Plan Brochure
CommunityCare Silver L21
Plan Year:
2026
Metal Level:
Silver
Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.
Medical Benefit
| In Network | |
| Individual Deductible | $100 |
| Family Deductible | $300 |
| Individual Out of Pocket Maximum | $1,000 |
| Family Out of Pocket Maximum | $3,000 |
| Primary Care Office Visits | $15Copayment per Visit |
| Specialty Care Office Visits | $25Copayment per Visit |
| Preventive Care | No Copayment |
| Emergency Room | 5%*Coinsurance |
| Urgent Care | $50Copayment per Visit |
| Inpatient Hospital | 5%*Coinsurance |
| Mental Health Physician Visit | $15Copayment per Visit |
| Laboratory | No Copayment |
| Radiology | No Copayment |
| MRI, CT Scan and PET Scan | 5%*Coinsurance |
*After Deductible, the Coinsurance/Copayment will apply.
Pharmacy Benefit
| | No BP Item.
Essential Benefits
All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health services
- Substance use disorder services
- Prescription drug coverage
- Rehabilitative and habilitative services and devices
- Preventative and wellness services
- Pediatric Services
