Standard Gwinnett Clinic SELECT Gold HMO $2000 $30
Centene Corporation DBA Ambetter from Peach State Health Plan · 2026 plan year
Gold
- Ind. deductible
- $2,000
- Family deductible
- $4,000
- Ind. OOP max
- $8,200
- Family OOP max
- $16,400
Compare with other Gold plans in GA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Centene Corporation DBA Ambetter from Peach State Health Plan plans in GA
Monthly premiums by age
Rating Area 3
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $456 | $456 |
| 21 | $596 | $685 |
| 30 | $676 | $777 |
| 40 | $761 | $875 |
| 50 | $1,064 | $1,223 |
| 60 | $1,617 | $1,859 |
| 64 and over | $1,787 | $2,055 |
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 | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Mental Behavioral Health Emergency Room | 25.00% Coinsurance after deductible |
| Mental Behavioral Health Urgent Care | $30.00 |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Substance Use Disorder Emergency Room | 25.00% Coinsurance after deductible |
| Substance Use Disorder Urgent Care | $30.00 |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $60.00 |
| OFF_LABEL_DRUGS | $250.00 |
| Preferred Brand Drugs | $30.00 |
| Specialty Drugs | $250.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Behavioral Health Emergency Transportation Ambulance | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $30.00 |
| Substance Use Disorder Emergency Transportation Ambulance | 25.00% Coinsurance after deductible |
| Substance Use Disorder Outpatient Other Services | 25.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 25.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Autism Spectrum Disorders | 25.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Bone Marrow Transplant | 25.00% Coinsurance after deductible |
| Chemotherapy | 25.00% Coinsurance after deductible |
| Chiropractic Care | $60.00 |
| CLINICAL_TRIALS | 25.00% Coinsurance after deductible |
| Cosmetic Surgery | 25.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| DENTAL_ANESTHESIA | 25.00% Coinsurance after deductible |
| Diabetes Care | $60.00 |
| Diabetes Education | $60.00 |
| Dialysis | 25.00% Coinsurance after deductible |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | $30.00 |
| Hearing Aids | Not covered |
| HEART_TRANSPLANT | 25.00% Coinsurance after deductible |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | 25.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infertility Treatment | 25.00% Coinsurance after deductible |
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 25.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| MENTAL_BEHAVIORAL_HEALTH_ER_PHYSICIAN_FEE | 25.00% Coinsurance after deductible |
| MENTAL_BEHAVIORAL_HEALTH_OUTPATIENT_OTHER_SERVICES | 25.00% Coinsurance after deductible |
| Nutritional Counseling | $60.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Outpatient Rehabilitation Services | $30.00 |
| Prenatal and Postnatal Care | $30.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 25.00% Coinsurance after deductible |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30.00 |
| Rehabilitative Speech Therapy | $30.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $60.00 |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| SUBSTANCE_USE_DISORDER_ER_PHYSICIAN_FEE | 25.00% Coinsurance after deductible |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 25.00% Coinsurance after deductible |
| Weight Loss Programs | $60.00 |
| Well Baby Visits and Care | No charge |
| Well Child Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 9 geographic areas. 9 of them are covered only in part, meaning specific ZIP codes rather than the whole county. The filing does not list which, so confirm with the insurer or on HealthCare.gov before enrolling.
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