Ambetter Premier Silver

Ambetter Premier Silver plans provide a balanced approach to healthcare costs, featuring moderate monthly premiums and out-of-pocket expenses, making them suitable for individuals seeking comprehensive coverage.

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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	✓	✓	✓