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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