UHC Gold Advantage Off Exchange

Health Insurance Plan Details (2025 Plan)

by UnitedHealthcare of New Mexico, Inc

Monthly Premium

HMO
$ubsidy
Gold
Deductible
$950 /yr
Max Out-of-Pocket
$6,800 /yr

Details

Deductible (per individual) $950 /yr
Deductible (per family) $1,900 /yr
Max Out-of-Pocket (per individual) $6,800 /yr
Max Out-of-Pocket (per family) $13,600 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type HMO
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $20 Copay
Specialist Visit $50 Copay
Emergency Room 20.00% Coinsurance after deductible
Inpatient Facility 20.00% Coinsurance after deductible
Inpatient Physician 20.00% Coinsurance after deductible
Drug Costs
Generic Drugs $1 Copay
Preferred Brand Drugs $30 Copay
Non-preferred Brand Drugs 30.00% Coinsurance after deductible
Specialty Drugs 30.00% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* 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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