Missouri health plan · 2025

Anthem Silver Pathway 7250 ($0 Virtual PCP + $0 Select Drugs + Incentives) · 32753MO0950015

Healthy Alliance Life Insurance Company offers this marketplace health insurance plan (Plan ID 32753MO0950015) 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: Silver Plan type: EPO CSR: 87% AV Level Silver Plan Issuer: Healthy Alliance Life Insurance Company
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 87.10%. Expect to pay roughly 12.90% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 87.14% (12.86% 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

$263 – $1736

Before subsidies

Estimate after subsidies

Deductible

$650

$1300 per group

See deductible details

Max out-of-pocket

$3,050

$6100 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $30.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $40.00

View formulary tiers

$607 / mo before subsidies

≈ $7278 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.

$1860 / mo before subsidies

≈ $22324 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2204 / mo before subsidies

≈ $26451 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1479 / mo before subsidies

≈ $17752 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

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% 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 Missouri). 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.
  • 87% AV Level Silver Plan 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

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% 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 32753MO0950015
Coverage year 2025
State Missouri
Issuer Healthy Alliance Life Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 32753MO0950015-05
Available variants

Standard Off Exchange Plan · 32753MO0950015-00

Standard On Exchange Plan · 32753MO0950015-01

Open to Indians below 300% FPL · 32753MO0950015-02

Open to Indians above 300% FPL · 32753MO0950015-03

73% AV Silver Plan · 32753MO0950015-04

87% AV Silver Plan · 32753MO0950015-05

94% AV Silver Plan · 32753MO0950015-06
Last plan update Sat, 22 Mar 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 Missouri 21888
PCPs in Missouri 3708
Telehealth support Data pending
Nationwide providers 110139
21,888 doctors statewide 3,708 PCPs 130 OB/GYN

Provider network(s)

Providers Missouri All US states
All 21888 110139
PCP 3708 4544
Allergy 16 18
OB/GYN 130 188
Dentists 933 55897

Drug coverage overview

3,584 drugs tracked

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

Tier Covered drugs
TIER-FOUR 3,584
Prior authorization Drugs
Required 736
Not Required 2,848
Step therapy Drugs
Required 81
Not Required 3,503
Quantity limits Drugs
Has Limit 2,029
No Limit 1,555

Customer highlights

What stands out for members

  • Issuer: Healthy Alliance Life Insurance Company · Plan ID 32753MO0950015 · 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 32753MO0950015-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 26.0 Visit(s) per Year

Chiropractic Manipulation Therapy visits beyond the 26 visit limit require Prior Authorization from Anthem in order to be covered.

Exclusions: nan

Diabetes Education

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

nan

Exclusions: nan

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 100.0 Visit(s) per Year

Benefit includes coverage for Private Duty Nursing in the home and Private Duty Nursing is limited to 82 visits per calendar year.

Exclusions: nan

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

High Sensitivity C-Reactive Protein Tests are coverd with no member cost share.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

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

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

This plan offers a Well-being Coach to encourage healthier habits and behavior changes to reduce the risk and costs associated with chronic conditions. This program will help modify behaviors associated with obesity, tobacco use, poor nutrition, inactivity, poor sleep and stress. 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. Immunizations prior to 6th birthday covered in full.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

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

Cardiologist office visits will follow this cost share. 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

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

Limit: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

Exclusions: nan

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Specialist Visit

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

Cardiologist office visits will follow the Primary Care Visit to Treat and Injury or Illness cost share. 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

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

nan

Exclusions: nan

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Carotid Intimal Medical Thickness Tests are covered with no member cost share.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Emergency Room copay is waived if directly admitted to the hospital.

Exclusions: nan

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Non-emergency ambulance/transportation out of network is NOT covered, unless prior authorization is obtained from Anthem. Authorized out of network is limited to $50,000 per occurrence.

Exclusions: nan

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

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

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Limitation of Two office visits per member per Year with a Non-Network licensed provider.

Exclusions: nan

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 150.0 Days per Year

Limited to 150 combined days per calendar year for Physical Medicine, Rehabilitation and Skilled Nursing Facility services.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Limitation of Two office visits per member per Year with a Non-Network licensed provider.

