Anthem Silver Pathway X 750 S05 $0 Select Drugs

HMO Colorado, Inc. · 2027 plan year

Silver

Ind. deductible: $750
Family deductible: $1,500
Ind. OOP max: $2,600
Family OOP max: $5,200

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	$20.00

Specialist

Benefit	In-network
Specialist Visit	$50.00

Hospital

Benefit	In-network
Emergency Room Services	40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	40.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Generic Drugs	$15.00
Medical Service Drugs	40.00% Coinsurance after deductible
Non-Preferred Brand Drugs	35.00% Coinsurance after deductible
Non-Preferred Generic Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	$30.00
Preventive Drugs	No charge
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Intensive Outpatient for Mental/Behavioral Health	40.00% Coinsurance after deductible
Intensive Outpatient for Substance Use Disorder	40.00% Coinsurance after deductible
Mental Health Wellness Visit	No charge
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Prenatal Care	40.00% Coinsurance after deductible
Office Visit - Mental/Behavioral Health	40.00% Coinsurance after deductible
Office Visit - Substance Use Disorder	40.00% Coinsurance after deductible
Partial Hospitalization for Mental/Behavioral Health	40.00% Coinsurance after deductible
Partial Hospitalization for Substance Use Disorder	40.00% Coinsurance after deductible
Postpartum Mental/Behavioral Health	40.00% Coinsurance after deductible
Postpartum Substance Use Disorder	40.00% Coinsurance after deductible
Residential Day Treatment for Mental/Behavioral Health	40.00% Coinsurance after deductible
Residential Day Treatment for Substance Use Disorder	40.00% Coinsurance after deductible
Substance Use Disorder Prenatal Care	40.00% Coinsurance after deductible
Telehealth Mental/Behavioral Health	40.00% Coinsurance after deductible
Telehealth Substance Use Disorder	40.00% Coinsurance after deductible

Other

Benefit	In-network
Outpatient Rehabilitation Services	$20.00
Abortion for Which Public Funding is Prohibited	No charge
Acupuncture	40.00% Coinsurance after deductible
Allergy Testing	40.00% Coinsurance after deductible
Applied Behavior Analysis Based Therapies	40.00% Coinsurance after deductible
Autism Spectrum Disorders - Assessment and Evaluation Services	40.00% Coinsurance after deductible
Bariatric Surgery	40.00% Coinsurance after deductible
Basic Dental Care - Child	50.00% Coinsurance after deductible
Chemotherapy	40.00% Coinsurance after deductible
Chiropractic Care	$20.00
Delivery and All Inpatient Services for Maternity Care	40.00% Coinsurance after deductible
Dental Check-Up for Children	No Charge after deductible
Diabetes Education	$50.00
Diabetic Supplies	40.00% Coinsurance after deductible
Dialysis	40.00% Coinsurance after deductible
Durable Medical Equipment	40.00% Coinsurance after deductible
Emergency Transportation/Ambulance	40.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Gender Affirming Care	40.00% Coinsurance after deductible
Habilitation Services	$20.00
Hearing Aids	40.00% Coinsurance after deductible
Home Health Care Services	40.00% Coinsurance after deductible
Hospice Services	40.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	40.00% Coinsurance after deductible
Infertility Treatment	40.00% Coinsurance after deductible
Infusion Therapy	40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	40.00% Coinsurance after deductible
Inpatient Rehabilitation	40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40.00% Coinsurance after deductible
Major Dental Care - Child	50.00% Coinsurance after deductible
Nutritional Counseling	40.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	40.00% Coinsurance after deductible
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	40.00% Coinsurance after deductible
Prosthetic Devices	40.00% Coinsurance after deductible
Prosthetics: Legs and Arms	20.00%
Prosthetics: Recreational	20.00%
Radiation	40.00% Coinsurance after deductible
Reconstructive Surgery	40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$20.00
Rehabilitative Occupational Therapy	$20.00
Rehabilitative Physical Therapy	$20.00
Rehabilitative Speech Therapy	$20.00
Routine Eye Exam for Children	No charge
Skilled Nursing Facility	40.00% Coinsurance after deductible
Standalone Laboratory	40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	40.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	40.00% Coinsurance after deductible
Telehealth PCP	$20.00
Telehealth Specialist	$50.00
Transplant	40.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	40.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	40.00% Coinsurance after deductible

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