Texas health plan · 2025

EMI Health Advantage Co-Pay · 91476TX0010003

EMI Health offers this marketplace plan (Plan ID 91476TX0010003). Use the modules below to compare premiums, coverage structure, provider access, and formulary context against alternative options in the same market.

Metal level: Low Plan type: PPO CSR: Standard Low On Exchange Plan Issuer: EMI Health
Telehealth Data pending HSA eligible Check with issuer Dental Adult/Child Vision Not listed
Pay / Manage Plan View issuer site

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 10 Mar 2026 06:40 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$18 – $23

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

N/A

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

$18 / mo before subsidies

≈ $215 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.

$63 / mo before subsidies

≈ $751 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.

$84 / mo before subsidies

≈ $1010 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.

$41 / mo before subsidies

≈ $492 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
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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 Texas). 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 Low On 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.

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 91476TX0010003
Coverage year 2025
State Texas
Issuer EMI Health
Marketing materials View marketing kit
Variant ID 91476TX0010003-01
Available variants

Standard On Exchange Plan · 91476TX0010003-01
Last plan update Sat, 11 Jan 2025 00:00 GMT
Last HealthPorta import Tue, 10 Mar 2026 06:40 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, 10 Mar 2026 06:40 GMT).

All providers in Texas N/A
PCPs in Texas N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['TXN002']

Providers Texas 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

0 drugs tracked

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

Prior authorization Drugs
Required 0
Not Required 0
Step therapy Drugs
Required 0
Not Required 0
Quantity limits Drugs
Has Limit 0
No Limit 0

Customer highlights

What stands out for members

  • Issuer: EMI Health · Plan ID 91476TX0010003 · 2025 filing.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 91476TX0010003-01 (Standard On Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

$91.00 Copay after deductible
Tier 1 in-network $91.00 Copay after deductible
Out-of-network $222.00 Copay after deductible

Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: Space Maintainers not covered after the end of the month the enrollee turns age 19.

Major Dental Care - Child

$93.00 Copay after deductible
Tier 1 in-network $93.00 Copay after deductible
Out-of-network $209.00 Copay after deductible

Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: Anesthesia is only covered when medically or dentally necessary. Implants not covered after the end of the month the enrollee turns age 19. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

nan

Exclusions: nan

Basic Dental Care - Adult

$86.00 Copay after deductible
Tier 1 in-network $86.00 Copay after deductible
Out-of-network $213.00 Copay after deductible

Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: Fillings on the same surface 1 every 18 months. Basic benefits covered after 6 month waiting period.

Dental Check-Up for Children

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network $27.00 Copay after deductible

Limit: 2.0 Visit(s) per Year

Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: nan

Major Dental Care - Adult

$227.00 Copay after deductible
Tier 1 in-network $227.00 Copay after deductible
Out-of-network $526.00 Copay after deductible

Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: Anesthesia only covered when medically or dentally necessary. Implants are not covered. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Waiting period applies.

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00%
Tier 1 in-network 50.00%
Out-of-network 50.00%

Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

Exclusions: Covered up to the end of the month the enrollee turns age 19.

Routine Dental Services (Adult)

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network $30.00 Copay after deductible

Limit: 2.0 Visit(s) per Year

Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.

Exclusions: nan

Variant attributes

EMI Health Advantage Co-Pay · Variant 91476TX0010003-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Low On Exchange Plan

HIOS Product ID

91476TX001

Metal Level

Low

Plan ID (Standard Component ID with Variant)

91476TX0010003-01

Plan Marketing Name

EMI Health Advantage Co-Pay

Plan Variant Marketing Name

EMI Health Advantage Co-Pay

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

91476

Issuer Marketplace Marketing Name

EMI Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

Yes

Network ID

TXN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the conditions outlined in the policy.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

PPO network or out-of-network coverage at PPO fee

Service Area ID

TXS001

State Code

TX

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group

$850 per group

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person

$425 per person

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out

$425

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

per group not applicable

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

per person not applicable

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

Not Applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Plan Brochure

Open link

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

Yes

EHB Apportionment for Pediatric Dental

0.925396418113433

First Tier Utilization

100%

Import Date

2025-01-11 00:01:52

Guaranteed Rate

Guaranteed Rate

New/Existing Plan

Existing

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

$150 per group

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

$50 per person

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

$50

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

per group not applicable

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

per person not applicable

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

Not Applicable

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

On the Exchange

Source Name

HIOS

Plan ID

91476TX0010003

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 Texas?

EMI Health Advantage Co-Pay (91476TX0010003) is a Low PPO from EMI Health in Texas 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 EMI Health Advantage Co-Pay 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 EMI Health Advantage Co-Pay HSA-eligible and does it include dental or vision coverage?

HSA eligibility is not published; check the Summary of Benefits or ask the issuer.

Dental add-ons: Adult, Child.

Vision coverage is not listed for this plan.

Does EMI Health Advantage Co-Pay 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 EMI Health Advantage Co-Pay?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the conditions outlined in the policy.

Does EMI Health Advantage Co-Pay 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: PPO network or out-of-network coverage at PPO fee

How do I enroll in or manage payments for EMI Health Advantage Co-Pay?

Use the issuer portal https://webpay.emihealth.com/pay-exchange to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 10 Mar 2026 06:40 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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