Anthem Ohio
Plan Overviews
Starting in 2018, Anthem will reduce their ACA plans on the exchange
Beginning on January 1, 2018, they will no longer off individual health insurance in Ohio. This doesn’t impact Anthem’s employer-based, Medicare Advantage, Dental, Vision or Medicaid plans, nor does it impact individuals or families whose plans are “grandfathered” or “grandmothered” (grandfathered plans must have been purchased prior to March 23, 2010, and grandmothered plans must have been purchased by December 2013).
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2018 Plan Year: Ohio Individual and Family
Your Health Plan Guide
Bronze, Silver, Gold and Catastrophic plans Certified by the Health Insurance Marketplace
Looking for a new health plan for 2018? We can help.
| Anthem Bronze Pathway X PPO 5150 (2EMP) | Anthem Bronze Pathway X PPO 5850 (2ENZ) | Anthem Bronze Pathway X PPO 0% for HSA (2EML) | |
| Network name | Pathway X Tiered Hospital | Pathway X Tiered Hospital | Pathway X Tiered Hospital |
| Plan includes out-of-network coverage? | Yes | Yes | Yes |
| Individual deductible | $5,150 / $15,450
Network / Non-network |
$5,850 / $17,550
Network / Non-network |
$6,550 / $19,650
Network / Non-network |
| Individual out-of-pocket limit | $7,150 / $21,450
Network / Non-network |
$7,150 / $21,450
Network / Non-network |
$6,550 / $26,200
Network / Non-network |
| Coinsurance (percentage may vary for some covered services) | 25% / 50%
Network / Non-network |
35% / 55%
Network / Non-network |
0% / 30%
Network / Non-network |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $50 copay per visit for the first 2 visits, then deductible and 25% coinsurance | Deductible, then 35% coinsurance | Deductible, then 0% coinsurance |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 25% coinsurance | Deductible, then 35% coinsurance | Deductible, then 0% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 25% coinsurance | Deductible, then 35% coinsurance | Deductible, then 0% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $400 copay and 50% coinsurance | Deductible, then $400 copay and 50% coinsurance | Deductible, then 0% coinsurance |
| Urgent care | Deductible, then $50 copay and 25% coinsurance | Deductible, then $75 copay and 35% coinsurance | Deductible, then 0% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 25% coinsurance | Deductible, then $500 copay and 35% coinsurance | Deductible, then 0% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Deductible, then 25% coinsurance | Tier 1: Deductible, then $1,000 copay
Tier 2: Deductible, then $750 copay and 55% coinsurance |
Deductible, then 0% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 25% coinsurance | Deductible, then 35% coinsurance | Deductible, then 0% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
| Retail pharmacy tier 16: level 1 / level 2 | 25% coinsurance / 35% coinsurance | 35% coinsurance / 45% coinsurance | 0% coinsurance / 0% coinsurance |
| Anthem Bronze Pathway X PPO 6800 (2EMT) | Anthem Bronze Pathway X HMO 5000 (1X2D) | Anthem Bronze Pathway X HMO 5200 (1X2G) | |
| Network name | Pathway X Tiered Hospital | Pathway X HMO | Pathway X HMO |
| Plan includes out-of-network coverage? | Yes | No | No |
| Individual deductible | $6,800 / $20,400
Network / Non-network |
$5,000 | $5,200 |
| Individual out-of-pocket limit | $7,150 / $21,450
Network / Non-network |
$7,150 | $7,150 |
| Coinsurance (percentage may vary for some covered services) | 25% / 50%
Network / Non-network |
40% | 20% |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $60 copay per visit for the first 2 visits, then deductible and 25% coinsurance | $50 copay per visit for the first 2 visits, then deductible and 40% coinsurance | $35 copay per visit for the first 2 visits, then deductible and 20% coinsurance |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 25% coinsurance | Deductible, then 40% coinsurance | $70 copay per visit for the first 2 visits, then deductible and 20% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 25% coinsurance | Deductible, then 40% coinsurance | Deductible, then 20% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then $400 copay and 50% coinsurance | Deductible, then $400 copay and 50% coinsurance |
| Urgent care | Deductible, then $50 copay and 25% coinsurance | Deductible, then $50 copay and 40% coinsurance | Deductible, then $50 copay and 20% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $300 copay and 25% coinsurance | Deductible, then $200 copay and 40% coinsurance | Deductible, then $500 copay and 20% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Tier 1: Deductible, then 25% coinsurance
Tier 2: Deductible, then 50% coinsurance |
Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 25% coinsurance | Deductible, then 40% coinsurance | Deductible, then 20% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
| Retail Pharmacy tier 16: level 1 / level 2 | $25 copay / $35 copay | 40% coinsurance / 50% coinsurance | 20% coinsurance / 30% coinsurance |
| Anthem Bronze Pathway X HMO 0% for HSA (2EDZ) | Anthem Bronze Pathway X HMO 7150 (1X2K) | Anthem Silver Pathway X PPO 2000 (2ENE) | |
| Network name | Pathway X HMO | Pathway X HMO | Pathway X Tiered Hospital |
