Alaska health plan · 2025

Premera Blue Cross Preferred Gold 1500 · 38344AK1060001

Premera Blue Cross Blue Shield of Alaska offers this marketplace health insurance plan (Plan ID 38344AK1060001) 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: PPO CSR: Limited Cost Sharing Plan Variation Issuer: Premera Blue Cross Blue Shield of Alaska
Telehealth Data pending HSA eligible No Dental Adult/Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 78.09%. Expect to pay roughly 21.91% of covered costs out of pocket, based on issuer reporting.

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

$566 – $2335

Before subsidies

Estimate after subsidies

Deductible

$1,500

$3000 per group

See deductible details

Max out-of-pocket

$6,300

$12600 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $60.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $45.00

View formulary tiers

$808 / mo before subsidies

≈ $9691 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.

$2536 / mo before subsidies

≈ $30426 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.

$3052 / mo before subsidies

≈ $36625 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.

$1970 / mo before subsidies

≈ $23635 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, No Charge

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

Advertisement

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 Alaska). 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.
  • Limited 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

No Charge, No Charge

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% 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 38344AK1060001
Coverage year 2025
State Alaska
Issuer Premera Blue Cross Blue Shield of Alaska
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 38344AK1060001-03
Available variants

Standard On Exchange Plan · 38344AK1060001-01

Open to Indians below 300% FPL · 38344AK1060001-02

Open to Indians above 300% FPL · 38344AK1060001-03
Last plan update Fri, 10 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 Alaska 10
PCPs in Alaska N/A
Telehealth support Data pending
Nationwide providers 115
10 doctors statewide

Provider network(s)

Providers Alaska All US states
All 10 115
PCP N/A 19
Allergy N/A N/A
OB/GYN N/A 1
Dentists 2 10

Drug coverage overview

9,376 drugs tracked

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

Tier Covered drugs
ACA-PREVENTIVE-DRUGS 6,236
PREFERRED-GENERIC-DRUGS 2,079
SPECIALTY-DRUGS 728
PREFERRED-BRAND-DRUGS 333
Prior authorization Drugs
Required 1,090
Not Required 8,286
Step therapy Drugs
Required 54
Not Required 9,322
Quantity limits Drugs
Has Limit 444
No Limit 8,932

Customer highlights

What stands out for members

  • Issuer: Premera Blue Cross Blue Shield of Alaska · Plan ID 38344AK1060001 · 2025 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 38344AK1060001-03 (Open to Indians above 300% FPL) currently displayed.
Advertisement

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
Tier 2 in-network $30.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 12.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Tier 2 in-network No Charge, No Charge
Out-of-network No Charge, No Charge

nan

Exclusions: nan

Home Health Care Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 130.0 Visit(s) per Year

130 visits per applies to home visits of a home health care provider or one or more: registered nurse; a licensed practical nurse; a licensed physical therapist or occupational therapist; a certified respiratory therapist; a speech therapist certified by the American Speech, Language, and Hearing Association; a home health aide directly supervised by one of the above providers; and a person with a master's degree in social work.

Exclusions: nan

Laboratory Outpatient and Professional Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $30.00
Out-of-network 60.00% Coinsurance after deductible

Covered only when the provider is licensed to practice where the care is provided, is providing a service within the scope of that license, is providing a service or supply for which benefits are specified in this plan, and when benefits would be payable if the services were provided by a physician.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Tier 2 in-network No Charge, No Charge
Out-of-network No Charge, 60.00% Coinsurance after deductible

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $30.00
Out-of-network 60.00% Coinsurance after deductible

The first two visits to a designated care provider (PCP) are subject to a $1 copay. Subsequent visits are subject to the PCP copay.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$60.00 Copay after deductible
Tier 1 in-network $60.00 Copay after deductible
Tier 2 in-network $60.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 45.0 Visit(s) per Year

Visit limit for physical, speech, and occupational therapy services combined.

Exclusions: nan

Rehabilitative Speech Therapy

$60.00 Copay after deductible
Tier 1 in-network $60.00 Copay after deductible
Tier 2 in-network $60.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 45.0 Visit(s) per Year

Visit limit for physical, speech, and occupational therapy services combined.

Exclusions: nan

Specialist Visit

$60.00
Tier 1 in-network $60.00
Tier 2 in-network $60.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Urgent Care Centers or Facilities

$60.00
Tier 1 in-network $60.00
Tier 2 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

X-rays and Diagnostic Imaging

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Dialysis

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Room Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

Air and Ground transpiration benefit is limited to medical emergency. Ambulance services is separate benefit, covers both medical emergency transport and non-emergent transport.

Exclusions: nan

Hospice Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 6.0 Months per Lifetime

Inpatient hospice care up to a maximum of 10 days. Respite care, up to a maximum of 240 hours, to relieve anyone who lives with and cares for the terminally ill member.

