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SilverHMO

Standard Silver with Atrium Health + Vision + Adult Dental

Ambetter of North Carolina

Starting at

$558

/month before subsidy

Key facts

Standard Silver with Atrium Health + Vision + Adult Dental is a 2026 Silver HMO health insurance plan from Ambetter of North Carolina, sold on the ACA Marketplace in North Carolina under plan ID 77264NC0020059. The monthly premium starts at $558 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $6,000 ($12,000 for a family), and the individual out-of-pocket maximum is $8,900 ($17,800 for a family). After the deductible, coinsurance is 40% for covered in-network care. The plan is not HSA-eligible.

Plan ID
77264NC0020059
Plan year
2026
State
North Carolina
Metal level
Silver
Plan type
HMO
HSA-eligible
No

Individual Deductible

$6,000

Family: $12,000

Out-of-Pocket Max

$8,900

Family: $17,800

Coinsurance

40%

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$40.00
Specialist Visit$80.00
Urgent Care$60.00
Emergency Room40.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$20.00
Brand Name Drugs$80.00 Copay after deductible
Specialty Drugs$350.00 Copay 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.
3.0overall
Medical care

How well doctors manage and coordinate care

Member experience

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

$7,710

your estimated cost

Deductible
$6,000
Copays
$50
Coinsurance
$1,600

Managing type 2 diabetes

A year of routine care

$2,020

your estimated cost

Deductible
$900
Copays
$1,100
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,500

your estimated cost

Deductible
$2,100
Copays
$400
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 Ambetter of North Carolina. 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 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

$1,300/month

Annual Premium

$6,696

OOP Maximum

$8,900

💡 What this means:

With a $6,000 deductible, you pay 100% of costs until you've spent that much. After that, you pay 40% (coinsurance) until you hit $8,900 total. Then insurance covers everything else for the year.

More plans from Ambetter of North Carolina in North Carolina

View all Marketplace plans in North Carolina

Frequently asked questions about Standard Silver with Atrium Health + Vision + Adult Dental

How much does Standard Silver with Atrium Health + Vision + Adult Dental cost per month?

Standard Silver with Atrium Health + Vision + Adult Dental from Ambetter of North Carolina starts at $558 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 Standard Silver with Atrium Health + Vision + Adult Dental?

The individual medical deductible is $6,000, and the family deductible is $12,000. 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 Standard Silver with Atrium Health + Vision + Adult Dental?

The most you would pay in a year for covered in-network care is $8,900 for an individual and $17,800 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Standard Silver with Atrium Health + Vision + Adult Dental HSA-eligible?

No. Standard Silver with Atrium Health + 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 Standard Silver with Atrium Health + Vision + Adult Dental use?

Standard Silver with Atrium Health + Vision + Adult 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

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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.