Is Ambetter Standard Silver SELECT Wellstar a good plan?
I am not a medical professional, nor do I understand medical terms very well. I am 65 yr old and make about $9,600 a year. Please tell me if the above plan is good or not . It costs me about $11 per month on marketplance.
Overall deductible is – $0 individual / $0 family.
Out-of-pocket limit for this plan – For network providers: $1,800 individual / $3,600 family. Not applicable for out-of-network providers.
Diagnostic test (x-ray, blood work) – 25% Coinsurance for laboratory & professional services 25% Coinsurance for xray & diagnostic imaging 25% Coinsurance for laboratory & professional services and x-ray & diagnostic imaging at other places of service
Imaging (CT/PET scans, MRIs) – 25% Coinsurance
Generic drugs (Tier 1) – O Charge
Summary:
This Ambetter Silver plan has the following key points:
No Deductible: You don’t have to pay anything before the plan starts to cover costs.
Out-of-Pocket Limit: For in-network providers, it’s $1,800 for individuals and $3,600 for families. This is the most you will have to pay for covered services in a year.
Copayments and Coinsurance:
Primary Care Visits: No charge. Specialist Visits: $10 copay per visit. Urgent Care: $5 copay per visit. Emergency Room Care: 25% coinsurance (you pay 25% of the cost). Prescription Drugs: No charge for generic drugs; $15 copay for preferred brand drugs; $50 copay for non-preferred brand drugs; $150 copay for specialty drugs. Network Providers: You pay less if you use providers in the plan’s network. Out-of-network services are generally not covered.
Preventive Care: No charge for preventive services like screenings and immunizations.
Limitations: Some services, like chiropractic care, are limited to a certain number of visits per year. Others, like home health care, are limited to 120 visits per year.
Prior Authorization: Certain services require prior authorization to be covered.
In summary, this plan is beneficial if you frequently use in-network services and prefer a plan with low out-of-pocket costs and no deductible. However, it’s important to ensure your preferred doctors and hospitals are in-network and to understand that out-of-network services are generally not covered.