CommunityCare Marketplace Plan

Plan Brochure

Plan Year:

2027

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	$4,800
Family Deductible	$14,400
Individual Out of Pocket Maximum	$7,300
Family Out of Pocket Maximum	$17,400
Primary Care Office Visits	$15^*Coinsurance
Specialty Care Office Visits	15%^*Coinsurance
Preventive Care	No Copayment
Emergency Room	15%^*Coinsurance
Urgent Care	15%^*Coinsurance
Inpatient Hospital	15%^*Coinsurance
Mental Health Physician Visit	15%^*Coinsurance
Laboratory	15%^*Coinsurance
Radiology	15%^*Coinsurance
MRI, CT Scan and PET Scan	15%^*Coinsurance

^*After Deductible, the Coinsurance/Copayment will apply.


Combined Pharmacy and Medical Individual Deductible	$4,800
Combined Pharmacy and Medical Family Deductible	$14,400
Combined Pharmacy and Medical Individual Out-of-Pocket Maximum	$7,300
Combined Pharmacy and Medical Family Out-of-Pocket Maximum	$17,400
Retail Pharmacy - Tier1 - Preferred Generic Drugs	15%^*
Retail Pharmacy - Tier 2 - Preferred Brand Drugs	15%^*
Retail Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs	15%^*
Retail Pharmacy - Diabetic, Ostomy, and Urologic Supplies	15%^‡
Mail Order Pharmacy - Tier 1 - Preferred Generic Drugs	15%^*
Mail Order Pharmacy - Tier 2 - Preferred Brand Drugs	15%^*
Mail Order Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs	15%^*
Mail Order Pharmacy - Diabetic, Ostomy, and Urologic Supplies	15%^‡
Specialty Pharmacy - Tier 4 - Preferred Specialty Pharmacy Drugs	15%^*
Specialty Pharmacy - Tier 5 - Non-Preferred Specialty Pharmacy Drugs	50%^*

^*After Deductible, the Coinsurance/Copayment will apply.

^‡Select supplies will be covered under applicable formulary tier copay/coinsurance, after deductible.

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