Maine health plan · 2025

Anthem Clear Choice Gold X Tiered 2500 · 48396ME0710094

Anthem Health Plans of Maine, Inc. offers this marketplace health insurance plan (Plan ID 48396ME0710094) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Anthem Health Plans of Maine, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Not listed

Issuer actuarial value: 78.75%. Expect to pay roughly 21.25% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 81.07% (18.93% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

See plan search for live pricing

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$5,000

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits
HSA Not eligible

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

Issuer profile See benefits
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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Maine). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 48396ME0710094
Coverage year 2025
State Maine
Issuer Anthem Health Plans of Maine, Inc.
Variant ID 48396ME0710094-03
Available variants

Standard On Exchange Plan · 48396ME0710094-01

Open to Indians below 300% FPL · 48396ME0710094-02

Open to Indians above 300% FPL · 48396ME0710094-03
Last plan update Sat, 08 Nov 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Maine 12
PCPs in Maine 1
Telehealth support Data pending
Nationwide providers 29
12 doctors statewide 1 PCPs

Provider network(s)

Providers Maine All US states
All 12 29
PCP 1 4
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 2 7

Drug coverage overview

3,801 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
TIER-FOUR 3,801
Prior authorization Drugs
Required 869
Not Required 2,932
Step therapy Drugs
Required 122
Not Required 3,679
Quantity limits Drugs
Has Limit 2,173
No Limit 1,628

Customer highlights

What stands out for members

  • Issuer: Anthem Health Plans of Maine, Inc. · Plan ID 48396ME0710094 · 2025 filing.
  • Disease management programs available: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma.
  • Variant 48396ME0710094-03 (Open to Indians above 300% FPL) currently displayed.
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Variant attributes

Anthem Clear Choice Gold X Tiered 2500 · Variant 48396ME0710094-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

48396ME071

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

48396ME0710094-03

Plan Marketing Name

Anthem Clear Choice Gold X Tiered 2500

Plan Variant Marketing Name

Anthem Clear Choice Gold X Tiered 2500 LCSR

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

78.75%

Issuer ID

48396

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

MEN002

Out of Country Coverage

No

Out of Country Coverage Description

Urgent/Emergency Coverage Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

TRAD/PAR network

Service Area ID

MES005

State Code

ME

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.810679624

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

SBC Scenario, Having a Baby, Coinsurance

$2,200

SBC Scenario, Having a Baby, Copayment

$300

SBC Scenario, Having a Baby, Deductible

$2,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,700

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,100

Specialty Drug Maximum Coinsurance

$700

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family

per person not applicable | per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family

$5000 per person | $10000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$5,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family

$7000 per person | $14000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$7,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family

per person not applicable | per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MEF516

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

1

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family

$0 per person | $0 per group

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, In Network (Tier 2), Family

$0 per person | $0 per group

Drug EHB Deductible, In Network (Tier 2), Individual

$0

Drug EHB Deductible, Out of Network, Family

per person not applicable | per group not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma

EHB Percent of Total Premium

99%

First Tier Utilization

90%

Import Date

1/13/2025

HSA Eligible

No

IsItANewPlan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family

per person not applicable | per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family

$2500 per person | $5000 per group

Medical EHB Deductible, In Network (Tier 1), Individual

$2,500

Medical EHB Deductible, In Network (Tier 2), Family

$5000 per person | $10000 per group

Medical EHB Deductible, In Network (Tier 2), Individual

$5,000

Medical EHB Deductible, Out of Network, Family

per person not applicable | per group not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2025

Plan Expiration Date

12/31/2025

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

10%

Source Name

SERFF

Specialist Requiring a Referral

All specialists require referral with the exception of OB/GYN

Plan ID

48396ME0710094

Unique Plan Design

Yes

Version Number

1

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Maine?

Anthem Clear Choice Gold X Tiered 2500 (48396ME0710094) is a Gold HMO from Anthem Health Plans of Maine, Inc. in Maine for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Anthem Clear Choice Gold X Tiered 2500 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Anthem Clear Choice Gold X Tiered 2500 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision coverage is not listed for this plan.

Does Anthem Clear Choice Gold X Tiered 2500 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Anthem Clear Choice Gold X Tiered 2500?

The issuer lists disease management resources for: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma.

Is there out-of-country coverage for Anthem Clear Choice Gold X Tiered 2500?

No, out-of-country services are not covered for this plan. Details: Urgent/Emergency Coverage Only

Does Anthem Clear Choice Gold X Tiered 2500 cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: TRAD/PAR network

How do I enroll in or manage payments for Anthem Clear Choice Gold X Tiered 2500?

Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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