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.
- Central Gold – $1,000 individual deductible
- Everyday Gold – $750 individual deductible
- Standard Gold– $1,500 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
| Central Gold | Everyday Gold | Standard Gold | |
| Overall Deductible Individual/Family | $1,000 / $2,000 | $750 / $1,500 | $1,500 / $3,000 |
| 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** | $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. |
Office Visit / Testing
| Central Gold | Everyday Gold | Standard Gold | |
| Primary Care for injury/illness | $25 | $35 | $30 |
| Specialist visit | $60 | $55 | $60 |
| Preventative care/screening | No Charge | No Charge | No Charge |
| Diagnostic test (xray, blood) Freestanding / Hospital | 40% | $35 / 35% | 25% |
| Imaging (CT/PET/MRI) Freestanding / Hospital | 40% | 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 Gold | Everyday Gold | Standard Gold | |
| Generic Drugs (Preferred) | $3 | $3 | $15 |
| Generic Drugs (Non Preferred) | $20 | $15 | $15 |
| Brand drugs (Preferred) | $40 | $60 | $30 |
| Brand Drugs Non Preferred | $250 | 45% | $60 |
| Specialty Drugs | $500 | 50% | $250 |
Outpatient Surgery / Emergency Comparison
| Central Gold | Everyday Gold | Standard Gold | |
| Facility Fee | 40% | 35% | 25% |
| Facility fee Hospital | 40% | 35% | 25% |
| Physician/surgeon Fee | 40% | 35% | 25% |
| Emergency Room Care | 40% | 35% | 25% |
| Emergency Medical Transportation | 40% | 35% | 25% |
| Urgent Care | $50 | $35 | $45 |
Hospital Stay / Health Services / Pregnancy
| Central Gold | Everyday Gold | Standard Gold | |
| Facility Fee for hospital stay | 40% | 35% | 25% |
| Physician/surgeon Fees | 40% | 35% | 25% |
| Mental health, behavioral health, or substance abuse services: Outpatient | $25 | $35 | $40 |
| Mental health, behavioral health, or substance abuse services: Inpatient | 40% | 35% | 25% |
| If you are pregnant – office visit | $25 | $35 | $30 |
| Childbirth/delivery/professional services | 40% | 35% | 25% |
| Childbirth/delivery facility services | 40% | 35% | 25% |
Help recovering / other special needs
| Central Gold | Everyday Gold | Standard Gold | |
| Home Health Care | 40% | 35% | 25% |
| Rehabilitation Services | $35 | 35% | $30 |
| Habilitation services | $35 | 35% | $30 |
| Skilled nursing care | 40% | 35% | 25% |
| Durable medical equipment | 40% | 35% | 25% |
| Hospice services | 40% | 35% | 25% |
Childrens Dental / Eye care
| Central Gold | Everyday Gold | Standard Gold | |
| 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 Gold | Everyday Gold | Standard Gold | |
| Acupuncture | ✓ | ✓ | ✓ |
| Dental Care (Adult) | ✓ | ✓ | ✓ |
| Long-term Care | ✓ | ✓ | ✓ |
| Non-emergency care when traveling outside of US | ✓ | ✓ | ✓ |
| Routine eye care (adult) | ✓ | ✓ | ✓ |
| Weight loss programs | ✓ | ✓ | ✓ |
| Central Gold | Everyday Gold | Standard Gold | |
| Abortion care | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ |
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