical Deductible (Family) $6,000
Medical Maximum Out Of Pocket (Family) $6,000
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 99.59%
Premium Child Age 0-14 300
Premium Child Age 18 359
Premium Adult Individual Age 21 393
Premium Adult Individual Age 27 412
Premium Adult Individual Age 30 446
Premium Adult Individual Age 40 502
Premium Adult Individual Age 50 702
Premium Adult Individual Age 60 1,067
Premium Couple 21 786
Premium Couple 30 892
Premium Couple 40 1,005
Premium Couple 50 1,404
Premium Couple 60 2,134
Couple+1 child, Age 21 1,087
Couple+1 child, Age 30 1,193
Couple+1 child, Age 40 1,305
Couple+1 child, Age 50 1,705
Couple+2 children, Age 21 1,388
Couple+2 children, Age 30 1,494
Couple+2 children, Age 40 1,606
Couple+2 children, Age 50 2,006
Couple+3 or more Children, Age 21 1,688
Couple+3 or more Children, Age 30 1,795
Couple+3 or more Children, Age 40 1,907
Couple+3 or more Children, Age 50 2,307
Individual+1 child, Age 21 694
Individual+1 child, Age 30 747
Individual+1 child, Age 40 803
Individual+1 child, Age 50 1,003
Individual+2 children, Age 21 994
Individual+2 children, Age 30 1,047
Individual+2 children, Age 40 1,104
Individual+2 children, Age 50 1,303
Individual+3 or more children, Age 21 1,295
Individual+3 or more children, Age 30 1,348
Individual+3 or more children, Age 40 1,404
Individual+3 or more children, Age 50 1,604
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