Consumer Health Insurance Plans For People Who Buy Their Own Insurance MARYLAND

Transcription

1 Consumer Health Insurance Plans 2014 For People Who Buy Their Own Insurance MARYLAND

2 Welcome Dear In our 75 years of service to your family, friends and neighbors, this is the first time that all of the plans we re offering from CareFirst BlueCross BlueShield and CareFirst, Inc. (CareFirst) are brand-new. That s because all 15 of our plans were designed to meet and have met the new guidelines of the Affordable Care Act (ACA), or, health care reform. Because the ACA is new, we know this is the first time anyone will be buying an ACA plan. Everyone will benefit from learning the ACA terms and ideas in the short overview section following this one. That s why we recommend you read this brief, step-by-step guide from front to back. Written in an easy-to-understand style, it will: Explain ACA and how it will affect you Define basic health insurance concepts and terms Explain new financial help that can lower your costs Give you info about ACA Metal Levels Provide rate tables so you can calculate your premium Give you 3 ways to enroll today The new ACA health care landscape may not be familiar, but CareFirst is. We ve always been committed to making sure you have the best information, when you need it. If you need more than you find in this book and the accompanying charts, visit or call us at , 7 days a week, 8:00 am 8:00 pm. You can use the same number for our no-charge bi-lingual services, too. As always, we re here for you. Ready to go shopping? You can also visit us online at to research and compare plans. Sincerely, Vickie S. Cosby Senior Director, Consumer Direct Sales 1

3 Consumer Health Insurance Plans 2014 What s Inside Get to know the basics How health care reform will affect you... 3 What you need to know before you shop... 5 Choosing your CareFirst health care plan Understanding your plans Calculating your total monthly premium Dental and vision The rewards of enrolling in HealthyBlue plans Taking your health to the next level Enroll today Three ways to enroll in your new CareFirst plan Additional information Our commitment to you Not all services and procedures are covered by your benefits contract. This plan summary is for comparison purposes only and does not create rights not given through the benefit plan. 2

4 Get to know the basics

5 How health care reform will affect you The Affordable Care Act (ACA), or health care reform, became law in 2010 and will affect the majority of people who buy their own insurance. In addition to requiring nearly everyone to buy health insurance starting in 2014, the ACA will have an impact on almost every other aspect of your health care. That s why you should understand the following basics about the law as you choose your new CareFirst health insurance plan. The ACA guarantees that no one can be denied coverage or be charged more because they re sick or because they have a pre-existing medical condition. The law also requires that each state s plans all cover the same core benefits. So all of the plans you re about to review will offer these Essential Health Benefits: Ambulatory patient services Emergency services Maternity & newborn care Hospitalization Prescription drugs Mental health/substance abuse services Laboratory services Rehabilitative/habilitative services & devices Preventive/wellness care Pediatric dental & vision services All plans (except Young Adult Catastrophic) must fit into one of 4 Metal Levels. Bronze, Silver, Gold & Platinum plans all cover the same benefits, but each level differs in how much of your care you ll pay. You ll find details about all plan types in the next section. To help make health insurance more affordable, the federal government offers Financial Assistance, called Subsidies. You may qualify if your projected 2014 household income is: less than $45,960 for an Individual less than $62,040 for a Family of 2 less than $78,120 for a Family of 3 less than $94,200 for a Family of 4 less than $110,280 for a Family of 5 We used 2013 income levels above to give you an idea of the income levels that may qualify for Subsidies. These levels change slightly each year. You ll find detailed information on The next section outlines some other things you should understand, to make choosing your health insurance plan easier. 3

6 What you need to know before you shop Now that you have a basic understanding of health care reform (ACA), you should also understand some of the ways it will affect the plans you re about to compare, and what you ll pay. Before you actually start comparing, spend a few minutes now to make sure you re comfortable with the terms used to describe how plans provide coverage. We ve broken it down into two sections: terms related to plans and providers, and financial-related terms. Plans & providers Provider Network CareFirst has a large group or network of providers doctors, hospitals and pharmacies you receive benefits and services from. Plan Types (HMO, PPO, POS) refer to how your plan provides coverage and which network of providers you receive care from. The differences have to do with how much freedom you have when choosing providers, balanced with how much of that provider s costs you will have to pay. CareFirst s HMO plans use the network. When you see any of our more than 28,000 participating providers, you ll save the most money. Except for emergency services, if you go outside of the network, your medical services will not be covered. CareFirst s PPO plans offer the most choice. You can receive care from the PPO network of more than 34,000 providers locally and thousands nationally. In addition, you can pay slightly more to go out-of-network. With our more flexible POS plans, your cost depends on which network you get your services in. POS policyholders can see providers: in the HMO network for the most savings in the PPO network and pay slightly more outside of CareFirst s networks, where you ll likely pay charges that exceed CareFirst s Allowed Amount. What s in a name? Our 4 plan names tell you what type of plan it is. plans are HMO plans BluePreferred plans are PPO plans HealthyBlue and Plus plans are POS plans 5

7 Consumer Health Insurance Plans 2014 Paying for coverage & care Premium the money you pay each month for your plan, or policy, is your premium. Premiums are based on your age, where you live, the family members the plan will cover, and how much of your health care costs the plan pays. Allowed Amount is the fee that providers in CareFirst s network have agreed to accept for a particular medical service. CareFirst has negotiated very favorable discounts on medical services for the people we insure. If you see a doctor who is not on your plan s network who charges more, the difference is your responsibility. Cost Sharing the portion of your health care costs that your plan doesn t pay is your share. Generally, the more costs you re willing to pay, the lower your premiums. The less cost sharing you want to be responsible for, the higher your premiums will be. Cost sharing is different from your premium. It s made up of three things: Deductible is the amount of money you must pay each calendar year before a plan begins paying its portion of your costs. Meeting your deductible of $1,500, for example, means you ll pay the first $1,500 for health care services covered by your plan, and then CareFirst will start paying for part or all of the services after that. Only costs based on CareFirst s Allowed Amount will count toward your deductible. Look closely at the plan options you are considering. All of them offer no charge preventive care that is not subject to a deductible. Some even cover all primary care visits, urgent care and generic drugs without needing to meet a deductible first. Copayment or copay is a fixed-dollar amount you pay when you visit a provider, like $25 when you visit a doctor, or $100 for a trip to the emergency room. Depending on the plan, you may pay copays before or after you meet your deductible. Coinsurance is the percentage you pay of the Allowed Amount after you ve met your deductible. So if your plan has 20% coinsurance, you would pay $20 for a $100 charge, and CareFirst would pay the remaining $80. Out-of-Pocket Maximum is the most you will have to pay in deductibles, copays, coinsurance and prescription drug costs in a calendar year. After that, CareFirst will pay 100% of the Allowed Amount for covered services except for your premiums for the rest of that year. Prescription Coverage All prescription drug charges count toward your out-of-pocket maximums. You ll pay your share in the form of coinsurance or a copay. You ll pay different amounts for different types of drugs, with generics costing the least. For example, you can get a 3-month supply of a generic maintenance drug for just 2 copays at our participating retail stores. Learn more at CareFirst.com/rx. How much will I pay for medical services? You pay the Allowed Amount * up to your deductible Your Deductible Then you ll share costs with CareFirst through copays and coinsurance up to your out-of-pocket maximum Your Out-of-Pocket Maximum Then, CareFirst will pay 100% of your costs except for your premiums, for the rest of the plan year * Depending on the plan, you may have coverage for certain services even before you meet your deductible 6

