Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental

Ambetter of North Carolina · 2026 plan year

Silver

Ind. deductible: $5,900
Family deductible: $11,800
Ind. OOP max: $8,150
Family OOP max: $16,300

Compare with other Silver plans in NC

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

Silver Simple Chronic Care CKM | with Atrium HealthOscar Health Plan of North Carolina, Inc · Deductible $5,900 · Out-of-pocket max $10,150
Blue Value Silver Standard | Limited Statewide DoctorsBlue Cross and Blue Shield of NC · Deductible $6,000 · Out-of-pocket max $8,900
Blue Local Silver Standard | with Atrium HealthBlue Cross and Blue Shield of NC · Deductible $6,000 · Out-of-pocket max $8,900

Compare 4 plans Browse all Silver plans in NC

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 North Carolina plans in NC

Complete Gold Enhanced Asthma/COPD Care Silver with $0 Drug Options Elite Bronze Clear Silver with $0 Insulin Options

Monthly premiums by age

Rating Area 2 — the lowest-priced of the 9 areas this plan covers. Premiums differ by area.

Age	Individual	Individual + tobacco
Under 15	$378	$378
21	$494	$569
30	$561	$645
40	$632	$727
50	$883	$1,016
60	$1,342	$1,543
64 and over	$1,483	$1,706

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	$40.00

Specialist

Benefit	In-network
Specialist Visit	$60.00

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 Asthma/COPD $0 Drug Options	No charge
Generic Drugs	$3.00
Non-Preferred Brand Drugs	45.00% Coinsurance after deductible
Preferred Brand Drugs	$75.00
Specialty Drugs	50.00% Coinsurance after deductible
Tier 1b Generic Drugs	$15.00

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	$40.00
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
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	50.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	$60.00
Asthma/COPD Care Management	No charge
Asthma/COPD Testing	No charge
Asthma/COPD Therapies	No charge
Bariatric Surgery	50.00% Coinsurance after deductible
Basic Dental Care - Adult	50.00%
Basic Dental Care - Child	Not covered
Chemotherapy	50.00% Coinsurance after deductible
Chiropractic Care	$60.00
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 Education	$60.00
Dialysis	50.00% Coinsurance after deductible
Durable Medical Equipment	50.00% Coinsurance after deductible
Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Enhanced Asthma/COPD Supplies & Equipment	No charge
Eye Glasses for Children	No charge
Habilitation Services	$40.00 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% Coinsurance after deductible
Infertility Treatment	50.00% Coinsurance after deductible
Infusion Therapy	50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	$40.00
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	50.00%
Major Dental Care - Child	Not covered
Nutritional Counseling	$60.00
Office Visits with a Pulmonologist	No charge
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$40.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	50.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$40.00 Copay after deductible
Prenatal and Postnatal Care	$40.00
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	$40.00 Copay after deductible
Rehabilitative Speech Therapy	$40.00 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	$60.00
Skilled Nursing Facility	50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$40.00
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% Coinsurance after deductible