Gold plans
Recommended if you:
- Will use your coverage often
- Have an ongoing medical condition that needs treatment
- Want additional security and peace of mind
- Are okay with higher monthly premiums
- Prefer lower out-of-pocket costs
Below is a summary of the three Ambetter Premier Gold Options. See toggles below for each plan detail or download the available plan summaries.
- Central Gold – $1,000 individual deductible
- Everyday Gold – $750 individual deductible
- Standard Gold – $1,500 individual deductible
See toggles below for plan comparisons. Information is based on Participating Providers. For Non-Participating Provider information, please download the plan summaries listed above.
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Deductibles
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Overall Deductible Individual/Family
|
$1,000 / $2,000 | $750 / $1,500 | $1,500 / $3,000 |
|
Are there services covered before you meet deductible
|
Yes. | Yes. | Yes. |
|
Are there other deductibles for specific services
|
No. | No. | No. |
|
Out-of-pocket limit Individual/Family**
|
$5,500 / $11,000 | $7,000 / $14,000 | $7,800 / $15,600 |
|
Will you pay less if you use network provider?
|
Yes. | Yes. | Yes. |
|
Referral to see a specialist?
|
No. | No. | No. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Primary Care for injury/illness
|
$25 | $35 | $30 |
|
Specialist visit
|
$60 | $55 | $60 |
|
Preventative care/screening
|
No Charge | No Charge | No Charge |
|
Diagnostic test (xray, blood) Freestanding / Hospital
|
40% | $35 / 35% | 25% |
|
Imaging (CT/PET/MRI) Freestanding / Hospital
|
40% | 35% | 25% |
Generic / Brand / Specialty Drug Comparison
If you need Drugs to treat your illness or condition. For information on whether or not deductibles apply, please download the plan summaries
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Generic Drugs (Preferred)
|
$3 | $3 | $15 |
|
Generic Drugs (Non Preferred)
|
$20 | $15 | $15 |
|
Brand drugs (Preferred)
|
$40 | $60 | $30 |
|
Brand Drugs Non Preferred
|
$250 | 45% | $60 |
|
Specialty Drugs
|
$500 | 50% | $250 |
Outpatient Surgery / Emergency Comparison
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Facility Fee
|
40% | 35% | 25% |
|
Facility fee Hospital
|
40% | 35% | 25% |
|
Physician/surgeon Fee
|
40% | 35% | 25% |
|
Emergency Room Care
|
40% | 35% | 25% |
|
Emergency Medical Transportation
|
40% | 35% | 25% |
|
Urgent Care
|
$50 | $35 | $45 |
Hospital Stay / Health Services / Pregnancy
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Facility Fee for hospital stay
|
40% | 35% | 25% |
|
Physician/surgeon Fees
|
40% | 35% | 25% |
|
Mental health, behavioral health, or substance abuse services: Outpatient
|
$25 | $35 | $40 |
|
Mental health, behavioral health, or substance abuse services: Inpatient
|
40% | 35% | 25% |
|
If you are pregnant ? office visit
|
$25 | $35 | $30 |
|
Childbirth/delivery/professional services
|
40% | 35% | 25% |
|
Childbirth/delivery facility services
|
40% | 35% | 25% |
Help recovering / other special needs
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Home Health Care
|
40% | 35% | 25% |
|
Rehabilitation Services
|
$35 | 35% | $30 |
|
Habilitation services
|
$35 | 35% | $30 |
|
Skilled nursing care
|
40% | 35% | 25% |
|
Durable medical equipment
|
40% | 35% | 25% |
|
Hospice services
|
40% | 35% | 25% |
Childrens Dental / Eye care
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Children?s eye exam
|
No Charge | No Charge | No Charge |
|
Children?s Glasses
|
No Charge | No Charge | No Charge |
|
Children?s Dental check-up
|
Not Covered | Not Covered | Not Covered |
Excluded & Other Covered Services
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Acupuncture
|
? | ? | ? |
|
Dental Care (Adult)
|
? | ? | ? |
|
Long-term Care
|
? | ? | ? |
|
Non-emergency care when traveling outside of US
|
? | ? | ? |
|
Routine eye care (adult)
|
? | ? | ? |
|
Weight loss programs
|
? | ? | ? |
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
| Central Gold | Everyday Gold | Standard Gold | |
|---|---|---|---|
|
Abortion care
|
? | ? | ? |
|
Bariatric surgery
|
? | ? | ? |
|
Chiropractic care
|
? | ? | ? |
|
Cosmetic surgery
|
? | ? | ? |
|
Hearing aids
|
? | ? | ? |
|
Infertility treatment
|
? | ? | ? |
|
Private-duty nursing
|
? | ? | ? |
|
Routine Foot Care
|
? | ? | ? |
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