Streamlined Silver (QualChoice)
Ambetter from Arkansas Health & Wellness · 2027 plan year
Silver
- Ind. deductible
- $4,700
- Family deductible
- $9,400
- Ind. OOP max
- $11,300
- Family OOP max
- $22,600
Compare with other Silver plans in AR
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Ambetter from Arkansas Health & Wellness plans in AR
Monthly premiums by age
The same in all 7 areas this plan covers.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $500 | $500 |
| 21 | $654 | $784 |
| 30 | $742 | $890 |
| 40 | $835 | $1,002 |
| 50 | $1,167 | $1,401 |
| 60 | $1,774 | $2,129 |
| 64 and over | $1,961 | $2,353 |
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 | $20.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital Services (e.g., Hospital Stay) | 30.00% Coinsurance after deductible |
| Emergency Room Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Emergency Room | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Urgent Care | $20.00 |
| Outpatient Surgery Physician/Surgical Services | 30.00% Coinsurance after deductible |
| Substance Use Disorder Emergency Room | 30.00% Coinsurance after deductible |
| Substance Use Disorder Urgent Care | $20.00 |
| Urgent Care Centers or Facilities | $55.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | 40.00% Coinsurance after deductible |
| Off Label Prescription Drugs | 45.00% Coinsurance after deductible |
| Preferred Brand Drugs | $30.00 Copay after deductible |
| Preventative Drugs | No charge |
| Specialty Drugs | 45.00% Coinsurance after deductible |
| Tier 1b Generic Drugs | $15.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Emergency Transportation/Ambulance | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health ER Physician Fee | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Other Services | 30.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $20.00 |
| Substance Use Disorder Emergency Transportation/Ambulance | 30.00% Coinsurance after deductible |
| Substance Use Disorder ER Physician Fee | 30.00% Coinsurance after deductible |
| Substance Use Disorder Outpatient Other Services | 30.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 30.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | $60.00 |
| Applied Behavior Analysis Based Therapies | 30.00% Coinsurance after deductible |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Cardiac Rehabilitation | 30.00% Coinsurance after deductible |
| Chemotherapy | 30.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 30.00% Coinsurance after deductible |
| Chiropractic Care | $60.00 |
| Cochlear Implants | 30.00% |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 30.00% Coinsurance after deductible |
| Dental Anesthesia | 30.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Care Management | $60.00 |
| Diabetes Education | $60.00 |
| 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 |
| Gastric Electrical Stimulation | 30.00% Coinsurance after deductible |
| Habilitation Services | 30.00% Coinsurance after deductible |
| Hearing Aids | 30.00% |
| 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 | Not covered |
| Infusion Therapy | 30.00% Coinsurance after deductible |
| Inherited Metabolic Disorder - PKU | $50.00 |
| Laboratory Outpatient and Professional Services | $50.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | $60.00 |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $20.00 |
| 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 | $20.00 |
| Private-Duty Nursing | Not covered |
| 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 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 | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 30.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $20.00 |
| Transplant | 30.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 30.00% Coinsurance after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| Well Child Care | No charge |
| X-rays and Diagnostic Imaging | 30.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 1 geographic area.
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