8 Consumer Health Insurance Plans 2014 Again depending on the plan, you may have to meet your plan s deductible before prescription coverage begins (it is integrated with your other medical expenses). Other plans have a separate, lower deductible just for drugs, which gives you drug coverage much sooner. We ve included an outline of prescription benefits in the fold-out chart that came with this book. Checkout line 37 in that chart for details. HSA-Compatible Plans can help lower your health care costs. HSA stands for Health Savings Account, a tax-deductible account that works like an IRA for health expenses. CareFirst offers five HSA-compatible plans that can help lower health care costs for high-deductible, lowerpremium plans. By contributing tax-deductible money (usually the money you save on lower premiums), you build up savings in your HSA that you use to cover you, your spouse and your dependents even if they are not enrolled in your medical plan. Opening an HSA provides you with a number of benefits, including: Tax Savings Your deposits and the interest you earn are tax-free, as is the money you take out to pay for qualified medical expenses. Freedom & Control Use the money in your HSA to pay for things like your copays, prescriptions and dental and vision care. Portability Your HSA account balance is yours even if you change your health plan or move out of state. Paying taxes vs. paying for health care For example $3,300 without an HSA Federal tax (25%) $825 $0 tax (5%) $165 $0 Social Security & Employment Taxes (7.65%) $252 $0 Total taxes paid $1,242 $0 Portion left to pay for your medical expenses $3,300 in an HSA $2,058 $3,300 Tax savings $0 $1,242 Growth Balances can grow because they earn interest. You can also use other bank investment services to grow your savings even more. Long-Term Access Unused funds roll over and accumulate year to year; there s no use it or lose it rule. Retirement Savings When you turn 65, you can use money in your HSA Bank Account as retirement savings, or continue to use it for medical expenses. Federal Financial Subsidies as you saw in the ACA overview on page 3, there is financial help available for people with certain incomes to help make health care more affordable. There are two kinds of Subsidies available: The Premium Subsidy helps reduce monthly premiums, so less of your income is spent on buying health insurance. If you qualify, the money can be sent directly to CareFirst, leaving a smaller premium (if any) for you to pay. You must apply for this Subsidy on s Health Insurance Marketplace (also known as Exchange) and it can only be used to help you pay for a plan purchased on the Marketplace. You can use this Subsidy on any ACA plan except the Young Adult (Catastrophic) plan, discussed in the next section. The Cost-Share Subsidy lowers the maximum dollar amount you are required to pay for outof-pocket expenses. Lowering your maximum means your plan begins paying 100% of your costs earlier than it would have without the help. The Cost-Share Subsidy is available only for Silver Plans bought on the Marketplace. If you qualify for a Subsidy, you can still purchase a CareFirst plan; you will just have to buy it on the public Marketplace, which, again, is the only place you can apply for Subsidies. To get more detailed information, visit your Marketplace at For illustration purposes only. Your rates may differ. 7

9 Choosing your CareFirst health care plan

10 Understanding your plans What you get with every CareFirst plan As you review the details of each plan in the following pages, and in the fold-out chart, keep in mind that all CareFirst plans feature the following benefits: A vast network of at least 28,000 providers No charge, no deductible for in-network: adult physicals well-child exams and immunizations OB/GYN visits cancer screenings including mammograms, pap tests, prostate and colorectal screenings routine pre-natal maternity services preventive maternity services No referrals needed to see a specialist Over 60,000 pharmacies nationwide Vision and dental coverage for kids under age 19 No charge, no deductible adult eye exam every 12 months* 24-hour advice by a registered nurse with NurseLine FirstHelp TM Discounts on contact lenses, laser vision correction surgery and glasses Exclusive discounts on health and wellness services such as: weight loss programs discounted gym memberships personal trainers & spa services massage therapy and more (see pages 33 34) Away From Home Care Some Blues plans offer policyholders living temporarily in other states the same coverage they have at home. See participating states on page 34. * Deductible applies to eye exam in the Young Adult plan only 9

11 Consumer Health Insurance Plans 2014 Understanding metal levels CareFirst s plans within each Metal Level give you choices of networks, different cost-sharing arrangements and, of course premiums. Here s a summary of what you can expect to find in each Metal Level. Highest annual deductibles Lowest monthly premiums Three tax-saving HSA options Bronze Level Plans feature our lowest premiums for people willing to pay a larger share of their health care costs. Offering a full range of provider networks, our four Bronze plans feature three with a money-saving HSA option. Premium subsidy option available. Higher annual deductibles Lower monthly premiums Two tax-saving HSA options Silver Level Plans combine slightly higher premiums with modest deductibles. Two plans have an HSA option and two cover additional medical services before you meet the plan s deductible. Premium and cost-share subsidies available. Lower annual deductibles Higher monthly premiums Additional no-cost services Gold Level Plans appeal to people who want to pay a higher premium in exchange for a plan with lower deductibles. Three of the four plans feature additional services you can use before having to meet a deductible. Premium subsidy option available. No annual deductibles Highest monthly premiums Additional no-cost services Platinum Level Plans have no deductible, so they begin paying their share of health care costs immediately. Their higher premiums also shrink out-of-pocket maximums to the lowest of any of our plans. Premium subsidy option available. High annual deductible Lower monthly premium Safety net for serious incident While not technically a Metal Level, Young Adult (Catastrophic Coverage) is the affordable alternative to living without any health insurance, with premiums of about $100 a month. Instead of having to pay tens or even hundreds of thousands of dollars that a serious injury or illness could cost, people under age 30* with this safety net plan would have those expenses capped at $6,350 for the calendar year they occurred in. *Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. 10

