Mississippi health plan · 2025

Freedom Silver 4000 · 14624MS0010004

Primewell Health Services of Mississippi, Inc. offers this marketplace health insurance plan (Plan ID 14624MS0010004) 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: POS CSR: Zero Cost Sharing Plan Variation Issuer: Primewell Health Services of Mississippi, Inc.
Telehealth Data pending HSA eligible No Dental Adult/Child Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 100.00% (0.00% 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

$271 – $1290

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00, 0.00%
Specialist $0.00, 0.00%
HSA Not eligible

Drug tiers

Generic $0.00, 0.00%
Preferred brand $0.00, 0.00%

View formulary tiers

$451 / mo before subsidies

≈ $5408 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.

$1372 / mo before subsidies

≈ $16467 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.

$1618 / mo before subsidies

≈ $19414 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.

$1099 / mo before subsidies

≈ $13190 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, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

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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 Mississippi). 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.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

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 14624MS0010004
Coverage year 2025
State Mississippi
Issuer Primewell Health Services of Mississippi, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 14624MS0010004-02
Available variants

Standard Off Exchange Plan · 14624MS0010004-00

Standard On Exchange Plan · 14624MS0010004-01

Open to Indians below 300% FPL · 14624MS0010004-02

Open to Indians above 300% FPL · 14624MS0010004-03

73% AV Silver Plan · 14624MS0010004-04

87% AV Silver Plan · 14624MS0010004-05

94% AV Silver Plan · 14624MS0010004-06
Last plan update Sat, 11 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 Mississippi 3597
PCPs in Mississippi 546
Telehealth support Data pending
Nationwide providers 75158
3,597 doctors statewide 546 PCPs 18 OB/GYN

Provider network(s)

Providers Mississippi All US states
All 3597 75158
PCP 546 3095
Allergy N/A 8
OB/GYN 18 134
Dentists 47 211

Drug coverage overview

4,796 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 2,859
NON-PREFERRED-BRAND 1,033
SPECIALTY 885
ZERO-COST-SHARE-PREVENTIVE 19
Prior authorization Drugs
Required 772
Not Required 4,024
Step therapy Drugs
Required 18
Not Required 4,778
Quantity limits Drugs
Has Limit 2,121
No Limit 2,675

Customer highlights

What stands out for members

  • Issuer: Primewell Health Services of Mississippi, Inc. · Plan ID 14624MS0010004 · 2025 filing.
  • Disease management programs available: Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 14624MS0010004-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

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

Limit: 20.0 Visit(s) per Year

Must be medically necessary. A treatment plan outlining goals of therapy, mode of therapy and duration of therapy must be submitted to Company by the provider prior to the initiation of treatment. The 20 visit limit is combined for chiropractic services, occupational therapy, and physical therapy.

Exclusions: nan

Diabetes Education

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

nan

Exclusions: nan

Home Health Care Services

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

May be available through the Care Management Program when provided by a network provider and prior authorization is received.

Exclusions: nan

Laboratory Outpatient and Professional Services

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

Lab services in the Emergency Room are subject to the deductible, if applicable.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

Quantitative limits depend on the type of visit.

Exclusions: nan

Preventive Care/Screening/Immunization

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

Covered services must be included in Grade A and B Recommendations of the USPSTF and include all other preventive health services required by PPACA.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

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

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

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

Limit: 20.0 Visit(s) per Year

The 20 visit limit is combined for chiropractic services, occupational therapy, and physical therapy.

Exclusions: nan

Rehabilitative Speech Therapy

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

Limit: 20.0 Visit(s) per Year

Not covered for learning disabilities and development problems.

Exclusions: nan

Specialist Visit

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

nan

Exclusions: nan

Urgent Care Centers or Facilities

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

nan

Exclusions: nan

X-rays and Diagnostic Imaging

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

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

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

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

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

Minimum stay of 48 hours; no charge for professional services

Exclusions: nan

Dialysis

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

nan

Exclusions: nan

Durable Medical Equipment

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

Various limitations apply

Exclusions: nan

Emergency Room Services

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

The ER Copay is waived if the visit results in an inpatient admission.

Exclusions: nan

Emergency Transportation/Ambulance

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

Air ambulance services are covered in only specified situations.

Exclusions: nan

Hospice Services

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

Limit: 6.0 Months per Lifetime

Subject to Care Management.

Exclusions: nan

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

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

Copays, if applicable, are per day for first three days only.

Exclusions: nan

Inpatient Physician and Surgical Services

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

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

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

Inpatient treatment for mental/behavioral health disorders must be Authorized

Exclusions: nan

Mental/Behavioral Health Outpatient Services

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

nan

Exclusions: nan

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

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

nan

Exclusions: nan

Outpatient Rehabilitation Services

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

Limit: 36.0 Visit(s) per Year

Benefits available for outpatient cardiac rehabilitation.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

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

nan

Exclusions: nan

Radiation

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

Must be medically necessary. Company may require a treatment plan, outlining the goals of therapy, mode of therapy, and duration of therapy, to be submitted by the provider prior to the initiation of treatment.

