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Ambetter 2018 Plans

Arizona Health Insurance
  Bronze Essential Care 1 Bronze Essental Care 2 H S A Silver Balanced Care 4 Silver Balanced Care 9 Gold Secure Care 4
Deductible $ 6,800.00 $ 6,550.00 $ 7,050.00 $ 4,200.00 $ 1,400.00
Coinsurance 0 0 0 20% 10%
Out of Pocket Max $ 6,800.00 $ 6,800.00 $ 7,050.00 $ 7,150.00 $ 5,705.00
Doctor Visit PCP Subject to Deductible Subject to Deductible $ 30.00 $ 30.00 $ 10.00
Doctor Visit Specialist Subject to Deductible Subject to Deductible $ 60.00 $ 50.00 $ 30.00
Preventative Care No Charge No Charge No Charge No Charge No Charge
Prescriptions          
Generic Drugs $ 20.00 Subject to Deductible $ 15.00 $ 20.00 $ 15.00
Brand Drugs Subject to Deductible Subject to Deductible $ 50.00 Deductible then $40 $ 50.00
Brand (Non-Preferred) Subject to Deductible Subject to Deductible Subject to Deductible Deductible then $70 Deductible then $70
Specialty Subject to Deductible Subject to Deductible Subject to Deductible Deductible then 50% Deductible then 50%
Emergency Room Subject to Deductible Subject to Deductible Subject to Deductible $ 400.00 Deductible then $150
Hosptial In Patient Subject to Deductible Subject to Deductible Subject to Deductible Deductible then 20% Deductible then $375/Day
X-Rays Subject to Deductible Subject to Deductible Subject to Deductible $ 50.00 Deductible then $60
CT Scans, Pet Scansm MRI Subject to Deductible Subject to Deductible Subject to Deductible $ 250.00 Deductible then $250
Lab Tests Subject to Deductible Subject to Deductible Subject to Deductible $ 20.00 No Charge after deductible