GoldHMO

HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29

Issuer 94788

Starting at

$1380

/month before subsidy

Key facts

HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 is a 2026 Gold HMO health insurance plan from Issuer 94788, sold on the ACA Marketplace in New York under plan ID 94788NY0280065. The monthly premium starts at $1,380 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $775 ($775 for a family), and the individual out-of-pocket maximum is $10,150 ($10,150 for a family). After the deductible, coinsurance is 0% for covered in-network care. The plan is not HSA-eligible.

Plan ID
94788NY0280065
Plan year
2026
State
New York
Metal level
Gold
Plan type
HMO
HSA-eligible
No

Individual Deductible

$775

Family: $775

Out-of-Pocket Max

$10,150

Family: $10,150

Coinsurance

0%

You pay after deductible

Network Type

HMO

NYN002

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?
Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.
Check a medication
Check a doctor

Enter your ZIP code first to search nearby doctors.

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

$2,226/month

Annual Premium

$16,560

OOP Maximum

$10,150

💡 What this means:

With a $775 deductible, you pay 100% of costs until you've spent that much. After that, you pay 0% (coinsurance) until you hit $10,150 total. Then insurance covers everything else for the year.

More plans from Issuer 94788 in New York

View all Marketplace plans in New York

Frequently asked questions about HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29

How much does HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 cost per month?

HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 from Issuer 94788 starts at $1,380 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 HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29?

The individual medical deductible is $775, and the family deductible is $775. 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 HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29?

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 HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 HSA-eligible?

No. HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 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 HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 use?

HMO Copayment 20, Gold, ST, INN, HMO Network, Dep29 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.