12 Consumer Health Insurance Plans 2014 Snapshot comparison of plans Here you can see how each type of plan relates to annual premiums* and individual annual deductible. As monthly premiums go up $635 $490 $390 $360 $275 $280 $290 $220 $225 $100 $130 $160 AGE 55 $180 AGE 55 AGE 55 AGE 55 AGE 26 AGE 26 AGE 40 AGE 26 AGE 40 AGE 26 AGE 40 AGE 26 AGE 40 Catastrophic Bronze Level Plans Silver Level Plans Gold Level Plans Platinum Level Plans $0 $1,500 Deductible $0 Deductible $1,300 $2,500 Deductible annual deductibles go down. $3,500 $6,000 Deductible $6,350 Deductible * Rates are based on the average for each plan per metal level and all four geographical regions for the age indicated. 11

13 Consumer Health Insurance Plans 2014 Narrowing down your selection This chart shows the features people use most often to compare plans. Use it to find your top 3 or 4 choices based on plan type or deductible, or specific features like the option to add an HSA account, or out-of-network coverage, coinsurance level whatever s most important to you. Check the plans you want to find your rates for, which is what awaits in the next section. Catastrophic Bronze Level Plans Silver Level Plans Plan Name Young Adult * $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 BluePreferred HSA Bronze $3,500 Plus Silver $2,500 Silver $2,000 Check to compare plans Plan Type (page 5) You Pay (page 6) HMO HMO POS HMO PPO POS HMO Individual Deductible $6,350 $6,000 $5,500 $4,000 $3,500 $2,500 $2,000 Individual Out-of-Pocket Max $6,350 $6,000 $6,350 $6,350 $6,350 $6,350 $6,350 Coinsurance 0% 0% 20% 30% 20% 20% 20% Copays (PCP/ Specialist) $0 $0 $35 / $45 $30 / $40 $30 / $40 $20 / $40 $30 / $40 Plan Features Lower Deductible Out-of-Network Coverage Pay no deductible for PCP, urgent care and preferred generics No-charge and nodeductible for PCP, labs, x-rays and generic drugs HSA-Compatible (page 7) HealthyRewards Program (page 31) Non-emergency coverage in the U.S. (page 34) Pediatric Dental * Available to individuals under the age of 30. Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. 12

14 Consumer Health Insurance Plans 2014 Silver Level Plans Gold Level Plans Platinum Level Plans BluePreferred HSA Silver $1,500 HSA Silver $1,300 HealthyBlue Gold $1,500 Gold $1,000 BluePreferred Gold $500 Gold $0 BluePreferred Platinum $0 HealthyBlue Platinum $0 PPO HMO POS HMO PPO HMO PPO POS $1,500 $1,300 $1,500 $1,000 $500 $0 $0 $0 $5,500 $6,350 $3,450 $3,750 $3,750 $6,350 $1,800 $2,000 30% 20% 0% 10% 20% 30% 10% 0% $30 / $40 $30 / $40 $0 / $40 $20 / $30 $30 / $40 $20 / $30 $20 / $30 $0 / $30 13

15 Consumer Health Insurance Plans 2014 A variety of plans for a variety of needs Everyone s health insurance needs are different. We know cost is a concern when selecting the best plan for you and your family. But we also know you have specific things you want your plan to cover. As you ll see from these examples, and from our plans, our plans offer the value you ve come to expect with the choices you deserve. Like most young people, 27-year-old Kyle didn t think about health insurance much. When he found out the law was going to require him to get it, he learned about affordable plans that limit the medical expenses of a serious injury or illness that could cost him tens or hundreds of thousands of dollars. Kyle trusts CareFirst and wants to buy the Young Adult Plan or a Bronze plan if he qualifies for a substantial premium subsidy. Although Amanda is excited to finally be running her own business at age 39, she doesn t get employer-sponsored health insurance like she used to. Amanda decided she is okay paying a little more each month for a low to moderate deductible similar to her old plan. She is going to look at Silver and Gold plans. Cheryl loves her job at the small eventplanning company where she s worked for two years. She trusts the owners when they say they ll offer health insurance one day. For now, because she qualifies for both Subsidies, Cheryl is going to get a Silver plan so she can save the most money. Justin and Rose just welcomed twins into the world, so quality health insurance is even more important than it was before. Earning a decent dual income, Justin and Rose like the lower out-of-pocket and deductibles in the Gold plans, but are leaning toward Platinum plans to make sure they get the best coverage for their new family. 14

