TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx · 54879ME0010008
Taro Health offers this marketplace health insurance plan (Plan ID 54879ME0010008) 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: SilverPlan type: HMOCSR: Limited Cost Sharing Plan VariationIssuer: Taro Health
Telehealth
Data pending
HSA eligible
No
Dental
Not listed
Vision
Not listed
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Maine). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
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Special Enrollment Periods
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Report the event within 60 days.
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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.
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).
Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.
Tier
Covered drugs
PREFERRED-GENERIC
3,580
NON-PREFERRED-BRAND
2,969
SPECIALTY
2,213
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 · Plan ID 54879ME0010008 · 2025 filing.
Variant 54879ME0010008-03 (Open to Indians above 300% FPL) currently displayed.
Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
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Variant attributes
TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx · Variant 54879ME0010008-03
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Limited Cost Sharing Plan Variation
HIOS Product ID
54879ME001
Metal Level
Silver
Plan ID (Standard Component ID with Variant)
54879ME0010008-03
Plan Marketing Name
TARO Clear Choice Silver 4200 (No Direct Primary Care/DPC)
Plan Variant Marketing Name
TARO Clear Choice Silver 4200 (No Direct Primary Care/DPC)
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
54879
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
No
Network ID
MEN002
Out of Country Coverage
No
Out of Service Area Coverage
No
Out of Service Area Coverage Description
Emergency Services Only
Service Area ID
MES001
State Code
ME
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
AV Calculator Output Number
0.70628258
Medical Drug Deductibles Integrated
Yes
Medical Drug Maximum Out of Pocket Integrated
Yes
SBC Scenario, Having a Baby, Coinsurance
$2,500
SBC Scenario, Having a Baby, Copayment
$10
SBC Scenario, Having a Baby, Deductible
$4,200
SBC Scenario, Having Diabetes, Coinsurance
$0
SBC Scenario, Having Diabetes, Copayment
$1,000
SBC Scenario, Having Diabetes, Deductible
$900
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$0
SBC Scenario, Treatment of a Simple Fracture, Copayment
$300
SBC Scenario, Treatment of a Simple Fracture, Deductible
$2,100
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family
$8000 per person | $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual
$8,000
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
$8000 per person | $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$8,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family
per person not applicable | per group 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
MEF007
SBC Scenario, Having a Baby, Limit
$60
SBC Scenario, Having Diabetes, Limit
$20
SBC Scenario, Treatment of a Simple Fracture, Limit
$0
Additional attributes
Issuer-provided metadata for this variant.
Begin Primary Care Cost-Sharing After Number Of Visits
1
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
99%
First Tier Utilization
100%
Import Date
1/13/2025
HSA Eligible
No
IsItANewPlan
Existing
Notice Required for Pregnancy
No
Is a Referral Required for Specialist?
No
Plan Effective Date
1/1/2025
Plan Expiration Date
12/31/2025
Plan Type
HMO
QHP/Non QHP
Both
Source Name
SERFF
Plan ID
54879ME0010008
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family
$4200 per person | $8400 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual
$4,200
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family
$4200 per person | $8400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual
$4,200
TEHBDedOutofNetFamily
per person not applicable | per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual
Not Applicable
Unique Plan Design
No
Version Number
1
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 Maine?
TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx (54879ME0010008) is a Silver HMO from Taro Health in Maine 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 TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx 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 TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx 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 coverage is not listed for this plan.
Does TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx 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 TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx?
No, out-of-country services are not covered for this plan.
Does TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx cover care outside the service area?
No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Emergency Services Only
How do I enroll in or manage payments for TARO Clear Choice Silver 4200 (No Direct Primary Care, for DPC select DPC Silver) OffEx?
Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.
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.
