Anthem Silver Pathway Guided Access HMO 5500 $10 $0 Virtual PCP $0 Select Drugs
Anthem Blue Cross and Blue Shield · 2026 plan year
Silver
- Ind. deductible
- $5,500
- Family deductible
- $11,000
- Ind. OOP max
- $10,000
- Family OOP max
- $20,000
Compare with other Silver plans in GA
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 GA
Monthly premiums by age
Rating Area 8
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $514 | $514 |
| 21 | $673 | $673 |
| 30 | $763 | $840 |
| 40 | $859 | $945 |
| 50 | $1,201 | $1,321 |
| 60 | $1,825 | $2,008 |
| 64 and over | $2,018 | $2,219 |
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 | $55.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $400.00 Copay per Stay after deductible + 20.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 20.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $85.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 40.00% Coinsurance after deductible |
| OFF_LABEL_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 | $400.00 Copay per Stay after deductible + 20.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | 20.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 20.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $55.00 |
| Acupuncture | Not covered |
| Allergy Testing | 20.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Transplant | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Chemotherapy | 20.00% Coinsurance after deductible |
| Chiropractic Care | 20.00% Coinsurance after deductible |
| CLINICAL_TRIALS | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Cosmetic Surgery | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Care | $80.00 |
| Diabetes Education | $55.00 |
| Dialysis | 20.00% Coinsurance after deductible |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 20.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | 20.00% Coinsurance after deductible |
| Hearing Aids | 20.00% Coinsurance after deductible |
| HEART_TRANSPLANT | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Home Health Care Services | 20.00% Coinsurance after deductible |
| Hospice Services | 20.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | $400.00 Copay after deductible + 50.00% Coinsurance after deductible |
| Infertility Treatment | 20.00% Coinsurance after deductible |
| Infusion Therapy | 20.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 20.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 20.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | 20.00% Coinsurance after deductible |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $10.00 |
| Outpatient Rehabilitation Services | 20.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | 20.00% Coinsurance after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | 20.00% Coinsurance after deductible |
| Reconstructive Surgery | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 20.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 20.00% 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 | Not covered |
| Skilled Nursing Facility | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | $400.00 Copay per Stay after deductible + 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 20.00% Coinsurance after deductible |
| Transplant | $400.00 Copay after deductible + 20.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 20.00% Coinsurance after deductible |
| Weight Loss Programs | $55.00 |
| Well Baby Visits and Care | No charge |
| Well Child Care | No charge |
| X-rays and Diagnostic Imaging | 20.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 2 geographic areas.
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