16 Young Adult $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 Consumer Health Insurance Plans 2014 HSA Bronze $3,500 Young Plus Silver Adult $2,500 $6,350 HSA Silver Bronze $2,000 $6,000 Consumer Health In 0-20 $64 $73 $86 $76 $ $118 $ $101 $114 $136 $120 $ $185 $ $101 $114 $136 $120 $ $185 $ $101 $114 $136 $120 $144 Calculating your total $185 $ $101 $114 $136 $120 $ $185 $ $101 $115 $136 $120 $ $186 $ $103 $117 Baltimore City; $139 Anne Arundel, $122 Baltimore, $ Harford $190 and Howard $185 Baltimo Countie 27 $105 $120 monthly $142 $125 premium $ $194 $189 Age Bronze Level Plans Age Silver Lev 28 $109 $124 $148 $130 $ $201 $ $113 $128 $152 $134 BluePreferred $ $207 $202 B 30 Young $114 Adult HSA $130 Bronze Plus $154 Bronze HSA $136 Bronze HSA $163 Bronze 30 Plus Young $210 Silver Adult HSA Silver $205 Bronze $6,350 $6,000 $5,500 $4,000 $3,500 $2,500 $6,350 $2,000 $6, NA* $133 $157 $139 $ $215 NA* $ NA* $64 $135 $73 $161 $86 $141 $76 $170 $ $219 $118 $64 NA* $213 $114 $ $101 NA* $137 $114 $163 $136 $120 $143 $144 $ $222 $185 $101 NA* $180 $216 $114 Everyone who will be covered by your plan has their $101 NA* own rate, based on their age. In, the county $101 NA* $139 $114 $140 $114 $136 $165 $136 $166 $120 $145 $146 $120 $144 $ $144 $ $225 $185 $101 NA* $226 $185 $101 NA* $219 $180 $114 $220 $180 $114 the subscriber lives in also affects the rate $101 Use your NA* $141 $114 Need a $136 $167 for instance? $120 $147 $144 $ $228 $185 $101 NA* $222 $180 $ $101 NA* $142 $115 $136 $168 $148 $120 $144 $178 county for all of your family members, even if they live in $229 $186 $101 NA* $223 $181 $115 Denny and Sari are married with 3 kids Meredith, $103 NA* $143 $117 $139 $169 $122 $149 $147 $ $190 $231 $103 NA* $225 $185 $117 another county $105 Michele, 17 and Josiah, 23. They live in Howard County Consumer NA* Health $144 $120 $142 Insurance $171 $125 Plans $ $181 $ Consumer $234 $194 $105 NA* Health $227 $189 $120 In and want to calculate their family s monthly premium for First, find your county s rate table you ll $109 only need NA* $124 this $146 $148 $174 $130 $153 $184 $ $201 $237 $109 NA* $196 $230 $ $113 NA* $128 $149 the $152 $177 Plus $134 $156 Silver $2,500. $187 $ $207 $241 $113 NA* $202 $235 $128 one table for all plans: $114 NA* $130 $152 $154 $180 $136 $158 $190 $ $210 $245 $114 NA* $205 $239 $ Baltimore City, Anne Arundel, Baltimore, 43 NA* $133 $155 $184 $157 $139 $162 $195 $ $215 $251 NA* NA* $209 $245 $ NA* $160 $135 Harford & Howard (page 16) Using their $190 $161 $141 county s $167 rate chart, $201 $ $219 $259 NA* NA* $213 $252 $ NA* $137 $165 Baltimore City; $196 $163 Anne Arundel, $173 $143 Baltimore, $208 $172 Howard 33 Harford and Howard Baltimo Countie they find their plan s column 45 County $222 $267 NA* NA* $260 $216 $137 Allegany, Carroll, Frederick, Garrett NA* $172 $139 $204 $165 $179 $145 $216 $ $278 $225 NA* NA* $270 $219 $139 Age and find Bronze and circle: Level Plans Age Silver Lev & Washington (page 18) NA* $140 $179 $212 $166 $146 $187 $225 $ $289 $226 NA* NA* $282 $220 $ NA* $187 $141 BluePreferred B Meredith $222 $167 and Michele s $195 $147 $235 $ $303 $228 NA* NA* $295 $222 $141 Calvert, Caroline, Cecil, Charles, Dorchester, Young NA* Adult HSA $195 $142 Bronze Plus $232 $168 Bronze HSA $204 $148 Bronze HSA $245 $178 Bronze Plus Young $229 $316 NA* NA* Silver Adult HSA Silver $307 $223 $142 Bronze $6,350 $6,000 rate $5,500 in their age $4,000 row $3,500 $2,500 $6,350 $2,000 $6,000 Kent, Queen Anne s, St. Mary s, Somerset, NA* $204 $143 $243 $169 $214 $149 $257 $ $331 $231 NA* NA* $322 $225 $ $64 $73 (0-20) $86 they make $76 $ $118 $64 $114 $73 Talbot, Wicomico & Worchester (page 51 20) NA* $213 $144 $253 $171 $223 $151 $268 $ $234 $345 NA* NA* x2 $336 $227 $ $101 NA* $223 $146 $114 a $265 $136 $174 note to add that $233 $120 $153 $281 $184 $ $361 $237 $185 $101 NA* NA* $230 $352 $180 $146 $114 Montgomery & Prince George s (page ) $101 NA* $234 $149 $114 rate $277 $136 $177 twice, once $244 $156 $120 for $293 $144 $ $378 $241 $185 $101 NA* NA* $368 $235 $180 $149 $ $101 NA* $244 $152 $114 each $290 $180 $136 daughter$255 $120 $158 $307 $190 $ $395 $245 $185 $101 NA* NA* $385 $239 $180 $152 $ $101 $114 $136 $120 $ $185 $101 NA* $180 $155 $114 A plan just for yourself? 55 NA* $255 $155 $303 $184 $267 $162 $320 $ $413 $251 NA* $402 $ $101 NA* $267 $160 $115 Josiah s $190 $317 $136 rate in $279 $120 $167 his age $201 $144 $ $432 $186 $259 $101 NA* NA* $420 $252 $181 $160 $115 For each plan you re interested in: $103 NA* $279 $165 $117 row $196 $331 $139 (23) $291 $173 $122 $208 $350 $ $190 $267 $451 $103 NA* NA* $260 $439 $185 $165 $ $105 NA* $292 $172 $120 $204 $346 $142 $305 $179 $125 $366 $216 $ $472 $278 $194 $105 NA* NA* $270 $459 $189 $172 $ Go down the plan column to the row that 59 $109 NA* $298 $124 $179 Sari s $354 $212 $148 rate in her $130 $187 $311 age $225 $156 $ $482 $201 $289 $109 NA* NA* $469 $196 $282 $179 $124 matches your age when coverage will begin$113 NA* $128 $311 $187 row $369 $222 $152 (48) $324 $134 $195 $390 $235 $ $303 $207 $503 $113 NA* NA* $489 $202 $295 $187 $ $114 NA* $322 $130 $195 $382 $232 $154 $204 $336 $136 $404 $245 $ $210 $114 NA* $205 $195 $ Circle that premium you can add it to the top of 61 $520 $316 NA* $506 $ $133 Denny s $157 rate in $139 his age 62 NA* $204 $329 $390 $243 $343 $214 $413 $257 $ $215 $331 $532 NA* NA* $209 $322 $518 $204 $133 the fold-out chart NA* $338 $213 $135 row $401 $253 $161 (53) $223 $353 $141 $424 $268 $ $219 $345 $547 NA* NA* $336 $532 $213 $ $223 $137 $265 $163 $233 $143 $281 $ $222 $361 NA* $216 $352 $223 $ Repeat for all of the plans you re interested 64 NA* in $343 $408 $359 $ $555 NA* $ ** NA* $234 $343 $139 $408 $277 $165 $244 $359 $145 $293 $431 $ ** $225 $378 $555 NA* NA* $368 $219 $541 $234 $ NA* $244 $140 $290 $166 $146 $255 $307 $ $226 $395 NA* $220 $385 $244 $140 Family plan? Use the same county rate table. Then they just: NA* $255 $141 $303 $167 $267 $147 $320 $ $228 $413 NA* $402 $222 $255 $ Find the age rows in the plan column and circle NA* $ $267 $142 $ Add it up $168 $317 $ and $148 $279 $ $335 $ $ 1,102 $229 $432 NA* $ $420 $223 $267 $142 $ NA* $279 $143 $331 $169 $291 $149 $350 $ $231 $451 NA* $225 $439 $279 $143 the rates for: NA* $144 $292 $346 $171 $305 $151 $366 $181 * If you are age $234 $ NA* or older, you $227 $459 can $292 $144 only app * Also available to people who have received certification from an Exchange that they are ** Also exempt available from the to people individual who mandate have receive bec You coverage option NA* or because they $298 $146 qualify Write for a it hardship $354 $174 in at the exemption. top $153 $311 of Visit the your fold-out public $184 $374 Exchange chart coverage to for use more option $482 $237 NA* in details. or because $469 $230 they $298 $146 qualify f ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare NA* $149 $311 Your spouse making $369 $177 their final decision. $324 $156 $390 $ $503 $241 NA* $489 $235 $311 $ NA* $322 $152 $382 $180 $336 $ $404 $ $245 $520 NA* $506 $239 $322 $152 Your 3 oldest kids under 21 (all are covered, NA* $329 $155 $390 $184 $343 $162 $413 $ $532 $251 NA* $245 $518 $329 $155 but only 3 count toward overall rate) NA* $338 $160 $401 $190 $353 $167 $424 $ $547 $259 NA* $532 $252 $338 $160 All kids NA* $343 $165 $408 $196 $359 $173 $208 $ $267 $555 NA* $260 $541 $343 $ ** 46 NA* $343 $172 $408 $204 $359 $179 $431 $ ** 46 $278 $555 NA* $270 $541 $343 $ Add up everyone s rate 47 NA* $179 $212 $187 To easily $225 compare 47 all $289 of NA* the $282 $ NA* $187 $222 $195 plans $235 you are 48 interested $303 NA* in, $295 $187 $ $ $ $ $ $ 3. Transfer that total premium to the 49 top of the NA* $195 $232 $204 transfer $245 your 49premiums $316 NA* $307 $195 $ fold-out chart 50 NA* $204 $243 $214 to the $257 top of 50the enclosed $331 NA* $322 $204 * Also 51 available NA* to people who have $213 received certification $253 from an $223 Exchange that fold-out they $268 are * chart. Also exempt 51 available from $345 NA* to the people individual who $336 mandate have $213 receive bec 4. Repeat for each plan you want to coverage consider option or because they qualify for a hardship exemption. Visit your public Exchange coverage for option more details. or because they qualify fo 52 NA* $223 $265 $233 $ $361 NA* $352 $223 ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. ** If you are age 65 or older, you can only ap 53 NA* $234 $277 $244 $ $378 NA* $368 $ NA* $244 $290 $255 $ $395 NA* $385 $ NA* 15$255 $303 $267 $ $413 NA* $402 $ NA* $267 $317 $279 $ $432 NA* $420 $267

