Ambetter Bronze Plans
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When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services.
A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care.
Essential Care 1 – Least expensive plan in portfolio. $6,800 deductible with 0% coinsurance. Thus, maximum out-of-pocket cost per individual is $6,800. Generic drugs ($20 copay) are not subject to the deductible. An annual eye exam and one pair of glasses included (no copay) for children.
- Ambetter Essential Care 1 (+Vision & Adult Dental)
- Ambetter Essential Care 1 + Vision (Zero Cost Share)
| Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $6,800 |
| Medical CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 0% Coinsurance |
| Prescription Drug Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | Integrated with medical deductible |
| Prescription Drug CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | Integrated with medical coinsurance |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $6,800 |
| Emergency Services | |
| Emergency Room Services | No charge after deductible |
| Emergency Transportation/Ambulance (Air or Ground) | No charge after deductible |
| Urgent Care | No charge after deductible |
| Provider Services | |
| Annual Well Visit/Screening/Immunization/Well Baby | No charge |
| Primary Care Visit to treat an injury or illness and Maternity | No charge after deductible |
| Specialist Visit (e.g. Cardiology, Podiatry, Chiropractic Care) | No charge after deductible |
| Imaging (CT/PET Scans, MRIs) | No charge after deductible |
| X-rays & Diagnostic imaging | No charge after deductible |
| Inpatient & Outpatient Services | |
| Inpatient Facility Fee (Includes Mental Health, Substanc Use and Maternity) | No charge after deductible |
| Inpatient Hospital Physician & Surgical Services | No charge after deductible |
| Outpatient Facility Fee (e.g. Ambulatory Surgery Center) | No charge after deductible |
| Outpatient Surgery Physician/Surgical Services | No charge after deductible |
| Laboratory Outpatient & Professional Services | No charge after deductible |
| Other Medical Services | |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | No charge after deductible |
| Rehabilitation Outpatient Services (includes Speech, Occupational and Physical Therapy) | No charge after deductible |
| Skilled Nursing Facility | No charge after deductible |
| Pediatric Vision | |
| Routine Eye Exam | 100% covered |
| Eyeglasses | 100% covered |
| Lenses | 100% covered |
| Prescription Drugs | |
| Generics | $20 copay |
| Preferred Brand Drugs | No charge after deductible |
| Non-preferred Brand Drugs | No charge after deductible |
| Specialty Drugs | No charge after deductible |
| Pediatric Vision | |
| Exams and Eyewear:
Routine Eye Exam |
100% Covered |
| Eyeglasses | 100% Covered |
| Lenses (per pair):
Single |
100% Covered |
| Bifocal | 100% Covered |
| Trifocal | 100% Covered |
| Lenticular | 100% Covered |
| Contact Lenses:
Contact lenses (in lieu of glasses) |
100% Covered |
| Contact lens fitting | 100% Covered |
| Specialty lens fitting | 100% Covered |
| Adult Vision | |
| Exams and Eyewear:
Routine Eye Exam |
100% Covered |
| Eyeglasses | Covered up to $130 |
| Lenses(per pair):
Single |
100% Covered |
| Bifocal | 100% Covered |
| Trifocal | 100% Covered |
| Lenticular | 100% Covered |
| Contact Lenses (in lieu of glasses) | Covered up to $130 |
| Contact lens fitting | 100% Covered |
| Specialty lens fitting | Covered up to $50 |
| Adult Dental (Ages 19 years of age and older, does not include Pediatric Dental Coverage) | |
| Annual Maximum Dental Benefit | $1,000 per covered person per calendar year |
| Routine Dental | |
| Routine Oral Exam | No charge, subject to Annual Maximum |
| Routine Cleaning | No charge, subject to Annual Maximum |
| Bite-wing X-ray | No charge, subject to Annual Maximum |