| Plan includes out-of-network coverage? | No | No | Yes |
| Individual deductible | $6,550 | $7,150 | $2,000 / $6,000
Network / Non-network |
| Individual out-of-pocket limit | $6,550 | $7,150 | $7,150 / $21,450
Network / Non-network |
| Coinsurance (percentage may vary for some covered services) | 0% | 0% | 20% / 50%
Network / Non-network |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | $45 copay per visit for the first 2 visits, then deductible and 20% coinsurance |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then 20% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then 20% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then $300 copay and 50% coinsurance |
| Urgent care | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then $50 copay and 20% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then $350 copay and 20% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Tier 1: Deductible, then $500 copay and 20% coinsurance
Tier 2: Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 0% coinsurance | Deductible, then 0% coinsurance | Deductible, then 20% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
| Anthem Silver Pathway X PPO 2500 (2ENL) | Anthem Silver Pathway X PPO 10% for HSA (2EN2) | Anthem Silver Pathway X PPO 3000 (2EMW) | |
| Network name | Pathway X Tiered Hospital | Pathway X Tiered Hospital | Pathway X Tiered Hospital |
| Plan includes out-of-network coverage? | Yes | Yes | Yes |
| Individual deductible | $2,500 / $7,500
Network / Non-network |
$2,700 / $8,100
Network / Non-network |
$3,000 / $9,000
Network / Non-network |
| Individual out-of-pocket limit | $7,150 / $21,450
Network / Non-network |
$6,550 / $19,650
Network / Non-network |
$6,000 / $18,000
Network / Non-network |
| Coinsurance (percentage may vary for some covered services) | 10% / 40%
Network / Non-network |
10% / 40%
Network / Non-network |
10% / 40%
Network / Non-network |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $45 copay | Deductible, then 10% coinsurance | $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance |
| Urgent care | Deductible, then $50 copay and 10% coinsurance | Deductible, then $50 copay and 10% coinsurance | Deductible, then $50 copay and 10% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $350 copay and 10% coinsurance | Deductible, then $200 copay and 10% coinsurance | Deductible, then $200 copay and 10% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Tier 1: Deductible, then $500 copay and 10% coinsurance
Tier 2: Deductible, then $500 copay and 50% coinsurance |
Tier 1: Deductible, then $500 copay and 10% coinsurance
Tier 2: Deductible, then $500 copay and 50% coinsurance |
Tier 1: Deductible, then $500 copay and 10% coinsurance
Tier 2: Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
| Anthem Silver Pathway X PPO 3500 (2ENS) | Anthem Silver Pathway X PPO 4050 (2EN8) | Anthem Silver Pathway X HMO 2850 (1X30) | |
| Network name | Pathway X Tiered Hospital | Pathway X Tiered Hospital | Pathway X HMO |
| Plan includes out-of-network coverage? | Yes | Yes | No |
| Individual deductible | $3,500 / $10,500
Network / Non-network |
$4,050 / $12,150
Network / Non-network |
$2,850 |
| Individual out-of-pocket limit | $5,700 / $17,100
Network / Non-network |
$6,500 / $19,500
Network / Non-network |
$7,150 |
| Coinsurance (percentage may vary for some covered services) | 25% / 50%
Network / Non-network |
0% / 30%
Network / Non-network |
15% |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $20 copay | $50 copay | $30 copay |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | $60 copay | Deductible, then 0% coinsurance | Deductible, then 15% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 25% coinsurance | Deductible, then 0% coinsurance | Deductible, then 15% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then 0% coinsurance | Deductible, then $300 copay and 50% coinsurance |
| Urgent care | $90 copay | Deductible, then $50 copay | Deductible, then $50 copay and 15% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then 25% coinsurance | Deductible, then $300 copay | Deductible, then $500 copay and 15% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Deductible, then $500 copay and 25% coinsurance | Tier 1: Deductible, then $500 copay
Tier 2: Deductible, then $500 copay and 50% coinsurance |
Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 25% coinsurance | Deductible, then 0% coinsurance | Deductible, then 15% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1: No deductible
Tier 2, 3, 4: $1,000 Combined pharmacy deductible |
Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
| Anthem Silver Pathway X HMO 10% for HSA (2EE2) | Anthem Silver Pathway X HMO 3500 (2EE8) | Anthem Silver Pathway X HMO 4250 (1X2N) | |
| Network name | Pathway X HMO | Pathway X HMO | Pathway X HMO |
| Plan includes out-of-network coverage? | No | No | No |
| Individual deductible | $3,200 | $3,500 | $4,250 |
| Individual out-of-pocket limit | $5,000 | $5,700 | $5,250 |
