Anthem Silver Pathway Essentials 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Blue Cross and Blue Shield · 2026 plan year
Silver
- Ind. deductible
- $5,350
- Family deductible
- $10,700
- Ind. OOP max
- $8,600
- Family OOP max
- $17,200
Compare with other Silver plans in MO
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Anthem Blue Cross and Blue Shield plans in MO
Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Bronze Pathway Essentials 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Silver Pathway Essentials 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Gold Pathway Essentials 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Heart Healthy Silver Pathway 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Monthly premiums by age
Rating Area 7
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $390 | $390 |
| 21 | $510 | $548 |
| 30 | $579 | $622 |
| 40 | $652 | $701 |
| 50 | $911 | $979 |
| 60 | $1,385 | $1,488 |
| 64 and over | $1,530 | $1,645 |
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 | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $65.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 35.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 35.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 35.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $75.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 35.00% Coinsurance after deductible |
| Preferred Brand Drugs | $35.00 |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 35.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 35.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Major Dental Care - Adult | Not covered |
| Inpatient Physician and Surgical Services | 35.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $65.00 |
| Acupuncture | Not covered |
| Allergy Testing | 35.00% Coinsurance after deductible |
| Applied Behavior Analysis Based Therapies | 35.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 50.00% Coinsurance after deductible |
| Bone Marrow Testing | 35.00% Coinsurance after deductible |
| Chemotherapy | 35.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 35.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Chiropractic Care | $30.00 |
| Clinical Trials | 35.00% Coinsurance after deductible |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 35.00% Coinsurance after deductible |
| Dental Anesthesia | 35.00% Coinsurance after deductible |
| Dental Check-Up for Children | No Charge after deductible |
| Diabetes Education | $65.00 |
| Dialysis | 35.00% Coinsurance after deductible |
| Durable Medical Equipment | 35.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 35.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | 35.00% Coinsurance after deductible |
| Hearing Aids | 35.00% Coinsurance after deductible |
| Home Health Care Services | 35.00% Coinsurance after deductible |
| Hospice Services | 35.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 35.00% Coinsurance after deductible |
| Infertility Treatment | Not covered |
| Infusion Therapy | 35.00% Coinsurance after deductible |
| Inherited Metabolic Disorder - PKU | 35.00% Coinsurance after deductible |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Newborn Hearing Screening | 35.00% Coinsurance after deductible |
| Nutritional Counseling | 35.00% Coinsurance after deductible |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | 50.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 35.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 35.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | 35.00% Coinsurance after deductible |
| Private-Duty Nursing | 35.00% Coinsurance after deductible |
| Prosthetic Devices | 35.00% Coinsurance after deductible |
| Radiation | 35.00% Coinsurance after deductible |
| Reconstructive Surgery | 35.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30.00 |
| Rehabilitative Speech Therapy | 35.00% 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 | $65.00 |
| Skilled Nursing Facility | 35.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 35.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 35.00% Coinsurance after deductible |
| Transplant | 35.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 35.00% Coinsurance after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 35.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 4 geographic areas.
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