Low Premium Silver 6200 $3 Generic Drugs + Adult Vision & Fitness

CareSource · 2026 plan year

Silver
Ind. deductible
$6,200
Family deductible
$12,400
Ind. OOP max
$9,800
Family OOP max
$19,600

Compare with other Silver plans in WV

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

More CareSource plans in WV

Monthly premiums by age

Rating Area 6 — the lowest-priced of the 11 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$567$567
21$742$816
30$842$976
40$948$1,099
50$1,324$1,563
60$2,013$2,375
64 and over$2,225$2,625

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$40.00

Specialist

BenefitIn-network
Specialist Visit$75.00

Hospital

BenefitIn-network
Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$500.00 Copay per Stay after deductible
Outpatient Surgery Physician/Surgical Services40.00% Coinsurance after deductible
Urgent Care Centers or Facilities$70.00

Pharmacy

BenefitIn-network
Non-Preferred Brand Drugs40.00% Coinsurance after deductible
Generic Drugs$3.00
Preferred Brand Drugs$75.00
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$500.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services$40.00

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental40.00% Coinsurance after deductible
AcupunctureNot covered
Allergy Testing$75.00
Bariatric Surgery40.00% Coinsurance after deductible
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Chemotherapy40.00% Coinsurance after deductible
Chiropractic Care$75.00
Chronic Pain Treatment$40.00
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care$500.00 Copay after deductible
Dental Check-Up for ChildrenNot covered
Diabetes Education40.00% Coinsurance after deductible
Dialysis40.00% Coinsurance after deductible
Durable Medical Equipment40.00% Coinsurance after deductible
Emergency Transportation/Ambulance40.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$40.00
Hearing AidsNot covered
Home Health Care Services40.00% Coinsurance after deductible
Hospice Services40.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)$250.00 Copay after deductible
Infertility Treatment40.00% Coinsurance after deductible
Infusion Therapy40.00% Coinsurance after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Laboratory Outpatient and Professional Services$50.00
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling40.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)$40.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)40.00% Coinsurance after deductible
Outpatient Rehabilitation Services40.00% Coinsurance after deductible
Prenatal and Postnatal Care$75.00
Private-Duty Nursing40.00% Coinsurance after deductible
Prosthetic Devices40.00% Coinsurance after deductible
Radiation40.00% Coinsurance after deductible
Reconstructive Surgery40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$40.00
Rehabilitative Speech Therapy$40.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)$40.00
Routine Eye Exam for ChildrenNo charge
Routine Foot CareNot covered
Skilled Nursing Facility$500.00 Copay per Stay after deductible
Substance Abuse Disorder Inpatient Services$500.00 Copay per Stay after deductible
Substance Abuse Disorder Outpatient Services$40.00
Transplant40.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders40.00% Coinsurance after deductible
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$200.00 Copay after deductible

Plan rules

Service area

This plan covers 1 geographic area.

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