What are the Best Benefits of Ambetter Balanced Care 1 in 2021?

Ambetter Balanced Care 1 is a Silver Level health insurance plan offered by Ambetter Health Insurance Company. It has a medical annual deductible of $5,650 for individual plans and $11,300 for family plans. With a 20% medical coinsurance, the plan also offers vision benefits for both adults and children and dental benefits for adults only. Ambetter Balanced Care 1 offers prescription drug coinsurance of up to 30% with a maximum annual out-of-pocket of $6,950 for individuals and $13,900 for family plans.

Popular Benefits of Ambetter Balanced Care 1 

Now we will see what benefits Ambetter Balanced Care 1 has to offer to its customers and their pricing in details:

Emergency Services:

Emergency Services

Your Cost (In-Network Providers Only)

Out-of-Network

Emergency Room Services 20% Coinsurance after deductible 20% Coinsurance after deductible
Emergency Transportation/Ambulance (Air or Ground) 20% Coinsurance after deductible 20% Coinsurance after deductible
Urgent Care $60 Copay Not covered

 

Provider Services:

Provider Services

Your Cost (In-Network Providers Only)

Out-of-Network

Annual Well Visit/Screening/Immunization/Well Baby No charge Not covered
Primary Care Visit to treat an injury or illness and Maternity $30 Copay Not covered
Specialist Visit (e.g. Cardiology, Podiatry, Chiropractic Care) $60 Copay Not covered
Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible Not covered
X-rays & Diagnostic Imaging 20% Coinsurance after deductible Not covered
Diagnostic Test* Lab-work/Other (i.e. EKG, Stress Test) 20% Coinsurance after deductible Not covered

Inpatient and Outpatient Services:

Inpatient & Outpatient Services

Your Cost (In-Network Providers Only)

Out-of-Network

Inpatient Facility Fee (Includes Mental Health, Substance Use, and Maternity) 20% Coinsurance after deductible Not covered
Inpatient Hospital Physician & Surgical Services 20% Coinsurance after deductible Not covered
Outpatient Facility Fee (e.g. Ambulatory Surgery Center) 20% Coinsurance after deductible Not covered
Outpatient Surgery Physician/Surgical Services 20% Coinsurance after deductible Not covered

Other Medical Services:

Other Medical Services

Your Cost (In-Network Providers Only)

Out-of-Network

Mental/Behavioral Health & Substance Use Disorder Outpatient Services $30 Copay/Office Visit (deductible does not apply); 20% Coinsurance after deductible for all other outpatient services Not covered
Rehabilitation Outpatient Services (includes Speech, Occupational and Physical Therapy) 20% Coinsurance after deductible Not covered

Pediatric Vision:

Pediatric Vision Your Cost (In-Network Providers Only)

Out-of-Network

Routine Eye Exam (1 visit per year) 100% Covered Not covered
Eyeglasses (frames, 1 item per year) 100% Covered Not covered
Lenses (per pair) 100% Covered Not covered

Prescription Drugs:

Prescription Drugs

Your Cost (In-Network Providers Only)

Out-of-Network

Generics* $10 Copay Not covered
Preferred Brand Drugs $55 Copay Not covered
Non-preferred Brand Drugs 30% Coinsurance after deductible Not covered
Specialty Drugs 30% Coinsurance after deductible Not covered

Pediatric Vision (0 – 19 years):

Pediatric Vision

Your Cost (In-Network Providers Only)

Out-of-Network

Exams and Eyewear: Routine Eye Exam (1 visit per year) 100% Covered Not covered
Eyeglasses (frames, 1 item per year) 100% Covered Not covered
Lenses (per pair): Single 100% Covered Not covered
Bifocal 100% Covered Not covered
Trifocal 100% Covered Not covered
Lenticular 100% Covered Not covered
Contact Lenses: Contact lenses (instead of glasses) 100% Covered Not covered
Contact lens fitting 100% Covered Not covered
Specialty lens fitting 100% Covered Not covered

Adult Vision (19 and above):

Adult Vision Your Cost (In-Network Providers Only)

Out-of-Network

Exams and Eyewear: Routine Eye Exam (1 visit per year) 100% Covered Not covered
Eyeglasses (frames, 1 item per year) Covered up to $130 Not covered
Lenses (per pair): Single 100% Covered Not covered
Bifocal 100% Covered Not covered
Trifocal 100% Covered Not covered
Lenticular 100% Covered Not covered
Contact Lenses: Contact lenses (instead of glasses) Covered up to $130 Not covered
Contact lens fitting 100% Covered Not covered
Specialty lens fitting Covered up to $50 Not covered

Adult Dental:

Ambetter Balanced Care 1 offers dental benefits for people 19 years old and above. It has a maximum annual benefit of $1,000 per person.

Routine Dental (Class 1):

Routine Dental (Class 1) Your Cost (In-Network Providers Only)

Out-of-Network

Routine Oral Exam (1 per 6 months) No charge, subject to Annual Maximum Not covered
Routine Cleaning (1 per 6 months) No charge, subject to Annual Maximum Not covered
Bite-wing X-ray (1 per 12 months) No charge, subject to Annual Maximum Not covered
Full Mouth X-ray (1 per 60 months) No charge, subject to Annual Maximum Not covered
Panoramic Film (1 per 60 months) No charge, subject to Annual Maximum Not covered
Topical Fluoride Application (2 per 12 months) No charge, subject to Annual Maximum Not covered
Palliative Treatment for relief of pain (minor procedures) No charge, subject to Annual Maximum Not covered

Basic Dental (Class 2):

Basic Dental (Class 2)

Your Cost (In-Network Providers Only)

Out-of-Network

Basic Services: Silver Fillings (1 per 2 years) 50% coinsurance, subject to Annual Maximum Not covered
Tooth-Colored Fillings (1 per 2 years, front teeth only) 50% coinsurance, subject to Annual Maximum Not covered
Endodontics: Therapeutic Pulpotomy on permanent teeth (1 per lifetime per tooth) 50% coinsurance, subject to Annual Maximum Not covered
Periodontics: Scaling and Root Planning (1 per 24 months) 50% coinsurance, subject to Annual Maximum Not covered
Periodontal Maintenance (4 in 12 months) 50% coinsurance, subject to Annual Maximum Not covered
Oral Surgery: Simple Extractions 50% coinsurance, subject to Annual Maximum Not covered
Surgical Extractions 50% coinsurance, subject to Annual Maximum Not covered
Removal of Impacted Teeth 50% coinsurance, subject to Annual Maximum Not covered
Alveoloplasty 50% coinsurance, subject to Annual Maximum Not covered
Prosthodontics: Relins (1 per 36 months) 50% coinsurance, subject to Annual Maximum Not covered
Rebase (1 per 36 months) 50% coinsurance, subject to Annual Maximum Not covered
Adjustments 50% coinsurance, subject to Annual Maximum Not covered
Repairs 50% coinsurance, subject to Annual Maximum Not covered

Ambetter provides health insurance plans with amazing benefits and at an affordable price. You can choose the plan that best fits your medical needs. For more information regarding insurance plans, you can contact your nearest insurance providers or agents. You can visit their website to get more information according to your demand.

Frequently Asked Questions

Q. Does Ambetter offer dental benefits for children?

Ambetter does not offer any dental benefits for children. They offer dental benefits for people of 19 years age and above.

Q. Does Ambetter offer any benefit for mental and behavioral health?

Ambetter offers various benefits for people with mental and behavioral health disorders. They also provide support for substance abuse disorder and rehabilitation. For more information, contact your local agents.

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