Bronze Bronze 60
Standard Bronze plan with 60% actuarial value
Cost Overview
Annual Deductible
$5,800
Out-of-Pocket Maximum
$8,850
Standardized Benefits
| Service | You Pay | Notes |
|---|---|---|
| Deductibles | ||
| Individual Deductible (Medical) | $5,800 | |
| Individual Deductible (Pharmacy) | $450 | |
| Family Deductible (Medical) | $11,600 | |
| Family Deductible (Pharmacy) | $900 | |
| Care Visits | ||
| Preventive Care | no charge | No deductible |
| Primary Care Visit | $60 | Deductible may apply |
| Urgent Care Visit | $60 | |
| Specialty Care Visit | $95 | Deductible may apply |
| Mental/Behavioral Health Visit | $60 | |
| Tests & Therapy | ||
| Other Therapy (PT/OT/Speech) | $60 | |
| Lab Testing | $40 | |
| X-rays & Diagnostic Imaging | 40% | |
| Advanced Imaging (CT/MRI) | 40% | |
| Hospital & Emergency | ||
| Outpatient Surgery | 40% | After deductible |
| Emergency Room | 40% | After deductible |
| Emergency Transport | 40% | |
| Prenatal/Postnatal Care | no charge | |
| Inpatient Hospital Stay | 40% | After deductible |
| Hospital Physician | 40% | |
| Prescription Drugs | ||
| Generic Drugs (Tier 1) | $19 | |
| Preferred Brand Drugs (Tier 2) | 40% up to $500 | |
| Non-Preferred Brand Drugs (Tier 3) | 40% up to $500 | |
| Specialty Drugs (Tier 4) | 40% up to $500 | |
| Out of Pocket Maximums | ||
| Maximum Out of Pocket (Individual) | $8,850 | Annual limit |
| Maximum Out of Pocket (Family) | $17,700 | Annual limit |
Carrier-Specific Variations
How individual carriers differ from the standard Bronze 60 benefits
1 carrier
Kaiser Permanente
HMO Network| Service | Their Cost |
|---|---|
| Mental Health Outpatient | no charge |
Understanding Your Benefits
- Copay: A fixed amount you pay for a covered service.
- Coinsurance: Your share of costs after meeting your deductible (shown as a percentage).
- Deductible: The amount you pay before your insurance starts covering costs.
- Out-of-Pocket Maximum: The most you'll pay in a year for covered services.