Plan Overviews
Ambetter from Superior HealthPlan provides quality healthcare solutions that help residents of Wisconsin live better. With a variety of affordable coverage options, they make it easier to stay healthy.
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| Prestige Bronze Essential | Prestige Bronze Standard | Prestige Bronze 20 HDHP | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 40% | 50% | 20% |
| Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.
(Individual/Family) |
$5,500/$11,000 | $6,650/$13,300 | $5,500/$11,000 |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) | $7,150/$14,300 | $7,150/$14,300 | $6,550/$13,100 |
| Preventative Care | $0 | $0 | $0 |
| Virtual Visit | $20 | $35 | 20% after deductible |
| Primary Care Doctor Visit | $30 after deductible | First 3 visits – $45
Then 50% after deductible |
20% after deductible |
| Specialist Visit | $80 after deductible | 50% after deductible | 20% after deductible |
| Hospital Stay | 40% after deductible | 50% after deductible | 20% after deductible |
| Maternity Care | 40% after deductible | 50% after deductible | 20% after deductible |
| Emergency Room | $400 after deductible | 50% after deductible | 20% after deductible |
| X-ray, Lab and Pathology | $75 after deductible | 50% after deductible | 20% after deductible |
| Ambulance | 40% after deductible | 50% after deductible | 20% after deductible |
| PET scans, MRIs, MRAs, CT scans and stress tests | $75 after deductible | 50% after deductible | 20% after deductible |
| Chiropractic | 40% after deductible | 50% after deductible | 20% after deductible |
| Urgent Care | $75 after deductible | 50% after deductible | 20% after deductible |
| Preventative Drugs 30-Day Supply | $0 per prescription or refill | $0 per prescription or refill | $0 per prescription or refill |
| Prestige Silver Essential | Prestige Silver 0 | Prestige Silver Standard | Prestige Silver 20 HDHP | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 30% | No charge after deductible | 20% | 20% |
| Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.
(Individual/Family) |
$2,500/$5,000 | $4,000/$8,000 | $3,500/$7,000 | $2,600/$5,200 |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) | $7,150/$14,300 | $7,150/$14,300 | $7,150/$14,300 | $6,550/$13,100 |
| Preventative Care | $0 | |||
| Virtual Visit | $10 per visit | No charge after deductible | $20 per visit | 20% after deductible |
| Primary Care Doctor Visit | $20 per visit | No charge after deductible | $65 per visit | 20% after deductible |
| Specialist Visit | $55 per visit | No charge after deductible | $65 per visit | 20% after deductible |
| Hospital Stay | 30% after deductible | No charge after deductible | 20% after deductible | 20% after deductible |
| Maternity Care | 40% after deductible | No charge after deductible | 20% after deductible | 20% after deductible |
| Emergency Room | $350 | No charge after deductible | $400 after deductible | 20% after deductible |
| X-ray, Lab and Pathology | $55 per service | No charge after deductible | 20% after deductible | 20% after deductible |
| Ambulance | $250 per trip | No charge after deductible | 20% after deductible | 20% after deductible |
| PET scans, MRIs, MRAs, CT scans and stress tests | 30% after deductible | No charge after deductible | 20% after deductible | 20% after deductible |
| Chiropractic | 30% after deductible | No charge after deductible | 20% after deductible | 20% after deductible |
| Urgent Care | $75 | No charge after deductible | $75 | 20% after deductible |
| Preventative Drugs 30-Day Supply | $0 per prescription or refill | $0 per prescription or refill | $0 per prescription or refill | $0 per prescription or refill |
| Prestige Gold Essential | Prestige Gold Standard | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 20% | 20% |
| Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.
(Individual/Family) |
$500/$1,000 | $1,250/$2,500 |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) | $7,150/$14,300 | $4,750/$9,500 |
| Preventative Care | $0 | $0 |
| Virtual Visit | $5 per visit | $10 per visit |
| Primary Care Doctor Visit | $15 per visit | $20 per visit |
| Specialist Visit | $35 per visit | $50 per visit |
| Hospital Stay | 20% after deductible | 20% after deductible |
| Maternity Care | 20% after deductible | 20% after deductible |
| Emergency Room | $250 | $250 after deductible |
| X-ray, Lab and Pathology | $35 per service | 20% after deductible |
| Ambulance | 20% after deductible | 20% after deductible |
| PET scans, MRIs, MRAs, CT scans and stress tests | $35 per service | 20% after deductible |
| Chiropractic | 20% after deductible | 20% after deductible |
| Urgent Care | $50 | $65 |
| Preventative Drugs 30-Day Supply | $0 per prescription or refill | $0 per prescription or refill |
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When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.
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Phone: (312) 726-6565
Email: [email protected]
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1570 Midway Place
Menasha, WI 54952
800-826-0940 or 920-720-1300
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