17 Consumer Health Insurance Plans 2014 Baltimore City; Anne Arundel, Baltimore, Harford and Howard Counties Age Bronze Level Plans Silver Level Plans Young Adult $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 BluePreferred HSA Bronze $3,500 Plus Silver $2,500 Silver $2,000 BluePreferred HSA Silver $1,500 HSA Silver $1, $64 $73 $86 $76 $91 $118 $114 $120 $ $101 $114 $136 $120 $144 $185 $180 $188 $ $101 $114 $136 $120 $144 $185 $180 $188 $ $101 $114 $136 $120 $144 $185 $180 $188 $ $101 $114 $136 $120 $144 $185 $180 $188 $ $101 $115 $136 $120 $144 $186 $181 $189 $ $103 $117 $139 $122 $147 $190 $185 $193 $ $105 $120 $142 $125 $151 $194 $189 $197 $ $109 $124 $148 $130 $156 $201 $196 $205 $ $113 $128 $152 $134 $161 $207 $202 $211 $ $114 $130 $154 $136 $163 $210 $205 $214 $ NA* $133 $157 $139 $167 $215 $209 $218 $ NA* $135 $161 $141 $170 $219 $213 $223 $ NA* $137 $163 $143 $172 $222 $216 $226 $ NA* $139 $165 $145 $174 $225 $219 $229 $ NA* $140 $166 $146 $176 $226 $220 $230 $ NA* $141 $167 $147 $177 $228 $222 $232 $ NA* $142 $168 $148 $178 $229 $223 $233 $ NA* $143 $169 $149 $179 $231 $225 $235 $ NA* $144 $171 $151 $181 $234 $227 $238 $ NA* $146 $174 $153 $184 $237 $230 $241 $ NA* $149 $177 $156 $187 $241 $235 $245 $ NA* $152 $180 $158 $190 $245 $239 $250 $ NA* $155 $184 $162 $195 $251 $245 $256 $ NA* $160 $190 $167 $201 $259 $252 $263 $ NA* $165 $196 $173 $208 $267 $260 $272 $ NA* $172 $204 $179 $216 $278 $270 $283 $ NA* $179 $212 $187 $225 $289 $282 $294 $ NA* $187 $222 $195 $235 $303 $295 $308 $ NA* $195 $232 $204 $245 $316 $307 $321 $ NA* $204 $243 $214 $257 $331 $322 $337 $ NA* $213 $253 $223 $268 $345 $336 $351 $ NA* $223 $265 $233 $281 $361 $352 $368 $ NA* $234 $277 $244 $293 $378 $368 $384 $ NA* $244 $290 $255 $307 $395 $385 $402 $ NA* $255 $303 $267 $320 $413 $402 $420 $ NA* $267 $317 $279 $335 $432 $420 $440 $ NA* $279 $331 $291 $350 $451 $439 $459 $ NA* $292 $346 $305 $366 $472 $459 $480 $ NA* $298 $354 $311 $374 $482 $469 $490 $ NA* $311 $369 $324 $390 $503 $489 $511 $ NA* $322 $382 $336 $404 $520 $506 $529 $ NA* $329 $390 $343 $413 $532 $518 $541 $ NA* $338 $401 $353 $424 $547 $532 $556 $ NA* $343 $408 $359 $431 $555 $541 $565 $ ** NA* $343 $408 $359 $431 $555 $541 $565 $536 $ $ $ $ $ $ $ $ $ * Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. 16

