AmeriHealth Caritas Next Silver Essential + No Referrals

AmeriHealth Caritas Next · 2026 plan year

Silver

Ind. deductible: $6,100
Family deductible: $12,200
Ind. OOP max: $9,000
Family OOP max: $18,000

Compare with other Silver plans in NC

Side by side: deductibles, out-of-pocket limits and copays.

Blue Value Silver Standard | Limited Statewide DoctorsBlue Cross and Blue Shield of NC · Deductible $6,000 · Out-of-pocket max $8,900
Blue Local Silver Standard | with Atrium HealthBlue Cross and Blue Shield of NC · Deductible $6,000 · Out-of-pocket max $8,900
Blue Local Silver Standard | with Atrium HealthBlue Cross and Blue Shield of NC · Deductible $6,000 · Out-of-pocket max $8,900

Compare 4 plans Browse all Silver plans in NC

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

More AmeriHealth Caritas Next plans in NC

AmeriHealth Caritas Next Bronze Essential + No Referrals AmeriHealth Caritas Next Bronze Signature + No Referrals AmeriHealth Caritas Next Silver Signature + No Referrals AmeriHealth Caritas Next Gold Signature + No Referrals AmeriHealth Caritas Next Bronze Premier + No Referrals

Monthly premiums by age

Rating Area 6 — the lowest-priced of the 7 areas this plan covers. Premiums differ by area.

Age	Individual	Individual + tobacco
Under 15	$354	$354
21	$462	$555
30	$525	$630
40	$591	$709
50	$826	$991
60	$1,254	$1,505
64 and over	$1,387	$1,664

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$25.00

Specialist

Benefit	In-network
Specialist Visit	$70.00

Hospital

Benefit	In-network
Emergency Room Services	35.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	35.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	35.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$45.00

Pharmacy

Benefit	In-network
Generic Drugs	$25.00
Non-Preferred Brand Drugs	45.00% Coinsurance after deductible
Preferred Brand Drugs	$60.00
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	35.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$25.00

Other

Benefit	In-network
Chemotherapy	35.00% Coinsurance after deductible
Chiropractic Care	$70.00
Clinical Trials	35.00% Coinsurance after deductible
Congenital Anomaly, including Cleft Lip/Palate	35.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Inpatient Physician and Surgical Services	35.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	35.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	35.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	$70.00
Anesthetics	35.00% Coinsurance after deductible
Bariatric Surgery	50.00% Coinsurance after deductible
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Blood and Blood Services	35.00% Coinsurance after deductible
Cardiac Rehabilitation	35.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	35.00% Coinsurance after deductible
Dental Anesthesia	35.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Care Management	35.00% Coinsurance after deductible
Diabetes Education	No charge
Diagnosis and Treatment of Lymphedema	35.00% Coinsurance after deductible
Dialysis	35.00% Coinsurance after deductible
Durable Medical Equipment	50.00% Coinsurance after deductible
Emergency Transportation/Ambulance	35.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	35.00% Coinsurance after deductible
Hearing Aids	35.00% Coinsurance after deductible
Home Health Care Services	35.00% Coinsurance after deductible
Hospice Services	No Charge after deductible
Imaging (CT/PET Scans, MRIs)	35.00% Coinsurance after deductible
Infertility Treatment	50.00% Coinsurance after deductible
Infusion Therapy	35.00% Coinsurance after deductible
Nutritional Counseling	No charge
Organ Donor Search	35.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Orthotic Devices for Positional Plagiocephaly	50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$25.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	35.00% Coinsurance after deductible
Outpatient Rehabilitation Services	35.00% Coinsurance after deductible
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	35.00% Coinsurance after deductible
Prosthetic Devices	50.00% Coinsurance after deductible
Pulmonary Rehabilitation	35.00% Coinsurance after deductible
Radiation	35.00% Coinsurance after deductible
Reconstructive Surgery	35.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	35.00% Coinsurance after deductible
Rehabilitative Speech Therapy	35.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	$70.00
Sexual Dysfunction	35.00% Coinsurance after deductible
Skilled Nursing Facility	35.00% Coinsurance after deductible
Sterilization	35.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	35.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$25.00
Transplant	35.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	35.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	35.00% Coinsurance after deductible