Gold
HMO
Standardized plan
Standard Gold + Vision + Adult Dental
Ambetter Health · Mississippi Marketplace plan for 2026
What you pay before the plan starts sharing costs
Deductible (individual)
$2,000
$4,000 for a family
Out-of-pocket maximum (individual)
$8,200
$16,400 for a family
The out-of-pocket maximum is the most you can pay in a year for covered in-network care. After you reach it, the plan pays everything else.
What you pay for common care
| Service | You pay (in-network) |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $30 |
| Specialist Visit | $60 |
| Emergency Room Services | 25% Coinsurance after deductible |
| Generic Drugs | $15 |
| Preferred Brand Drugs | $30 |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 25% Coinsurance after deductible |
| X-rays and Diagnostic Imaging | 25% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $30 |
Where this plan is sold in Mississippi
Available in 13 of the rating areas we cover. Premiums differ by area, so check the one you live in.
Benton CountyColumbus Area (Northeast Mississippi)Hattiesburg Area (South Mississippi)Jackson Metro Area (Mississippi)Lafayette CountyMemphis Metro Area (Mississippi Side)Mississippi (Northeast & Southern Rural Counties)Mississippi Delta & Central CountiesMississippi Gulf Coast (Biloxi & Gulfport)Natchez & Starkville Area (Mississippi)Panola CountySouth Central Mississippi (Copiah & Simpson Counties)Tupelo Area (Northeast Mississippi)
Everything Standard Gold + Vision + Adult Dental covers
| Benefit | You pay (in-network) |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $30 |
| Specialist Visit | $60 |
| Other Practitioner Office Visit Nurse Physician Assistant | $30 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25% Coinsurance after deductible |
| Hospice Services | 25% Coinsurance after deductible |
| Routine Dental Services (Adult)Limit: 1000 dollars per year | No Charge |
| Routine Eye Exam (Adult)Limit: 1 exams per year | No Charge |
| Urgent Care Centers Or Facilities | $45 |
| Home Health Care Services | 25% Coinsurance after deductible |
| Emergency Room Services | 25% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25% Coinsurance after deductible |
| Skilled Nursing FacilityLimit: 60 days per year | 25% Coinsurance after deductible |
| Prenatal And Postnatal Care | $30 |
| Delivery And All Inpatient Services For Maternity Care | 25% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $30 |
| Mental/Behavioral Health Inpatient Services | 25% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $30 |
| Substance Abuse Disorder Inpatient Services | 25% Coinsurance after deductible |
| Generic Drugs | $15 |
| Preferred Brand Drugs | $30 |
| Non-Preferred Brand Drugs | $60 |
| Specialty Drugs | $250 |
| Outpatient Rehabilitation ServicesLimit: 20 visits per year | $30 |
| Habilitation ServicesLimit: 20 visits per year | $30 |
| Chiropractic CareLimit: 20 visits per year | $60 |
| Durable Medical Equipment | 25% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25% Coinsurance after deductible |
| Preventive Care/Screening/Immunization | No Charge |
| Routine Foot Care | $60 |
| Routine Eye Exam for ChildrenLimit: 1 exams per year | No Charge |
| Eye Glasses for ChildrenLimit: 1 items per year | No Charge |
| Rehabilitative Speech TherapyLimit: 20 visits per year | $30 |
| Rehabilitative Occupational And Rehabilitative Physical TherapyLimit: 20 visits per year | $30 |
| Well Baby Visits And Care | No Charge |
| Laboratory Outpatient and Professional Services | 25% Coinsurance after deductible |
| X-rays and Diagnostic Imaging | 25% Coinsurance after deductible |
| Basic Dental Care - AdultLimit: 1000 dollars per year | 50% |
| Major Dental Care - AdultLimit: 1000 dollars per year | 50% |
| Transplant | 25% Coinsurance after deductible |
| Accidental Dental | 25% Coinsurance after deductible |
| Dialysis | 25% Coinsurance after deductible |
| Allergy Testing | $60 |
| Chemotherapy | 25% Coinsurance after deductible |
| Radiation | 25% Coinsurance after deductible |
| Diabetes Education | $60 |
| Prosthetic Devices | 25% Coinsurance after deductible |
| Infusion Therapy | 25% Coinsurance after deductible |
| Treatment For Temporomandibular Joint Disorders | 25% Coinsurance after deductible |
| Nutritional Counseling | $60 |
| Reconstructive Surgery | 25% Coinsurance after deductible |
Not covered by this plan
- Infertility Treatment
- Long Term Custodial Nursing Home Care
- Private-Duty Nursing
- Bariatric Surgery
- Cosmetic Surgery
- Hearing Aids
- Acupuncture
- Weight Loss Programs
- Dental Check-Up for Children
- Basic Dental Care - Child
- Orthodontia - Child
- Major Dental Care - Child
- Orthodontia - Adult
- Abortion Services
Official plan documents
What this page does not show
No premium and no subsidy estimate. Both depend on your age, household size, income and county, not on the plan, so any figure here would be wrong for almost everyone. Check what you would actually pay for Standard Gold + Vision + Adult Dental in your area:
Coverage and cost sharing come from the official Marketplace record for plan 90714MS0030066, 2026 plan year. Always confirm against the Summary of Benefits before enrolling.
Plans shown based on input. Not insurance advice. Policymage is not a licensed broker or agent.