Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental

Ambetter of Oklahoma · 2026 plan year

Silver

Ind. deductible: $5,000
Family deductible: $10,000
Ind. OOP max: $8,650
Family OOP max: $17,300

Compare with other Silver plans in OK

Side by side: deductibles, out-of-pocket limits and copays.

Silver Simple PCP SaverOscar Insurance Company · Deductible $5,750 · Out-of-pocket max $8,600
Silver Simple Chronic Care CKMOscar Insurance Company · Deductible $5,900 · Out-of-pocket max $10,150
Harmony by Medica Silver Standard + Adult Eye ExamMedica · Deductible $6,000 · Out-of-pocket max $8,900

Compare 4 plans Browse all Silver plans in OK

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

More Ambetter of Oklahoma plans in OK

Elite Bronze Standard Expanded Bronze

Monthly premiums by age

Rating Area 3 — the lowest-priced of the 5 areas this plan covers. Premiums differ by area.

Age	Individual	Individual + tobacco
Under 15	$361	$361
21	$472	$543
30	$536	$616
40	$603	$694
50	$843	$970
60	$1,282	$1,474
64 and over	$1,417	$1,629

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	$50.00

Hospital

Benefit	In-network
Emergency Room Services	50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	50.00% Coinsurance after deductible
Mental/Behavioral Health Emergency Room	50.00% Coinsurance after deductible
Mental/Behavioral Health Urgent Care	$30.00
Outpatient Surgery Physician/Surgical Services	50.00% Coinsurance after deductible
Substance Use Disorder Emergency Room	50.00% Coinsurance after deductible
Substance Use Disorder Urgent Care	$30.00
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Enhanced Diabetes $0 Drug Options	No charge
Generic Drugs	$3.00
Non-Preferred Brand Drugs	45.00% Coinsurance after deductible
Preferred Brand Drugs	$60.00
Specialty Drugs	50.00% Coinsurance after deductible
Tier 1b Generic Drugs	$20.00

Mental Health

Benefit	In-network
Mental/Behavioral Health Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Mental/Behavioral Health ER Physician Fee	50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Other Services	50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$30.00
Substance Use Disorder Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Substance Use Disorder ER Physician Fee	50.00% Coinsurance after deductible
Substance Use Disorder Outpatient Other Services	50.00% Coinsurance after deductible

Other

Benefit	In-network
Diabetic Services Lab-work	No charge
Dialysis	50.00% Coinsurance after deductible
Durable Medical Equipment	50.00% Coinsurance after deductible
Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	50.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	$50.00
Annual Diabetic Eye Exam	No charge
Bariatric Surgery	Not covered
Basic Dental Care - Adult	50.00%
Basic Dental Care - Child	Not covered
Chemotherapy	50.00% Coinsurance after deductible
Chiropractic Care	$50.00
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	50.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Care Management	No charge
Diabetes Education	No charge
Diabetes Nutritional Counseling	No charge
Diabetic Routine Foot Care	No charge
Enhanced Diabetic Supplies and Equipment	No charge
Eye Glasses for Children	No charge
Habilitation Services	$50.00 Copay after deductible
Hearing Aids	50.00% Coinsurance after deductible
Home Health Care Services	50.00% Coinsurance after deductible
Hospice Services	50.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	$50.00 Copay after deductible
Infertility Treatment	Not covered
Infusion Therapy	50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	$30.00
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	50.00%
Major Dental Care - Child	Not covered
Nutritional Counseling	$50.00
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$30.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	50.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$50.00 Copay after deductible
Prenatal and Postnatal Care	$30.00
Private-Duty Nursing	50.00% Coinsurance after deductible
Prosthetic Devices	50.00% Coinsurance after deductible
Radiation	50.00% Coinsurance after deductible
Reconstructive Surgery	50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$50.00 Copay after deductible
Rehabilitative Speech Therapy	$50.00 Copay after deductible
Routine Dental Services (Adult)	No charge
Routine Eye Exam (Adult)	No charge
Routine Eye Exam for Children	No charge
Routine Foot Care	$50.00
Skilled Nursing Facility	50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$30.00
Transplant	50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	50.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$50.00 Copay after deductible