Wisconsin health plan · 2025

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) · 79475WI0340183

Compcare Health Services Insurance Corporation (HMO/POS-in network) offers this marketplace health insurance plan (Plan ID 79475WI0340183) 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: Compcare Health Services Insurance Corporation (HMO/POS-in network)
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 78.06%. Expect to pay roughly 21.94% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 78.06% (21.94% 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

$308 – $1209

Before subsidies

Estimate after subsidies

Deductible

$1,500

$3000 per group

See deductible details

Max out-of-pocket

$7,800

$15600 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $60.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $30.00

View formulary tiers

$422 / mo before subsidies

≈ $5068 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1338 / mo before subsidies

≈ $16059 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1621 / mo before subsidies

≈ $19448 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1030 / mo before subsidies

≈ $12360 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00% Coinsurance after deductible

Durable Medical Equipment

25.00% Coinsurance after deductible

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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 Wisconsin). 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.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00% Coinsurance after deductible

Durable Medical Equipment

25.00% Coinsurance after deductible

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 79475WI0340183
Coverage year 2025
State Wisconsin
Issuer Compcare Health Services Insurance Corporation (HMO/POS-in network)
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 79475WI0340183-03
Available variants

Standard Off Exchange Plan · 79475WI0340183-00

Standard On Exchange Plan · 79475WI0340183-01

Open to Indians below 300% FPL · 79475WI0340183-02

Open to Indians above 300% FPL · 79475WI0340183-03
Last plan update Tue, 14 Jan 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 Wisconsin 246
PCPs in Wisconsin 33
Telehealth support Data pending
Nationwide providers 274
246 doctors statewide 33 PCPs

Provider network(s)

Providers Wisconsin All US states
All 246 274
PCP 33 40
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,692 drugs tracked

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

Tier Covered drugs
TIER-FOUR 3,692
Prior authorization Drugs
Required 758
Not Required 2,934
Step therapy Drugs
Required 97
Not Required 3,595
Quantity limits Drugs
Has Limit 2,110
No Limit 1,582

Customer highlights

What stands out for members

  • Issuer: Compcare Health Services Insurance Corporation (HMO/POS-in network) · Plan ID 79475WI0340183 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 79475WI0340183-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Member is responsible for the Primary Care Physician cost share amount when service is performed by a Primary Care Physician or Chiropractor.

Exclusions: nan

Diabetes Education

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Copay is for Primary Care office visit and Specialist Office visits only, other services provided during the visit are subject to deductible and coinsurance.You have $0 virtual visits and medical chats using our preferred virtual care-only Primary Care Physicians (PCP). These services can be accessed via our Sydney application or member website.

Exclusions: nan

Preventive Care/Screening/Immunization

0.00%
Tier 1 in-network 0.00%
Out-of-network 100.00%

You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for. Covered Services also include lead poisoning screening for Dependents under age six (6), as required by state law.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Copay is for Primary Care office visit and Specialist Office visits only, other services provided during the visit are subject to deductible and coinsurance. You have $0 virtual visits and medical chats using our preferred virtual care-only Primary Care Physicians (PCP). These services can be accessed via our Sydney application or member website.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 40.0 Visit(s) per Year

20 visits each Physical Therapy/Occupational Therapy per year. Limit is combined across professional visits and outpatient facilities.

Exclusions: nan

Rehabilitative Speech Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Limit is combined across professional visits and outpatient facilities.

Exclusions: nan

Specialist Visit

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

Copay is for Primary Care office visit and Specialist Office visits only, other services provided during the visit are subject to deductible and coinsurance. You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our Sydney application.

Exclusions: nan

Urgent Care Centers or Facilities

$45.00
Tier 1 in-network $45.00
Out-of-network $45.00

nan

Exclusions: nan

X-rays and Diagnostic Imaging

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Excludes services related to surrogacy if member is not the surrogate.

Exclusions: nan

Dialysis

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Limited to a single purchase of a type of Durable Medical Equipment/Prosthetic (including repair and replacement) every 3 years.

Exclusions: nan

Emergency Room Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

Non-emergency ambulance/transportation out of network is not covered unless authorized. Authorized out of network is limited to $50,000 per occurrence.

Exclusions: nan

Hospice Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis) Limited to a maximum of 60 days per Member, per Calendar Year.

Exclusions: nan

Inpatient Physician and Surgical Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits. Similar services provided in an Outpatient Hospital setting may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

20 visit limit for each Physical Therapy, Occupational Therapy and Speech Therapy

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Days per Admission

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits. Similar services provided in an Outpatient Hospital setting may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information

Exclusions: nan

Transplant

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hearing Aids

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

1 hearing aid per ear every 3 years

Exclusions: nan

Major Dental Care - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Prenatal and Postnatal Care

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Benefits are covered under preventive care.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

30 day supply retail

Exclusions: nan

Non-Preferred Brand Drugs

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

30 day supply retail

Exclusions: nan

Preferred Brand Drugs

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

30 day supply retail

Exclusions: nan

Specialty Drugs

$250.00
Tier 1 in-network $250.00
Out-of-network 100.00%

30 day supply retail

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

Limit: 3000.0 Dollars per Episode

Limited to $900 per tooth

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Limit: 2.0 Visit(s) per Year

nan

Exclusions: nan

Infusion Therapy

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Prosthetic Devices

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Limit is applicable to a single purchase of a type of prosthetic device. Limit does not apply to prosthetics required by the Womens Health and Cancer Rights Act of 1998.

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Limited to therapeutic (only in case of rape, incest or health of mother)

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

Coverage details pending

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

20 visit limit for each Physical Therapy, Occupational Therapy and Speech Therapy

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services. Covered Services do not include fixed or removable appliances that involve movement or repositioning of the teeth (braces), repair of teeth (fillings), or prosthetics (crowns, bridges, dentures)

Exclusions: nan

Variant attributes

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) · Variant 79475WI0340183-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

79475WI034

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

79475WI0340183-03

Plan Marketing Name

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

Plan Variant Marketing Name

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

78.06%

Issuer ID

79475

Issuer Marketplace Marketing Name

Anthem Blue Cross and Blue Shield

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

WIN002

Out of Country Coverage

No

Out of Country Coverage Description

Urgent/Emergency Coverage Only

Out of Service Area Coverage

No

Out of Service Area Coverage Description

TRAD/PAR network

Service Area ID

WIS014

State Code

WI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.780612576352931

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,800

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,400

SBC Scenario, Having Diabetes, Deductible

$100

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,500

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

25.00%

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

$15600 per group

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

$7800 per person

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

$7,800

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

per group not applicable

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

per person 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

WIF505

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Design 1

Disease Management Programs Offered

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

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-01-14 00:02:24

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

79475WI0340183

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

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

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$3000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$1500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

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 Wisconsin?

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) (79475WI0340183) is a Gold HMO from Compcare Health Services Insurance Corporation (HMO/POS-in network) in Wisconsin 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 Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 add-ons: Child.

Vision add-ons: Child.

Does Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)?

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

Is there out-of-country coverage for Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)?

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

Does Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: TRAD/PAR network

How do I enroll in or manage payments for Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)?

Use the issuer portal https://payment.anthem.com/sales/payment/exchange?state=WI to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

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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