Maine health plan · 2025

TARO Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) OffEx · 54879ME0010006

Taro Health offers this marketplace plan (Plan ID 54879ME0010006). Use the modules below to compare premiums, coverage structure, provider access, and formulary context against alternative options in the same market.

Metal level: Gold Plan type: HMO CSR: Standard Gold On Exchange Plan Issuer: Taro Health
Telehealth Data pending HSA eligible No Dental Not listed Vision Not listed

CMS AV Calculator output: 81.80% (18.20% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 10 Mar 2026 06:40 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

See plan search for live pricing

Before subsidies

Estimate after subsidies

Deductible

$0

N/A

See deductible details

Max out-of-pocket

$7,800

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits
HSA Not eligible

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

Issuer profile See benefits
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 Maine). 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 On 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.

Plan ID 54879ME0010006
Coverage year 2025
State Maine
Issuer Taro Health
Variant ID 54879ME0010006-01
Available variants

Standard On Exchange Plan · 54879ME0010006-01

Open to Indians below 300% FPL · 54879ME0010006-02

Open to Indians above 300% FPL · 54879ME0010006-03
Last plan update Wed, 08 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 10 Mar 2026 06:40 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, 10 Mar 2026 06:40 GMT).

All providers in Maine N/A
PCPs in Maine N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['PREFERRED']

Providers Maine 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

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 3,580
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 54879ME0010006 · 2025 filing.
  • Variant 54879ME0010006-01 (Standard On Exchange Plan) currently displayed.
  • Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
Advertisement

Variant attributes

TARO Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) OffEx · Variant 54879ME0010006-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

54879ME001

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

54879ME0010006-01

Plan Marketing Name

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

Plan Variant Marketing Name

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

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

MEN001

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

0.818025342

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$6,300

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$500

SBC Scenario, Having Diabetes, Copayment

$700

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

$7800 per person | $15600 per group

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

$7,800

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

50.00%

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

$7800 per person | $15600 per group

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

$7,800

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

MEF003

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.

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

54879ME0010006

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

$0 per person | $0 per group

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

$0

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

$0 per person | $0 per group

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

$0

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 Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) OffEx (54879ME0010006) is a Gold 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 Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) 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 Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) 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 Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) 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 Direct Primary Care Gold $0 Ded ($0 DPC + $0 PCP + $0 Mental Health) OffEx?

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

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

Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.

Disclaimer: Based on the Tue, 10 Mar 2026 06:40 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.