Low Premium Silver HMO 900 $15 PCP

CareSource Nevada Co. · 2027 plan year

Silver

Ind. deductible: $900
Family deductible: $1,800
Ind. OOP max: $3,550
Family OOP max: $7,100

Other cost-sharing reduction variants for this plan:

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

More CareSource Nevada Co. plans in NV

Core Bronze HMO 8500 $50 PCP Silver HMO 6000 $0 Diabetes care

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	$15.00

Specialist

Benefit	In-network
Specialist Visit	$40.00

Hospital

Benefit	In-network
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$350.00 Copay per Stay after deductible
Outpatient Surgery Physician/Surgical Services	20.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$25.00

Pharmacy

Benefit	In-network
Generic Drugs	$3.00
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Preferred Brand Drugs	20.00% Coinsurance after deductible
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$350.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services	$15.00

Other

Benefit	In-network
Accidental Dental	20.00% Coinsurance after deductible
Allergy Testing	$40.00
Bariatric Surgery	20.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	20.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	$350.00 Copay after deductible
Diabetes Education	20.00% Coinsurance after deductible
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
Gender Affirming Care	20.00% Coinsurance after deductible
Habilitation Services	20.00% Coinsurance after deductible
Hearing Aids	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)	$200.00 Copay after deductible
Infertility Treatment	20.00% Coinsurance after deductible
Infusion Therapy	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Laboratory Outpatient and Professional Services	$20.00
Nutritional Counseling	20.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$15.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	20.00% Coinsurance after deductible
Outpatient Rehabilitation Services	20.00% Coinsurance after deductible
Prenatal and Postnatal Care	$40.00
Private-Duty Nursing	20.00% Coinsurance after deductible
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	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 Eye Exam for Children	No charge
Skilled Nursing Facility	$300.00 Copay per Stay after deductible
Substance Abuse Disorder Inpatient Services	$350.00 Copay per Stay after deductible
Substance Abuse Disorder Outpatient Services	$15.00
Transplant	$350.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders	20.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$150.00 Copay after deductible

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