Gold HMO 3400 $0 Diabetes care + Adult Vision & Fitness
CareSource Nevada Co. · 2027 plan year
Gold
- Ind. deductible
- $3,400
- Family deductible
- $6,800
- Ind. OOP max
- $8,000
- Family OOP max
- $16,000
Compare with other Gold plans in NV
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
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Monthly premiums by age
Rating Area 1 — the lowest-priced of the 4 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $465 | $465 |
| 21 | $608 | $669 |
| 30 | $690 | $801 |
| 40 | $777 | $902 |
| 50 | $1,086 | $1,282 |
| 60 | $1,651 | $1,948 |
| 64 and over | $1,825 | $2,153 |
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 | $10.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $40.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 30.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 30.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 30.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $30.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $10.00 |
| Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
| Preferred Brand Drugs | $60.00 |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $10.00 |
Other
| Benefit | In-network |
|---|---|
| Accidental Dental | 30.00% Coinsurance after deductible |
| Allergy Testing | $40.00 |
| Bariatric Surgery | 30.00% Coinsurance after deductible |
| Chemotherapy | 30.00% Coinsurance after deductible |
| Chiropractic Care | 30.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 30.00% Coinsurance after deductible |
| Diabetes Education | No charge |
| Dialysis | 30.00% Coinsurance after deductible |
| Durable Medical Equipment | 30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 30.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 30.00% Coinsurance after deductible |
| Habilitation Services | 30.00% Coinsurance after deductible |
| Hearing Aids | 30.00% Coinsurance after deductible |
| Home Health Care Services | 30.00% Coinsurance after deductible |
| Hospice Services | 30.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 30.00% Coinsurance after deductible |
| Infertility Treatment | 30.00% Coinsurance after deductible |
| Infusion Therapy | 30.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 30.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $30.00 |
| Nutritional Counseling | No charge |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $10.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 30.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 30.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | $40.00 |
| Private-Duty Nursing | 30.00% Coinsurance after deductible |
| Prosthetic Devices | 30.00% Coinsurance after deductible |
| Radiation | 30.00% Coinsurance after deductible |
| Reconstructive Surgery | 30.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 30.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 30.00% Coinsurance after deductible |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $10.00 |
| Transplant | 30.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 30.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 30.00% Coinsurance after deductible |
Service area
This plan covers 1 geographic area.
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