Apex Gold
Ambetter from Meridian · 2027 plan year
Gold
- Ind. deductible
- $1,500
- Family deductible
- $3,000
- Ind. OOP max
- $8,350
- Family OOP max
- $16,700
Compare with other Gold plans in MI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Ambetter from Meridian plans in MI
Monthly premiums by age
Rating Area 5 — the lowest-priced of the 13 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $323 | $323 |
| 21 | $422 | $485 |
| 30 | $479 | $550 |
| 40 | $539 | $620 |
| 50 | $753 | $866 |
| 60 | $1,144 | $1,316 |
| 64 and over | $1,265 | $1,455 |
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 | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $65.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Emergency Room | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Urgent Care | $30.00 |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Substance Use Disorder Emergency Room | 25.00% Coinsurance after deductible |
| Substance Use Disorder Urgent Care | $30.00 |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 35.00% Coinsurance after deductible |
| Preferred Brand Drugs | $30.00 |
| Specialty Drugs | 45.00% Coinsurance after deductible |
| Tier 1b Generic Drugs | $15.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health ER Physician Fee | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Other Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $30.00 |
| Substance Use Disorder Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Substance Use Disorder ER Physician Fee | 25.00% Coinsurance after deductible |
| Substance Use Disorder Outpatient Other Services | 25.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 25.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $65.00 |
| Bariatric Surgery | 25.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 25.00% Coinsurance after deductible |
| Chiropractic Care | $65.00 |
| 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 | $65.00 |
| Dialysis | 25.00% Coinsurance after deductible |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | 25.00% Coinsurance after deductible |
| Hearing Aids | Not covered |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | 25.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infertility Treatment | 25.00% Coinsurance after deductible |
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $20.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | $65.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 25.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | $30.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 25.00% Coinsurance after deductible |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 25.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 25.00% 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 | $65.00 |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Specified Sex-trait Modification Procedures | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 25.00% Coinsurance after deductible |
| Weight Loss Programs | $65.00 |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 41 geographic areas. 8 of them are covered only in part, meaning specific ZIP codes rather than the whole county. The filing does not list which, so confirm with the insurer or on HealthCare.gov before enrolling.
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