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SilverHMO

AmeriHealth Caritas Next Silver Essential + No Referrals

AmeriHealth Caritas Next

Starting at

$591

/month before subsidy

Key facts

AmeriHealth Caritas Next Silver Essential + No Referrals is a 2026 Silver HMO health insurance plan from AmeriHealth Caritas Next, sold on the ACA Marketplace in North Carolina under plan ID 17414NC0010013. The monthly premium starts at $591 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $6,100 ($12,200 for a family), and the individual out-of-pocket maximum is $9,000 ($18,000 for a family). After the deductible, coinsurance is 35% for covered in-network care. The plan is not HSA-eligible.

Plan ID: 17414NC0010013
Plan year: 2026
State: North Carolina
Metal level: Silver
Plan type: HMO
HSA-eligible: No

Individual Deductible

$6,100

Family: $12,200

Out-of-Pocket Max

$9,000

Family: $18,000

Coinsurance

35%

You pay after deductible

Network Type

HMO

NCN001

Cost Sharing

What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$25.00

Specialist Visit$70.00

Urgent Care$45.00

Emergency Room35.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$25.00

Brand Name Drugs45.00% Coinsurance after deductible

Specialty Drugs50.00% Coinsurance after deductible

CMS Quality Rating

The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.

2.0overall

Medical care
Member experience: Not rated
Plan administration

What you'd typically pay

Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$7,570

your estimated cost

Deductible: $6,100
Copays: $70
Coinsurance: $1,400

Managing type 2 diabetes

A year of routine care

$2,100

your estimated cost

Deductible: $900
Copays: $1,200
Coinsurance: $0

A simple fracture

ER visit + follow-up

$2,780

your estimated cost

Deductible: $2,700
Copays: $80
Coinsurance: $0

Is your medication or doctor covered?

Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.

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Official Plan Documents

Published by AmeriHealth Caritas Next. These are the authoritative source for coverage details.

Summary of Benefits & Coverage (SBC)Standardized cost & coverage summary Plan BrochureFull plan details from the insurer Drug FormularyCovered prescriptions & drug tiers

Who This Plan Is Best For

This Silver HMO plan offers a balanced approach between monthly premiums and out-of-pocket costs, making it a popular choice for many families.

Consider this plan if you:

Visit the doctor a few times per year
Take regular prescription medications
Want moderate protection against high medical bills
May qualify for Cost-Sharing Reductions (CSR) to lower deductibles

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost

What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,341/month

Annual Premium

$7,092

OOP Maximum

$9,000

💡 What this means:

With a $6,100 deductible, you pay 100% of costs until you've spent that much. After that, you pay 35% (coinsurance) until you hit $9,000 total. Then insurance covers everything else for the year.

More plans from AmeriHealth Caritas Next in North Carolina

View all Marketplace plans in North Carolina

Frequently asked questions about AmeriHealth Caritas Next Silver Essential + No Referrals

How much does AmeriHealth Caritas Next Silver Essential + No Referrals cost per month?

AmeriHealth Caritas Next Silver Essential + No Referrals from AmeriHealth Caritas Next starts at $591 per month before any subsidy in North Carolina. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for AmeriHealth Caritas Next Silver Essential + No Referrals?

The individual medical deductible is $6,100, and the family deductible is $12,200. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for AmeriHealth Caritas Next Silver Essential + No Referrals?

The most you would pay in a year for covered in-network care is $9,000 for an individual and $18,000 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is AmeriHealth Caritas Next Silver Essential + No Referrals HSA-eligible?

No. AmeriHealth Caritas Next Silver Essential + No Referrals is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does AmeriHealth Caritas Next Silver Essential + No Referrals use?

AmeriHealth Caritas Next Silver Essential + No Referrals is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.

Understand what you'd actually pay

2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
How ACA subsidies work
Premium tax credits and who qualifies
The 2026 subsidy cliff
Why income near 400% FPL matters again this year

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Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.