Anthem (PPO)

Anthem (PPO) | Anthem Gold X PPO 25

  • Anthem Gold X PPO 25 is an Obamacare health insurance plan offered by Anthem (PPO) 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 Gold metal level plan, which generally has a higher monthly cost but lower deductible (and co-pay), and provides good insurance coverage for people and families who spend more on health care (doctor visits, Rx, tests) than the average person.

  • 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 $6,850, 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

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Plan Summary

Monthly Cost

Plan Name:
Anthem Gold X PPO 25

Plan ID:
87269CO1190009

Plan Type:
PPO

Deductible:
No Charge

Maximum Out-of-Pocket:
$6,850

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. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. 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


Dental Coverage:
Child

Emergency Room:
$500 then 25%

Retail Drugs:
$40

Generic Drugs:
$15

Overview


Plan Type:
PPO

Metal Level:
Gold

Health Spending Account:
No

Primary Care Office Visit:
$25

Specialist Office Visit:
25%

Out of Network Coverage:
No

Out of Country Coverage:
No

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
50%
Well Baby Care
In Network:
No Charge

Out of Network:
50%

Inpatient

Hospital Services
In Network:
$500 Copay per Stay then 25%

Out of Network:
$500 Copay per Stay then 50% Coinsurance after deductible
Physician Fee
In Network:
25%

Out of Network:
50%
Skilled Nursing Facility
In Network:
25%

Out of Network:
50%
Mental Health
In Network:
$500 Copay per Stay then 25%

Out of Network:
$500 Copay per Stay then 50% Coinsurance after deductible
Substance Abuse
In Network:
$500 Copay per Stay then 25%

Out of Network:
$500 Copay per Stay then 50% Coinsurance after deductible
Home Healthcare
In Network:
25%

Out of Network:
50%

Outpatient

Surgery
In Network:
25%

Out of Network:
50%
X-ray and Diagnostics
In Network:
25%

Out of Network:
50%
Labs
In Network:
25%

Out of Network:
50%
Facility Fee
In Network:
25%

Out of Network:
50%
Mental Health
In Network:
25%

Out of Network:
50%
Substance Abuse
In Network:
25%

Out of Network:
50%
Rehabilitation Services
In Network:
25%

Out of Network:
50%

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
25%

Out of Network:
50%
Labor and Delivery Inpatient Services
In Network:
$500 then 25%

Out of Network:
$500 then 50%

Dental

Basic Dental Care (Child)
In Network:
50%

Out of Network:
50%
Dental Checkup (Child)
In Network:
10%

Out of Network:
30%
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:
25%

Out of Network:
50%
Rehabilitation Services (Speech)
In Network:
25%

Out of Network:
50%
Rehabilitation Services (Occupational Therapy)
In Network:
25%

Out of Network:
50%
Hospice Service
In Network:
25%

Out of Network:
50%
Diabetes Care Management
In Network:
25%

Out of Network:
50%
Durable Medical Equipment
In Network:
25%

Out of Network:
50%
Hearing Aids
In Network:
25%

Out of Network:
50%
Nutritional Consuleling
In Network:
25%

Out of Network:
50%
Reconstructive Surgery
In Network:
$500 then 25%

Out of Network:
50%

Doctor Visits

Primary Care Visit
In Network:
$25

Out of Network:
50%
Specialist Visit
In Network:
25%

Out of Network:
50%
Other Practitioner Office Visit
In Network:
$25 then 25%

Out of Network:
50%
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
50%

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$500 then 25%

Out of Network:
$500 then 25%
Urgent Care Services
In Network:
$50 then 25%

Out of Network:
$50 then 25%
Ambulance/Transportation Services
In Network:
25%

Out of Network:
25%

Drugs

Generic Prescription
In Network:
$15

Out of Network:
50%
Retail Brand Drugs
In Network:
$40

Out of Network:
50%
Non Retail Brand Drugs
In Network:
$80

Out of Network:
50%
Specialty Drugs
In Network:
$500

Out of Network:
Not Covered

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.

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