Community Premier Gold 005 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)
Community Health Choice · 2026 plan year
Gold
- Ind. deductible
- $2,500
- Family deductible
- $5,000
- Ind. OOP max
- $7,500
- Family OOP max
- $15,000
Compare with other Gold plans in TX
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Community Health Choice plans in TX
Community Ultra Select Bronze 018 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)Community Ultra Select Silver 020 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)Community Ultra Select Gold 022 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)
Monthly premiums by age
Rating Area 4 — the lowest-priced of the 4 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $354 | $354 |
| 21 | $463 | $555 |
| 30 | $525 | $630 |
| 40 | $592 | $710 |
| 50 | $827 | $992 |
| 60 | $1,256 | $1,507 |
| 64 and over | $1,388 | $1,666 |
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 | $20.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $40.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $40.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $10.00 |
| Non-Preferred Brand Drugs | $75.00 Copay after deductible |
| Preferred Brand Drugs | $50.00 Copay after deductible |
| Specialty Drugs | 35.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $20.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $40.00 |
| Acupuncture | Not covered |
| Allergy Testing | $40.00 Copay after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | $40.00 Copay after deductible |
| Chiropractic Care | $40.00 Copay after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $20.00 Copay after deductible |
| Dialysis | $40.00 Copay after deductible |
| Durable Medical Equipment | 30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | $40.00 Copay after deductible |
| Eye Glasses for Children | $40.00 Copay after deductible |
| Habilitation Services | $40.00 Copay after deductible |
| Hearing Aids | 30.00% Coinsurance after deductible |
| Home Health Care Services | $40.00 Copay after deductible |
| Hospice Services | $40.00 Copay after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | $40.00 Copay after deductible |
| Inpatient Physician and Surgical Services | No Charge after deductible |
| Laboratory Outpatient and Professional Services | $20.00 Copay 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) | $20.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $40.00 Copay after deductible |
| Prenatal and Postnatal Care | $40.00 Copay after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 30.00% Coinsurance after deductible |
| Radiation | $40.00 Copay after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $40.00 Copay after deductible |
| Rehabilitative Speech Therapy | $40.00 Copay after deductible |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $40.00 Copay after deductible |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $20.00 |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | $40.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $20.00 Copay after deductible |
Plan rules
Service area
This plan covers 20 geographic areas.
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