Anthem Silver Pathway/Lean 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Blue Cross and Blue Shield · 2026 plan year
Silver
- Ind. deductible
- $5,500
- Family deductible
- $11,000
- Ind. OOP max
- $9,200
- Family OOP max
- $18,400
Compare with other Silver plans in WI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Anthem Blue Cross and Blue Shield plans in WI
Anthem Bronze Pathway/Lean HSA (+ Incentives)Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
Monthly premiums by age
Rating Area 1
| Age | Individual |
|---|---|
| Under 15 | $401 |
| 21 | $525 |
| 30 | $596 |
| 40 | $671 |
| 50 | $937 |
| 60 | $1,424 |
| 64 and over | $1,574 |
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 | $15.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $65.00 |
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 35.00% Coinsurance after deductible |
| Emergency Room Services | 40.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $75.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Non-Preferred Brand Drugs | 35.00% Coinsurance after deductible |
| Preferred Brand Drugs | $40.00 |
| Generic Drugs | $3.00 |
| Specialty Drugs | 40.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 40.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 35.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Imaging (CT/PET Scans, MRIs) | 40.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 35.00% Coinsurance after deductible |
| 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 |
| Nutritional Counseling | Not covered |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $15.00 |
| 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 | 35.00% Coinsurance after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 35.00% Coinsurance after deductible |
| Radiation | 35.00% Coinsurance after deductible |
| Reconstructive Surgery | 40.00% Coinsurance after deductible |
| Hearing Aids | 35.00% Coinsurance after deductible |
| Hospice Services | 35.00% Coinsurance after deductible |
| Habilitation Services | 35.00% Coinsurance after deductible |
| Home Health Care Services | 35.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $65.00 |
| Acupuncture | Not covered |
| Allergy Testing | Not covered |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 35.00% Coinsurance after deductible |
| Chiropractic Care | $15.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 40.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $65.00 |
| Dialysis | 35.00% Coinsurance after deductible |
| Durable Medical Equipment | 35.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| 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 | Not covered |
| Skilled Nursing Facility | 35.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 40.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 35.00% Coinsurance after deductible |
| Transplant | 40.00% 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 |
Plan rules
Service area
This plan covers 1 geographic area.
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