Hometown HealthPPO

Hometown HealthPPO | 16 IF PPO NA-80 CINS S D1250X2

  • 16 IF PPO NA-80 CINS S D1250X2 is an Obamacare health insurance plan offered by Hometown HealthPPO 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 $1,250. 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 $3,200, 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:
16 IF PPO NA-80 CINS S D1250X2

Plan ID:
85266NV0030057

Plan Type:
PPO

Deductible:
$1,250

Maximum Out-of-Pocket:
$3,200

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:
20% Coinsurance after deductible

Retail Drugs:
$30

Generic Drugs:
$10

Overview


Plan Type:
PPO

Metal Level:
Gold

Health Spending Account:

Primary Care Office Visit:
No Charge For the First 2 visits then 20% after deductible

Specialist Office Visit:
20% Coinsurance after deductible

Out of Network Coverage:
Not Covered

Out of Country Coverage:
Not Covered

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Physician Fee
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Skilled Nursing Facility
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Home Healthcare
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Outpatient

Surgery
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
X-ray and Diagnostics
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Labs
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Facility Fee
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
CYD then 50%

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
Not Applicable
Labor and Delivery Inpatient Services
In Network:
20% Coinsurance after deductible

Out of Network:
CYD then 40%

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
30% Coinsurance after deductible
Glasses (Child)
In Network:
No Charge

Out of Network:
30% Coinsurance after deductible

Additional Coverage

Habilitation Services
In Network:
20% Coinsurance after deductible

Out of Network:
CYD then 50%
Hospice Service
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Durable Medical Equipment
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
No Charge For the First 2 visits then 20% after deductible

Out of Network:
CYD then 50%
Specialist Visit
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
No ChargeFor the First 2 visits then 20% after deductible

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

Out of Network:
50% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
20% Coinsurance after deductible

Out of Network:
20% Coinsurance after deductible
Urgent Care Services
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Ambulance/Transportation Services
In Network:
20% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Drugs

Generic Prescription
In Network:
$10

Out of Network:
50% Coinsurance after deductible
Retail Brand Drugs
In Network:
$30

Out of Network:
Not Applicable
Non Retail Brand Drugs
In Network:
$30 Copay after deductible then 50%

Out of Network:
Not Applicable
Specialty Drugs
In Network:
30% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Drug Deductible
In Network:
Individual: $500 Family: $1,000

Out of Network:
Individual: Not Applicable Family: Not Applicable

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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