Oklahoma health plan · 2026

MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) · 58944OK0010006

Taro Health Inc. offers this marketplace health insurance plan (Plan ID 58944OK0010006) 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: Gold Plan type: HMO CSR: Standard Gold Off Exchange Plan Issuer: Taro Health Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 81.76% (18.24% 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

$414 – $1742

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$8,800

$17600 per group

Review MOOP rules

Office visits

Primary care No Charge
Specialist $35.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $50.00

View formulary tiers

$609 / mo before subsidies

≈ $7304 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.

$1837 / mo before subsidies

≈ $22045 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.

$2246 / mo before subsidies

≈ $26958 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.

$1393 / mo before subsidies

≈ $16713 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

No Charge

Emergency Room Services

50.00%

Durable Medical Equipment

50.00%

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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 Oklahoma). 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 Gold 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.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

50.00%

Durable Medical Equipment

50.00%

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 58944OK0010006
Coverage year 2026
State Oklahoma
Issuer Taro Health Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 58944OK0010006-00
Available variants

Standard Off Exchange Plan · 58944OK0010006-00

Standard On Exchange Plan · 58944OK0010006-01

Open to Indians below 300% FPL · 58944OK0010006-02

Open to Indians above 300% FPL · 58944OK0010006-03
Last plan update Wed, 29 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 Oklahoma 16195
PCPs in Oklahoma 2387
Telehealth support Data pending
Nationwide providers 20948
16,195 doctors statewide 2,387 PCPs 71 OB/GYN

Provider network(s)

Providers Oklahoma All US states
All 16195 20948
PCP 2387 2596
Allergy 7 7
OB/GYN 71 76
Dentists 26 28

Drug coverage overview

9,237 drugs tracked

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

Tier Covered drugs
PREFERRED-GENERIC 3,560
NON-PREFERRED-BRAND 2,985
SPECIALTY 2,217
ZERO-COST-SHARE-PREVENTIVE 475
Prior authorization Drugs
Required 2,575
Not Required 6,662
Step therapy Drugs
Required 234
Not Required 9,003
Quantity limits Drugs
Has Limit 0
No Limit 9,237

Customer highlights

What stands out for members

  • Issuer: Taro Health Inc. · Plan ID 58944OK0010006 · 2026 filing.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 58944OK0010006-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

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

Limit: 30.0 Visit(s) per Benefit Period

Chiropractic Care limit is combined with Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Diabetes Education

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

Home Health Care Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Laboratory Outpatient and Professional Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

Preventive Care/Screening/Immunization

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

Primary Care Visit to Treat an Injury or Illness

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

Rehabilitative Occupational and Rehabilitative Physical Therapy

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

Limit: 30.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Rehabilitative Speech Therapy

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

Limit: 30.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Specialist Visit

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

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

X-rays and Diagnostic Imaging

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Dialysis

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Durable Medical Equipment

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Emergency Room Services

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

Emergency Transportation/Ambulance

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

Services are only covered if medically necessary

Hospice Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization required.

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

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Inpatient Physician and Surgical Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Mental/Behavioral Health Inpatient Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. Prior authorization required.

Mental/Behavioral Health Outpatient Services

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

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.

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

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Outpatient Rehabilitation Services

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

Limit: 30.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Outpatient Surgery Physician/Surgical Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Radiation

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Skilled Nursing Facility

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 30.0 Days per Benefit Period

Prior authorization required.

Substance Abuse Disorder Inpatient Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. Prior authorization required.

Substance Abuse Disorder Outpatient Services

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

Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.

Transplant

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

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

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

One hearing aid per ear every 48 months up to the last day of the month when the child turns age 19.

Major Dental Care - Child

Coverage details pending

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

Prenatal and Postnatal Care

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Routine Eye Exam for Children

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

Limit: 1.0 Exam(s) per Year

One eye exam every 12 months from last date of service.

Well Baby Visits and Care

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

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs. Insulin will not exceed $30 for a 30-day supply and $90 for a 90-day supply.

Non-Preferred Brand Drugs

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

Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs. Insulin will not exceed $30 for a 30-day supply and $90 for a 90-day supply.

Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Up to 30-day supply Retail and up to 90-day supply Retail & Mail Order, except narcotics and Specialty Drugs. Insulin will not exceed $30 for a 30-day supply and $90 for a 90-day supply.

Specialty Drugs

$200.00
Tier 1 in-network $200.00
Out-of-network 100.00%

Up to 30-day supply Retail only.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

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

Limit: 2.0 Visit(s) per Year

Infusion Therapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Covered under Outpatient Therapy Services.

Major Dental Care - Adult

Coverage details pending

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

Nutritional Counseling

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

Diabetes self-management training and training related to medical nutrition therapy.

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

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required

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

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Issuer clarifies this is a covered benefit but stipulated under the Medical Policy and not written in the member materials.

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

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

Limit: 1.0 Item(s) per Year

Habilitation Services

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

Limit: 30.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Imaging (CT/PET Scans, MRIs)

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior authorization may be required.

Infertility Treatment

Coverage details pending

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

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

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 85.0 Visit(s) per Benefit Period

Prior authorization required.

Reconstructive Surgery

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.

Routine Eye Exam (Adult)

Coverage details pending

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

Routine Foot Care

Coverage details pending

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

Treatment for Temporomandibular Joint Disorders

Coverage details pending

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

Variant attributes

MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) · Variant 58944OK0010006-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Gold Off Exchange Plan

HIOS Product ID

58944OK001

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

58944OK0010006-00

Plan Marketing Name

MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health)

Plan Variant Marketing Name

MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

58944

Issuer Marketplace Marketing Name

Mending Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

OKN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Emeregency Services Only

Service Area ID

OKS001

State Code

OK

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.817613922

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

$5,000

SBC Scenario, Having a Baby, Copayment

$50

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$500

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$1,000

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

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

$17600 per group

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

$8800 per person

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

$8,800

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

30.00%

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

$17600 per group

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

$8800 per person

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

$8,800

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

OKF005

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

First Tier Utilization

100%

Import Date

10/29/2025

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

HIOS

Plan ID

58944OK0010006

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 Oklahoma?

MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) (58944OK0010006) is a Gold HMO from Taro Health Inc. in Oklahoma 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 MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) 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 MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) 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: Child.

Does MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) 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 MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health)?

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

Does MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Emeregency Services Only

How do I enroll in or manage payments for MENDING Direct Primary Care Gold $0 Ded ($0 DPC $0 PCP + $0 Mental Health)?

Use the issuer portal https://enroll.mending.com/ehp/eapp/samlpaymentacs 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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