Ambetter Secure Care 5

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Plan id 39006NM0010008-02
CSR Variation Type Zero Cost Sharing Plan Variation
Insurance Company What is this? Ambetter
Plan Type What is this? HMO
Plan Metal Level What is this? Gold
Link to Plan's Doctor Directory What is this? View Plan's Doctor Directory
List of Hospitals in Plan's Network Show Hospitals
Summary of Benefits and Coverage What is this? View Summary of Benefits and Coverage
Estimated Monthly Premium Savings (APTC) What is this?
Monthly Premium Cost after Subtracting the Estimated Subsidy
(Subsidies are not available for Catastrophic Plans)
Benefits and Coverage (assuming you use preferred providers) expand

(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.)

In-Network Deductible What is this?
(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.)
Extra Deductible for Drugs What is this?
Doctor Visits
Doctor Visit - Preventive Care No Charge
Doctor Visit - Primary Care No Charge
Doctor Visit - Specialist No Charge
Doctor Visit - Well Baby Visits and Care No Charge
Other Practitioner Office Visit (Nurse, Physician Assistant) No Charge
Inpatient Hospital Facility No Charge
Inpatient Hospital Physician/Surgeon No Charge
Outpatient Hospital Facility No Charge
Outpatient Hospital Physician/Surgeon No Charge
Inpatient Maternity Services No Charge
Emergency Room Services No Charge
Emergency Medical Transportation No Charge
Urgent Care Centers or Facilities No Charge
Plan's Drug Formulary What is this? View Plan's Drug Formulary
Generic Drug on Formulary in a Local Pharmacy No Charge
Preferred Brand Drug on Formulary in a Local Pharmacy No Charge
Non-Preferred Brand Drug on Formulary in a Local Pharmacy No Charge
Specialty Drug on Formulary in a Local Pharmacy No Charge
Tests & Imaging
Diagnostic Tests (Blood work) No Charge
X-Rays No Charge
Imaging (CT/PET Scans, MRI, etc) No Charge
Mental/Behavioral Health
Mental/Behavioral Health Inpatient Services No Charge
Mental/Behavioral Health Outpatient Services No Charge
Substance Use Disorder Inpatient No Charge
Substance Use Disorder Outpatient No Charge
Vision/Hearing Aids
Routine Eye Exam for Child No Charge
Eye Glasses for Child No Charge
Routine Eye Exam - Adult
Hearing Aids No Charge
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 No Charge
Home and Nursing Care
Home Health Care Services No Charge
Skilled Nursing Care - Facility No Charge
Rehabilitative and habilitative services
Habilitation Services No Charge
Outpatient Rehabilitation Services No Charge
Rehabilitative Occupational and Rehabilitative Physical Therapy No Charge
Rehabilitative Speech Therapy No Charge
Other Services What is this?
Is HSA Eligible? No
Allergy Testing No Charge
Chemotherapy No Charge
Chiropractic No Charge
Diabetes Education No Charge
Dialysis No Charge
Durable Medical Equipment No Charge
Hospice Service No Charge
Infusion Therapy No Charge
Nutritional Counseling No Charge
Prosthetic Devices No Charge
Radiation No Charge
Reconstructive Surgery No Charge
Routine Foot Care
Treatment for Temporomandibular Joint Disorders No Charge
Transplant No Charge
Weight Loss Programs
Wellness Programs What is this?
Asthma Program Available
Heart Disease Program Available
Depression Program Not Available
Diabetes Program Available
High Blood Pressure & Cholesterol Program Not Available
Low Back Pain Program Not Available
Pain Management Program Not Available
Pregnancy Program Available
Weight Loss Programs Not Available
Out-of-Network - See Summary of Benefits and Coverage What is this? View Summary of Benefits and Coverage
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