AmeriHealth Caritas Next Gold Premier + No Referrals
AmeriHealth Caritas Next · 2026 plan year
Gold
- Ind. deductible
- $950
- Family deductible
- $1,900
- Ind. OOP max
- $8,500
- Family OOP max
- $17,000
Compare with other Gold plans in LA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More AmeriHealth Caritas Next plans in LA
Monthly premiums by age
Rating Area 5
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $422 | $422 |
| 21 | $552 | $663 |
| 30 | $627 | $752 |
| 40 | $706 | $847 |
| 50 | $986 | $1,183 |
| 60 | $1,499 | $1,798 |
| 64 and over | $1,657 | $1,988 |
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 | $15.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $45.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 20.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 20.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 20.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $125.00 Copay after deductible |
| Preferred Brand Drugs | $60.00 |
| Specialty Drugs | $150.00 Copay after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 20.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $15.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 20.00% Coinsurance after deductible |
| Acupuncture | $45.00 |
| Allergy Testing | $45.00 |
| Attention Deficit Disorder | $15.00 |
| Autism Spectrum Disorders | $15.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Cancer Monitoring Screening | 20.00% Coinsurance after deductible |
| Cardiac Rehabilitation | 20.00% Coinsurance after deductible |
| Chemotherapy | 20.00% Coinsurance after deductible |
| Chiropractic Care | $45.00 |
| Clinical Trials | 20.00% Coinsurance after deductible |
| Congenital Anomaly, including Cleft Lip/Palate | 20.00% Coinsurance after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 20.00% Coinsurance after deductible |
| Dental Anesthesia | 20.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Dental Services for Children with Severe Disabilities | 20.00% Coinsurance after deductible |
| Diabetes Care Management | 20.00% Coinsurance after deductible |
| Diabetes Education | No charge |
| Dialysis | 20.00% Coinsurance after deductible |
| Doula | $45.00 |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 20.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | Not covered |
| Habilitation Services | 20.00% Coinsurance after deductible |
| Hearing Aids | 20.00% Coinsurance after deductible |
| Home Health Care Services | 20.00% Coinsurance after deductible |
| Hospice Services | No Charge after deductible |
| Imaging (CT/PET Scans, MRIs) | 20.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 20.00% Coinsurance after deductible |
| Inherited Metabolic Disorder - PKU | 20.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 20.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 20.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Newborn Hearing Screening | No charge |
| Nutritional Counseling | No charge |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $15.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 20.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 20.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 20.00% Coinsurance after deductible |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Pulmonary Rehabilitation | 20.00% Coinsurance after deductible |
| Radiation | 20.00% Coinsurance after deductible |
| Reconstructive Surgery | 20.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 20.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 20.00% Coinsurance after deductible |
| Reversible Contraveptives | 20.00% Coinsurance after deductible |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $45.00 |
| School Based Health Centers | 20.00% Coinsurance after deductible |
| Skilled Nursing Facility | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $15.00 |
| Transplant | 20.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | Not covered |
| Weight Loss Programs | No charge |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 20.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 4 geographic areas.
Open enrollment coming up?
Get notified when it opens — we'll remind you so you don't miss your window.