Ambetter Health Solutions Silver Copay HSA 4000 + Vision + Adult Dental
by Ambetter Health
This is the insurance company offering this plan. Another name for insurance company is carrier or issuer.
2026 health insurance plan
Monthly Premium
Monthly premium is the monthly cost of this plan. The monthly premium does not include additional out-of-pocket costs you must pay when receiving medical care (deductibles, copays, coinsurance).
Add your household and income to see your personalized premium and any subsidy.
Price this plan →Silver
This plan is classified as a Silver plan. Silver plans usually have low – medium monthly premium costs, but medium – high out-of-pocket costs when you need medical care.
HMOHealth Maintenance Organization (HMO) is a type of plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
HSA eligibleHealth Savings Account (HSA) is a type of savings account which can be used to pay for medical expenses with tax-free dollars. Not all plans are eligible for an HSA. Plans must have high deductibles and meet other requirements to be HSA eligible.
Deductible · ind / family
You usually have to pay the full cost for medical care until you reach the deductible amount. After reaching the deductible you then start paying for medical care based on the out-of-pocket cost details of the plan (copays, coinsurance). For plans covering a family, there are typically separate deductible amounts for individuals and the whole family. The deductible resets each year and the monthly premium does not count towards it.
$4,000 / $8,000Max out-of-pocket · ind / family
Max Out-of-Pocket is the maximum amount you will have to pay for out-of-pocket medical costs (deductible, copays, coinsurance) when you need medical care. For plans covering a family, there are typically separate max out-of-pocket amounts for individuals and the whole family. Once you reach the max out-of-pocket amount you will not have to pay another dollar for medical care. The monthly premium does not count towards the max out-of-pocket.
$7,000 / $14,000Support Our Enrollment Help Partner
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Estimated yearly cost
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These totals depend on your premium. Add your household to unlock them.
Price this plan →Coverage details
Deductible · individual
You usually have to pay the full cost for medical care until you reach the deductible amount. After reaching the deductible you then start paying for medical care based on the out-of-pocket cost details of the plan (copays, coinsurance). For plans covering a family, there are typically separate deductible amounts for individuals and the whole family. The deductible resets each year and the monthly premium does not count towards it.
$4,000 /yrDeductible · family
You usually have to pay the full cost for medical care until you reach the deductible amount. After reaching the deductible you then start paying for medical care based on the out-of-pocket cost details of the plan (copays, coinsurance). For plans covering a family, there are typically separate deductible amounts for individuals and the whole family. The deductible resets each year and the monthly premium does not count towards it.
$8,000 /yrMax out-of-pocket · individual
Max Out-of-Pocket is the maximum amount you will have to pay for out-of-pocket medical costs (deductible, copays, coinsurance) when you need medical care. For plans covering a family, there are typically separate max out-of-pocket amounts for individuals and the whole family. Once you reach the max out-of-pocket amount you will not have to pay another dollar for medical care. The monthly premium does not count towards the max out-of-pocket.
$7,000 /yrMax out-of-pocket · family
Max Out-of-Pocket is the maximum amount you will have to pay for out-of-pocket medical costs (deductible, copays, coinsurance) when you need medical care. For plans covering a family, there are typically separate max out-of-pocket amounts for individuals and the whole family. Once you reach the max out-of-pocket amount you will not have to pay another dollar for medical care. The monthly premium does not count towards the max out-of-pocket.
$14,000 /yrIncludes child dental
Some plans include dental coverage for certain adult or child dental expenses.
NoIncludes adult dental
Some plans include dental coverage for certain adult or child dental expenses.
YesBenefit details and out-of-pocket costsYou usually have to pay the full cost for medical care until you reach the deductible amount. After reaching the deductible you then start paying for medical care based on the out-of-pocket cost details of the plan (copays, coinsurance). Out-of-pocket costs are also called cost sharing.
Doctor visits
Preventive care & screenings
All health insurance plans are required to provide preventive care services at no cost. Examples of preventive care services are doctor checkups and certain lab tests.
No chargePrimary care visit
A primary care visit is a visit with a primary care physician, nurse, or other provider for services which are not considered preventive care.
$25 Copay after deductibleSpecialist visit
A specialist visit is a visit with a physician who specializes in a specific area of medicine or group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
$50 Copay after deductibleHospital & emergency
Emergency room
Emergency room is a visit to the emergency room to receive an evaluation of an emergency medical condition and treatment.
30.00% Coinsurance after deductibleInpatient facility
Inpatient facility is the facility cost for medical care you receive when admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.
30.00% Coinsurance after deductibleInpatient physician
Inpatient physician is the provider cost for medical care you receive when admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.
30.00% Coinsurance after deductiblePrescription drugs
Tier 1 · Generic
Generic drugs are classified as Tier 1 drugs — your lowest-cost option.
$3 Copay after deductibleTier 2 · Preferred brand
Preferred brand drugs are classified as Tier 2 drugs — your midrange-cost option.
$60 Copay after deductibleTier 3 · Non-preferred brand
Non-preferred brand drugs are classified as Tier 3 drugs — your highest-cost option.
45.00% Coinsurance after deductibleTier 4 · Specialty
Specialty drugs are classified as Tier 4 drugs — additional high-cost options.
50.00% Coinsurance after deductiblePlan documents & tools
* Figures shown are only for in-network medical costs.
** Please check with the insurance company if copay and coinsurance rates are before or after the deductible.
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