2021 Silver Plans

2021 Silver Plans

Silver Plans Overview

Once you understand the differences, it’s easier to find the best plan that fits you and your family. We want you to get all the coverage you need without paying for benefits you don’t.

Silver cheat sheet:

  • Silver plans have mid-range premiums.
  • Silver plans have mid-range out-of-pocket costs.
  • On average, the insurance company pays 70%. You pay 30%.
  • “The comprehensive plan balanced with affordability.”

All Community plans come with:

 

Free preventative care

 

24/7/365 Nurse Advice Line

 

Huge doctor & hospital network

 

No referrals for specialists

Questions?

Our hours of operation are 8 a.m. – 5 p.m.

Call Us:
Local: 713.295.6704 Toll-Free 1.855.315.5386

Which Silver plan is right for you?

  • Standard Preferred Silver 009
  • Advance Preferred Silver 004
  • Standard Silver 12
  • Advance Silver 13

Standard Preferred Silver 009

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for families who expect a few doctor appointments throughout the year but no major medical expenses, and who don’t mind paying a little more in premiums for a lower deductible.
  • HIOS ID: 27248TX0010009

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for families who expect a few doctor appointments throughout the year but no major medical expenses, and who don’t mind paying a little more in premiums for a lower deductible.
  • HIOS ID: 27248TX0010009

  • Annual Deductible
    $5,000
  • Maximum out-of-pocket
    $7,000
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $15
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    45%

  • Annual Deductible
    $3,000
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $60
  • Non-Preferred Brand
    $110
  • Specialty Drugs
    45%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $85
  • Specialty Drugs
    30%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,500
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $10
  • Occupational and Physical Therapy
    $10
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Advance Preferred Silver 004

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or generic medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for people who expect multiple visits to doctors/specialists throughout the year and are willing to pay a little more in premiums for lower out of pocket costs.
  • HIOS ID: 27248TX0010004

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or generic medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for people who expect multiple visits to doctors/specialists throughout the year and are willing to pay a little more in premiums for lower out of pocket costs.
  • HIOS ID: 27248TX0010004

  • Annual Deductible
    $3,000
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $110
  • Specialty Drugs
    50%

  • Annual Deductible
    $2,900
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $60
  • Non-Preferred Brand
    $100
  • Specialty Drugs
    40%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $85
  • Specialty Drugs
    30%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,500
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $10
  • Occupational and Physical Therapy
    $10
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Standard Silver 012

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for a lower deductible.
  • HIOS ID: 27248TX00100012

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for a lower deductible.
  • HIOS ID: 27248TX00100012

  • Annual Deductible
    $2,500
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    50%
  • Inpatient Hospital Stay
    50%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    50%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    50%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    50%
  • Outpatient Surgery Physician/Surgical Services
    50%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $80
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    50%

  • Annual Deductible
    $6,000
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    50%
  • Inpatient Hospital Stay
    50%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    50%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    50%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    50%
  • Outpatient Surgery Physician/Surgical Services
    50%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $80
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    50%

  • Annual Deductible
    $500
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $100
  • Specialty Drugs
    40%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,700
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $20
  • Occupational and Physical Therapy
    $20
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Advance Silver 013

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for lower out of pocket costs.
  • HIOS ID: 27248TX00100013

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for lower out of pocket costs.
  • HIOS ID: 27248TX00100013

  • Annual Deductible
    $8,550
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $6,800
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $10
  • Specialist
    $15
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $2,300
  • Maximum out-of-pocket
    $2,300
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $10
  • Specialist
    $15
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $750
  • Maximum out-of-pocket
    $750
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $5
  • Specialist
    $10
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $5
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

Which Silver plan is right for you?

Standard Preferred Silver 009

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for families who expect a few doctor appointments throughout the year but no major medical expenses, and who don’t mind paying a little more in premiums for a lower deductible.
  • HIOS ID: 27248TX0010009

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for families who expect a few doctor appointments throughout the year but no major medical expenses, and who don’t mind paying a little more in premiums for a lower deductible.
  • HIOS ID: 27248TX0010009

  • Annual Deductible
    $5,000
  • Maximum out-of-pocket
    $7,000
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $15
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    45%

  • Annual Deductible
    $3,000
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $60
  • Non-Preferred Brand
    $110
  • Specialty Drugs
    45%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    30%
  • Inpatient Hospital Stay
    30%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    30%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    30%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $85
  • Specialty Drugs
    30%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,500
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $10
  • Occupational and Physical Therapy
    $10
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Advance Preferred Silver 004

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or generic medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for people who expect multiple visits to doctors/specialists throughout the year and are willing to pay a little more in premiums for lower out of pocket costs.
  • HIOS ID: 27248TX0010004

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or generic medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for people who expect multiple visits to doctors/specialists throughout the year and are willing to pay a little more in premiums for lower out of pocket costs.
  • HIOS ID: 27248TX0010004

