Anthem

Anthem | Platinum 90 D PPO (a Tiered PPO Plan)

  • Platinum 90 D PPO (a Tiered PPO Plan) is an Obamacare health insurance plan offered by Anthem that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Platinum metal level plan, which has the highest monthly cost, and for that cost provides the highest coverage (in terms of lowest deductibles and co-pays). Platinum plans are best for those who expect to use their health care benefits a lot throughout the year.

  • Deductible amount of No Charge. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $4,000, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

SPEAK WITH A LICENSED AGENT

Plan Summary

Monthly Cost

Plan Name:
Platinum 90 D PPO (a Tiered PPO Plan)

Plan ID:
1X5Q

Plan Type:
PPO

Deductible:
No Charge

Maximum Out-of-Pocket:
$4,000

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. Plans with this type of provider network tend to have a more broad provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights


Emergency Room:
$150

Retail Drugs:
$15

Generic Drugs:
$5

Overview


Plan Type:
PPO

Metal Level:
Platinum

Health Spending Account:
No

Primary Care Office Visit:
$20

Specialist Office Visit:
$40

Out of Network Coverage:
No

Out of Country Coverage:
No

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
60% Coinsurance after deductible
Well Baby Care
In Network:
No Charge

Out of Network:
60% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
10%

Out of Network:
$1,000 Copay per Stay then 60% Coinsurance after deductible
Physician Fee
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Skilled Nursing Facility
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Mental Health
In Network:
10%

Out of Network:
$1,000 Copay per Stay then 60% Coinsurance after deductible
Substance Abuse
In Network:
10%

Out of Network:
$1,000 Copay per Stay then 60% Coinsurance after deductible
Home Healthcare
In Network:
10%

Out of Network:
60% Coinsurance after deductible

Outpatient

Surgery
In Network:
10%

Out of Network:
60% Coinsurance after deductible
X-ray and Diagnostics
In Network:
$40

Out of Network:
60% Coinsurance after deductible
Labs
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Facility Fee
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Mental Health
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Substance Abuse
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Rehabilitation Services
In Network:
$20

Out of Network:
60% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
Prenatal: No ChargePostnatal: $20

Out of Network:
60% Coinsurance after deductible
Labor and Delivery Inpatient Services
In Network:
10%

Out of Network:
$1,000 then 60% Coinsurance after deductible

Dental

Basic Dental Care (Child)
In Network:
20%

Out of Network:
20%
Dental Checkup (Child)
In Network:
No Charge

Out of Network:
No Charge
Major Dental Care (Child)
In Network:
50%

Out of Network:
50%
Orthodontia (Child)
In Network:
50%

Out of Network:
50%

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
No Charge
Glasses (Child)
In Network:
No Charge

Out of Network:
No Charge

Additional Coverage

Habilitation Services
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Hospice Service
In Network:
No Charge

Out of Network:
60% Coinsurance after deductible
Diabetes Care Management
In Network:
No Charge

Out of Network:
60% Coinsurance after deductible
Durable Medical Equipment
In Network:
10%

Out of Network:
60% Coinsurance after deductible
Reconstructive Surgery
In Network:
10%

Out of Network:
$1,000 then 60% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Specialist Visit
In Network:
$40

Out of Network:
60% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
$20

Out of Network:
60% Coinsurance after deductible
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
60% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$150

Out of Network:
$150
Urgent Care Services
In Network:
$40

Out of Network:
$40
Ambulance/Transportation Services
In Network:
$150

Out of Network:
$150

Drugs

Generic Prescription
In Network:
$5

Out of Network:
60% Coinsurance after deductible
Retail Brand Drugs
In Network:
$15

Out of Network:
60% Coinsurance after deductible
Non Retail Brand Drugs
In Network:
$25

Out of Network:
60% Coinsurance after deductible
Specialty Drugs
In Network:
10%

Out of Network:
60% Coinsurance after deductible

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

Anthem All medical plans and rates are subject to regulatory approval. We will continue to add to our plan offerings on this site as we obtain regulatory approvals. Please keep checking back. By state law, you are required to have coverage for all 10 essential health benefits, including Child (Pediatric) Dental. If you have selected a Medical Plan that does not include coverage for the Pediatric Dental essential health benefit, you will be required to purchase the required Pediatric Dental coverage in addition to your selected medical coverage even if you have other dental coverage. The cost of the dental coverage will be in addition to the cost of your selected medical coverage. At this time, the separate Pediatric Dental plan is not available. It will be available on this quoting site in the near future. Until then, you can create a profile and save the medical plan you selected so the application process is faster when the Pediatric Dental plans and application are available. Catastrophic plans are only available to those under the age of 30 or those who meet the eligibility requirements set forth by the Affordable Care Act. If you don’t meet the requirements, please choose one of our many other plans. Anthem reserves the right to request additional documentation to confirm eligibility.

Powered by Quotit -quotit.com

LOOKING FOR A NEW HEALTH INSURANCE QUOTE?
Talk to one of our partner agents:*

* Note: This number does not reach HealthCare.com personnel.
For frequently-asked questions and support documentation:
Visit the HealthCare.com Help Center >