Ohio health plan · 2026

Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness · 77552OH0020218

CareSource offers this marketplace health insurance plan (Plan ID 77552OH0020218) 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: 94% AV Level Silver Plan Issuer: CareSource
Telehealth Data pending HSA eligible No Dental Not listed Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 94.04% (5.96% 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

$334 – $1882

Before subsidies

Estimate after subsidies

Deductible

$250

$500 per group

See deductible details

Max out-of-pocket

$1,100

$2200 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $10.00
HSA Not eligible

Drug tiers

Generic $3.00
Preferred brand $30.00

View formulary tiers

$457 / mo before subsidies

≈ $5485 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.

$1829 / mo before subsidies

≈ $21944 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.

$2208 / mo before subsidies

≈ $26493 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.

$1414 / mo before subsidies

≈ $16971 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

10.00% Coinsurance after deductible

Durable Medical Equipment

15.00% 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 Ohio). 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

10.00% Coinsurance after deductible

Durable Medical Equipment

15.00% 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 77552OH0020218
Coverage year 2026
State Ohio
Issuer CareSource
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 77552OH0020218-06
Available variants

Standard Off Exchange Plan · 77552OH0020218-00

Standard On Exchange Plan · 77552OH0020218-01

Open to Indians below 300% FPL · 77552OH0020218-02

Open to Indians above 300% FPL · 77552OH0020218-03

73% AV Silver Plan · 77552OH0020218-04

87% AV Silver Plan · 77552OH0020218-05

94% AV Silver Plan · 77552OH0020218-06
Last plan update Wed, 15 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 Ohio 74163
PCPs in Ohio 10659
Telehealth support Data pending
Nationwide providers 99976
74,163 doctors statewide 10,659 PCPs 335 OB/GYN

Provider network(s)

Providers Ohio All US states
All 74163 99976
PCP 10659 14379
Allergy 26 32
OB/GYN 335 445
Dentists 128 148

Drug coverage overview

4,242 drugs tracked

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

Tier Covered drugs
GENERIC 2,735
NON-PREFERRED-BRAND 572
MEDICAL-SERVICE-DRUGS 560
SPECIALTY-DRUGS 375
Prior authorization Drugs
Required 778
Not Required 3,464
Step therapy Drugs
Required 226
Not Required 4,016
Quantity limits Drugs
Has Limit 1,389
No Limit 2,853

Customer highlights

What stands out for members

  • Issuer: CareSource · Plan ID 77552OH0020218 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 77552OH0020218-06 (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

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

Limit: 12.0 Visit(s) per Year

For limits, See Outpatient Rehabilitation Services and Habilitation Services

Diabetes Education

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Diabetes Self-Management Training for an individual with insulin dependent diabetes, non-insulin dependent diabetes, or elevated blood glucose levels induced by pregnancy or another medical condition.

Home Health Care Services

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 100.0 Visit(s) per Year

When therapy services are provided in the home (including physical, speech, and occupational therapy) as part of home health care services, they are not subject to separate visit limits for therapy services. The 100 visit/year limit is also not applicable to home infusion therapy or private duty nursing rendered in the home setting. One visit equals at least 4 hours.

Laboratory Outpatient and Professional Services

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

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00
Tier 1 in-network $0.00
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

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

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

Occupational Therapy is limited to 20 visits per benefit period, and Physical Therapy is limited to a separate 20 visits per benefit period.

Rehabilitative Speech Therapy

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

Limit: 20.0 Visit(s) per Year

Specialist Visit

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$15.00
Tier 1 in-network $15.00
Out-of-network $15.00

X-rays and Diagnostic Imaging

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

$150.00 Copay after deductible
Tier 1 in-network $150.00 Copay after deductible
Out-of-network 100.00%

Coverage for the Inpatient postpartum stay for mother and newborn child in a hospital will be, at a minimum, 48 hours for a vaginal delivery and 96 hours for a cesarean section.