| Full Mouth X-ray | No charge, subject to Annual Maximum |
| Panoramic Film | No charge, subject to Annual Maximum |
| Topical Fluoride Application | No charge, subject to Annual Maximum |
| Palliative Treatment for relief of pain | No charge, subject to Annual Maximum |
| Basic Dental | |
| Basic Services:
Silver Fillings |
50% coinsurance, subject to Annual Maximum |
| tooth Colored Fillings | 50% coinsurance, subject to Annual Maximum |
| Endodontics:
Therapeutic Pulpotomy on permanent teeth |
50% coinsurance, subject to Annual Maximum |
| Periodontics:
Scaling & Root Planning |
50% coinsurance, subject to Annual Maximum |
| Periodontal Maintenance | 50% coinsurance, subject to Annual Maximum |
| Oral Surgery:
Simple Extractions |
50% coinsurance, subject to Annual Maximum |
| Surgical Extractions | 50% coinsurance, subject to Annual Maximum |
| Removal of Impacted Teeth | 50% coinsurance, subject to Annual Maximum |
| Alveoloplasty | 50% coinsurance, subject to Annual Maximum |
| Prosthodontics:
Relines |
50% coinsurance, subject to Annual Maximum |
| Rebase | 50% coinsurance, subject to Annual Maximum |
| Adjustments | 50% coinsurance, subject to Annual Maximum |
| Repairs | 50% coinsurance, subject to Annual Maximum |
| Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $0 |
| Medical CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 0% Coinsurance |
| Prescription Drug Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | Integrated with medical deductible |
| Prescription Drug CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | Integrated with medical coinsurance |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $0 |
| Emergency Services | |
| Emergency Room Services | No charge |
| Emergency Transportation/Ambulance (Air or Ground) | No charge |
| Urgent Care | No charge |
| Provider Services | |
| Annual Well Visit/Screening/Immunization/Well Baby | No charge |
| Primary Care Visit to treat an injury or illness and Maternity | No charge |
| Specialist Visit (e.g. Cardiology, Podiatry, Chiropractic Care) | No charge |
| Imaging (CT/PET Scans, MRIs) | No charge |
| X-rays & Diagnostic imaging | No charge |
| Inpatient & Outpatient Services | |
| Inpatient Facility Fee (Includes Mental Health, Substanc Use and Maternity) | No charge |
| Inpatient Hospital Physician & Surgical Services | No charge |
| Outpatient Facility Fee (e.g. Ambulatory Surgery Center) | No charge |
| Outpatient Surgery Physician/Surgical Services | No charge |
| Laboratory Outpatient & Professional Services | No charge |
| Other Medical Services | |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | No charge |
| Rehabilitation Outpatient Services (includes Speech, Occupational and Physical Therapy) | No charge |
| Skilled Nursing Facility | No charge |
| Pediatric Vision | |
| Routine Eye Exam | 100% covered |
| Eyeglasses | 100% covered |
| Lenses | 100% covered |
| Prescription Drugs | |
| Generics | No charge |
| Preferred Brand Drugs | No charge |
| Non-preferred Brand Drugs | No charge |
| Specialty Drugs | No charge |
| Pediatric Vision | |
| Exams and Eyewear:
Routine Eye Exam |
100% Covered |
| Eyeglasses | 100% Covered |
| Lenses (per pair):
Single |
100% Covered |
| Bifocal | 100% Covered |
| Trifocal | 100% Covered |
| Lenticular | 100% Covered |
| Contact Lenses:
Contact lenses (in lieu of glasses) |
100% Covered |
| Contact lens fitting | 100% Covered |
| Specialty lens fitting | 100% Covered |
| Adult Vision | |
| Exams and Eyewear:
Routine Eye Exam |
100% Covered |
| Eyeglasses | Covered up to $130 |
| Lenses(per pair):
Single |
100% Covered |
| Bifocal | 100% Covered |
| Trifocal | 100% Covered |
| Lenticular | 100% Covered |
| Contact Lenses (in lieu of glasses) | Covered up to $130 |
| Contact lens fitting | 100% Covered |
| Specialty lens fitting | Covered up to $50 |
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