18 Consumer Health Insurance Plans 2014 Baltimore City; Anne Arundel, Baltimore, Harford and Howard Counties Age Gold Level Plans Platinum Level Plans HealthyBlue Gold $1,500 Gold $1,000 BluePreferred Gold $500 Gold $0 BluePreferred Platinum $0 HealthyBlue Platinum $ $157 $130 $151 $145 $194 $ $247 $204 $237 $229 $306 $ $247 $204 $237 $229 $306 $ $247 $204 $237 $229 $306 $ $247 $204 $237 $229 $306 $ $248 $205 $238 $230 $307 $ $253 $209 $243 $234 $313 $ $259 $214 $249 $240 $320 $ $268 $222 $258 $249 $332 $ $276 $229 $265 $256 $342 $ $280 $232 $269 $260 $347 $ $286 $237 $275 $265 $354 $ $292 $242 $281 $271 $362 $ $296 $245 $284 $274 $366 $ $299 $248 $288 $278 $371 $ $301 $250 $290 $280 $373 $ $303 $251 $292 $281 $376 $ $305 $253 $294 $283 $378 $ $307 $255 $296 $285 $381 $ $311 $258 $299 $289 $386 $ $315 $261 $303 $292 $391 $ $321 $266 $309 $298 $398 $ $327 $271 $314 $303 $405 $ $335 $277 $322 $311 $415 $ $345 $286 $331 $320 $427 $ $356 $295 $343 $330 $441 $ $370 $307 $356 $343 $458 $ $386 $319 $371 $358 $478 $ $403 $334 $388 $374 $500 $ $421 $349 $405 $390 $521 $ $441 $365 $424 $409 $546 $ $460 $381 $442 $427 $570 $ $481 $399 $463 $447 $597 $ $503 $417 $484 $467 $623 $ $527 $436 $506 $489 $652 $ $550 $456 $529 $510 $682 $ $575 $477 $553 $534 $713 $ $601 $498 $578 $558 $745 $ $629 $521 $604 $583 $779 $ $642 $532 $617 $596 $795 $ $669 $555 $644 $621 $829 $ $693 $574 $666 $643 $859 $ $709 $587 $681 $657 $878 $ $728 $603 $700 $676 $902 $ $740 $613 $712 $686 $917 $ * $740 $613 $712 $686 $917 $866 $ $ $ $ $ $ * If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. A plan just for yourself? For each plan you re interested in. 1. Go down the plan column to the row that matches your age when coverage will begin. 2. Circle that premium you can add it to the top of the folding chart to use later 3. Repeat for all of the plans you re interested in Family plan? Use the same county rate table. 1. Find the age rows in the plan column and circle the rates for: You Your spouse Your 3 oldest kids under 21 (all are covered, but only 3 count toward overall rate) All kids Add up everyone s rate 3. Transfer that total premium to the top of fold-out chart 4. Repeat for each plan you want to consider To easily compare all of the plans you are interested in, transfer your premiums to the top of the enclosed fold-out chart. 17

19 Consumer Health Insurance Plans 2014 Allegany, Carroll, Frederick, Garrett and Washington Counties Age Bronze Level Plans Silver Level Plans Young Adult $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 BluePreferred HSA Bronze $3,500 Plus Silver $2,500 Silver $2,000 BluePreferred HSA Silver $1,500 HSA Silver $1, $59 $67 $79 $70 $84 $108 $105 $110 $ $93 $105 $125 $110 $132 $170 $166 $173 $ $93 $105 $125 $110 $132 $170 $166 $173 $ $93 $105 $125 $110 $132 $170 $166 $173 $ $93 $105 $125 $110 $132 $170 $166 $173 $ $93 $106 $126 $111 $133 $171 $167 $174 $ $95 $108 $128 $113 $135 $175 $170 $178 $ $97 $110 $131 $115 $139 $179 $174 $182 $ $101 $115 $136 $120 $144 $185 $180 $189 $ $104 $118 $140 $123 $148 $191 $186 $194 $ $105 $120 $142 $125 $150 $194 $188 $197 $ NA* $122 $145 $128 $153 $198 $192 $201 $ NA* $125 $148 $130 $157 $202 $196 $205 $ NA* $126 $150 $132 $159 $204 $199 $208 $ NA* $128 $152 $134 $161 $207 $201 $211 $ NA* $129 $153 $135 $162 $208 $203 $212 $ NA* $130 $154 $135 $163 $210 $204 $213 $ NA* $130 $155 $136 $164 $211 $205 $215 $ NA* $131 $156 $137 $165 $212 $207 $216 $ NA* $133 $158 $139 $167 $215 $209 $219 $ NA* $135 $160 $141 $169 $218 $212 $222 $ NA* $137 $163 $143 $172 $222 $216 $226 $ NA* $140 $166 $146 $175 $226 $220 $230 $ NA* $143 $170 $149 $180 $231 $225 $235 $ NA* $147 $175 $154 $185 $238 $232 $242 $ NA* $152 $181 $159 $191 $246 $240 $251 $ NA* $158 $188 $165 $198 $256 $249 $260 $ NA* $165 $196 $172 $207 $266 $259 $271 $ NA* $172 $205 $180 $216 $279 $271 $284 $ NA* $180 $213 $188 $226 $291 $283 $296 $ NA* $188 $223 $197 $236 $305 $296 $310 $ NA* $197 $233 $205 $247 $318 $309 $324 $ NA* $206 $244 $215 $258 $333 $324 $339 $ NA* $215 $255 $225 $270 $348 $339 $354 $ NA* $225 $267 $235 $283 $364 $354 $370 $ NA* $235 $279 $245 $295 $380 $370 $387 $ NA* $246 $292 $257 $309 $398 $387 $405 $ NA* $257 $305 $268 $322 $415 $404 $423 $ NA* $269 $319 $280 $337 $434 $423 $442 $ NA* $274 $326 $287 $344 $444 $432 $452 $ NA* $286 $339 $299 $359 $463 $450 $471 $ NA* $296 $351 $309 $372 $479 $466 $488 $ NA* $303 $359 $316 $380 $490 $477 $498 $ NA* $311 $369 $325 $391 $503 $490 $512 $ NA* $316 $375 $330 $397 $511 $498 $520 $ ** NA* $316 $375 $330 $397 $511 $498 $520 $494 $ $ $ $ $ $ $ $ $ * Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. 18

