Ambetter Balanced Care 1 (2019)

Plan Type: HMO
Plan Tier: Silver
Medical Deductible - Individual: $5,500
Medical Deductible - Family: $11,000
Drug Deductible - Individual: Included in Medical
Drug Deductible - Family: Included in Medical
Out of Pocket Max - Individual: $6,500
Out of Pocket Max - Family: $13,000
Primary Care Visit: $30
Specialist Visit: $60
Emergency Room: 20% Coinsurance after deductible
Hospital - Physician: 20% Coinsurance after deductible
Hospital - Facility: 20% Coinsurance after deductible
Link to Full SBC: https://api.centene.com/SBC/2019/41047OH0010018-01.pdf
Plan Brochure: https://api.centene.com/Brochures/2019/41047OH0010018-01.pdf

Other Coverage:

Child Dental: No
Adult Dental No

Prescription Drug Pricing:

Generic Drugs: $10
Non-Preferred Brand Drugs: 20% Coinsurance after deductible
Preferred Brand Drugs: $50
Specialty Drugs: 20% Coinsurance after deductible
Link to Full Policy Formulary: https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html

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About The Carrier

AmBetter from Buckeye Community Health Plan provides quality healthcare solutions that help residents of Ohio live better. With a variety of affordable coverage options, they make it easier to stay healthy.

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