Choosing a Plan
Picking a health plan starts by considering a coverage tier: Catastrophic, Bronze, Silver, Gold, and Platinum. These tiers represent different levels of coverage and cost-sharing.Â
Weigh the trade-offs between deductibles and different coverage costs like copays.
You may qualify for a very low or $0 premium plan.
Premium tax credits might be available to lower monthly premiums.
All premiums are calculated based on each person’s individual circumstances such as age, location, and plan type.
Good choice if…
you’re under 30 and don’t use medical services often, yet want coverage in case of emergency and for annual preventive health screenings or checkups.
Only available for people under 30.
Premium Level
Lowest
Average Cost Split*
You pay 100%
CO-OP pays 0%.
Includes Signature Benefits
• 24/7 Telehealth access
• Dental & Vision exam reimbursements
• 100% Preventive Care coverage
• Travel Support
… Learn More
*Cost split refers to what you pay out-of-pocket vs what your plan pays (coinsurance). Estimated average based on in-network rates for coverage tier. Plans vary. Consult the specific plan documents (listed under plan documents and details) for exact details.
Catastrophic
Link
Deductible
$9,450
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Catastrophic
Engage
Deductible
$9,450
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Catastrophic
Access
Deductible
$9,450
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Good choice if…
you’re mostly healthy already and want to keep monthly premiums relatively low so you’re willing to accept higher out-of-pocket costs.
Premium Level
Low
Average Cost Split*
You pay 40%
CO-OP pays 60%
Includes Signature Benefits
• 24/7 Telehealth access
• Dental & Vision exam reimbursements
• 100% Preventive Care coverage
• Travel Support
… Learn More
*Cost split refers to what you pay out-of-pocket vs what your plan pays (coinsurance). Estimated average based on in-network rates for coverage tier. Plans vary. Consult the specific plan documents (listed under plan documents and details) for exact details.
Bronze
Link High Deductible
Deductible
$7,500
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Bronze
Link
Deductible
$9,450
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Bronze
Engage High Deductible
Deductible
$7,500
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Bronze
Engage
Deductible
$8,700
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Good choice if…
you anticipate needing some medical care throughout the year but not excessively, a silver plan can provide a good balance between monthly costs and out-of-pocket expenses.
Premium Level
Medium
Average Cost Split*
You pay 30%
CO-OP pays 70%
Includes Signature Benefits
• 24/7 Telehealth access
• Dental & Vision exam reimbursements
• 100% Preventive Care coverage
• Travel Support
… Learn More
*Cost split refers to what you pay out-of-pocket vs what your plan pays (coinsurance). Estimated average based on in-network rates for coverage tier. Plans vary. Consult the specific plan documents (listed under plan documents and details) for exact details.
Silver
Link 94 Option 2
Deductible
$0
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Income Eligibility Required
Silver
Link 94
Deductible
$0
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Income Eligibility Required
Silver
Link 87 Option 2
Deductible
$800
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Income Eligibility Required
Silver
Link 87
Deductible
$600
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Income Eligibility Required
Good choice if…
you see doctors frequently or are anticipating upcoming events such as surgery or pregnancy. Lower copays, deductibles, and out-of-pocket maximums compared to bronze or silver plans, can save you money in the long run.
Premium Level
High
Average Cost Split*
You pay 20%
CO-OP pays 80%
Includes Signature Benefits
• 24/7 Telehealth access
• Dental & Vision exam reimbursements
• 100% Preventive Care coverage
• Travel Support
… Learn More
*Cost split refers to what you pay out-of-pocket vs what your plan pays (coinsurance). Estimated average based on in-network rates for coverage tier. Plans vary. Consult the specific plan documents (listed under plan documents and details) for exact details.
Gold
Access
Deductible
$1,000
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Gold
Engage
Deductible
$1,000
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Gold
Link
Deductible
$1,000
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Good choice if…
you have chronic conditions, ongoing medical treatments, or need regular specialist visits. These plans have the lowest out-of-pocket costs which can significantly reduce recurring healthcare expenses over the course of the year.
Premium Level
Highest
Average Cost Split*
You pay 10%
CO-OP pays 90%
Includes Signature Benefits
• 24/7 Telehealth access
• Dental & Vision exam reimbursements
• 100% Preventive Care coverage
• Travel Support
… Learn More
*Cost split refers to what you pay out-of-pocket vs what your plan pays (coinsurance). Estimated average based on in-network rates for coverage tier. Plans vary. Consult the specific plan documents (listed under plan documents and details) for exact details.
Platinum
Link
Deductible
$500
Max out-of-pocket
Coinsurance (you pay)
Tier 1-Preferred Generic Drug
Primary Care Visit
Specialist Visit
Mental Health Visit
Fine print
‘Income Eligibility Required’
Plans with this label require an income validation. Please visit your state based exchange or federally facilitated marketplace to apply for these plans.
Native American plans can only be purchased on the Exchange and you must meet eligibility requirements.
All preventive services are covered at no cost, also check our drug formulary because many preventive medications are also covered in full.
CO-OP Plus Plans are a two-tier provider network product:
Tier 1 — Participating Community Health Centers for lower office visit copays.
Tier 2 — All other Connected Care Network providers and facilities.
The Outline of Coverage (OOC) is a brief description of the important features of your policy. This is not the insurance contract and only the actual policy document will provide complete details.
Key Details:
- Outline focuses mostly on in-network and out-of-network costs
- No examples or explanations of services
The Summary of Benefits and Coverage (SBC), for most people, will probably be the most important document to examine when comparing plans and understanding coverage options.
The SBC summarizes how your plan shares the costs for covered health care services. This is a summary of the legal requirements found in the Policy.
Key Details:
- Brief descriptions of limitations, exceptions, and other important details
- Deductibles
- Copays
- Coinsurance
- More in depth than the OOC
This is a legally binding contract between us, the insurance company, and you, the policy holder.
It details the rights and obligations, of both you and those of Mountain Health Co-Op.
Key Details:
- Highly detailed explanations of all coverage and benefits
- Explains prior authorization requirements
- Lists all excluded benefits
- out-of-network options
Provider Networks are doctors, hospitals, and other healthcare facilities who have contracts with Mountain Health Co-Op to provide services at lower negotiated rates. These rates are known as In-Network rates.
Copay –
Coinsurance –
HD Plans –
Deductible –Â
Premium –
HSA Compatible –
Income Eligibility Required –Â
Get advice choosing a plan that fits.
Talk to an advisor: 855-447-2900
