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Silver Plan 4
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Silver Plan 4

Overview
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Silver Plan 4 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
75293AR1200021
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
$5,250
Out-of-pocket maximum
$7,900
Generic drug co-pay
$25
Preferred brand drug co-pay
$50 Copay after deductible
Primary care physician visit cost
$30
Specialist doctor visit cost
$70
Doctor Visits
Primary Care Visit $30
Specialist Visit $70
Emergency Room Visit $600 Copay after deductible
Inpatient Facility Visit $600 Copay per Day after deductible
Inpatient Physician Visit 40% Coinsurance after deductible
Prescription Drugs
Generic Drugs $25
Preferred Brand Drugs $50 Copay after deductible
Non-preferred Brand Drugs $125 Copay after deductible
Specialty Drugs 40% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $5,250
Medical Maximum Out Of Pocket (Individual) $7,900
Medical Deductible (Family) $10,500
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 99.59%
Premium Child Age 0-14 228
Premium Child Age 18 272
Premium Adult Individual Age 21 298
Premium Adult Individual Age 27 312
Premium Adult Individual Age 30 338
Premium Adult Individual Age 40 380
Premium Adult Individual Age 50 532
Premium Adult Individual Age 60 808
Premium Couple 21 596
Premium Couple 30 676
Premium Couple 40 761
Premium Couple 50 1,064
Premium Couple 60 1,617
Couple+1 child, Age 21 824
Couple+1 child, Age 30 904
Couple+1 child, Age 40 989
Couple+1 child, Age 50 1,292
Couple+2 children, Age 21 1,052
Couple+2 children, Age 30 1,132
Couple+2 children, Age 40 1,217
Couple+2 children, Age 50 1,520
Couple+3 or more Children, Age 21 1,280
Couple+3 or more Children, Age 30 1,360
Couple+3 or more Children, Age 40 1,445
Couple+3 or more Children, Age 50 1,748
Individual+1 child, Age 21 526
Individual+1 child, Age 30 566
Individual+1 child, Age 40 608
Individual+1 child, Age 50 760
Individual+2 children, Age 21 754
Individual+2 children, Age 30 794
Individual+2 children, Age 40 836
Individual+2 children, Age 50 988
Individual+3 or more children, Age 21 982
Individual+3 or more children, Age 30 1,022
Individual+3 or more children, Age 40 1,064
Individual+3 or more children, Age 50 1,216
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