Exclusions: nan

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

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Physician and Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$60.00
Tier 1 in-network $60.00
Tier 2 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

The cost sharing that displays applies to outpatient office visits only. All other outpatient services (Outpatient Facility Fee, Laborartory Outpatient and Professional Services, etc.) may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

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

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

$60.00 Copay after deductible
Tier 1 in-network $60.00 Copay after deductible
Tier 2 in-network $60.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 45.0 Visit(s) per Year

A 'visit' is a session of treatment for each type of therapy. Each type of therapy combined accrues toward the above visit maximum. Multiple therapy sessions on the same day will be counted as 1 visit, unless provided by different health care providers.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Radiation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 60.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$60.00
Tier 1 in-network $60.00
Tier 2 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 75000.0 Dollars per Lifetime

Quantitative limit on Donor costs only. The types of solid organ transplants and bone marrow/stem cell reinfusion procedures that currently meet the plan's criteria for coverage are: Heart, Heart/double lung, single lung, Double lung, Liver, Kidney, Pancreas, Pancreas with kidney, Bone marrow (autologous and allogenic), Stem cell (autologous and allogeneic).

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

Limit: 4.0 Procedure(s) per Year

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per 3 Years

nan

Exclusions: nan

Prenatal and Postnatal Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam for Children

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

Limit: 1.0 Exam(s) per Year

Under age 19, 1 PCY; Over age 19 Not covered

Exclusions: nan

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Tier 2 in-network No Charge, No Charge
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

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

Limit: 90.0 Item(s) per Month

Up to 90 day supply Retail (copay times 3); 90 day supply for Mail order. This tier contains only Preferred Generic Drugs

Exclusions: nan

Non-Preferred Brand Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 90.0 Item(s) per Month

Up to 90 day supply Retail (copay times 3); 90 day supply for Mail order. This tier contains only non-preferred drugs.

Exclusions: nan

Preferred Brand Drugs

$45.00
Tier 1 in-network $45.00
Out-of-network $45.00

Limit: 90.0 Item(s) per Month

Up to 90 day supply Retail (copay times 3); 90 day supply for Mail order.

Exclusions: nan

Specialty Drugs

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

Limit: 30.0 Item(s) per Month

30 day supply Retail and Mail

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00% Coinsurance after deductible

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Tier 2 in-network No Charge, No Charge
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Prosthetic Devices

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Benefit limited to initial purchase of prosthetic; does not cover replacement unless the existing device can't be repaired, or replacement is prescribed by a physician because of a change in your physical condition.

Exclusions: nan

Routine Dental Services (Adult)

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00% Coinsurance after deductible

Limit: 2.0 Exam(s) per Year

Routine Exam - 2 PCY and Cleanings- 2 PCY; Routine X-rays (bitewing) - 1 PCY; Annual Maximum of $750 PCY

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Acupuncture

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $30.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 12.0 Visit(s) per Year

Services must be medically necessary to relieve pain, induce surgical anesthesia, or to treat a covered illness, injury or condition.

Exclusions: nan

Allergy Testing

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

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

Limit: 1.0 Item(s) per Year

Under age 19; 1 pair of frames and lenses PCY includes polycarbonate lenses and scratch resistent coating; 12 month supply of contacts in lieu of glasses; Over age 19 Not Covered

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$60.00 Copay after deductible
Tier 1 in-network $60.00 Copay after deductible
Tier 2 in-network $60.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 45.0 Visit(s) per Year

Habilitative services is only covered in the context of autism spectrum disorders services, including ABA, counseling and treatment programs necessary to develop, maintain, or restore the functioning of an individual.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Premera-Designated Centers of Excellence Program

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Breast reconstruction allowed.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Routine foot care when the member is a diabetic.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

Premera Blue Cross Preferred Gold 1500 · Variant 38344AK1060001-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

38344AK106

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

38344AK1060001-03

Plan Marketing Name

Premera Blue Cross Preferred Gold 1500

Plan Variant Marketing Name

Premera Blue Cross Preferred Gold 1500

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

78.09%

Issuer ID

38344

Issuer Marketplace Marketing Name

Premera Blue Cross Blue Shield of Alaska

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

AKN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under this plan.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

If you're outside Alaska and Washington (the service area), covered services received from any provider licensed to provide the service will be paid the out of network benefit level (except emergencies).

Service Area ID

AKS001

State Code

AK

URL for Summary of Benefits & Coverage

Open link

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

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$3,300

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,600

SBC Scenario, Having Diabetes, Deductible

$200

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$300

SBC Scenario, Treatment of a Simple Fracture, Copayment

$300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,500

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

30.00%

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

40.00%

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

$12600 per group

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

$6300 per person

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

$6,300

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$12600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$6300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$6,300

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

AKF001

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

2

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, Diabetes, Heart Disease

EHB Percent of Total Premium

0.9928

First Tier Utilization

95%

Import Date

2025-01-10 00:01:52

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

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

On the Exchange

Second Tier Utilization

5%

Source Name

HIOS

Plan ID

38344AK1060001

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$3000 per group

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

$1500 per person

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

$1,500

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group

$3000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person

$1500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual

$1,500

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

$4500 per person

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

$4,500

Unique Plan Design

Yes

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 Alaska?

Premera Blue Cross Preferred Gold 1500 (38344AK1060001) is a Gold PPO from Premera Blue Cross Blue Shield of Alaska in Alaska 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 Premera Blue Cross Preferred Gold 1500 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 Premera Blue Cross Preferred Gold 1500 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: Child.

Does Premera Blue Cross Preferred Gold 1500 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 Premera Blue Cross Preferred Gold 1500?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease.

Is there out-of-country coverage for Premera Blue Cross Preferred Gold 1500?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under this plan.

Does Premera Blue Cross Preferred Gold 1500 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: If you're outside Alaska and Washington (the service area), covered services received from any provider licensed to provide the service will be paid the out of network benefit level (except emergencies).

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.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.