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2023 Gold Plans

2023 Gold Plans

Gold 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.

Gold cheat sheet:

  • Gold plans have the highest premiums.
  • Gold plans have lower out-of-pocket costs.
  • On average, the insurance company pays 80%. You pay 20%.
  • “Get this plan if your doctor knows you better than your spouse.”

Questions?

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

Call Us:
Local: 713.295.6704
Toll-Free: 1.855.315.5386

Ready to Enroll

All Community plans come with:

Preventative Services

One of the largest Provider
and facilities network in
Southwest Texas

Low copay on many
generic drugs

Most primary care visits, specialist visits, urgent care, and generic drugs are not subject to deductible

Free 24/7 telehealth

No referrals needed
for specialists

Preventative Services

Free 24/7 telehealth

One of the largest Provider and facilities network in
Southwest Texas

Low copay on many
generic drugs

No referrals needed
for specialists

Most primary care visits, specialist visits, urgent care, and generic drugs are not subject to deductible

Which Gold plan is right for you?

PREMIER GOLD PLAN 001

MODERATE MONTHLY PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Premier Gold 001 Plan:
  • Telehealth services available
  • Referrals not required to see specialists
  • Preventive care available at no cost
  • This plan does not have a medical or pharmacy deductible
Things to Keep in Mind:
  • Out-of-network services are not covered under this plan
  • Prior Authorization/Step Therapy requirements apply to some medical and pharmacy benefits

The Advanced Premium Tax Credit can lower your monthly payment. If you’re eligible, you can apply it to any Bronze plan.

View Quick Reference Guide
Learn More

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

LOWEST PREMIUMS
HIGHER OUT-OF-POCKET COST FOR SERVICES

View 2023 Premier Gold Plan 001 Details
  • Medical Deductible (Individual)
    N/A
  • Maximum Out-of-Pocket (Individual)
    $9,100
  • Primary Care Physician Office Visit
    $30
  • Specialist Office Visit
    $65
  • Urgent Care Visit
    $65
  • Emergency Room Visit
    $800
  • Inpatient Hospital Stay
    $800**
  • Prescription Drug Deductible
    N/A
  • Generic
    $20
  • Preferred Brand
    $40
  • Non-Preferred Brand
    $80
  • Specialty High-Cost Drugs
    30%

**Copay applies for first 5 days of admission for all inpatient services

PREMIER GOLD PLAN 005

MODERATE MONTHLY PREMIUMS
LOW COST-SHARING

Plan Overview

Important Features of 2023 Premier Gold 005 Plan:
  • PCP, specialist, urgent care, and generic drugs are not subject to deductible
  • Telehealth services available
  • Referrals not required to see specialists
  • Preventive care available at no cost
Things to Keep in Mind:
  • Out-of-network services are not covered under this plan
  • Prior Authorization/Step Therapy requirements apply to some medical and pharmacy benefits

The Advanced Premium Tax Credit can lower your monthly payment. If you’re eligible, you can apply it to the Gold 005 Plan.

View Quick Reference Guide
Learn More

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost-Sharing

Download PDF

Limited Cost-Sharing

Download PDF

View 2023 Premier Gold 005 Plan Details
  • Medical Deductible (Individual)
     $1,600
  • Maximum Out-of-Pocket (Individual)
    $9,100
  • Primary Care Physician Office Visit
    $20*
  • Specialist Office Visit
    $40*
  • Urgent Care Visit
    $40*
  • Emergency Room Visit
    25%
  • Inpatient Hospital Stay
    25%
  • Prescription Drug Deductible
    Combined with Medical Deductible
  • Generic
    $10*
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty High-Cost Drugs
    35%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

PREMIER GOLD PLAN 021

MODERATE MONTHLY PREMIUMS
LOW COST-SHARING

Plan Overview

Important Features of 2023 Premier Gold 021 Plan:
  • PCP, specialist, urgent care, and generic drugs are not subject to deductible
  • Telehealth services available
  • Referrals not required to see specialists
  • Preventive care available at no cost
Things to Keep in Mind:
  • Out-of-network services are not covered under this plan
  • Prior Authorization/Step Therapy requirements apply to some medical and pharmacy benefits

The Advanced Premium Tax Credit can lower your monthly payment.

View Quick Reference Guide
Learn More

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost-Sharing

Download PDF

Limited Cost-Sharing

Download PDF

View Premier Gold 021 Details
  • Medical Deductible (Individual)
    $2,000
  • Maximum Out-of-Pocket (Individual)
    $8,700
  • Primary Care Physician Office Visit
    $30*
  • Specialist Office Visit
    $60*
  • Urgent Care Visit
    $45*
  • Emergency Room Visit
    25%
  • Inpatient Hospital Stay
    25%
  • Prescription Drug Deductible
    Combined with Medical Deductible
  • Generic
    $15*
  • Preferred Brand
    $30*
  • Non-Preferred Brand
    $60*
  • Specialty High-Cost Drugs
    $250*

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

Download your Evidence of Coverage:

Evidence of Coverage for Enhanced Gold OO5

Evidence of Coverage for Elite Gold OO1

Evidence of Coverage for Elite Gold O14

View Plan Documents

Community Enhanced Gold 005

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

View 2022 Gold 005 Plan Details
  • Annual Deductible
    $2,000
  • Maximum out-of-pocket
    $8,700
  • Emergency Room Visits
    25%
  • Inpatient Hospital Stay
    25%
  • PCP
    $20
  • Specialist
    $40
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $20
  • Imaging (CT/MRI/PET)
    25%
  • Speech Therapy
    $40
  • Occupational and Physical Therapy
    $40
  • Laboratory Outpatient and Professional Services
    $20
  • X-rays and Diagnostic Imaging
    $20
  • Skilled Nursing Facility
    25%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    25%
  • Outpatient Surgery Physician/Surgical Services
    25%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty Drugs
    35%

Community Elite Gold 001

Plan Overview

  • The Community Elite Gold 001 plan is only offered Off-Exchange.
View Plan Details

Community Elite HSA Gold 14

Plan Overview

  • The Community Elite HSA Gold 14 plan is only offered Off-Exchange.
View Plan Details

Which Gold plan is right for you?

Enhanced Gold 005

Community Enhanced Gold 005

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

View 2022 Gold 005 Plan Details
  • Annual Deductible
    $2,000
  • Maximum out-of-pocket
    $8,700
  • Emergency Room Visits
    25%
  • Inpatient Hospital Stay
    25%
  • PCP
    $20
  • Specialist
    $40
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $20
  • Imaging (CT/MRI/PET)
    25%
  • Speech Therapy
    $40
  • Occupational and Physical Therapy
    $40
  • Laboratory Outpatient and Professional Services
    $20
  • X-rays and Diagnostic Imaging
    $20
  • Skilled Nursing Facility
    25%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    25%
  • Outpatient Surgery Physician/Surgical Services
    25%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty Drugs
    35%
Elite Gold 001

Community Elite Gold 001

Plan Overview

  • The Community Elite Gold 001 plan is only offered Off-Exchange.
View Plan Details
Elite HSA Gold 14

Community Elite HSA Gold 14

Plan Overview

  • The Community Elite HSA Gold 14 plan is only offered Off-Exchange.
View Plan Details

Download your Evidence of Coverage for Gold OO5 
View Plan Documents

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.

Find a Doctor
Service Area Map

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.

“Community Health Choice is always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.”

– Cecily
Member of Community Health Choice
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Medicaid
Health Plan
04/01/2027

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Marketplace
Health Plan
03/01/2027

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