Exclusions: nan

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Includes coverage for travel/lodging as approved by the plan ($10,000 per transplant). Donor search charges are limited to 10 best matched donors identified by an authorized registry.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic 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

Hearing Aids

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

One hearing aid per ear every 36 months. Limit does not apply to newborn.

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

Newborn Hearing Screening

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Prenatal and Postnatal Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% 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%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Tier 2 in-network $20.00
Out-of-network 100.00%

Cost share shown is for a 30 day supply.

Exclusions: nan

Non-Preferred Brand Drugs

35.00% Coinsurance after deductible
Tier 1 in-network 35.00% Coinsurance after deductible
Tier 2 in-network 45.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share shown is for a 30 day supply.

Exclusions: nan

Preferred Brand Drugs

$40.00
Tier 1 in-network $40.00
Tier 2 in-network $55.00
Out-of-network 100.00%

Cost share shown is for a 30 day supply.

Exclusions: nan

Specialty Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share shown is for a 30 day supply.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

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

Limit: 3000.0 Dollars per Episode

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Benefits are provided only for the administration of general anesthesia and for both facility and professional charges occurring in connection with dental services, regardless of age, when prior authorization for an inpatient dental care procedure is approved by us. In addition and as required by law, benefits for the administration of general anesthesia, including facility and professional charges, are provided for the following Members; a Member through the age of four; a Member who is severely disabled and a Member who has a medical or behavioral condition that requires hospitalization or general anesthesia when dental services are provided.

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Benefits include the purchase, fitting, adjustments, repairs and replacements.

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

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Applied Behavior Analysis Based Therapies

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limited to members through 18 years of age.

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Bone Marrow Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Clinical Trials

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Cardiac Calcium Screenings are covered with no member cost share.

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Inherited Metabolic Disorder - PKU

35.00% Coinsurance after deductible
Tier 1 in-network 35.00% Coinsurance after deductible
Tier 2 in-network 45.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 82.0 Visit(s) per Year

Benefit includes coverage for Private Duty Nursing in the home and Private Duty Nursing is limited to 82 visits per calendar year.

Exclusions: nan

Reconstructive Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Benefits include reconstructive surgery to correct significant deformities caused by congenital or developmental abnormalities, illness, injury or an earlier treatment in order to create a more normal appearance.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

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

Coverage is available if Medically Necessary Services

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% 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, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures).

Exclusions: nan

Variant attributes

Anthem Silver Pathway 7250 ($0 Virtual PCP + $0 Select Drugs + Incentives) · Variant 32753MO0950015-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

32753MO095

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

32753MO0950015-05

Plan Marketing Name

Anthem Silver Pathway 7250 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Plan Variant Marketing Name

Anthem Silver Pathway X 650 ($0 Virtual PCP + $0 Select Drugs + Incentives) S05

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

87.10%

Issuer ID

32753

Issuer Marketplace Marketing Name

Anthem Blue Cross and Blue Shield

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

MON001

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

Standard Bluecard PPO Network

Service Area ID

MOS001

State Code

MO

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.871414802046982

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

$2,400

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$650

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,200

SBC Scenario, Having Diabetes, Deductible

$100

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$300

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$650

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

20.00%

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

20.00%

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

$6100 per group

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

$3050 per person

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

$3,050

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

$6100 per group

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

$3050 per person

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

$3,050

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

MOF510

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

Not Applicable

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

40%

Import Date

2025-03-22 02:01:57

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

EPO

QHP/Non QHP

Both

Second Tier Utilization

60%

Source Name

HIOS

Plan ID

32753MO0950015

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

$1300 per group

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

$650 per person

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

$650

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group

$1300 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person

$650 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual

$650

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 Missouri?

Anthem Silver Pathway 7250 ($0 Virtual PCP + $0 Select Drugs + Incentives) (32753MO0950015) is a Silver EPO from Healthy Alliance Life Insurance Company in Missouri 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 Silver Pathway 7250 ($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 Silver Pathway 7250 ($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 Silver Pathway 7250 ($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 Silver Pathway 7250 ($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 Silver Pathway 7250 ($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 Silver Pathway 7250 ($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: Standard Bluecard PPO Network

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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