Dental Choice 0-20-50 1000
PacificSource Health Plans · 2026 plan year
High
- Ind. deductible
- —
- Family deductible
- Not listed
- Ind. OOP max
- —
- Family OOP max
- Not listed
Other cost-sharing reduction variants for this plan:
More PacificSource Health Plans plans in MT
Monthly premiums by age
The same in all 4 areas this plan covers.
| Age | Individual |
|---|---|
| Under 15 | $46 |
| 21 | $41 |
| 30 | $48 |
| 40 | $56 |
| 50 | $62 |
| 60 | $66 |
| 64 and over | $66 |
Live premium estimate
Benefits & cost sharing
Other
| Benefit | In-network |
|---|---|
| Accidental Dental | 50.00% Coinsurance after deductible |
| Basic Dental Care - Adult | 20.00% Coinsurance after deductible |
| Basic Dental Care - Child | 20.00% Coinsurance after deductible |
| Dental Check-Up for Children | No charge |
| Major Dental Care - Adult | 50.00% Coinsurance after deductible |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | 50.00% Coinsurance after deductible |
| Routine Dental Services (Adult) | No charge |
Plan rules
Service area
This plan covers 1 geographic area.
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