Ambetter Premier Silver

Ambetter Premier Silver plans provide a balanced approach to healthcare costs, featuring moderate monthly premiums and out-of-pocket expenses, making them suitable for individuals seeking comprehensive coverage.

Ambetter Premier Silver
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Silver plans

Recommended if you:

  • See your primary care physician for preventive care every year
  • Don’t anticipate any major ongoing medical needs
  • Would like a premium that fits most budgets
  • Would like out-of-pocket expenses that fit most budgets

Below is a summary of the three Ambetter Premier Silver Options. See toggles below for each plan detail or download the available plan summaries.

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

Clear Silver Focused Silver Standard Silver
Overall Deductible Individual/Family
 $5,000 / $10,000 $8,450 / $16,900 $7,500 / $15,000
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**
 $8,500 / $17,000 $9,200 / $18,400 $9,200 / $18,400
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

Clear Silver Focused Silver Standard Silver
Primary Care for injury/illness
 $5,000 / $10,000 $8,450 / $16,900 $7,500 / $15,000
Specialist visit
 Yes. Yes. Yes.
Preventative care/screening
 No. No. No.
Diagnostic test (xray, blood) Freestanding / Hospital
 $8,500 / $17,000 $9,200 / $18,400 $9,200 / $18,400
Imaging (CT/PET/MRI) Freestanding / Hospital
 50% 50% coinsurance 50%

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

Clear Silver Focused Silver Standard Silver
Generic Drugs (Preferred)
 $5,000 / $10,000 $8,450 / $16,900 $7,500 / $15,000
Generic Drugs (Non Preferred)
 Yes. Yes. Yes.
Brand drugs (Preferred)
 No. No. No.
Brand Drugs Non Preferred
 $8,500 / $17,000 $9,200 / $18,400 $9,200 / $18,400
Specialty Drugs 
 $750 50% $500

Outpatient Surgery / Emergency Comparison

Clear Silver Focused Silver Standard Silver
Facility Fee
 $5,000 / $10,000 $8,450 / $16,900 $7,500 / $15,000
Facility fee Hospital
 Yes. Yes. Yes.
Physician/surgeon Fee
 No. No. No.
Emergency Room Care
 $8,500 / $17,000 $9,200 / $18,400 $9,200 / $18,400
Emergency Medical Transportation
 50% 50% 50%
Urgent Care
 50% $50 $75

Hospital Stay / Health Services / Pregnancy

Clear Silver Focused Silver Standard Silver
Facility Fee for hospital stay
 $5,000 / $10,000 $8,450 / $16,900 $7,500 / $15,000
Physician/surgeon Fees
 Yes. Yes. Yes.
Mental health, behavioral health, or substance abuse services: Outpatient
 No. No. No.
Mental health, behavioral health, or substance abuse services: Inpatient
 $8,500 / $17,000 $9,200 / $18,400 $9,200 / $18,400
If you are pregnant ? office visit
 50% coinsurance $40/visit $50 / visit
Childbirth/delivery/professional services
 50% coinsurance 50% coinsurance 50% coinsurance
Childbirth/delivery facility services
 50% coinsurance 50% coinsurance 50% coinsurance

Help recovering / other special needs

Central Bronze Everyday Bronze Standard Expanded Bronze
Home Health Care
 50% 50% 50%
Rehabilitation Services
 50% / 50% 50% / 50% $50 / 50%
Habilitation services
 50% / 50% 50% / 50% $50 / 50%
Skilled nursing care
 50% 50% 50%
Durable medical equipment
 50% 50% 50%
Hospice services
 50% 50% 50%

Childrens Dental / Eye care

Central Bronze Everyday Bronze Standard Expanded Bronze
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 Bronze Everyday Bronze Standard Expanded Bronze
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 Bronze Everyday Bronze Standard Expanded Bronze
Abortion care
  ?  ?  ?
Bariatric surgery
  ?  ?  ?
Chiropractic care
  ?  ?  ?
Cosmetic surgery
  ?  ?  ?
Hearing aids
  ?  ?  ?
Infertility treatment
  ?  ?  ?
Private-duty nursing
  ?  ?  ?
Routine Foot Care
  ?  ?  ?

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