Silver HMO Options
| Plan Info | Silver 5 | Silver 6 | Silver 7 | Silver S |
|---|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $8,395 / $16,790 | $7,795 / $15,590 | $7,795 / $15,590 | $5,900 / $11,800 |
| Out of Pocket Max – Individual/Family | $8,885 / $17,770 | $8,445 / $16,890 | $8,845 / $17,690 | $9,100 / $18,200 |
| Primary Care/Specialist | $50 / $80 | $35 / $80 | $30 / $60 | $40 / $80 |
| Emergency Room Care | 50% coinsurance | 50% coinsurance | 50% coinsurance | 40% coinsurance |
| Urgent Care | $50 copay | $50 copay | $50 copay | $60 copay |
| Inpatient hospital stay | 50% coinsurance | 50% coinsurance | 50% coinsurance | 40% coinsurance |
| Lab services / Xray | Lab: $25 copay X-ray: $30 copay | Lab: $40 copay X-ray: $45 copay | Lab: $30 copay X-ray: $50 copay | 40% coinsurance |
| Prescription Drugs | ||||
| Preferred generic | Tier 1A: $5 copay/ $12.50 copay Tier 1: $25 copay/ $62.50 copay ded does not apply | Tier 1A: $5 copay / $12.50 copay Tier 1: $25 copay / $62.50 copay ded does not apply | Tier 1A: $5 copay / $12.50 copay Tier 1: $25 copay / $62.50 copay ded does not apply | $20 copay / $50 copay ded does not apply |
| Preferred Brand Drugs | 40% coinsurance ded does not apply | $60 copay / $150 copay ded does not apply | $60 copay / $150 copay ded does not apply | $40 copay / $100 copay ded does not apply |
| Non-preferred generic/brand drugs | $125 copay / $312.50 copay ded does not apply | $125 copay / $312.50 copay ded does not apply | $125 copay / $312.50 copay ded does not apply | $80 copay/ $200 copay |
| Preferred/non-preferred specialty drugs | $400 copay ded does not apply | $400 copay ded does not apply | $400 copay ded does not apply | $350 copay |
Every ACA plan covers 10 essential benefits:
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
Aetna CVS Health Plans – 2024 Illinois HMO Hospital Network
Hospital Network Highlights – Hospitals include, but are not limited to:
- Edward Hospital
- Elmhurst Memorial Hospital
- Holy Cross Hospital
- Humboldt Park Health
- Insight Chicago, Inc.
- Jackson Park Hospital Foundation
- John H. Stroger Hospital of Cook County
- LaRabida Children’s Hospital
- Loretto Hospital
- Louis A. Weiss Memorial Hospital
- Mercy Harvard Hospital, Inc.
- Methodist Hospital of Chicago
- Mount Sinai Hospital Medical Center
- Northshore University Health System – Evanston Hospital
- NorthShore University HealthSystem – Glenbrook Hospital
- NorthShore University HealthSystem – Highland Park
- NorthShore University Health System – Skokie Hospital
- Northwest Community Hospital
- OSF Little Company of Mary Medical Center
- Provident Hospital of Cook County
- Roseland Community Hospital
- Shriners Hospital for Children-Chicago IL
- South Shore Hospital