Dialysis

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Benefits include supportive use of an artificial kidney machine.

Durable Medical Equipment

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Covered services include durable medical equipment, medical devices and supplies, prosthetics and appliances, including cochlear implants and eyeglasses/contact lenses (for cataract surgery or injury), and medical/surgical supplies and equipment that serve only a medical purpose for the management of disease. Benefit limits: Wigs are limited to the first one following cancer treatment not to exceed one per Benefit Period; limit of four (4) surgical bras following mastectomy per benefit period; (as required by the Women's Health and Cancer Rights Act); Left Ventricular Artificial Devices (LVAD) covered only as bridge to heart transplant.

Emergency Room Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 10.00% Coinsurance after deductible

Emergency Transportation/Ambulance

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 15.00% Coinsurance after deductible

Ambulance transports must be made to the closest local facility that can provide you with covered services appropriate for your medical condition.

Hospice Services

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

To be eligible for Hospice benefits, the patient must have a life expectancy of six months or less, as confirmed by the attending Physician.

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

$150.00 Copay per Stay after deductible
Tier 1 in-network $150.00 Copay per Stay after deductible
Out-of-network 100.00%

There are specific exceptions to certain exclusions and/or additional exclusions that are detailed in plan document; inpatient hospital services include charges from a hospital, skilled nursing facility or other provider for room, board, general nursing services; and ancillary (related) services.

Inpatient Physician and Surgical Services

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

There are specific exceptions to certain exclusions and/or additional exclusions that are detailed in plan document; inpatient medical care visits limited to one visit per day by any one physician.

Mental/Behavioral Health Inpatient Services

$150.00 Copay per Stay after deductible
Tier 1 in-network $150.00 Copay per Stay after deductible
Out-of-network 100.00%

Coverage and limits must comply with state mandates and the parity standards set forth in the federal Mental Health Parity and Addiction Equity Act of 2008.

Mental/Behavioral Health Outpatient Services

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

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

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

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

See specific exceptions to these exclusions and/or additional exclusions that are detailed in plan document; benefits for facility charges for Outpatient Services are payable for the removal of teeth or for other dental processes only if the patient's medical condition or the dental procedure requires a Hospital setting to ensure the safety of the patient

Outpatient Rehabilitation Services

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Physical, Occupational and Speech Therapy limited to 20 visits each. \n\nPulmonary Therapy limited to 20 visits, except if rendered as part of Physical Therapy, the Physical Therapy visit limit will apply. \n\nCardiac Rehabilitation limited to 36 visits. \n\nCognitive Therapy limited to 20 visits.\n\nManipulation Therapy is limited to 12 visits. \n\nPost Cochlear Rehabilitation limited to 30 visits.\n\nBenefit also includes Physical Medicine and Rehabilitation Day Rehabilitation Therapy services on an Outpatient basis. Limited to a combined 60 days per Benefit Period maximum for both Inpatient and outpatient day rehabilitation therapy services.\n\nPhysical and Manipulation Therapy is covered when performed by a chiropractor.\n

Outpatient Surgery Physician/Surgical Services

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

See specific exceptions to these exclusions and/or additional exclusions that are detailed in plan document.

Radiation

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 90.0 Days per Year

Benefits include Items and services provided as an inpatient in a skilled nursing bed of skilled nursing facility or hospital, including room and board in semi-private accommodations; rehabilitative services; and drugs, biologicals, and supplies furnished for use in the skilled nursing facility and other medically necessary services and supplies. 90 days per year in a Skilled Nursing Facility. 60 days per year in an Inpatient Rehabilitation Facility.

Substance Abuse Disorder Inpatient Services

$150.00 Copay per Stay after deductible
Tier 1 in-network $150.00 Copay per Stay after deductible
Out-of-network 100.00%

Coverage and limits must comply with state mandates and the parity standards set forth in the federal Mental Health Parity and Addiction Equity Act of 2008.

