GoldEPO

Clear Gold + Vision + Adult Dental

Ambetter Health of Delaware

Starting at

$755

/month before subsidy

Key facts

Clear Gold + Vision + Adult Dental is a 2026 Gold EPO health insurance plan from Ambetter Health of Delaware, sold on the ACA Marketplace in Delaware under plan ID 64004DE0100011. The monthly premium starts at $755 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $1,200 ($2,400 for a family), and the individual out-of-pocket maximum is $9,150 ($18,300 for a family). After the deductible, coinsurance is 30% for covered in-network care. The plan is not HSA-eligible.

Plan ID
64004DE0100011
Plan year
2026
State
Delaware
Metal level
Gold
Plan type
EPO
HSA-eligible
No

Individual Deductible

$1,200

Family: $2,400

Out-of-Pocket Max

$9,150

Family: $18,300

Coinsurance

30%

You pay after deductible

Network Type

EPO

DEN001

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

Medical Services

Primary Care Visit$25.00
Specialist Visit$60.00
Urgent Care$60.00
Emergency Room30.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$3.00
Brand Name Drugs45.00% 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

$3,900

your estimated cost

Deductible
$1,200
Copays
$40
Coinsurance
$2,600

Managing type 2 diabetes

A year of routine care

$1,920

your estimated cost

Deductible
$900
Copays
$1,000
Coinsurance
$0

A simple fracture

ER visit + follow-up

$1,800

your estimated cost

Deductible
$1,200
Copays
$300
Coinsurance
$300
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 Ambetter Health of Delaware. These are the authoritative source for coverage details.
Who This Plan Is Best For

This Gold EPO 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

$1,518/month

Annual Premium

$9,060

OOP Maximum

$9,150

💡 What this means:

With a $1,200 deductible, you pay 100% of costs until you've spent that much. After that, you pay 30% (coinsurance) until you hit $9,150 total. Then insurance covers everything else for the year.

More plans from Ambetter Health of Delaware in Delaware

View all Marketplace plans in Delaware

Frequently asked questions about Clear Gold + Vision + Adult Dental

How much does Clear Gold + Vision + Adult Dental cost per month?

Clear Gold + Vision + Adult Dental from Ambetter Health of Delaware starts at $755 per month before any subsidy in Delaware. 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 Clear Gold + Vision + Adult Dental?

The individual medical deductible is $1,200, and the family deductible is $2,400. 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 Clear Gold + Vision + Adult Dental?

The most you would pay in a year for covered in-network care is $9,150 for an individual and $18,300 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Clear Gold + Vision + Adult Dental HSA-eligible?

No. Clear Gold + Vision + Adult Dental 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 Clear Gold + Vision + Adult Dental use?

Clear Gold + Vision + Adult Dental 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.