Silver Cost-Sharing 94 Access Care

The cost-sharing versions of our Connected Care and Access plans are only available to individuals with certain income levels. Check your eligibility for (or purchase) these plans here. Have questions? Just call us at 855-447-2900.

Silver 94 Access Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $50
Family: $100
Individual: $150
Family: $300
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $1,500
Family: $3,000
Individual: $4,500
Family: $9,000
Co-insurance
(What’s this?)
You pay 10% You pay 30%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $10 copay per visit after deductible You pay 30% after deductible
Specialist Office Visits You pay $20 copay per visit You pay 30% after deductible
Emergency Room Visits You pay 10% after deductible You pay 10% after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 15% per drug
Tier 3 Non-Preferred: You pay 25% per drug
Tier 4 Specialty: You pay 30% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 30% after deductible
Tier 2 Preferred Brand: You pay 30% after deductible
Tier 3 Non-Preferred: You pay 30% after deductible
Tier 4 Specialty: You pay 30% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 30% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $20 copay after deductible You pay 30% after deductible
Diagnostic X-Ray & Lab Services You pay 10% after deductible You pay 30% after deductible
Inpatient Hospital Services You pay 10% after deductible You pay 30% after deductible
Maternity You pay 10% after deductible You pay 30% after deductible
Physician, Surgical & Medical Services You pay 10% after deductible You pay 30% after deductible
Physical, Occupational & Speech Therapy You pay 10% after deductible You pay 30% after deductible

Get PricingDownload a comparison chart

Silver 94 Access Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $50
Family: $100
Individual: $150
Family: $300
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $1,500
Family: $3,000
Individual: $4,500
Family: $9,000
Co-insurance
(What’s this?)
You pay 10% You pay 30%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $10 copay per visit You pay 30% after deductible
Specialist Office Visits You pay $20 copay per visit You pay 30% after deductible
Emergency Room Visits You pay 10% after deductible You pay 10% after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 15% per drug
Tier 3 Non-Preferred: You pay 25% per drug
Tier 4 Specialty: You pay 30% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 30% after deductible
Tier 2 Preferred Brand: You pay 30% after deductible
Tier 3 Non-Preferred: You pay 30% after deductible
Tier 4 Specialty: You pay 30% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 30% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $20 copay You pay 30% after deductible
Diagnostic X-Ray & Lab Services You pay 10% after deductible You pay 30% after deductible
Inpatient Hospital Services You pay 10% after deductible You pay 30% after deductible
Maternity You pay 10% after deductible You pay 30% after deductible
Physician, Surgical & Medical Services You pay 10% after deductible You pay 30% after deductible
Physical, Occupational & Speech Therapy You pay 10% after deductible You pay 30% after deductible

Get PricingDownload a comparison chart

Silver Cost-Sharing 94 Access Care

In Network Out of Network
Deductible
(What’s this?)
$50 individual
$100 family
$150 individual
$300 family
Annual Out-of-Pocket Maximum
(What’s this?)
$1,350 individual
$2,700 family
$4,050 individual
$8,100 family
Co-insurance
(What’s this?)
You pay 10% You pay 30%
Primary Care Provider and Non-specialist Office Visits
(Find a Provider)
$10 copay after deductible You pay 30% after deductible
Specialist Office Visits You pay 10% after deductible You pay 30% after deductible
Emergency Room Visits You pay 10% after deductible You pay 10% after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay $5 copay per drug
Tier 2 Preferred Brand: You pay $15 copay per drug
Tier 3 Non-Preferred: You pay $40 copay per drug
Tier 4 Specialty: You pay $65 copay per drug
Tier 5 Non-preferred Specialty: You pay $215 copay per drug.
You pay 30% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network – deductible does not apply You pay 30% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay 10% after deductible You pay 30% after deductible
Diagnostic X-Ray & Lab Services You pay 10% after deductible You pay 30% after deductible
Inpatient Hospital Services You pay 10% after deductible You pay 30% after deductible
Maternity You pay 10% after deductible You pay 30% after deductible
Physician, Surgical & Medical Services You pay 10% after deductible You pay 30% after deductible
Physical, Occupational & Speech Therapy You pay 10% after deductible You pay 30% after deductible

Get Pricing