Substance Abuse Disorder Outpatient Services

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

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Transplant

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Includes coverage for unrelated donor search services ($30,000 per transplant/network & Non network combined) and travel/lodging as approved by the plan ($10,000 per transplant/network & Non network combined). Transplant benefits apply to any medically necessary human organ and stem cell/bone marrow transplants (except cornea and kidney transplants) and transfusions including necessary acquisition procedures, harvest and storage, necessary preparatory myeloablative therapy, and initial evaluation/testing to determine eligibility as a transplant candidate. Covered the same as office visits, inpatient services, and outpatient services.

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

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

1 Hearing aid per hearing impaired ear every 48 months for members 21 years and younger up to $2500 limit

Major Dental Care - Child

Coverage details pending

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

Prenatal and Postnatal Care

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Includes post-delivery follow-up care performed, by a physician or nurse, within 72 hours of discharge, through home health care visits or, at patient's discretion, in a medical setting. This coverage includes, but is not limited to parent education; assistance and training in breast or bottle feeding; and routine maternal or neonatal tests and screening (including collection of sample for hereditary and metabolic newborn screening).

Routine Eye Exam for Children

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

Limit: 1.0 Exam(s) per Year

Coverage includes benefits specified in the FEDVIP FEP Blue Vision - High Option plan, including low vision benefits.

Well Baby Visits and Care

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

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Out-of-network 100.00%

Must comply with Regulations at 45 C.F.R. 156.122, providing coverage for at least the greater of (1) one drug in every USP category and class, or (2) the same number of prescription drugs in each USP category and class as the state's EHB-benchmark plan; coverage must be provided at no cost sharing for over the counter drugs, stop smoking aids, and nutritional or dietary supplements that are required to be covered under the Preventive/Screening/Immunization benefits. $0 Chronic Care Drugs & Services generally related to the heart - see plan brochure for more details. \n

Non-Preferred Brand Drugs

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

Must comply with Regulations at 45 C.F.R. 156.122, providing coverage for at least the greater of (1) one drug in every USP category and class, or (2) the same number of prescription drugs in each USP category and class as the state's EHB-benchmark plan; coverage must be provided at no cost sharing for over the counter drugs, stop smoking aids, and nutritional or dietary supplements that are required to be covered under the Preventive/Screening/Immunization benefits.

Preferred Brand Drugs

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

Must comply with Regulations at 45 C.F.R. 156.122, providing coverage for at least the greater of (1) one drug in every USP category and class, or (2) the same number of prescription drugs in each USP category and class as the state's EHB-benchmark plan; coverage must be provided at no cost sharing for over the counter drugs, stop smoking aids, and nutritional or dietary supplements that are required to be covered under the Preventive/Screening/Immunization benefits.

Specialty Drugs

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

Must comply with Regulations at 45 C.F.R. 156.122, providing coverage for at least the greater of (1) one drug in every USP category and class, or (2) the same number of prescription drugs in each USP category and class as the state's EHB-benchmark plan; coverage must be provided at no cost sharing for over the counter drugs, stop smoking aids, and nutritional or dietary supplements that are required to be covered under the Preventive/Screening/Immunization benefits.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 3000.0 Dollars per Episode

Quantitative Limit represents established actuarial equivalent of benchmark plan annual dollar limits. Annual and lifetime dollar limits will no longer apply. Coverage for dental services resulting from an accidental injury when treatment is performed within 12 months after the injury. The benefit limit will not apply to outpatient facility charges, anesthesia billed by a provider other than the physician performing the service, or to covered services required by law; coverage includes oral examinations, x-rays, tests and laboratory examinations, restorations, prosthetic services, oral surgery, mandibular/maxillary reconstruction, anesthesia and include facility charges for outpatient services for the removal of teeth or for other dental processes if the patient's medical condition or the dental procedure requires a hospital setting to ensure the safety of the patient.

