Anthem Silver Pathway X 850 S05 Rx Copay $0 Select Drugs

HMO Colorado, Inc. · 2027 plan year

Silver

Ind. medical deductible: $850
Rx deductible (separate): $0
Family deductible: $1,700
Ind. OOP max: $3,100
Family OOP max: $6,200

This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.

Other cost-sharing reduction variants for this plan:

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

More HMO Colorado, Inc. plans in CO

Anthem Bronze Mountain Enhanced X 10800 HSA $0 Select Drugs Anthem Bronze Pathway Essentials X 5650 Rx Copay $0 Select Drugs Anthem Bronze Pathway X 5650 Rx Copay $0 Select Drugs Anthem Bronze Pathway X 6000 HSA $0 Select Drugs Anthem Bronze Pathway X 8300 for HSA

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 + 15.00% Coinsurance after deductible

Specialist

Benefit	In-network
Specialist Visit	15.00% Coinsurance after deductible

Hospital

Benefit	In-network
Emergency Room Services	15.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	15.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Medical Service Drugs	15.00% Coinsurance after deductible
Non-Preferred Brand Drugs	$75.00
Non-Preferred Generic Drugs	$75.00
Preferred Brand Drugs	$30.00
Preventive Drugs	No charge
Specialty Drugs	$500.00

Mental Health

Benefit	In-network
Intensive Outpatient for Mental/Behavioral Health	15.00% Coinsurance after deductible
Intensive Outpatient for Substance Use Disorder	15.00% Coinsurance after deductible
Mental Health Wellness Visit	No charge
Mental/Behavioral Health Inpatient Services	30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	15.00% Coinsurance after deductible
Mental/Behavioral Health Prenatal Care	15.00% Coinsurance after deductible
Office Visit - Mental/Behavioral Health	15.00% Coinsurance after deductible
Office Visit - Substance Use Disorder	15.00% Coinsurance after deductible
Partial Hospitalization for Mental/Behavioral Health	15.00% Coinsurance after deductible
Partial Hospitalization for Substance Use Disorder	15.00% Coinsurance after deductible
Postpartum Mental/Behavioral Health	15.00% Coinsurance after deductible
Postpartum Substance Use Disorder	15.00% Coinsurance after deductible
Residential Day Treatment for Mental/Behavioral Health	30.00% Coinsurance after deductible
Residential Day Treatment for Substance Use Disorder	30.00% Coinsurance after deductible
Substance Use Disorder Prenatal Care	15.00% Coinsurance after deductible
Telehealth Mental/Behavioral Health	15.00% Coinsurance after deductible
Telehealth Substance Use Disorder	15.00% Coinsurance after deductible

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	No charge
Acupuncture	15.00% Coinsurance after deductible
Allergy Testing	15.00% Coinsurance after deductible
Applied Behavior Analysis Based Therapies	15.00% Coinsurance after deductible
Autism Spectrum Disorders - Assessment and Evaluation Services	15.00% Coinsurance after deductible
Bariatric Surgery	30.00% Coinsurance after deductible
Basic Dental Care - Child	50.00% Coinsurance after deductible
Chemotherapy	15.00% Coinsurance after deductible
Chiropractic Care	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	30.00% Coinsurance after deductible
Dental Check-Up for Children	No Charge after deductible
Diabetes Education	15.00% Coinsurance after deductible
Diabetic Supplies	15.00% Coinsurance after deductible
Dialysis	15.00% Coinsurance after deductible
Durable Medical Equipment	15.00% Coinsurance after deductible
Emergency Transportation/Ambulance	15.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Gender Affirming Care	15.00% Coinsurance after deductible
Habilitation Services	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Hearing Aids	15.00% Coinsurance after deductible
Home Health Care Services	15.00% Coinsurance after deductible
Hospice Services	15.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	15.00% Coinsurance after deductible
Infertility Treatment	15.00% Coinsurance after deductible
Infusion Therapy	15.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	15.00% Coinsurance after deductible
Inpatient Rehabilitation	30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	15.00% Coinsurance after deductible
Major Dental Care - Child	50.00% Coinsurance after deductible
Nutritional Counseling	15.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$25.00 + 15.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	15.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	15.00% Coinsurance after deductible
Prosthetic Devices	15.00% Coinsurance after deductible
Prosthetics: Legs and Arms	15.00%
Prosthetics: Recreational	15.00%
Radiation	15.00% Coinsurance after deductible
Reconstructive Surgery	30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Rehabilitative Occupational Therapy	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Rehabilitative Physical Therapy	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Rehabilitative Speech Therapy	$25.00 Copay with deductible + 15.00% Coinsurance after deductible
Routine Eye Exam for Children	No charge
Skilled Nursing Facility	15.00% Coinsurance after deductible
Standalone Laboratory	15.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	15.00% Coinsurance after deductible
Telehealth PCP	$25.00 + 15.00% Coinsurance after deductible
Telehealth Specialist	15.00% Coinsurance after deductible
Transplant	30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	15.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	15.00% Coinsurance after deductible

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