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.

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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
 $7,000/ $14,000 $6,300/ $12,600 $6,000/ $12,000
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**
 $7,000/ $14,000 $8,400 / $16,800 $8,900/ $17,800
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
 $50 $40 $40
Specialist visit
 $100 $85 $80
Preventative care/screening
 No charge No charge No charge
Diagnostic test (xray, blood) 
 $25 $50 or 50% 40%
Imaging (CT/PET/MRI) Freestanding / Hospital
 No Charge 50%  40%

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 

Tier 1a ? Preferred

Generic Retail: No
charge
Tier 1b ? Generic Retail: No charge

 Tier 1a ? Preferred
Generic Retail: $3
Copay / prescription;
deductible does not
apply
Tier 1b ? Generic Retail: $15 Copay /
prescription; deductible does not apply		 Tier 1a ? Preferred
Generic Retail: $20
Copay / prescription;
deductible does not
apply
Tier 1b ? Generic Retail: $20 Copay /
prescription; deductible
does not apply
Preferred Brand drugs
 Tier 2 ? Retail: No
charge		 Tier 2 ? Retail: $75
Copay / prescription;
deductible does not
apply		 Tier 2 ? Retail: $40
Copay / prescription;
deductible does not
apply
Non-preferred brand & generic drugs
 Tier 3 ? Retail: No
charge		 Tier 3 ? Retail: $250
Copay / prescription;
deductible does not
apply		 Tier 3 ? Retail: $80
Copay / prescription
Specialty Drugs
 Tier 4 ? Retail: No
charge		 Tier 4 ? Retail: $650
Copay / prescription;
deductible does not
apply		 Tier 4 ? Retail: $350
Copay / prescription

Outpatient Surgery / Emergency Comparison

Clear Silver Focused Silver Standard Silver
Facility Fee
 No charge 50% Coinsurance 40% Coinsurance
Facility fee Hospital
 No charge 50% Coinsurance 40% Coinsurance
Physician/surgeon Fee
 No charge 50% Coinsurance 40% Coinsurance
Emergency Room Care
 No charge 50% Coinsurance 40% Coinsurance
Emergency Medical Transportation
 No charge 50% Coinsurance 40% Coinsurance
Urgent Care
 $75 Copay $60 Copay $60 Copay

Hospital Stay / Health Services / Pregnancy

Clear Silver Focused Silver Standard Silver
Facility Fee for hospital stay
 No Charge 50% coinsurance 40% coinsurance
Physician/surgeon Fees
 No Charge 50% coinsurance 40% coinsurance
Mental health, behavioral health, or substance abuse services: Outpatient
 $50  $40 $40
Mental health, behavioral health, or substance abuse services: Inpatient
 No Charge 50% coinsurance 40% Coinsurance
If you are pregnant ? office visit
 $50 $40/visit $50 / visit
Childbirth/delivery/professional services
 No Charge 50% coinsurance 50% coinsurance
Childbirth/delivery facility services
 No Charge 50% coinsurance 50% coinsurance

Help recovering / other special needs

Clear Silver Focused Silver Standard Silver
Home Health Care
 No Charge 50% 40%
Rehabilitation Services
 No Charge 50% $40 / 40% (out vs in)
Habilitation services
 No Charge 50% / 50% $40 / 40% (out vs in)
Skilled nursing care
 No Charge 50% 40%
Durable medical equipment
 No Charge 50% 40%
Hospice services
 No Charge 50% 40%

Childrens Dental / Eye care

Clear Silver Focused Silver Standard Silver
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.)

Clear Silver Focused Silver Standard Silver
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.)

Clear Silver Focused Silver Standard Silver
Abortion care
  ?  ?  ?
Bariatric surgery
  ?  ?  ?
Chiropractic care
  ?  ?  ?
Cosmetic surgery
  ?  ?  ?
Hearing aids
  ?  ?  ?
Infertility treatment
  ?  ?  ?
Private-duty nursing
  ?  ?  ?
Routine Foot Care
  ?  ?  ?

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