20 Consumer Health Insurance Plans 2014 Allegany, Carroll, Frederick, Garrett and Washington Counties Age Gold Level Plans Platinum Level Plans HealthyBlue Gold $1,500 Gold $1,000 BluePreferred Gold $500 Gold $0 * If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. BluePreferred Platinum $0 HealthyBlue Platinum $ $144 $120 $139 $134 $179 $ $227 $188 $218 $211 $281 $ $227 $188 $218 $211 $281 $ $227 $188 $218 $211 $281 $ $227 $188 $218 $211 $281 $ $228 $189 $219 $212 $283 $ $233 $193 $224 $216 $288 $ $238 $197 $229 $221 $295 $ $247 $205 $237 $229 $306 $ $254 $211 $244 $236 $315 $ $258 $214 $248 $239 $319 $ $263 $218 $253 $244 $326 $ $269 $223 $258 $249 $333 $ $272 $225 $262 $252 $337 $ $276 $228 $265 $256 $342 $ $278 $230 $267 $257 $344 $ $279 $232 $269 $259 $346 $ $281 $233 $270 $261 $348 $ $283 $235 $272 $263 $351 $ $287 $238 $276 $266 $355 $ $290 $241 $279 $269 $360 $ $296 $245 $284 $274 $366 $ $301 $249 $289 $279 $373 $ $308 $255 $296 $286 $382 $ $317 $263 $305 $294 $393 $ $328 $272 $315 $304 $406 $ $341 $282 $328 $316 $422 $ $355 $294 $341 $329 $440 $ $371 $308 $357 $345 $460 $ $387 $321 $373 $359 $480 $ $406 $336 $390 $376 $503 $ $424 $351 $407 $393 $525 $ $443 $367 $426 $411 $549 $ $463 $384 $446 $430 $574 $ $485 $402 $466 $450 $601 $ $506 $420 $487 $470 $628 $ $530 $439 $510 $492 $657 $ $554 $459 $532 $513 $686 $ $579 $480 $556 $537 $717 $ $591 $490 $568 $548 $732 $ $616 $511 $593 $572 $764 $ $638 $529 $614 $592 $791 $ $653 $541 $627 $605 $808 $ $670 $556 $645 $622 $831 $ $681 $565 $655 $632 $844 $ * $681 $565 $655 $632 $844 $798 $ $ $ $ $ $ A plan just for yourself? For each plan you re interested in. 1. Go down the plan column to the row that matches your age when coverage will begin. 2. Circle that premium you can add it to the top of the folding chart to use later 3. Repeat for all of the plans you re interested in Family plan? Use the same county rate table. 1. Find the age rows in the plan column and circle the rates for: You Your spouse Your 3 oldest kids under 21 (all are covered, but only 3 count toward overall rate) All kids Add up everyone s rate 3. Transfer that total premium to the top of fold-out chart 4. Repeat for each plan you want to consider To easily compare all of the plans you are interested in, transfer your premiums to the top of the enclosed fold-out chart. 19

21 Consumer Health Insurance Plans 2014 Calvert, Caroline, Cecil, Charles, Dorchester, Kent, Queen Anne s, St. Mary s, Somerset, Talbot, Wicomico and Worcester Counties Age Bronze Level Plans Silver Level Plans Young Adult $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 BluePreferred HSA Bronze $3,500 Plus Silver $2,500 Silver $2,000 BluePreferred HSA Silver $1,500 HSA Silver $1, $63 $71 $85 $74 $89 $115 $112 $117 $ $99 $112 $133 $117 $141 $181 $177 $185 $ $99 $112 $133 $117 $141 $181 $177 $185 $ $99 $112 $133 $117 $141 $181 $177 $185 $ $99 $112 $133 $117 $141 $181 $177 $185 $ $99 $113 $134 $118 $141 $182 $177 $185 $ $101 $115 $136 $120 $144 $186 $181 $189 $ $103 $118 $140 $123 $148 $190 $185 $194 $ $107 $122 $145 $127 $153 $197 $192 $201 $ $110 $126 $149 $131 $158 $203 $198 $207 $ $112 $127 $151 $133 $160 $206 $200 $210 $ NA* $130 $154 $136 $163 $210 $205 $214 $ NA* $133 $158 $139 $167 $215 $209 $218 $ NA* $134 $160 $140 $169 $217 $212 $221 $ NA* $136 $162 $142 $171 $220 $214 $224 $ NA* $137 $163 $143 $172 $222 $216 $226 $ NA* $138 $164 $144 $173 $223 $217 $227 $ NA* $139 $165 $145 $174 $225 $219 $229 $ NA* $140 $166 $146 $176 $226 $220 $230 $ NA* $142 $168 $148 $178 $229 $223 $233 $ NA* $143 $170 $150 $180 $232 $226 $236 $ NA* $146 $173 $153 $183 $236 $230 $240 $ NA* $149 $176 $155 $187 $240 $234 $245 $ NA* $152 $181 $159 $191 $246 $240 $251 $ NA* $157 $186 $164 $197 $254 $247 $258 $ NA* $162 $192 $169 $203 $262 $255 $267 $ NA* $168 $200 $176 $211 $272 $265 $277 $ NA* $175 $208 $183 $220 $284 $276 $289 $ NA* $183 $218 $192 $230 $297 $289 $302 $ NA* $191 $227 $200 $240 $310 $301 $315 $ NA* $200 $238 $209 $252 $324 $315 $330 $ NA* $209 $248 $219 $263 $338 $329 $344 $ NA* $219 $260 $229 $275 $354 $345 $361 $ NA* $229 $272 $239 $287 $370 $360 $377 $ NA* $240 $284 $250 $301 $387 $377 $394 $ NA* $250 $297 $261 $314 $405 $394 $412 $ NA* $262 $311 $273 $329 $423 $412 $431 $ NA* $273 $325 $286 $343 $442 $430 $450 $ NA* $286 $339 $299 $359 $462 $450 $471 $ NA* $292 $347 $305 $367 $472 $460 $481 $ NA* $305 $361 $318 $382 $493 $479 $501 $ NA* $315 $374 $329 $396 $510 $496 $519 $ NA* $322 $383 $337 $405 $521 $508 $531 $ NA* $331 $393 $346 $416 $536 $521 $545 $ NA* $337 $399 $352 $423 $544 $530 $554 $ ** NA* $337 $399 $352 $423 $544 $530 $554 $525 $ $ $ $ $ $ $ $ $ * Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. 20

