Ambetter Bronze Plans
Apply Online Now
- 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 |
Apply Online Now
Contact Us
New Enrollments:
Phone: (312) 726-6565
Email: [email protected]