Elite Gold HMO $0 $5 + Vision + Adult Dental
Centene Corporation DBA Ambetter from Peach State Health Plan · 2026 plan year
Gold
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $6,500
- Family OOP max
- $13,000
Compare with other Gold plans in GA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Centene Corporation DBA Ambetter from Peach State Health Plan plans in GA
Monthly premiums by age
Rating Area 10 — the lowest-priced of the 16 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $380 | $380 |
| 21 | $497 | $571 |
| 30 | $564 | $648 |
| 40 | $635 | $730 |
| 50 | $887 | $1,020 |
| 60 | $1,348 | $1,550 |
| 64 and over | $1,490 | $1,713 |
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 | $5.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 30.00% |
| Inpatient Hospital Services (e.g., Hospital Stay) | 30.00% |
| Mental Behavioral Health Emergency Room | 30.00% |
| Mental Behavioral Health Urgent Care | $5.00 |
| Outpatient Surgery Physician/Surgical Services | $200.00 |
| Substance Use Disorder Emergency Room | 30.00% |
| Substance Use Disorder Urgent Care | $5.00 |
| Urgent Care Centers or Facilities | $35.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 45.00% |
| OFF_LABEL_DRUGS | 50.00% |
| Preferred Brand Drugs | $50.00 |
| Specialty Drugs | 50.00% |
| TIER_1B_GENERIC_DRUGS | $15.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Behavioral Health Emergency Transportation Ambulance | 30.00% |
| Mental/Behavioral Health Inpatient Services | 30.00% |
| Mental/Behavioral Health Outpatient Services | $5.00 |
| Substance Use Disorder Emergency Transportation Ambulance | 30.00% |
| Substance Use Disorder Outpatient Other Services | $200.00 |
Other
| Benefit | In-network |
|---|---|
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $200.00 |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $200.00 |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Autism Spectrum Disorders | $200.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | 50.00% |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Transplant | 30.00% |
| Chemotherapy | 30.00% |
| Chiropractic Care | $60.00 |
| CLINICAL_TRIALS | $200.00 |
| Cosmetic Surgery | 30.00% |
| Delivery and All Inpatient Services for Maternity Care | 30.00% |
| Dental Check-Up for Children | Not covered |
| DENTAL_ANESTHESIA | $200.00 |
| Diabetes Care | $60.00 |
| Diabetes Education | $60.00 |
| Dialysis | $200.00 |
| Durable Medical Equipment | 30.00% |
| Emergency Transportation/Ambulance | 30.00% |
| Eye Glasses for Children | No charge |
| Habilitation Services | $50.00 |
| Hearing Aids | Not covered |
| HEART_TRANSPLANT | 30.00% |
| Home Health Care Services | 30.00% |
| Hospice Services | 30.00% |
| Imaging (CT/PET Scans, MRIs) | $75.00 |
| Infertility Treatment | $200.00 |
| Infusion Therapy | $200.00 |
| Inpatient Physician and Surgical Services | 30.00% |
| Laboratory Outpatient and Professional Services | $40.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | 50.00% |
| Major Dental Care - Child | Not covered |
| MENTAL_BEHAVIORAL_HEALTH_ER_PHYSICIAN_FEE | 30.00% |
| MENTAL_BEHAVIORAL_HEALTH_OUTPATIENT_OTHER_SERVICES | $200.00 |
| Nutritional Counseling | $60.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $5.00 |
| Outpatient Rehabilitation Services | $50.00 |
| Prenatal and Postnatal Care | $5.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 30.00% |
| Radiation | $200.00 |
| Reconstructive Surgery | 30.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $50.00 |
| Rehabilitative Speech Therapy | $50.00 |
| Routine Dental Services (Adult) | No charge |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $60.00 |
| Skilled Nursing Facility | 30.00% |
| Substance Abuse Disorder Inpatient Services | 30.00% |
| Substance Abuse Disorder Outpatient Services | $5.00 |
| SUBSTANCE_USE_DISORDER_ER_PHYSICIAN_FEE | 30.00% |
| Transplant | 30.00% |
| Treatment for Temporomandibular Joint Disorders | $200.00 |
| Weight Loss Programs | $60.00 |
| Well Baby Visits and Care | No charge |
| Well Child Care | No charge |
| X-rays and Diagnostic Imaging | $75.00 |
Plan rules
Service area
This plan covers 149 geographic areas.
Open enrollment coming up?
Get notified when it opens — we'll remind you so you don't miss your window.