Silver Cost-Sharing 87 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 87 Access Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $550
Family: $1,100
Individual: $1,650
Family: $3,300
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $2,100
Family: $4,200
Individual: $6,300
Family: $12,600
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
1st 3 visits $15 copay then $15 copay per visit after deductible You pay 40% after deductible
Specialist Office Visits You pay $45 copay per visit after deductible You pay 40% after deductible
Emergency Room Visits You pay 20% after deductible You pay 20% 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 20% per drug
Tier 3 Non-Preferred: You pay 30% per drug
Tier 4 Specialty: You pay 40% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 40% after deductible
Tier 2 Preferred Brand: You pay 40% after deductible
Tier 3 Non-Preferred: You pay 40% after deductible
Tier 4 Specialty: You pay 40% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $45 copay per visit after deductible You pay 40% after deductible
Diagnostic X-Ray & Lab Services You pay 20% after deductible You pay 40% after deductible
Inpatient Hospital Services You pay 20% after deductible You pay 40% after deductible
Maternity You pay 20% after deductible You pay 40% after deductible
Physician, Surgical & Medical Services You pay 20% after deductible You pay 40% after deductible
Physical, Occupational & Speech Therapy You pay 20% after deductible You pay 70% after deductible

Get PricingDownload a comparison chart

Silver 87 Access Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $550
Family: $1,100
Individual: $1,650
Family: $3,300
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $2,100
Family: $4,200
Individual: $6,300
Family: $12,600
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $15 copay per visit You pay 40% after deductible
Specialist Office Visits You pay $45 copay per visit after deductible You pay 40% after deductible
Emergency Room Visits You pay 20% after deductible You pay 20% 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 20% per drug
Tier 3 Non-Preferred: You pay 30% per drug
Tier 4 Specialty: You pay 40% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 40% after deductible
Tier 2 Preferred Brand: You pay 40% after deductible
Tier 3 Non-Preferred: You pay 40% after deductible
Tier 4 Specialty: You pay 40% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $45 copay per visit after deductible You pay 40% after deductible
Diagnostic X-Ray & Lab Services You pay 20% after deductible You pay 40% after deductible
Inpatient Hospital Services You pay 20% after deductible You pay 40% after deductible
Maternity You pay 20% after deductible You pay 40% after deductible
Physician, Surgical & Medical Services You pay 20% after deductible You pay 40% after deductible
Physical, Occupational & Speech Therapy You pay 20% after deductible You pay 70% after deductible

Get PricingDownload a comparison chart

Silver Cost-Sharing 87 Access Care

In Network Out of Network
Deductible
(What’s this?)
$550 individual
$1,100 family
$1,650 individual
$3,300 family
Annual Out-of-Pocket Maximum
(What’s this?)
$2,100 individual
$4,200 family
$6,300 individual
$12,600 family
Co-insurance
(What’s this?)
You pay 20% You pay 40%
Primary Care Provider and Non-specialist Office Visits
(Find a Provider)
$10 copay after deductible You pay 40% after deductible
Specialist Office Visits You pay 20% after deductible You pay 40% after deductible
Emergency Room Visits You pay 20% after deductible You pay 20% 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 40% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network – deductible does not apply You pay 40% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay 20% after deductible You pay 40% after deductible
Diagnostic X-Ray & Lab Services You pay 20% after deductible You pay 40% after deductible
Inpatient Hospital Services You pay 20% after deductible You pay 40% after deductible
Maternity You pay 20% after deductible You pay 40% after deductible
Physician, Surgical & Medical Services You pay 20% after deductible You pay 40% after deductible
Physical, Occupational & Speech Therapy You pay 20% after deductible You pay 40% after deductible

Get Pricing