This is an overview of the AM Better Bronze Zero Deductible Plan you purchased (or we like to call Bronze Plus). It’s better than the regular Bronze yet cheaper than the Silver Plan. 
We generally find that someone who purchases this plan is planning to have a minimal to occasional medical expenses and mainly looking for flat copays when you have medical needs and to protect from a major emergency. Usually someone sees the doctor less often, has only a few cheaper generic prescriptions or has moderate ongoing medical conditions. Each person in a household can buy their own plan separately on the WA Exchange. Often, we have one member that buys a Bronzer plan that needs minimal medical coverage and the other family members get a Gold or Silver plan because they need more medical services. Here are some highlights of the AM Better Zero Deductible plan. To have services covered you MUST go to an in-network doctor, unless it’s a true emergency. There is also coverage in 24 other states, see at the bottom for other in-network states for routine facilities and care.
- Prescription Drugs. Covers Generic Drugs for $35/mo (often it can be cheaper to pay cash instead of using insurance yet keep your receipt. It can be applied to your Max Out of Pocket later). Preferred Brand name drugs are $195. Non-Preferred Brand name and Specialty Drugs are covered after a $3,800 deductible for $250 for Non-Preferred and 50% for Specialty (until you hit the max out of pocket).
- Copay for ALL services: Below in the Green & Grey section you can see what flat copays are covered for; $45 for doctor visits, $115 for specialists, you pay 50% for Physical Therapy, $60 for urgent care, $2,5000 for Emergency Room visits, $60 for lab blood work and 50% for all imaging (X-Rays, MRI, CT scan, etc). This plan is much cheaper than Gold and Silver plans for a reason. All plans cover a max of 10 chiropractor and 12 acupuncture visits per calendar year at $45 per visit.
This image is a summary of the benefits, we find that for most people it’s easier to understand how the plan works by looking at an image of the plan benefits (easier than a spreadsheet). Here’s a real-life example with the AM Better Bronze Zero Deductible Plan: If you are expecting to have a $10,000 surgery (or a $10,000 medical expense), you would likely pay about $5,000 in medical expenses (it could be lower due to copays). Once you hit the $8,700 max out of pocket for the year in-network or true emergency, then your insurance carrier will pay 100% of your medical expenses that are approved as medically necessary.
NOTE: You will need to set up auto pay from a personal checking account separately for each plan, even if you each choose the same insurance carrier. If you have any additional questions please let us know, we also recommend setting up a login at your insurance carrier’s website. Within the client portal there are a variety of resources: you can print temporary ID cards, review your claims, change your primary care provider, and find details about your benefits.
Gary Franke & Tamara Chandler
Independent Broker
Achieve Alpha Insurance LLC
12505 Bel-Red Rd, Ste 106
Bellevue, WA 98005
425-802-2783 (call or text office line)
health@achieve-alpha.com
www.achieve-alpha.com
