![Molina Healthcare (1) Molina Healthcare Silver 1 Plan](https://www.ilhealthagents.com/wp-content/uploads/2023/07/Molina-Healthcare-1.png)
Silver Plan 1 Cost Sharing Reduction | Silver Plan 1 Cost Sharing Reduction | Silver Plan 1 Cost Sharing Reduction | Silver Plan | |
---|---|---|---|---|
Services | CSR 100 | CSR 150 | CSR 200 | 1/250 |
Value Basics | ||||
Teladoc Virtual Care Visits 24/7/365 | FREE | FREE | FREE | FREE |
Annual Wellness Visit – Adults | FREE | FREE | FREE | FREE |
Routine Preventive Screenings – Children & Adults | FREE | FREE | FREE | FREE |
Routine Vision Exams & eyewear for Children (0-18) | FREE | FREE | FREE | FREE |
Preventive Prescription Drugs | FREE | FREE | FREE | FREE |
24 Hour Nurse Line | FREE | FREE | FREE | FREE |
Urgent Care at Same Cost as Primary Physician Visit | YES | YES | YES | YES |
Plan Options with Adult Vision Services | YES | YES | YES | YES |
Benefit and Cost Share Highlights | ||||
Deductible (Ind/Fam) | $0/$0 | $0/$0 | $0/$0 | $0/$0 |
Out-of-Pocket Max (Ind/Fam) | $1,200/$2,400 | $2,800/$5,600 | $6,700 / $13,400 | $8,500 / $17,000 |
Drug Deductible (Ind/Fam) | $0/$0 | $150/$300 Rx tiers 3&4 only | $350/$700 Rx tiers 3&4 only | $800 / $1,600 Rx Tiers 3&4 Only |
Emergency Room Services | $250 | $400 | $750 | $750 |
Hospital / Facility Services | ||||
Inpatient Hospital | $600/day (max 2 copays) | $750/day (max 2 copays) | $1,200/day (max 2 copays) | $1,200/day (max 2 copays) |
Skilled Nursing Facility Services | $600/day | $750/day | $1,200/day | $1,200/day |
Hospital Physician Services | $10 | $30 | $60 | $60 |
Outpatient Surgery Services | $100 | $350 | $500 | $500 |
Outpatient Services | ||||
Primary & Urgent Care Services | $0 | $6 | $30 | $30 |
Specialist Services | $10 | $30 | $60 | $60 |
Mental/Behavioral Health Services | $0 | $6 | $30 | $30 |
Imaging & Specialized Radiology | $50 | $400 | $700 | $700 |
Rehabilitative Services -ST, OT, PT | $10 | $30 | $60 | $60 |
Routine Laboratory Services | $5 | $20 | $45 | $45 |
Routine X-Ray & Diagnostic Services | $15 | $50 | $80 | $80 |
Prescription Drugs | ||||
Tier 1 – Preferred Generic Drugs | $0 | $5 | $20 | $29 |
Tier 2 – Preferred Brand Drugs | $10 | $25 | $60 | $60 |
Tier 3 – Non-Pref Brand & Generic Drugs | 10% | 40% after ded | 40% after ded | 40% after ded |
Tier 4 – Specialty Drugs | 10% | 40% after ded | 40% after ded | 40% after ded |
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