Marketplace Gold Plans 
Lowest Out-of-Pocket Costs
Are you are looking for a health plan with no or low deductibles and/or copays? Then our Marketplace Gold Plans are for you.
Call us today to learn more about enrollment timeframes and to find a plan that fits your needs.
1-855-572-7238.
Glance through the chart below for a comparison, or open up the linked PDFs for more details.
| 2017 Plan Benefits |
HMO Gold
Coinsurance
|
HMO Gold
Copay |
Medical Deductible (if any)
Single/Family |
$1,200/$2,400 |
$0/$0 |
Medication Deductible (if any)
Single/Family |
$0/$0 |
$0/$0 |
| Preventive Care Copay |
No Cost |
No Cost |
| Adult Primary Care Visit Copay |
$30 |
$30 |
Pediatric Primary Care Visit Copay
(Ages 0-19) |
$0 |
$0 |
| Specialty Care Visit Copay |
$50 |
$50 |
| Inpatient Copay |
20%1 |
$700 per day, not to exceed $3,500 per stay |
| Outpatient Copay |
20%1 |
$600 |
| Emergency Room Copay |
$5001 |
$500 |
| Urgent Care Copay |
$50 |
$50 |
| Routine Lab/X-Ray Copay |
No Cost |
No Cost |
| Imaging (MRI, CT, Scans) Copay |
$250 per test1 |
$250 per test1 |
Medication Copays:
Tier I
Tier II
Tier III
Tier IV
Tier V |
$0
$10
$50
$100
30%
|
$0
$20
$50
$100
30%
|
| Formulary |
link |
link |
| Compare Medication Costs |
link |
link |
Maximum Out-Of-Pocket
Single/Family |
$4,600/$9,200 |
$7,150/$14,300 |
| Plan ID |
26539TX0140001-01 |
26539TX0140002-00 |
Summary of Benefits & Coverage
(SBC) |
 |
|
| Plan Documents |
|
|
1After Medical Deductible