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 – $7,000 individual deductible
- Focused Silver – $6,300 individual deductible
- Standard Silver – $6,000 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 | $7,000/ $14,000 | $6,300/ $12,600 | $6,000/ $12,000 |
| 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** | $7,000/ $14,000 | $8,400 / $16,800 | $8,900/ $17,800 |
| 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 | $50 | $40 | $40 |
| Specialist visit | $100 | $85 | $80 |
| Preventative care/screening | No charge | No charge | No charge |
| Diagnostic test (xray, blood) | $25 | $50 or 50% | 40% |
| Imaging (CT/PET/MRI) Freestanding / Hospital | No Charge | 50% | 40% |
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 |
Tier 1a – Preferred Generic Retail: No |
Tier 1a – Preferred Generic Retail: $3 Copay / prescription; deductible does not apply Tier 1b – Generic Retail: $15 Copay / prescription; deductible does not apply |
Tier 1a – Preferred Generic Retail: $20 Copay / prescription; deductible does not apply Tier 1b – Generic Retail: $20 Copay / prescription; deductible does not apply |
| Preferred Brand drugs | Tier 2 – Retail: No charge |
Tier 2 – Retail: $75 Copay / prescription; deductible does not apply |
Tier 2 – Retail: $40 Copay / prescription; deductible does not apply |
| Non-preferred brand & generic drugs | Tier 3 – Retail: No charge |
Tier 3 – Retail: $250 Copay / prescription; deductible does not apply |
Tier 3 – Retail: $80 Copay / prescription |
| Specialty Drugs | Tier 4 – Retail: No charge |
Tier 4 – Retail: $650 Copay / prescription; deductible does not apply |
Tier 4 – Retail: $350 Copay / prescription |
Outpatient Surgery / Emergency Comparison
| Clear Silver | Focused Silver | Standard Silver | |
| Facility Fee | No charge | 50% Coinsurance | 40% Coinsurance |
| Facility fee Hospital | No charge | 50% Coinsurance | 40% Coinsurance |
| Physician/surgeon Fee | No charge | 50% Coinsurance | 40% Coinsurance |
| Emergency Room Care | No charge | 50% Coinsurance | 40% Coinsurance |
| Emergency Medical Transportation | No charge | 50% Coinsurance | 40% Coinsurance |
| Urgent Care | $75 Copay | $60 Copay | $60 Copay |
Hospital Stay / Health Services / Pregnancy
| Clear Silver | Focused Silver | Standard Silver | |
| Facility Fee for hospital stay | No Charge | 50% coinsurance | 40% coinsurance |
| Physician/surgeon Fees | No Charge | 50% coinsurance | 40% coinsurance |
| Mental health, behavioral health, or substance abuse services: Outpatient | $50 | $40 | $40 |
| Mental health, behavioral health, or substance abuse services: Inpatient | No Charge | 50% coinsurance | 40% Coinsurance |
| If you are pregnant – office visit | $50 | $40/visit | $50 / visit |
| Childbirth/delivery/professional services | No Charge | 50% coinsurance | 50% coinsurance |
| Childbirth/delivery facility services | No Charge | 50% coinsurance | 50% coinsurance |
Help recovering / other special needs
| Clear Silver | Focused Silver | Standard Silver | |
| Home Health Care | No Charge | 50% | 40% |
| Rehabilitation Services | No Charge | 50% | $40 / 40% (out vs in) |
| Habilitation services | No Charge | 50% / 50% | $40 / 40% (out vs in) |
| Skilled nursing care | No Charge | 50% | 40% |
| Durable medical equipment | No Charge | 50% | 40% |
| Hospice services | No Charge | 50% | 40% |
Childrens Dental / Eye care
| Clear Silver | Focused Silver | Standard Silver | |
| 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.)
| Clear Silver | Focused Silver | Standard Silver | |
| 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.)
| Clear Silver | Focused Silver | Standard Silver | |
| Abortion care | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ |
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