| Coinsurance (percentage may vary for some covered services) | 10% | 25% | 30% |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 10% coinsurance | $20 copay | $25 copay |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 10% coinsurance | $60 copay | $50 copay |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 30% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance | Deductible, then $300 copay and 50% coinsurance |
| Urgent care | Deductible, then $50 copay and 10% coinsurance | $90 copay | $90 copay |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then $500 copay and 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 30% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 25% coinsurance | Deductible, then $500 copay and 50% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 30% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy Tier 1: No deductible
Tier 2, 3, 4: $1,000 Combined pharmacy deductible |
Level 1 / Level 2 Pharmacy Tier 1: No deductible
Tier 2, 3, 4: $1,000 Combined pharmacy deductible |
| Retail pharmacy tier 16: level 1 / level 2 | 10% coinsurance / 20% coinsurance | $10 copay / $20 copay | $15 copay / $25 copay |
| Anthem Silver Core Pathway X HMO 5300 (2EDT) | Anthem Gold Pathway X HMO 1450 (1X36) | Anthem Catastrophic Pathway X PPO 7150 (2EMJ) | |
| Network name | Pathway X HMO | Pathway X HMO | Pathway X Tiered Hospital |
| Plan includes out-of-network coverage? | No | No | Yes |
| Individual deductible | $5,300 | $1,450 | $7,150 / $21,450
Network / Non-network |
| Individual out-of-pocket limit | $6,750 | $4,200 | $7,150 / $28,600
Network / Non-network |
| Coinsurance (percentage may vary for some covered services) | 25% | 20% | 0% / 30%
Network / Non-network |
| Preventive care1 | No additional cost to you. | No additional cost to you. | No additional cost to you. |
| Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) | $35 copay | $30 copay | $40 copay per visit for the first 3 visits, then deductible and 0% coinsurance |
| Office visit: specialist3 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 25% coinsurance | $50 copay | Deductible, then 0% coinsurance |
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 25% coinsurance | Deductible, then 20% coinsurance | Deductible, then 0% coinsurance |
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then 25% coinsurance | Deductible, then $200 copay and 50% coinsurance Deductible, then 0% coinsurance | |
| Urgent care | Deductible, then $50 copay | $90 copay | Deductible, then 0% coinsurance |
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then 25% coinsurance | Deductible, then 20% coinsurance | Deductible, then 0% coinsurance |
| Hospital: inpatient admission4 (includes maternity, mental health / substance use) | Deductible, then 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then 0% coinsurance |
| Hospital: outpatient surgery hospital facility
(includes maternity, mental health / substance use) |
Deductible, then 25% coinsurance | Deductible, then 20% coinsurance | Deductible, then 0% coinsurance |
| Pharmacy deductible5 (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy Tier 1: No deductible
Tier 2, 3, 4: $600 Combined pharmacy deductible |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Why Anthem?
Health plans don’t have to be complicated.
We understand that every individual and family is unique. That’s why we offer many affordable plan options for different health care needs and budgets. Our goal is not just to be there when you’re sick, but also to help you stay well – at every stage of life.
With Anthem Blue Cross and Blue Shield (Anthem), you can count on:
- A strong network with access to major hospital systems.
- Dedicated customer service.
- All your benefits, including dental and vision, from one source.
- Competitive pricing.
- Convenient online tools, including 24/7 access to doctors through LiveHealth Online.
- A simple enrollment process.
- Coordinated care that connects your doctors and other health care providers.
- Resources to support your health care goals.
FAQ
Q: I have an Anthem individual ACA health plan — when do I have to find new coverage?
A: Nothing is changing with your Anthem ACA health plan in 2017. Later this year, you’ll have to shop for a new plan for 2018. You’ll do this during the open enrollment period starting November 1. Affected members will receive an official notice that their plan is ending, along with information on options for next year. We’ll help you connect with the right people to find a new plan.
Q: I didn’t switch to an ACA plan, my individual health plan is grandfathered/grandmothered. Does this affect me?
A: No, this change affects Anthem’s ACA individual health plans only.
Q: Is Anthem also discontinuing individual dental and vision plans in Ohio?
A: No, this change affects Anthem’s individual ACA health plans only. We’ll continue to offer dental and vision plans in Ohio.
Q: I get health benefits from my employer. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Plans sponsored by employers are not impacted.
Q: I have an Anthem Medicare plan. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Anthem’s Medicare plans are not impacted.
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Contact Us
New Enrollments:
Phone: (312) 726-6565
Email: [email protected]
Anthem Ohio
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Contact
(312) 726-6565