CommunityCare Marketplace Plan

Plan Brochure

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.

	In Network
Individual Deductible	$0
Family Deductible	$0
Individual Out of Pocket Maximum	$2,200
Family Out of Pocket Maximum	$4,400
Primary Care Office Visits	No Copayment
Specialty Care Office Visits	$10Copayment per Visit
Preventive Care	No Copayment
Emergency Room	25%Coinsurance
Urgent Care	$5Copayment per Visit
Inpatient Hospital	25%Coinsurance
Mental Health Physician Visit	No Copayment
Laboratory	25%Coinsurance
Radiology	25%Coinsurance
MRI, CT Scan and PET Scan	25%Coinsurance


Combined Pharmacy and Medical Individual Out-of-Pocket Maximum	$2,200
Combined Pharmacy and Medical Family Out-of-Pocket Maximum	$4,400
Retail Pharmacy - Tier1 - Preferred Generic Drugs	$0
Retail Pharmacy - Tier 2 - Preferred Brand Drugs	$15
Retail Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs	$50
Retail Pharmacy - Diabetic, Ostomy, and Urologic Supplies	25%^†
Mail Order Pharmacy - Tier 1 - Preferred Generic Drugs	$0
Mail Order Pharmacy - Tier 2 - Preferred Brand Drugs	$45
Mail Order Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs	$150
Mail Order Pharmacy - Diabetic, Ostomy, and Urologic Supplies	25%^†
Specialty Pharmacy - Tier 4 - Preferred Specialty Pharmacy Drugs	$150

^†Select supplies will be covered under the applicable formulary tier copay/coinsurance.

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include: