Silver plans
Recommended if you:
- See your primary care physician for preventive care every year
- Don’t anticipate any major ongoing medical needs
- Would like a premium that fits most budgets
- Would like out-of-pocket expenses that fit most budgets
Below is a summary of the three Ambetter Premier Silver Options. See toggles below for each plan detail or download the available plan summaries.
- Clear Silver – $6,500 individual deductible
- Focused Silver – $5,000 individual deductible
- Standard Silver – $6,300 individual deductible
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
| Clear Silver | Focused Silver | Standard Silver | |
| Overall Deductible Individual/Family | $5,000 / $10,000 | $8,450 / $16,900 | $7,500 / $15,000 |
| Are there services covered before you meet deductible | Yes. | Yes. | Yes. |
| Are there other deductibles for specific services | No. | No. | No. |
| Out-of-pocket limit Individual/Family** | $8,500 / $17,000 | $9,200 / $18,400 | $9,200 / $18,400 |
| 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
| Clear Silver | Focused Silver | Standard Silver | |
| Primary Care for injury/illness | $5,000 / $10,000 | $8,450 / $16,900 | $7,500 / $15,000 |
| Specialist visit | Yes. | Yes. | Yes. |
| Preventative care/screening | No. | No. | No. |
| Diagnostic test (xray, blood) Freestanding / Hospital | $8,500 / $17,000 | $9,200 / $18,400 | $9,200 / $18,400 |
| Imaging (CT/PET/MRI) Freestanding / Hospital | 50% | 50% coinsurance | 50% |
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
| Clear Silver | Focused Silver | Standard Silver | |
| Generic Drugs (Preferred) | $5,000 / $10,000 | $8,450 / $16,900 | $7,500 / $15,000 |
| Generic Drugs (Non Preferred) | Yes. | Yes. | Yes. |
| Brand drugs (Preferred) | No. | No. | No. |
| Brand Drugs Non Preferred | $8,500 / $17,000 | $9,200 / $18,400 | $9,200 / $18,400 |
| Specialty Drugs | $750 | 50% | $500 |
Outpatient Surgery / Emergency Comparison
| Clear Silver | Focused Silver | Standard Silver | |
| Facility Fee | $5,000 / $10,000 | $8,450 / $16,900 | $7,500 / $15,000 |
| Facility fee Hospital | Yes. | Yes. | Yes. |
| Physician/surgeon Fee | No. | No. | No. |
| Emergency Room Care | $8,500 / $17,000 | $9,200 / $18,400 | $9,200 / $18,400 |
| Emergency Medical Transportation | 50% | 50% | 50% |
| Urgent Care | 50% | $50 | $75 |
Hospital Stay / Health Services / Pregnancy
| Clear Silver | Focused Silver | Standard Silver | |
| Facility Fee for hospital stay | $5,000 / $10,000 | $8,450 / $16,900 | $7,500 / $15,000 |
| Physician/surgeon Fees | Yes. | Yes. | Yes. |
| Mental health, behavioral health, or substance abuse services: Outpatient | No. | No. | No. |
| Mental health, behavioral health, or substance abuse services: Inpatient | $8,500 / $17,000 | $9,200 / $18,400 | $9,200 / $18,400 |
| If you are pregnant – office visit | 50% coinsurance | $40/visit | $50 / visit |
| Childbirth/delivery/professional services | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| Childbirth/delivery facility services | 50% coinsurance | 50% coinsurance | 50% coinsurance |
Help recovering / other special needs
| Central Bronze | Everyday Bronze | Standard Expanded Bronze | |
| Home Health Care | 50% | 50% | 50% |
| Rehabilitation Services | 50% / 50% | 50% / 50% | $50 / 50% |
| Habilitation services | 50% / 50% | 50% / 50% | $50 / 50% |
| Skilled nursing care | 50% | 50% | 50% |
| Durable medical equipment | 50% | 50% | 50% |
| Hospice services | 50% | 50% | 50% |
Childrens Dental / Eye care
| Central Bronze | Everyday Bronze | Standard Expanded Bronze | |
| Children’s eye exam | No Charge | No Charge | No Charge |
| Children’s Glasses | No Charge | No Charge | No Charge |
| Children’s Dental check-up | Not Covered | Not Covered | Not 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 Bronze | Everyday Bronze | Standard Expanded Bronze | |
| 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 Bronze | Everyday Bronze | Standard Expanded Bronze | |
| Abortion care | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ |
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