AmeriHealth Caritas Next Gold Signature + No Referrals

AmeriHealth Caritas Next

Gold
Ind. deductible
$2,000
Family deductible
$2,000
Ind. OOP max
$8,200
Family OOP max
$8,200

More AmeriHealth Caritas Next plans in NC

Monthly premiums by age

AgeIndividual
21$488
30$553
40$623
50$871
60$1,323

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/Immunization0.00%
Primary Care Visit to Treat an Injury or Illness$30.00

Specialist

BenefitIn-network
Specialist Visit$60.00

Hospital

BenefitIn-network
Emergency Room ServicesNo charge
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible
Urgent Care Centers or FacilitiesNo charge

Pharmacy

BenefitIn-network
Generic DrugsNo charge
Non-Preferred Brand Drugs$60.00
Preferred Brand DrugsNo charge
Specialty Drugs$250.00

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$30.00

Other

BenefitIn-network
Weight Loss ProgramsNot covered
Dental Check-Up for ChildrenNot covered
Diabetes Care Management25.00% Coinsurance after deductible
Diabetes EducationNo charge
Well Baby Visits and CareNo charge
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental25.00% Coinsurance after deductible
AcupunctureNot covered
Allergy TestingNo charge
Anesthetics25.00% Coinsurance after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Blood and Blood Services25.00% Coinsurance after deductible
Cardiac Rehabilitation25.00% Coinsurance after deductible
Chemotherapy25.00% Coinsurance after deductible
Chiropractic Care$60.00
Clinical TrialsNo charge
Congenital Anomaly, including Cleft Lip/Palate25.00% Coinsurance after deductible
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Dental Anesthesia25.00% Coinsurance after deductible
Diagnosis and Treatment of Lymphedema25.00% Coinsurance after deductible
Dialysis25.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation ServicesNo charge
Hearing AidsNo charge
Home Health Care Services25.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)No charge
Infertility Treatment50.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Laboratory Outpatient and Professional ServicesNo charge
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible
Nutritional CounselingNo charge
Organ Donor Search25.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Orthotic Devices for Positional PlagiocephalyNo charge
Other Practitioner Office Visit (Nurse, Physician Assistant)No charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation ServicesNo charge
Prenatal and Postnatal CareNo charge
Private-Duty Nursing25.00% Coinsurance after deductible
Prosthetic Devices50.00% Coinsurance after deductible
Pulmonary Rehabilitation25.00% Coinsurance after deductible
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical TherapyNo charge
Rehabilitative Speech Therapy$30.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for ChildrenNo charge
Routine Foot Care$60.00
Sexual Dysfunction25.00% Coinsurance after deductible
Skilled Nursing Facility25.00% Coinsurance after deductible
Sterilization25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$30.00
Transplant25.00% Coinsurance after deductible
Treatment for Temporomandibular Joint DisordersNo charge

Plan rules

Service area

This plan covers 41 geographic areas.