Missouri health plan · 2025

Cox HealthPlans Silver Preferred $3,500 Deductible · 96384MO0220016

Cox Health Systems Insurance Company offers this marketplace health insurance plan (Plan ID 96384MO0220016) 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: 94% AV Level Silver Plan Issuer: Cox Health Systems Insurance Company
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 94.17% (5.83% 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

$309 – $1211

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$1,500

$3000 per group

Review MOOP rules

Office visits

Primary care $5.00
Specialist 20.00%
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand 20.00%

View formulary tiers

$423 / mo before subsidies

≈ $5076 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.

$1341 / mo before subsidies

≈ $16092 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.

$1624 / mo before subsidies

≈ $19488 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.

$1032 / mo before subsidies

≈ $12384 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

20.00%

Durable Medical Equipment

20.00%

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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.
  • 94% 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

0.00%

Emergency Room Services

20.00%

Durable Medical Equipment

20.00%

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 96384MO0220016
Coverage year 2025
State Missouri
Issuer Cox Health Systems Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 96384MO0220016-06
Available variants

Standard Off Exchange Plan · 96384MO0220016-00

Standard On Exchange Plan · 96384MO0220016-01

Open to Indians below 300% FPL · 96384MO0220016-02

Open to Indians above 300% FPL · 96384MO0220016-03

73% AV Silver Plan · 96384MO0220016-04

87% AV Silver Plan · 96384MO0220016-05

94% AV Silver Plan · 96384MO0220016-06
Last plan update Fri, 10 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 Missouri N/A
PCPs in Missouri N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Missouri All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

5,785 drugs tracked

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

Tier Covered drugs
GENERIC 2,982
NON-PREFERRED-BRAND 1,377
SPECIALTY 1,241
ZERO-COST-PREVENTATIVE 185
Prior authorization Drugs
Required 1,416
Not Required 4,369
Step therapy Drugs
Required 80
Not Required 5,705
Quantity limits Drugs
Has Limit 1,136
No Limit 4,649

Customer highlights

What stands out for members

  • Issuer: Cox Health Systems Insurance Company · Plan ID 96384MO0220016 · 2025 filing.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 96384MO0220016-06 (94% 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%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Chiropractic visits beyond 26 per benefit period require Prior Authorization.

Exclusions: nan

Diabetes Education

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

nan

Exclusions: nan

Home Health Care Services

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

Limit: 100.0 Visit(s) per Benefit Period

To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis.

Exclusions: nan

Laboratory Outpatient and Professional Services

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

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

nan

Exclusions: nan

Preventive Care/Screening/Immunization

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

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

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

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

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

Limit: 20.0 Visit(s) per Benefit Period

20 visit limit each for PT and OT.

Exclusions: nan

Rehabilitative Speech Therapy

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

Unlimited visits for speech therapy.

Exclusions: nan

Specialist Visit

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

nan

Exclusions: nan

Urgent Care Centers or Facilities

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

nan

Exclusions: nan

X-rays and Diagnostic Imaging

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

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

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

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

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

nan

Exclusions: nan

Dialysis

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

Covered Services include dialysis treatments in an outpatient dialysis, or home dialysis and training for you and the person who will help you with home self-dialysis.

Exclusions: nan

Durable Medical Equipment

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

nan

Exclusions: nan

Emergency Room Services

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

nan

Exclusions: nan

Emergency Transportation/Ambulance

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

nan

Exclusions: nan

Hospice Services

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

nan

Exclusions: nan

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

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

nan

Exclusions: nan

Inpatient Physician and Surgical Services

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

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

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

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

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

Limit: 2.0 Visit(s) per Benefit Period

Out-of-network benefits available include two sessions per year for the purpose of diagnosis or assessment of mental health.

Exclusions: nan

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

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

nan

Exclusions: nan

Outpatient Rehabilitation Services

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

Limit: 20.0 Visit(s) per Benefit Period

To be Covered Services, rehabilitation services must involve goals you can reach in a reasonable period of time. Benefits will end when treatment is no longer Medically Necessary and you stop progressing toward those goals.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

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

nan

Exclusions: nan

Radiation

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

nan

Exclusions: nan

Skilled Nursing Facility

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

Limit: 150.0 Days per Benefit Period

Limit is for in-and out-of-network combined and includes rehab and outpatient day rehab.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

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

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

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

nan

Exclusions: nan

Transplant

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

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

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

nan

Exclusions: nan

Hearing Aids

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

Benefits include hearing aids provided to a newborn for initial amplification following a newborn hearing screening.

Exclusions: nan

Major Dental Care - Child

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

nan

Exclusions: nan

Prenatal and Postnatal Care

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

nan

Exclusions: nan

Routine Eye Exam for Children

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

Limit: 1.0 Exam(s) per Benefit Period

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

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

nan

Exclusions: nan

Non-Preferred Brand Drugs

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

nan

Exclusions: nan

Preferred Brand Drugs

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

nan

Exclusions: nan

Specialty Drugs

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

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

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

Treatment must begin within 12 months of the injury.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

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

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

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

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

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

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

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

Limit: 1.0 Procedure(s) per Lifetime

nan

Exclusions: nan

Prosthetic Devices

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

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

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

Limit: 1.0 Item(s) per Year

Covered lenses and frames each available at limit of one per year.

Exclusions: nan

Gender Affirming Care

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

nan

Exclusions: nan

Habilitation Services

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

Limit: 20.0 Visit(s) per Benefit Period

Habilitative services definition: 'help you keep, learn or improve skills and functioning for daily living.'

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

20.00%
Tier 1 in-network 20.00%
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

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

Limit: 82.0 Visit(s) per Benefit Period

Private duty nursing services are a Covered Service only when given as part of the 'Home Care Services' benefit. Private Duty Lifetime Maximum: 164 visits In- and Out-of-Network combined.

Exclusions: nan

Reconstructive Surgery

20.00%
Tier 1 in-network 20.00%
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

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

Coverage is available if Medically Necessary.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

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

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services.

Exclusions: nan

Variant attributes

Cox HealthPlans Silver Preferred $3,500 Deductible · Variant 96384MO0220016-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

96384MO022

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

96384MO0220016-06

Plan Marketing Name

Cox HealthPlans Silver Preferred $3,500 Deductible

Plan Variant Marketing Name

Cox HealthPlans Silver Preferred $0 Deductible

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

96384

Issuer Marketplace Marketing Name

Cox HealthPlans

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MON002

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

MOS002

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

0.941661801177482

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

$1,500

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$900

SBC Scenario, Having Diabetes, Copayment

$40

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$600

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

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

$3000 per group

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

$1500 per person

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

$1,500

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

20.00%

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

$3000 per group

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

$1500 per person

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

$1,500

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

MOF009

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

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-01-10 00:01:52

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

Source Name

HIOS

Plan ID

96384MO0220016

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

$0 per group

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

$0 per person

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

$0

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

$0 per group

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

$0 per person

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

$0

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 Missouri?

Cox HealthPlans Silver Preferred $3,500 Deductible (96384MO0220016) is a Silver EPO from Cox Health Systems 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 Cox HealthPlans Silver Preferred $3,500 Deductible 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 Cox HealthPlans Silver Preferred $3,500 Deductible 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 Cox HealthPlans Silver Preferred $3,500 Deductible support mail-order prescriptions?

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

Is there out-of-country coverage for Cox HealthPlans Silver Preferred $3,500 Deductible?

No, out-of-country services are not covered for this plan.

Does Cox HealthPlans Silver Preferred $3,500 Deductible cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

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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