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GoldHMO

Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives)

WellPoint

Starting at

$568

/month before subsidy

Key facts

Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) is a 2026 Gold HMO health insurance plan from WellPoint, sold on the ACA Marketplace in Texas under plan ID 47501TX0040009. The monthly premium starts at $568 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $800 ($1,600 for a family), and the individual out-of-pocket maximum is $9,000 ($18,000 for a family). After the deductible, coinsurance is 30% for covered in-network care. The plan is not HSA-eligible.

Plan ID
47501TX0040009
Plan year
2026
State
Texas
Metal level
Gold
Plan type
HMO
HSA-eligible
No

Individual Deductible

$800

Family: $1,600

Out-of-Pocket Max

$9,000

Family: $18,000

Coinsurance

30%

You pay after deductible

Network Type

HMO

TXN002

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

Medical Services

Primary Care Visit$10.00
Specialist Visit$45.00
Urgent Care$50.00
Emergency Room$500.00 Copay after deductible

Prescription Drugs

Generic Drugs$5.00
Brand Name Drugs40.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible
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

$4,370

your estimated cost

Deductible
$800
Copays
$10
Coinsurance
$3,500

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

$1,400

your estimated cost

Deductible
$800
Copays
$100
Coinsurance
$500
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 WellPoint. These are the authoritative source for coverage details.
Summary of Benefits & Coverage (SBC)Standardized cost & coverage summaryPlan BrochureFull plan details from the insurerDrug FormularyCovered prescriptions & drug tiers
Who This Plan Is Best For

This Gold HMO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

  • Have ongoing health conditions requiring regular care
  • Take multiple prescription medications
  • Prefer lower costs at the time of service
  • Want peace of mind with comprehensive coverage

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

$1,318/month

Annual Premium

$6,816

OOP Maximum

$9,000

💡 What this means:

With a $800 deductible, you pay 100% of costs until you've spent that much. After that, you pay 30% (coinsurance) until you hit $9,000 total. Then insurance covers everything else for the year.

More plans from WellPoint in Texas

View all Marketplace plans in Texas

Frequently asked questions about Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives)

How much does Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) cost per month?

Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) from WellPoint starts at $568 per month before any subsidy in Texas. 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 Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

The individual medical deductible is $800, and the family deductible is $1,600. 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 Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

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 Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) HSA-eligible?

No. Wellpoint Essential Gold 800 ($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 Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) use?

Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) 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

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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.