Anthem Silver X 0 Medicaid Transition Plan ($0 Virtual PCP + $0 Select Drugs + Incentives) S06

HMO Colorado, Inc., DBA HMO Nevada · 2027 plan year

Silver
Ind. deductible
$0
Family deductible
$0
Ind. OOP max
$1,400
Family OOP max
$2,800

More HMO Colorado, Inc., DBA HMO Nevada plans in NV

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or IllnessNo charge

Specialist

BenefitIn-network
Specialist Visit$25.00

Hospital

BenefitIn-network
Emergency Room Services$75.00 + 40.00%
Inpatient Hospital Services (e.g., Hospital Stay)$150.00 Copay per Stay + 50.00%
Outpatient Surgery Physician/Surgical Services40.00%
Urgent Care Centers or Facilities$50.00

Pharmacy

BenefitIn-network
Preferred Brand Drugs$20.00
Generic Drugs$15.00
Non-Preferred Brand Drugs40.00%
Specialty Drugs45.00%

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$150.00 Copay per Stay + 50.00%
Mental/Behavioral Health Outpatient Services40.00%

Other

BenefitIn-network
Prenatal and Postnatal Care40.00%
Accidental Dental40.00%
Allergy Testing40.00%
Bariatric Surgery$150.00 + 50.00%
Chemotherapy40.00%
Chiropractic Care40.00%
Delivery and All Inpatient Services for Maternity Care$150.00 + 50.00%
Diabetes Education40.00%
Dialysis40.00%
Durable Medical Equipment40.00%
Emergency Transportation/Ambulance40.00%
Eye Glasses for ChildrenNo charge
Gender Affirming Care40.00%
Habilitation Services40.00%
Hearing Aids40.00%
Home Health Care Services40.00%
Hospice Services40.00%
Imaging (CT/PET Scans, MRIs)40.00%
Infertility Treatment40.00%
Infusion Therapy40.00%
Inpatient Physician and Surgical Services40.00%
Laboratory Outpatient and Professional Services40.00%
Nutritional Counseling40.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)No charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)40.00%
Outpatient Rehabilitation Services40.00%
Private-Duty Nursing40.00%
Prosthetic Devices40.00%
Radiation40.00%
Reconstructive Surgery$150.00 + 50.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy40.00%
Rehabilitative Speech Therapy40.00%
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility$150.00 Copay per Stay + 50.00%
Substance Abuse Disorder Inpatient Services$150.00 Copay per Stay + 50.00%
Substance Abuse Disorder Outpatient Services40.00%
Transplant$150.00 + 50.00%
Treatment for Temporomandibular Joint Disorders40.00%
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$75.00

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