Elite Gold
Ambetter from Meridian · 2026 plan year
Gold
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $6,500
- Family OOP max
- $13,000
Compare with other Gold plans in MI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Ambetter from Meridian plans in MI
Monthly premiums by age
Rating Area 5 — the lowest-priced of the 10 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $281 | $281 |
| 21 | $367 | $422 |
| 30 | $417 | $479 |
| 40 | $469 | $539 |
| 50 | $655 | $754 |
| 60 | $996 | $1,145 |
| 64 and over | $1,101 | $1,266 |
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 | $5.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 30.00% |
| Inpatient Hospital Services (e.g., Hospital Stay) | 30.00% |
| Mental/Behavioral Health Emergency Room | 30.00% |
| Mental/Behavioral Health Urgent Care | $5.00 |
| Outpatient Surgery Physician/Surgical Services | $200.00 |
| Substance Use Disorder Emergency Room | 30.00% |
| Substance Use Disorder Urgent Care | $5.00 |
| Urgent Care Centers or Facilities | $35.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 45.00% |
| Preferred Brand Drugs | $50.00 |
| Specialty Drugs | 50.00% |
| Tier 1b Generic Drugs | $15.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Emergency Transportation/Ambulance | 30.00% |
| Mental/Behavioral Health ER Physician Fee | 30.00% |
| Mental/Behavioral Health Inpatient Services | 30.00% |
| Mental/Behavioral Health Outpatient Other Services | $200.00 |
| Mental/Behavioral Health Outpatient Services | $5.00 |
| Substance Use Disorder Emergency Transportation/Ambulance | 30.00% |
| Substance Use Disorder ER Physician Fee | 30.00% |
| Substance Use Disorder Outpatient Other Services | $200.00 |
Other
| Benefit | In-network |
|---|---|
| Home Health Care Services | 30.00% |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $200.00 |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Bariatric Surgery | 30.00% |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 30.00% |
| Chiropractic Care | $60.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 30.00% |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $60.00 |
| Dialysis | $200.00 |
| Durable Medical Equipment | 30.00% |
| Emergency Transportation/Ambulance | 30.00% |
| Eye Glasses for Children | No charge |
| Habilitation Services | $50.00 |
| Hearing Aids | Not covered |
| Hospice Services | 30.00% |
| Imaging (CT/PET Scans, MRIs) | $75.00 |
| Infertility Treatment | $200.00 |
| Infusion Therapy | $200.00 |
| Inpatient Physician and Surgical Services | 30.00% |
| Laboratory Outpatient and Professional Services | $40.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | $60.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $5.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $200.00 |
| Outpatient Rehabilitation Services | $50.00 |
| Prenatal and Postnatal Care | $5.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 30.00% |
| Radiation | $200.00 |
| Reconstructive Surgery | 30.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $50.00 |
| Rehabilitative Speech Therapy | $50.00 |
| 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% |
| Specified Sex-trait Modification Procedures | 30.00% |
| Substance Abuse Disorder Inpatient Services | 30.00% |
| Substance Abuse Disorder Outpatient Services | $5.00 |
| Transplant | 30.00% |
| Treatment for Temporomandibular Joint Disorders | $200.00 |
| Weight Loss Programs | $60.00 |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $75.00 |
Plan rules
Service area
This plan covers 78 geographic areas. 55 of them are covered only in part, meaning specific ZIP codes rather than the whole county. The filing does not list which, so confirm with the insurer or on HealthCare.gov before enrolling.
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