Clear Gold HMO $1200 $25
Centene Corporation DBA Ambetter from Peach State Health Plan · 2026 plan year
Gold
- Ind. deductible
- $1,200
- Family deductible
- $2,400
- Ind. OOP max
- $9,150
- Family OOP max
- $18,300
Compare with other Gold plans in GA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Centene Corporation DBA Ambetter from Peach State Health Plan plans in GA
Monthly premiums by age
Rating Area 10 — the lowest-priced of the 16 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $321 | $321 |
| 21 | $420 | $483 |
| 30 | $476 | $548 |
| 40 | $536 | $617 |
| 50 | $750 | $862 |
| 60 | $1,139 | $1,310 |
| 64 and over | $1,259 | $1,448 |
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 | 30.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 30.00% Coinsurance after deductible |
| Mental Behavioral Health Emergency Room | 30.00% Coinsurance after deductible |
| Mental Behavioral Health Urgent Care | $25.00 |
| Outpatient Surgery Physician/Surgical Services | 30.00% Coinsurance after deductible |
| Substance Use Disorder Emergency Room | 30.00% Coinsurance after deductible |
| Substance Use Disorder Urgent Care | $25.00 |
| Urgent Care Centers or Facilities | $60.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 45.00% Coinsurance after deductible |
| OFF_LABEL_DRUGS | 50.00% Coinsurance after deductible |
| Preferred Brand Drugs | $40.00 |
| Specialty Drugs | 50.00% Coinsurance after deductible |
| TIER_1B_GENERIC_DRUGS | $15.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Behavioral Health Emergency Transportation Ambulance | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $25.00 |
| Substance Use Disorder Emergency Transportation Ambulance | 30.00% Coinsurance after deductible |
| Substance Use Disorder Outpatient Other Services | 30.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 30.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 30.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Autism Spectrum Disorders | 30.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Transplant | 30.00% Coinsurance after deductible |
| Chemotherapy | 30.00% Coinsurance after deductible |
| Chiropractic Care | $60.00 |
| CLINICAL_TRIALS | 30.00% Coinsurance after deductible |
| Cosmetic Surgery | 30.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 30.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| DENTAL_ANESTHESIA | 30.00% Coinsurance after deductible |
| Diabetes Care | $60.00 |
| Diabetes Education | $60.00 |
| Dialysis | 30.00% Coinsurance after deductible |
| Durable Medical Equipment | 30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 30.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | $35.00 |
| Hearing Aids | Not covered |
| HEART_TRANSPLANT | 30.00% Coinsurance after deductible |
| Home Health Care Services | 30.00% Coinsurance after deductible |
| Hospice Services | 30.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 30.00% Coinsurance after deductible |
| Infertility Treatment | 30.00% Coinsurance after deductible |
| Infusion Therapy | 30.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 30.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 30.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| MENTAL_BEHAVIORAL_HEALTH_ER_PHYSICIAN_FEE | 30.00% Coinsurance after deductible |
| MENTAL_BEHAVIORAL_HEALTH_OUTPATIENT_OTHER_SERVICES | 30.00% Coinsurance after deductible |
| Nutritional Counseling | $60.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $25.00 |
| Outpatient Rehabilitation Services | $35.00 |
| Prenatal and Postnatal Care | $25.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 30.00% Coinsurance after deductible |
| Radiation | 30.00% Coinsurance after deductible |
| Reconstructive Surgery | 30.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $35.00 |
| Rehabilitative Speech Therapy | $35.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $60.00 |
| Skilled Nursing Facility | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $25.00 |
| SUBSTANCE_USE_DISORDER_ER_PHYSICIAN_FEE | 30.00% Coinsurance after deductible |
| Transplant | 30.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 30.00% Coinsurance after deductible |
| Weight Loss Programs | $60.00 |
| Well Baby Visits and Care | No charge |
| Well Child Care | No charge |
| X-rays and Diagnostic Imaging | 30.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 149 geographic areas.
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