Managed Care for Families and Individuals · 26250TX0070005
Guardian offers this marketplace health insurance plan (Plan ID 26250TX0070005) 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: LowPlan type: HMOCSR: Standard Low Off Exchange PlanIssuer: Guardian
Telehealth
Data pending
HSA eligible
Check with issuer
Dental
Adult/Child
Vision
Not listed
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 Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
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.
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 TexasN/A
PCPs in TexasN/A
Telehealth supportData pending
Nationwide providersN/A
N/A doctors statewideN/A PCPsN/A OB/GYN
Provider network(s)
['TXN001']
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: Guardian · Plan ID 26250TX0070005 · 2025 filing.
Variant 26250TX0070005-00 (Standard Off Exchange Plan) currently displayed.
Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
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Benefits
Covered services & limitations
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
$28.00
Tier 1 in-network$28.00
Out-of-network100.00%
Patient charge listed is a sample copayment of basic service D2140 (Amalgam - one surface, primary or permanent). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.
Exclusions: nan
Major Dental Care - Child
$326.00
Tier 1 in-network$326.00
Out-of-network100.00%
Patient charge listed is a sample copayment of major service D2510 (Inlay - metallic - one surface). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.
Patient charge listed is a sample copayment of basic service D2140 (Amalgam - one surface, primary or permanent). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.
Exclusions: nan
Dental Check-Up for Children
$0.00
Tier 1 in-network$0.00
Out-of-network100.00%
Patient charge listed is a sample copayment of preventive service D0120 (Periodic oral evaluation - established patient). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.
Exclusions: nan
Major Dental Care - Adult
$326.00
Tier 1 in-network$326.00
Out-of-network100.00%
Patient charge listed is a sample copayment of major service D2510 (Inlay - metallic - one surface). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.
Exclusions: nan
Orthodontia - Adult
$2,800.00
Tier 1 in-network$2,800.00
Out-of-network100.00%
Patient charge listed is a sample copayment of orthodontic service D8090 (Comprehensive orthodontic treatment of the adult dentition). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.
Exclusions: nan
Orthodontia - Child
$425.00
Tier 1 in-network$425.00
Out-of-network100.00%
Patient charge listed is a sample copayment of orthodontic service for D8080 (Comprehensive orthodontic treatment of the adolescent dentition) and is for when orthodontic treatment is deemed medically necessary as defined by your state's Pediatric Essential Benefits benchmark definition. The Pediatric Essential Benefits orthodontic coverage does not include cosmetic treatment. Plan documents are the final arbiter of coverage.
Exclusions: nan
Routine Dental Services (Adult)
$0.00
Tier 1 in-network$0.00
Out-of-network100.00%
Patient charge listed is a sample copayment of preventive service D0120 (Periodic oral evaluation - established patient). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.
Exclusions: nan
Variant attributes
Managed Care for Families and Individuals · Variant 26250TX0070005-00
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard Low Off Exchange Plan
HIOS Product ID
26250TX007
Metal Level
Low
Plan ID (Standard Component ID with Variant)
26250TX0070005-00
Plan Marketing Name
Managed Care for Families and Individuals
Plan Variant Marketing Name
Managed Care for Families and Individuals
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
26250
Issuer Marketplace Marketing Name
Guardian
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
No
Network ID
TXN001
Out of Country Coverage
No
Out of Service Area Coverage
No
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
per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out
Not Applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group
$850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person
$425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual
$425
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
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.