  • Annual Deductible
    $3,000
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $110
  • Specialty Drugs
    50%

  • Annual Deductible
    $2,900
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $60
  • Non-Preferred Brand
    $100
  • Specialty Drugs
    40%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    40%
  • Outpatient Surgery Physician/Surgical Services
    40%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $85
  • Specialty Drugs
    30%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,500
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $10
  • Occupational and Physical Therapy
    $10
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Standard Silver 012

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for a lower deductible.
  • HIOS ID: 27248TX00100012

Plan Overview

  • No deductible for PCP visits, Urgent Care visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for a lower deductible.
  • HIOS ID: 27248TX00100012

  • Annual Deductible
    $2,500
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    50%
  • Inpatient Hospital Stay
    50%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    50%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    50%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    50%
  • Outpatient Surgery Physician/Surgical Services
    50%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $80
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    50%

  • Annual Deductible
    $6,000
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    50%
  • Inpatient Hospital Stay
    50%
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    50%
  • Speech Therapy
    $60
  • Occupational and Physical Therapy
    $60
  • Laboratory Outpatient and Professional Services
    $30
  • X-rays and Diagnostic Imaging
    $30
  • Skilled Nursing Facility
    50%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    50%
  • Outpatient Surgery Physician/Surgical Services
    50%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $80
  • Non-Preferred Brand
    $120
  • Specialty Drugs
    50%

  • Annual Deductible
    $500
  • Maximum out-of-pocket
    $2,850
  • Emergency Room Visits
    40%
  • Inpatient Hospital Stay
    40%
  • PCP
    $25
  • Specialist
    $50
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $25
  • Imaging (CT/MRI/PET)
    40%
  • Speech Therapy
    $50
  • Occupational and Physical Therapy
    $50
  • Laboratory Outpatient and Professional Services
    $25
  • X-rays and Diagnostic Imaging
    $25
  • Skilled Nursing Facility
    40%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    30%
  • Outpatient Surgery Physician/Surgical Services
    30%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $70
  • Non-Preferred Brand
    $100
  • Specialty Drugs
    40%

  • Annual Deductible
    $0
  • Maximum out-of-pocket
    $2,700
  • Emergency Room Visits
    10%
  • Inpatient Hospital Stay
    10%
  • PCP
    $10
  • Specialist
    $20
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    10%
  • Speech Therapy
    $20
  • Occupational and Physical Therapy
    $20
  • Laboratory Outpatient and Professional Services
    $10
  • X-rays and Diagnostic Imaging
    $10
  • Skilled Nursing Facility
    10%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    10%
  • Outpatient Surgery Physician/Surgical Services
    10%
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    $20
  • Non-Preferred Brand
    $40
  • Specialty Drugs
    20%

Community Advance Silver 013

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for lower out of pocket costs.
  • HIOS ID: 27248TX00100013

Plan Overview

  • No deductible for PCP visits, urgent care visits, specialist visits, or Generic Medications
  • Free 24/7 Telehealth
  • Eligible for cost-sharing reductions
  • This plan is best suited for individuals and families whose income qualifies them for extra savings known as cost-sharing reductions, and who are willing to pay a higher premium for lower out of pocket costs.
  • HIOS ID: 27248TX00100013

  • Annual Deductible
    $8,550
  • Maximum out-of-pocket
    $8,550
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $30
  • Specialist
    $60
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $30
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $6,800
  • Maximum out-of-pocket
    $6,800
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $10
  • Specialist
    $15
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $2,300
  • Maximum out-of-pocket
    $2,300
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $10
  • Specialist
    $15
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $10
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

  • Annual Deductible
    $750
  • Maximum out-of-pocket
    $750
  • Emergency Room Visits
    No charge after deductible
  • Inpatient Hospital Stay
    No charge after deductible
  • PCP
    $5
  • Specialist
    $10
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $5
  • Imaging (CT/MRI/PET)
    No charge after deductible
  • Speech Therapy
    No charge after deductible
  • Occupational and Physical Therapy
    No charge after deductible
  • Laboratory Outpatient and Professional Services
    No charge after deductible
  • X-rays and Diagnostic Imaging
    No charge after deductible
  • Skilled Nursing Facility
    No charge after deductible
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    No charge after deductible
  • Outpatient Surgery Physician/Surgical Services
    No charge after deductible
  • Prescription Drugs: Generics
    $5
  • Preferred Brand
    No charge after deductible
  • Non-Preferred Brand
    No charge after deductible
  • Specialty Drugs
    No charge after deductible

Local and Neighborly

What does it mean when we say we are local? It means that our service area is 20 counties in the Greater Houston and Beaumont areas. It means that our Providers and facilities are near to you. That’s why we partner with about 7,500 Providers across 20 counties in Southeast Texas, including doctors and clinics at integrated-care organizations. The doctors and facilities and specialists that you see in your times of need are nearby and neighborly.

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”

– Chandolyn
Member of Community Health Choice