Community First Mercado Plan - Gold
Community First · 2027 plan year
Gold
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $9,700
- Family OOP max
- $19,400
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:
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Monthly premiums by age
Rating Area 18
| Age | Individual |
|---|---|
| Under 15 | $387 |
| 21 | $506 |
| 30 | $575 |
| 40 | $647 |
| 50 | $904 |
| 60 | $1,374 |
| 64 and over | $1,519 |
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 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $300.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $800.00 Copay per Stay |
| Outpatient Surgery Physician/Surgical Services | $600.00 |
| Urgent Care Centers or Facilities | $30.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $10.00 |
| Non-Preferred Brand Drugs | $50.00 |
| Preferred Brand Drugs | $25.00 |
| Specialty Drugs | 30.00% |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $800.00 Copay per Stay |
| Mental/Behavioral Health Outpatient Services | $25.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $300.00 |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | $105.00 |
| Chiropractic Care | $60.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $800.00 |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | No charge |
| Dialysis | $105.00 |
| Durable Medical Equipment | $30.00 |
| Emergency Transportation/Ambulance | $300.00 |
| Eye Glasses for Children | $25.00 |
| Habilitation Services | $105.00 |
| Hearing Aids | $60.00 |
| Home Health Care Services | $30.00 |
| Hospice Services | $60.00 |
| Imaging (CT/PET Scans, MRIs) | $135.00 |
| Infertility Treatment | Not covered |
| Infusion Therapy | $105.00 |
| Inpatient Physician and Surgical Services | No charge |
| Laboratory Outpatient and Professional Services | $135.00 |
| 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) | $25.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $105.00 |
| Outpatient Rehabilitation Services | $105.00 |
| Prenatal and Postnatal Care | $25.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | $30.00 |
| Radiation | $105.00 |
| Reconstructive Surgery | $800.00 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $105.00 |
| Rehabilitative Speech Therapy | $105.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $25.00 |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | $300.00 Copay per Day |
| Substance Abuse Disorder Inpatient Services | $800.00 Copay per Stay |
| Substance Abuse Disorder Outpatient Services | $25.00 |
| Transplant | $800.00 |
| Treatment for Temporomandibular Joint Disorders | $60.00 |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $135.00 |
Plan rules
Service area
This plan covers 1 geographic area.
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