Florida health plan · 2026

Capital Health Plan HMO Silver 2300 · 66966FL0050006

Capital Health Plan offers this marketplace health insurance plan (Plan ID 66966FL0050006) 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: HMO CSR: Standard Silver Off Exchange Plan Issuer: Capital Health Plan
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 70.01% (29.99% member share on average). Learn about AV methodology.

2026 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

$379 – $2055

Before subsidies

Estimate after subsidies

Deductible

$6,000

$12000 per group

See deductible details

Max out-of-pocket

$8,900

$17800 per group

Review MOOP rules

Office visits

Primary care $40.00
Specialist $80.00
HSA Not eligible

Drug tiers

Generic $20.00
Preferred brand $40.00

View formulary tiers

$718 / mo before subsidies

≈ $8613 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.

$1745 / mo before subsidies

≈ $20935 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.

$2181 / mo before subsidies

≈ $26174 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.

$1326 / mo before subsidies

≈ $15914 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

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Florida). 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.
  • Standard Silver Off Exchange 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

0.00%

Emergency Room Services

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% 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 66966FL0050006
Coverage year 2026
State Florida
Issuer Capital Health Plan
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 66966FL0050006-00
Available variants

Standard Off Exchange Plan · 66966FL0050006-00

Standard On Exchange Plan · 66966FL0050006-01

Open to Indians below 300% FPL · 66966FL0050006-02

Open to Indians above 300% FPL · 66966FL0050006-03

73% AV Silver Plan · 66966FL0050006-04

87% AV Silver Plan · 66966FL0050006-05

94% AV Silver Plan · 66966FL0050006-06
Last plan update Tue, 28 Oct 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 Florida 884
PCPs in Florida 233
Telehealth support Data pending
Nationwide providers 928
884 doctors statewide 233 PCPs 8 OB/GYN

Provider network(s)

Providers Florida All US states
All 884 928
PCP 233 240
Allergy 3 3
OB/GYN 8 8
Dentists 9 10

Drug coverage overview

4,411 drugs tracked

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

Tier Covered drugs
NON-PREFERRED-GENERIC 2,405
NON-PREFERRED-BRAND 1,015
SPECIALTY 991
Prior authorization Drugs
Required 1,018
Not Required 3,393
Step therapy Drugs
Required 51
Not Required 4,360
Quantity limits Drugs
Has Limit 1,664
No Limit 2,747

Customer highlights

What stands out for members

  • Issuer: Capital Health Plan · Plan ID 66966FL0050006 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 66966FL0050006-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

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

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Diabetes Education

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

Home Health Care Services

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

Limit: 20.0 Days per Benefit Period

Laboratory Outpatient and Professional Services

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

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

Preventive Care/Screening/Immunization

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

Primary Care Visit to Treat an Injury or Illness

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

Rehabilitative Occupational and Rehabilitative Physical Therapy

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

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Rehabilitative Speech Therapy

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

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Specialist Visit

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$60.00
Tier 1 in-network $60.00

X-rays and Diagnostic Imaging

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

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

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

Delivery and All Inpatient Services for Maternity Care

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

Dialysis

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

Durable Medical Equipment

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

Emergency Room Services

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

Coinsurance and Copayment is waived if inpatient admission occurs; however if moved to observation status an additional copayment may apply based on services rendered.

Emergency Transportation/Ambulance

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

Hospice Services

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

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

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

Inpatient Physician and Surgical Services

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

Mental/Behavioral Health Inpatient Services

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

Mental/Behavioral Health Outpatient Services

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

Non-Office Mental Health visit cost share will align with Outpatient Facility Fee cost share

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

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

Outpatient Rehabilitation Services

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

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Outpatient Surgery Physician/Surgical Services

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

Radiation

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

Skilled Nursing Facility

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

Limit: 60.0 Days per Benefit Period

Substance Abuse Disorder Inpatient Services

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

Substance Abuse Disorder Outpatient Services

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

Non-Office Substance Use Disorder visit cost share will align with Outpatient Facility Fee cost share

Transplant

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

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Routine Eye Exam for Children

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Provided at Capital Health Plan's Eye Care Centers

Well Baby Visits and Care

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

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

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

Non-Preferred Brand Drugs

$80.00 Copay after deductible
Tier 1 in-network $80.00 Copay after deductible
Out-of-network 100.00%

Preferred Brand Drugs

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

Specialty Drugs

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network 100.00%

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

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

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Diabetes coverage includes 'nutrition counseling'; home health services include 'nutritional guidance.'

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

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

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

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

Limit: 1.0 Item(s) per Year

Provided at Capital Health Plan's Eye Care Centers

Habilitation Services

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

Limit: 35.0 Visit(s) per Benefit Period

Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Imaging (CT/PET Scans, MRIs)

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

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

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

Only for Breast reconstruction following a Mastectomy.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Treatment for Temporomandibular Joint Disorders

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

Variant attributes

Capital Health Plan HMO Silver 2300 · Variant 66966FL0050006-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

66966FL005

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

66966FL0050006-00

Plan Marketing Name

Capital Health Plan HMO Silver 2300

Plan Variant Marketing Name

Capital Health Plan HMO Silver 2300

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

66966

Issuer Marketplace Marketing Name

Capital Health Plan

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

FLN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Care

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Urgent and Emergency Care

Service Area ID

FLS001

State Code

FL

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.700079495

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

$2,600

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$6,000

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$900

SBC Scenario, Having Diabetes, Deductible

$900

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$400

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,100

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

$16000 per group

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

$8000 per person

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

$8,000

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

40.00%

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

$17800 per group

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

$8900 per person

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

$8,900

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

FLF010

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

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/28/2025

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

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

66966FL0050006

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

$10000 per group

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

$5000 per person

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

$5,000

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

$12000 per group

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

$6000 per person

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

$6,000

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

No

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 Florida?

Capital Health Plan HMO Silver 2300 (66966FL0050006) is a Silver HMO from Capital Health Plan in Florida for the 2026 coverage year.

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

Does Capital Health Plan HMO Silver 2300 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 Capital Health Plan HMO Silver 2300 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 add-ons: Child.

Does Capital Health Plan HMO Silver 2300 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 Capital Health Plan HMO Silver 2300?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease.

Is there out-of-country coverage for Capital Health Plan HMO Silver 2300?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Care

Does Capital Health Plan HMO Silver 2300 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: Urgent and Emergency Care

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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