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

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Home IV therapy includes but is not limited to: injections (intra-muscular, subcutaneous, continuous subcutaneous), Total Parenteral Nutrition (TPN), Enteral nutrition therapy, antibiotic therapy, pain management and chemotherapy.

Major Dental Care - Adult

Coverage details pending

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

Nutritional Counseling

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Covered benefit under home health services and covered as USPSTF A or B recommendation under preventive health services (includes diet counseling for adults at higher risk for chronic disease, obesity screening and counseling for all adults, and healthy diet counseling for adults with cardiovascular risk factors).

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

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Prosthetic appliance must replace all or part of a missing body part and its adjoining tissues or part of the function of a permanently useless or malfunctioning body part.

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

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

Cost share is driven by the place of service.

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

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

Limit: 1.0 Item(s) per Year

Limited to one pair of glasses or one year supply of contact lenses per year.

Habilitation Services

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

Physical, Occupational, and Speech Therapy limited to 20 visits each. \n\nOccupational and Speech Therapy for Autism Spectrum Disorder is limited to 20 visits each. \n\nPhysical Therapy is covered when performed by a chiropractor.

Imaging (CT/PET Scans, MRIs)

$175.00 Copay after deductible
Tier 1 in-network $175.00 Copay after deductible
Out-of-network 100.00%

Infertility Treatment

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility and voluntary family planning services are required benefits under state law for HMO plans only per ORC section 1751.01 (A)(1)(h), and must be provided in accordance with Ohio Department of Insurance Bulletin No. 2009-07.

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

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 100.0 Visit(s) per Year

Private Duty Nursing Services are Covered Services only when provided through the Home Care Services benefit; Quantitative Limit has been determined as 90 - 110 visits per year and represents the number of visits to meet the established actuarial equivalent of benchmark plan annual dollar limits. Annual and lifetime dollar limits will no longer apply.

Reconstructive Surgery

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% 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. Benefits include surgery performed to restore symmetry after a mastectomy.

Routine Eye Exam (Adult)

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

Limit: 1.0 Exam(s) per Year

Routine Foot Care

Coverage details pending

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

Treatment for Temporomandibular Joint Disorders

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Benefits provided for temporomandibular (joint connecting the lower jaw to the temporal bone at the side of the head) and craniomandibular (head and neck muscle) disorders. Covered the same as office visits, inpatient services, and outpatient services.

Variant attributes

Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness · Variant 77552OH0020218-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

77552OH002

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

77552OH0020218-06

Plan Marketing Name

Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness

Plan Variant Marketing Name

Healthy Heart Silver 250 $0 Chronic Care Drugs & Services + Adult Vision & Fitness

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

77552

Issuer Marketplace Marketing Name

CareSource

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

OHN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Services Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency Services Only

Service Area ID

OHS002

State Code

OH

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.9404221348896992

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

$0

SBC Scenario, Having a Baby, Copayment

$300

SBC Scenario, Having a Baby, Deductible

$250

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$100

SBC Scenario, Having Diabetes, Deductible

$200

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$200

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$250

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

$2200 per group

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

$1100 per person

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

$1,100

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

15.00%

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

$2200 per group

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

$1100 per person

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

$1,100

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

OHF008

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

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, Pregnancy

EHB Percent of Total Premium

0.99216409

First Tier Utilization

100%

Import Date

10/15/2025

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

SERFF

Plan ID

77552OH0020218

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

$500 per group

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

$250 per person

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

$250

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

$500 per group

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

$250 per person

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

$250

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

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 Ohio?

Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness (77552OH0020218) is a Silver HMO from CareSource in Ohio 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 Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness 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 Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness 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: Adult, Child.

Does Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness 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 Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness?

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

Does Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness 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: Emergency Services Only

How do I enroll in or manage payments for Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness?

Use the issuer portal https://enroll.caresource.com to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

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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