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Constant Care Silver 1 Off Exchange
Which medical plans are best for you? Use New Mexico Plan Comparison Tool 2021 to find out.
| Plan id | 19722NM0010002-00 |
| CSR Variation Type | Standard Silver Off Exchange Plan |
Insurance Company 
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Molina Healthcare |
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Plan Type
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HMO |
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Plan Metal Level
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Silver |
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Link to Plan's Doctor Directory
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View Plan's Doctor Directory |
| List of Hospitals in Plan's Network | Show Hospitals |
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Summary of Benefits and Coverage
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View Summary of Benefits and Coverage |
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Estimated Monthly Premium Savings (APTC)
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Monthly Premium Cost after Subtracting the Estimated Subsidy (Subsidies are not available for Catastrophic Plans) |
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Cost in a Good Year: Estimated Yearly Cost to You if Your Health Care Usage is Low (for Very Healthy Consumers "Low" is Defined as Only Preventive Care)
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Your Chances of Having a Good Year--a Year with No More Than Low-Usage
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Cost in an Average Year: Average for People Like You
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Cost in a Bad Year: Estimate for People Like You in a High-Health Care Usage Year
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Your Chances of Having a Bad Year--a Year with Very High Usage
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Actual Maximum Out-of-Pocket (includes premiums)
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Benefits and Coverage (assuming you use preferred providers) 
(Note: For a more detailed and accurate explanation of the benefits offered by this plan please refer to the Summary of Benefits and Coverage [SBC]. The benefits are described in more detail in the SBC and it will include additional information about those benefits. Some nuances about the benefits like visit limits and other details are not listed below. You should refer to the SBC for those details about the plan. Click on the "View Summary of Benefits and Coverage" link above to view the SBC.) |
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In-Network Deductible
(Note: Unless excepted in the plan's benefit description, you must pay all the costs up to the deductible amount before the plan begins to pay for covered services you use. There may be additional details about the deductible that are not shown below. Please refer to the SBC for additional details.) |
$0 |
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Extra Deductible for Drugs
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$800 |
| Doctor Visits | |
| Doctor Visit - Preventive Care | No Charge |
| Doctor Visit - Primary Care | $30 Copay |
| Doctor Visit - Specialist | $60 Copay |
| Doctor Visit - Well Baby Visits and Care | No Charge |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30 Copay |
| Hospital | |
| Inpatient Hospital Facility | $1200 Copay per Day |
| Inpatient Hospital Physician/Surgeon | $60 Copay |
| Outpatient Hospital Facility | $500 Copay |
| Outpatient Hospital Physician/Surgeon | $75 Copay |
| Inpatient Maternity Services | $60 Copay |
| Emergency | |
| Emergency Room Services | $750 Copay |
| Emergency Medical Transportation | $500 Copay |
| Urgent Care Centers or Facilities | $30 Copay |
| Drugs | |
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Plan's Drug Formulary
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View Plan's Drug Formulary |
| Generic Drug on Formulary in a Local Pharmacy | $29 Copay |
| Preferred Brand Drug on Formulary in a Local Pharmacy | $60 Copay |
| Non-Preferred Brand Drug on Formulary in a Local Pharmacy | 40% Coinsurance after deductible |
| Specialty Drug on Formulary in a Local Pharmacy | 40% Coinsurance after deductible |
| Tests & Imaging | |
| Diagnostic Tests (Blood work) | $45 Copay |
| X-Rays | $80 Copay |
| Imaging (CT/PET Scans, MRI, etc) | $700 Copay |
| Mental/Behavioral Health | |
| Mental/Behavioral Health Inpatient Services | $1200 Copay per Day |
| Mental/Behavioral Health Outpatient Services | $30 Copay |
| Substance Use Disorder Inpatient | $1200 Copay per Day |
| Substance Use Disorder Outpatient | $30 Copay |
| Vision/Hearing Aids | |
| Routine Eye Exam for Child | No Charge |
| Eye Glasses for Child | No Charge |
| Routine Eye Exam - Adult | |
| Hearing Aids | $500 Copay |
| Child Dental Coverage | |
| Dental Check-Up for Children | |
| Basic Dental Care – Child | |
| Major Dental Care – Child | |
| Orthodontia – Child | |
| Adult Dental Coverage | |
| Basic Dental Care – Adult | |
| Major Dental Care – Adult | |
| Orthodontia – Adult | |
| Accidental Dental | $500 Copay |
| Home and Nursing Care | |
| Home Health Care Services | No Charge |
| Skilled Nursing Care - Facility | $1200 Copay per Day |
| Rehabilitative and habilitative services | |
| Habilitation Services | $30 Copay |
| Outpatient Rehabilitation Services | $30 Copay |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30 Copay |
| Rehabilitative Speech Therapy | $30 Copay |
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Other Services
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| Is HSA Eligible? | No |
| Allergy Testing | $30 Copay |
| Chemotherapy | $500 Copay |
| Chiropractic | $30 Copay |
| Diabetes Education | No Charge |
| Dialysis | $60 Copay |
| Durable Medical Equipment | $500 Copay |
| Hospice Service | No Charge |
| Infusion Therapy | |
| Nutritional Counseling | $30 Copay |
| Prosthetic Devices | $500 Copay |
| Radiation | $500 Copay |
| Reconstructive Surgery | $60 Copay |
| Routine Foot Care | |
| Treatment for Temporomandibular Joint Disorders | $500 Copay |
| Transplant | $60 Copay |
| Weight Loss Programs | |
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Wellness Programs
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| Asthma Program | Available |
| Heart Disease Program | Available |
| Depression Program | Available |
| Diabetes Program | Available |
| High Blood Pressure & Cholesterol Program | Available |
| Low Back Pain Program | Not Available |
| Pain Management Program | Not Available |
| Pregnancy Program | Not Available |
| Weight Loss Programs | Not Available |
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Out-of-Network - See Summary of Benefits and Coverage
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View Summary of Benefits and Coverage |