Elite Bronze + Vision + Adult Dental
Ambetter from NH Healthy Families · 2026 plan year
Expanded BronzeHSA eligible
- Ind. medical deductible
- $0
- Rx deductible (separate)
- $3,800
- Family deductible
- $0
- Ind. OOP max
- $10,150
- Family OOP max
- $20,300
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Expanded Bronze plans in NH
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Ambetter from NH Healthy Families plans in NH
Monthly premiums by age
Rating Area 1
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $258 | $258 |
| 21 | $337 | $387 |
| 30 | $382 | $439 |
| 40 | $430 | $495 |
| 50 | $601 | $692 |
| 60 | $914 | $1,051 |
| 64 and over | $1,010 | $1,162 |
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 | $55.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $120.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $4,000.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% |
| Mental/Behavioral Health Emergency Room | $2,000.00 |
| Mental/Behavioral Health Urgent Care | $50.00 |
| Outpatient Surgery Physician/Surgical Services | 50.00% |
| Substance Use Disorder Emergency Room | $2,000.00 |
| Substance Use Disorder Urgent Care | $50.00 |
| Urgent Care Centers or Facilities | $60.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | $250.00 Copay after deductible |
| Preferred Brand Drugs | $195.00 |
| Specialty Drugs | 50.00% Coinsurance after deductible |
| Tier 1b Generic Drugs | $40.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Emergency Transportation/Ambulance | $2,000.00 |
| Mental/Behavioral Health ER Physician Fee | $2,000.00 |
| Mental/Behavioral Health Inpatient Services | 50.00% |
| Mental/Behavioral Health Outpatient Other Services | 50.00% |
| Mental/Behavioral Health Outpatient Services | $55.00 |
| Substance Use Disorder Emergency Transportation/Ambulance | $2,000.00 |
| Substance Use Disorder ER Physician Fee | $2,000.00 |
| Substance Use Disorder Outpatient Other Services | 50.00% |
Other
| Benefit | In-network |
|---|---|
| Emergency Transportation/Ambulance | 50.00% |
| Eye Glasses for Children | No charge |
| Habilitation Services | 50.00% |
| Hearing Aids | 50.00% |
| Home Health Care Services | 50.00% |
| Hospice Services | 50.00% |
| Imaging (CT/PET Scans, MRIs) | 50.00% |
| Infertility Treatment | 50.00% |
| Infusion Therapy | 50.00% |
| Inpatient Physician and Surgical Services | 50.00% |
| Laboratory Outpatient and Professional Services | $65.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | 50.00% |
| Major Dental Care - Child | Not covered |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 50.00% |
| Acupuncture | $55.00 |
| Allergy Testing | $120.00 |
| Bariatric Surgery | 50.00% |
| Basic Dental Care - Adult | 50.00% |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 50.00% |
| Chiropractic Care | $80.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 50.00% |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $120.00 |
| Dialysis | 50.00% |
| Durable Medical Equipment | 50.00% |
| Nutritional Counseling | $120.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $55.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 50.00% |
| Outpatient Rehabilitation Services | 50.00% |
| Prenatal and Postnatal Care | $55.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 50.00% |
| Radiation | 50.00% |
| Reconstructive Surgery | 50.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 50.00% |
| Rehabilitative Speech Therapy | 50.00% |
| Routine Dental Services (Adult) | No charge |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $120.00 |
| Skilled Nursing Facility | 50.00% |
| Substance Abuse Disorder Inpatient Services | 50.00% |
| Substance Abuse Disorder Outpatient Services | $55.00 |
| Transplant | 50.00% |
| Treatment for Temporomandibular Joint Disorders | 50.00% |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 50.00% |
Plan rules
Service area
This plan covers 1 geographic area.
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