Select Plan Basic - HMO

Plan summary
Get our guide to the Essential Health Benefits covered by this plan and all other Marketplace plans.
Your premium is the amount you pay for health insurance each month.
Deductible
N/A
N/A
Your deductible is the amount you pay for healthcare services before your insurance starts helping you cover the cost.
Depending on the plan, some basic services (like doctor visits and prescriptions) may be covered before your deductible is met.
Out-of-pocket max
$425 per person
$850 per family
This is the most you will have to pay for healthcare services during your coverage period (typically 12 months).
After you spend this amount on deductibles, copayments, and coinsurance, your health insurance plan will pay the rest.
Note: monthly premiums don’t count towards your out-of-pocket max.
Network type
HMO
The type of network you choose (HMO, PPO, POS, or EPO) will determine which providers (doctors, pharmacies, hospitals, and specialist) you can see.
HMO plans usually limit coverage to providers who are within the plan’s network, and require a doctor’s referral to see specialists.
PPO plans usually cover some of the cost of out-of-network providers (but not as much as for in-network providers), and don’t require a doctor’s referral to see specialists.
EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Metal tier
Low
Metal levels (which include bronze, silver, gold, and platinum) determine how you will split the cost of your healthcare services with your insurance carrier.
Bronze plans have the lowest monthly premiums and the highest costs when you need care
Silver plans have moderate monthly premiums and moderate costs when you need care.
Gold plans have high monthly premiums and low costs when you need care.
Platinum plans have the highest monthly premiums and the lowest costs when you need care.
Adult coverage
Checkups
$10
Basic Dental
30%
Major dental care
43%
Orthodontia
54%
Child coverage
Checkups
$20
Basic Dental
28%
Major dental care
39%
Orthodontia
$425
The Affordable Care Act requires that all health insurance plans cover preventive care for free. Preventive care services focus on managing and maintaining your health before something becomes serious. This includes routine check-ups, counseling, screenings, and immunizations. Grab our free guide to preventive care to refer back to later.
Abdominal aortic aneurysm one-time screening
For men of specified ages who have ever smoked
Free
Alcohol misuse screening and counseling
To prevent cardiovascular disease for men and women of certain ages
Free
Cholesterol screening
For adults of certain ages or at higher risk
Free
Colorectal cancer screening
For adults over 50
Free
Diabetes (Type 2) screening
For adults with high blood pressure
Free
Diet counseling
For adults at higher risk for chronic disease
Free
Hepatitis B screening
For people at high risk
Free
Hepatitis C screening
For adults at increased risk, and one time for everyone born 1945 – 1965
Free
HIV screening
For everyone ages 15 to 65, and other ages at increased risk
Free
Lung cancer screening
For adults 55 - 80 at high risk for lung cancer
Free
Syphilis screening
For adults at higher risk and all pregnant women
Free
Tobacco Use screening
For all adults and cessation interventions for tobacco users
Free
Official documents
If you'd like to see the official documents from the health insurance company, we've provided links to those here.
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