Ambetter Premier Gold

Ambetter Premier Gold plans offer comprehensive health coverage with higher monthly premiums and lower out-of-pocket costs, making them ideal for individuals who anticipate frequent healthcare needs.

Ambetter Premier Gold

Gold plans

Recommended if you:

  • Will use your coverage often
  • Have an ongoing medical condition that needs treatment
  • Want additional security and peace of mind
  • Are okay with higher monthly premiums
  • Prefer lower out-of-pocket costs

Below is a summary of the three Ambetter Premier Gold Options. See toggles below for each plan detail or download the available plan summaries.

See toggles below for plan comparisons. Information is based on Participating Providers. For Non-Participating Provider information, please download the plan summaries listed above. 

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Deductibles

Central GoldEveryday GoldStandard Gold
Overall Deductible Individual/Family$1,000 / $2,000$750 / $1,500$1,500 / $3,000
Are there services covered before you meet deductibleYes.Yes.Yes.
Are there other deductibles for specific servicesNo.No.No.
Out-of-pocket limit Individual/Family**$5,500 / $11,000$7,000 / $14,000$7,800 / $15,600
Will you pay less if you use network provider?Yes.Yes.Yes.
Referral to see a specialist?No.No.No.

**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit

Office Visit / Testing

Central GoldEveryday GoldStandard Gold
Primary Care for injury/illness$25$35$30
Specialist visit$60$55$60
Preventative care/screeningNo ChargeNo ChargeNo Charge
Diagnostic test (xray, blood) Freestanding / Hospital40%$35 / 35%25%
Imaging (CT/PET/MRI) Freestanding / Hospital40%35%25%

 

Generic / Brand / Specialty Drug Comparison

If you need Drugs to treat your illness or condition. For information on whether or not deductibles apply, please download the plan summaries

Central GoldEveryday GoldStandard Gold
Generic Drugs (Preferred)$3$3$15
Generic Drugs (Non Preferred)$20$15$15
Brand drugs (Preferred)$40$60$30
Brand Drugs Non Preferred$25045%$60
Specialty Drugs$50050%$250

 

Outpatient Surgery / Emergency Comparison

Central GoldEveryday GoldStandard Gold
Facility Fee40%35%25%
Facility fee Hospital40%35%25%
Physician/surgeon Fee40%35%25%
Emergency Room Care40%35%25%
Emergency Medical Transportation40%35%25%
Urgent Care$50$35$45

 

Hospital Stay / Health Services / Pregnancy

Central GoldEveryday GoldStandard Gold
Facility Fee for hospital stay40%35%25%
Physician/surgeon Fees40%35%25%
Mental health, behavioral health, or substance abuse services: Outpatient$25$35$40
Mental health, behavioral health, or substance abuse services: Inpatient40%35%25%
If you are pregnant – office visit$25$35$30
Childbirth/delivery/professional services40%35%25%
Childbirth/delivery facility services40%35%25%

 

Help recovering / other special needs

Central GoldEveryday GoldStandard Gold
Home Health Care40%35%25%
Rehabilitation Services$3535%$30
Habilitation services$3535%$30
Skilled nursing care40%35%25%
Durable medical equipment40%35%25%
Hospice services40%35%25%

Childrens Dental / Eye care

 

Central GoldEveryday GoldStandard Gold
Children’s eye examNo ChargeNo ChargeNo Charge
Children’s GlassesNo ChargeNo ChargeNo Charge
Children’s Dental check-upNot CoveredNot CoveredNot Covered

 

Excluded & Other Covered Services

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Central GoldEveryday GoldStandard Gold
Acupuncture ✓ ✓ ✓
Dental Care (Adult) ✓ ✓ ✓
Long-term Care ✓ ✓ ✓
Non-emergency care when traveling outside of US ✓ ✓ ✓
Routine eye care (adult) ✓ ✓ ✓
Weight loss programs ✓ ✓ ✓

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

Central GoldEveryday GoldStandard Gold
Abortion care ✓ ✓ ✓
Bariatric surgery ✓ ✓ ✓
Chiropractic care ✓ ✓ ✓
Cosmetic surgery ✓ ✓ ✓
Hearing aids ✓ ✓ ✓
Infertility treatment ✓ ✓ ✓
Private-duty nursing ✓ ✓ ✓
Routine Foot Care ✓ ✓ ✓

 

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