22 Consumer Health Insurance Plans 2014 Calvert, Caroline, Cecil, Charles, Dorchester, Kent, Queen Anne s, St. Mary s, Somerset, Talbot, Wicomico and Worcester Counties Age Gold Level Plans Platinum Level Plans HealthyBlue Gold $1,500 Gold $1,000 BluePreferred Gold $500 Gold $0 BluePreferred Platinum $0 HealthyBlue Platinum $ $154 $127 $148 $142 $190 $ $242 $200 $232 $224 $300 $ $242 $200 $232 $224 $300 $ $242 $200 $232 $224 $300 $ $242 $200 $232 $224 $300 $ $243 $201 $233 $225 $301 $ $248 $205 $238 $230 $307 $ $253 $210 $244 $235 $314 $ $263 $218 $253 $244 $326 $ $271 $224 $260 $251 $335 $ $274 $227 $264 $255 $340 $ $280 $232 $269 $260 $347 $ $286 $237 $275 $265 $354 $ $290 $240 $279 $269 $359 $ $294 $243 $282 $272 $364 $ $295 $245 $284 $274 $366 $ $297 $246 $286 $276 $368 $ $299 $248 $288 $278 $371 $ $301 $250 $290 $279 $373 $ $305 $253 $293 $283 $378 $ $309 $256 $297 $287 $383 $ $315 $261 $303 $292 $390 $ $320 $265 $308 $297 $397 $ $328 $272 $315 $304 $406 $ $338 $280 $325 $313 $418 $ $349 $289 $336 $324 $433 $ $363 $301 $349 $336 $449 $ $378 $313 $363 $351 $468 $ $395 $328 $380 $367 $490 $ $412 $342 $397 $383 $511 $ $432 $358 $415 $401 $535 $ $451 $374 $434 $418 $559 $ $472 $391 $454 $438 $585 $ $493 $409 $474 $458 $611 $ $516 $428 $496 $479 $640 $ $539 $447 $518 $500 $668 $ $564 $467 $542 $523 $699 $ $589 $488 $567 $547 $730 $ $616 $511 $592 $572 $763 $ $629 $522 $605 $584 $780 $ $656 $544 $631 $609 $813 $ $679 $563 $653 $630 $842 $ $695 $576 $668 $644 $861 $ $714 $591 $686 $662 $884 $ $725 $601 $697 $673 $899 $ * $725 $601 $697 $673 $899 $849 $ $ $ $ $ $ * If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. A plan just for yourself? For each plan you re interested in. 1. Go down the plan column to the row that matches your age when coverage will begin. 2. Circle that premium you can add it to the top of the folding chart to use later 3. Repeat for all of the plans you re interested in Family plan? Use the same county rate table. 1. Find the age rows in the plan column and circle the rates for: You Your spouse Your 3 oldest kids under 21 (all are covered, but only 3 count toward overall rate) All kids Add up everyone s rate 3. Transfer that total premium to the top of fold-out chart 4. Repeat for each plan you want to consider To easily compare all of the plans you are interested in, transfer your premiums to the top of the enclosed fold-out chart. 21

23 Consumer Health Insurance Plans 2014 Montgomery and Prince George s Counties Age Bronze Level Plans Silver Level Plans Young Adult $6,350 HSA Bronze $6,000 Plus Bronze $5,500 HSA Bronze $4,000 BluePreferred HSA Bronze $3,500 Plus Silver $2,500 Silver $2,000 BluePreferred HSA Silver $1,500 HSA Silver $1, $59 $68 $80 $71 $85 $109 $107 $111 $ $94 $107 $126 $111 $134 $172 $168 $175 $ $94 $107 $126 $111 $134 $172 $168 $175 $ $94 $107 $126 $111 $134 $172 $168 $175 $ $94 $107 $126 $111 $134 $172 $168 $175 $ $94 $107 $127 $112 $134 $173 $168 $176 $ $96 $109 $129 $114 $137 $176 $172 $180 $ $98 $112 $133 $117 $140 $181 $176 $184 $ $102 $116 $137 $121 $145 $187 $182 $191 $ $105 $119 $141 $125 $150 $193 $188 $196 $ $106 $121 $144 $126 $152 $196 $190 $199 $ NA* $123 $147 $129 $155 $200 $194 $203 $ NA* $126 $150 $132 $158 $204 $198 $207 $ NA* $128 $151 $133 $160 $206 $201 $210 $ NA* $129 $153 $135 $162 $209 $204 $213 $ NA* $130 $155 $136 $163 $211 $205 $214 $ NA* $131 $156 $137 $165 $212 $206 $216 $ NA* $132 $157 $138 $166 $213 $208 $217 $ NA* $133 $158 $139 $167 $215 $209 $218 $ NA* $134 $160 $140 $169 $217 $212 $221 $ NA* $136 $162 $142 $171 $220 $214 $224 $ NA* $139 $165 $145 $174 $224 $218 $228 $ NA* $141 $168 $147 $177 $228 $222 $232 $ NA* $145 $172 $151 $181 $234 $228 $238 $ NA* $149 $177 $155 $187 $241 $234 $245 $ NA* $154 $183 $161 $193 $249 $242 $253 $ NA* $160 $190 $167 $201 $258 $252 $263 $ NA* $167 $198 $174 $209 $269 $262 $274 $ NA* $174 $207 $182 $219 $282 $274 $287 $ NA* $182 $216 $190 $228 $294 $286 $299 $ NA* $190 $226 $199 $239 $308 $300 $313 $ NA* $199 $236 $208 $249 $321 $313 $327 $ NA* $208 $247 $217 $261 $336 $327 $342 $ NA* $217 $258 $227 $273 $352 $342 $358 $ NA* $227 $270 $238 $286 $368 $358 $374 $ NA* $238 $282 $248 $298 $384 $374 $391 $ NA* $249 $295 $260 $312 $402 $391 $409 $ NA* $260 $308 $271 $326 $420 $409 $427 $ NA* $271 $322 $284 $341 $439 $427 $447 $ NA* $277 $329 $290 $348 $449 $437 $456 $ NA* $289 $343 $302 $363 $468 $455 $476 $ NA* $299 $355 $313 $376 $484 $471 $493 $ NA* $306 $363 $320 $384 $495 $482 $504 $ NA* $315 $373 $328 $395 $509 $495 $518 $ NA* $320 $379 $334 $401 $517 $503 $526 $ ** NA* $320 $379 $334 $401 $517 $503 $526 $499 $ $ $ $ $ $ $ $ $ * Also available to people who have received certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. Visit your public Exchange for more details. ** If you are age 65 or older, you can only apply if you are NOT eligible for Medicare. 22