Exclusions: nan

Skilled Nursing Facility

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

Limit: 30.0 Days per Benefit Period

Three-day prior inpatient stay

Exclusions: nan

Substance Abuse Disorder Inpatient Services

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

Inpatient treatment for substance abuse must be Authorized

Exclusions: nan

Substance Abuse Disorder Outpatient Services

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

nan

Exclusions: nan

Transplant

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

Non-EHB and out-of-network transplant services not covered

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

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

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

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

nan

Exclusions: nan

Prenatal and Postnatal Care

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

nan

Exclusions: nan

Routine Eye Exam for Children

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

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

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

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

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

Quantity limits, authorizations and step therapy limits may apply.

Exclusions: nan

Non-Preferred Brand Drugs

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

Quantity limits, authorizations and step therapy limits may apply.

Exclusions: nan

Preferred Brand Drugs

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

Quantity limits, authorizations and step therapy limits may apply.

Exclusions: nan

Specialty Drugs

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

Specialty drugs may be limited to a thirty (30) day supply. Quantity limits, authorizations and step therapy limits may apply.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

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

nan

Exclusions: nan

Basic Dental Care - Adult

$0.00, No Charge
Tier 1 in-network $0.00, No Charge
Out-of-network $0.00, No Charge

An added benefit. Combined $1,000 maximum coverage per benefit period for Adult Basic and Major Dental Care.

Exclusions: nan

Dental Check-Up for Children

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

Limit: 2.0 Visit(s) per Year

nan

Exclusions: nan

Infusion Therapy

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

nan

Exclusions: nan

Major Dental Care - Adult

$0.00, No Charge
Tier 1 in-network $0.00, No Charge
Out-of-network $0.00, No Charge

An added benefit. Combined $1,000 maximum coverage per benefit period for Adult Basic and Major Dental Care.

Exclusions: nan

Nutritional Counseling

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

Limit: 4.0 Visit(s) per Year

Coverage only for diabetes education.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

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

Medically Necessary orthodontia only.

Exclusions: nan

Prosthetic Devices

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

Various limitations apply as stated in the Benchmark plan.

Exclusions: nan

Routine Dental Services (Adult)

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

Limit: 2.0 Visit(s) per Year

Covers exam and cleaning

Exclusions: nan

Weight Loss Programs

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

Vantage Weight Loss programs are covered as part of the Vantage Wellness Program.

Exclusions: Non-Vantage Weight Loss programs are excluded.

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

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

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

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

Limit: 1.0 Item(s) per Benefit Period

nan

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

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

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.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

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

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

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

Plan only outlines benefits for breast reconstruction. Must be medically necessary and related to mastectomy.

Exclusions: nan

Routine Eye Exam (Adult)

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

Limit: 1.0 Visit(s) per Year

An added benefit

Exclusions: nan

Routine Foot Care

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

Limit: 1.0 Visit(s) per Year

Requires a Diabetes diagnosis.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

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

Medical necessity documentation and a treatment plan must be submitted to and approved by the Company prior to the commencement of treatment. Prior authorization is required.

Exclusions: nan

Variant attributes

Freedom Silver 4000 · Variant 14624MS0010004-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

14624MS001

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

14624MS0010004-02

Plan Marketing Name

Freedom Silver 4000

Plan Variant Marketing Name

Freedom Silver 4000 Zero

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

14624

Issuer Marketplace Marketing Name

Primewell Health Services of Mississippi

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MSN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Limited to Emergency Services only. Covered as in-network.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Out-of-Network Deductible and Co-insurance

Service Area ID

MSS001

State Code

MS

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1.0

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

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

0.00%

Inpatient Copayment Maximum Days

3

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

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

0.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

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

$0 per group

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

$0 per person

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

$0

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

$0 per group

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

$0 per person

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

$0

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

$0 per group

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

$0 per person

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

$0

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MSF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

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

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

$0 per group

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

$0 per person

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

$0

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

$0 per group

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

$0 per person

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

$0

Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Out of Network, Individual

$0

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Weight Loss Programs

EHB Percent of Total Premium

0.97776179

First Tier Utilization

100%

Import Date

2025-01-11 00:01:52

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

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

$0 per group

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

$0 per person

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

$0

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

$0 per group

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

$0 per person

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

$0

Medical EHB Deductible, Out of Network, Family Per Group

$0 per group

Medical EHB Deductible, Out of Network, Family Per Person

$0 per person

Medical EHB Deductible, Out of Network, Individual

$0

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

POS

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

14624MS0010004

Unique Plan Design

No

Wellness Program Offered

Yes

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 Mississippi?

Freedom Silver 4000 (14624MS0010004) is a Silver POS from Primewell Health Services of Mississippi, Inc. in Mississippi 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 Freedom Silver 4000 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 Freedom Silver 4000 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: Adult, Child.

Vision add-ons: Adult, Child.

Does Freedom Silver 4000 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 Freedom Silver 4000?

The issuer lists disease management resources for: Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Weight Loss Programs.

Is there out-of-country coverage for Freedom Silver 4000?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Limited to Emergency Services only. Covered as in-network.

Does Freedom Silver 4000 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: Out-of-Network Deductible and Co-insurance

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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