CareSource Marketplace Core Gold Dental, Vision, & Fitness

Health Insurance Plan Details (2024 Plan)

by CareSource Indiana, Inc.

Monthly Premium

HMO
$ubsidy
Gold
Deductible
$2,000 /yr
Max Out-of-Pocket
$7,000 /yr

Details

Deductible (per individual) $2,000 /yr
Deductible (per family) $4,000 /yr
Max Out-of-Pocket (per individual) $7,000 /yr
Max Out-of-Pocket (per family) $14,000 /yr
Drug Deductible (per individual) Included in Medical
Drug Deductible (per family) Included in Medical
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type HMO
Includes Child Dental? Yes
Includes Adult Dental? Yes
Medical Services
Preventive Care No Charge
Primary Care Visit $20 Copay
Specialist Visit $60 Copay
Emergency Room $400 Copay after deductible
Inpatient Facility 25% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $50 Copay
Non-preferred Brand Drugs 40% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List drug list

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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