BronzeHMOHSA Eligible

Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental

Issuer 25303

Starting at

$471

/month before subsidy

Key facts

Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental is a 2026 Bronze HMO health insurance plan from Issuer 25303, sold on the ACA Marketplace in New York under plan ID 25303NY0110001. The monthly premium starts at $471 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $4,125 ($4,125 for a family), and the individual out-of-pocket maximum is $10,150 ($10,150 for a family). After the deductible, coinsurance is 50% for covered in-network care. The plan is HSA-eligible, so it can be paired with a Health Savings Account.

Plan ID
25303NY0110001
Plan year
2026
State
New York
Metal level
Bronze
Plan type
HMO
HSA-eligible
Yes

Individual Deductible

$4,125

Family: $4,125

Out-of-Pocket Max

$10,150

Family: $10,150

Coinsurance

50%

You pay after deductible

Network Type

HMO

NYN001

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

Medical Services

Primary Care VisitSee plan details
Specialist VisitSee plan details
Urgent CareSee plan details
Emergency RoomSee plan details

Prescription Drugs

Generic DrugsSee plan details
Brand Name DrugsSee plan details
Specialty DrugsSee plan details
Is your medication or doctor covered?
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Who This Plan Is Best For

This Bronze HMO plan is ideal for healthy individuals who want the lowest monthly premium and can handle higher out-of-pocket costs if they need care.

Consider this plan if you:

  • Rarely visit the doctor beyond annual checkups
  • Have savings to cover the $4,125 deductible if needed
  • Primarily need coverage for unexpected emergencies
  • Want to minimize monthly healthcare expenses

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

$1,317/month

Annual Premium

$5,652

OOP Maximum

$10,150

💡 What this means:

With a $4,125 deductible, you pay 100% of costs until you've spent that much. After that, you pay 50% (coinsurance) until you hit $10,150 total. Then insurance covers everything else for the year.

More plans from Issuer 25303 in New York

View all Marketplace plans in New York

Frequently asked questions about Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental

How much does Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental cost per month?

Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental from Issuer 25303 starts at $471 per month before any subsidy in New York. 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 Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental?

The individual medical deductible is $4,125, and the family deductible is $4,125. 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 Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental?

The most you would pay in a year for covered in-network care is $10,150 for an individual and $10,150 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental HSA-eligible?

Yes. Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental is a qualified high-deductible health plan, so you can pair it with a Health Savings Account (HSA) and pay for eligible medical expenses with pre-tax dollars.

What type of network does Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental use?

Ambetter from Fidelis Care Bronze, Bronze, ST, INN, Fidelis Care HBX Network, Dep29, Free Telemedicine Program, Pediatric Dental 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

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.