SilverEPO

Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Anthem Blue Cross and Blue Shield

Starting at

$645

/month before subsidy

Key facts

Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) is a 2026 Silver EPO health insurance plan from Anthem Blue Cross and Blue Shield, sold on the ACA Marketplace in Missouri under plan ID 32753MO0990014. The monthly premium starts at $645 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $7,200 ($14,400 for a family), and the individual out-of-pocket maximum is $8,625 ($17,250 for a family). After the deductible, coinsurance is 50% for covered in-network care. The plan is not HSA-eligible.

Plan ID
32753MO0990014
Plan year
2026
State
Missouri
Metal level
Silver
Plan type
EPO
HSA-eligible
No

Individual Deductible

$7,200

Family: $14,400

Out-of-Pocket Max

$8,625

Family: $17,250

Coinsurance

50%

You pay after deductible

Network Type

EPO

MON004

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

Medical Services

Primary Care Visit$20.00
Specialist Visit$75.00
Urgent Care$75.00
Emergency Room50.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$10.00
Brand Name Drugs35.00% Coinsurance after deductible
Specialty Drugs40.00% 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

How well doctors manage and coordinate care

Member experience
Not rated

Member-survey satisfaction with the plan

Plan administration

Customer service, billing, and access to information

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

$8,660

your estimated cost

Deductible
$7,200
Copays
$0
Coinsurance
$1,400

Managing type 2 diabetes

A year of routine care

$1,620

your estimated cost

Deductible
$100
Copays
$1,500
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,400

your estimated cost

Deductible
$2,100
Copays
$300
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 Anthem Blue Cross and Blue Shield. These are the authoritative source for coverage details.
Who This Plan Is Best For

This Silver EPO 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

$1,364/month

Annual Premium

$7,740

OOP Maximum

$8,625

💡 What this means:

With a $7,200 deductible, you pay 100% of costs until you've spent that much. After that, you pay 50% (coinsurance) until you hit $8,625 total. Then insurance covers everything else for the year.

More plans from Anthem Blue Cross and Blue Shield in Missouri

View all Marketplace plans in Missouri

Frequently asked questions about Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives)

How much does Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) cost per month?

Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) from Anthem Blue Cross and Blue Shield starts at $645 per month before any subsidy in Missouri. 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 Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

The individual medical deductible is $7,200, and the family deductible is $14,400. 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 Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

The most you would pay in a year for covered in-network care is $8,625 for an individual and $17,250 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) HSA-eligible?

No. Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) use?

Anthem Silver Pathway Essentials 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) is a EPO plan. EPO plans cover in-network care only (except emergencies) and usually do not require referrals to see specialists.

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.