Silver Simple Diabetes
Silver · EPO · Oscar Insurance Company · Iowa
At age 40 it costs between $559.70 and $644.23 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What this Silver plan costs if your income qualifies
Below certain incomes the marketplace improves a Silver plan's cost sharing automatically — you do not apply for it, and it happens on Silver and on no other metal level. The premium does not change; the deductible and what you pay at the doctor do.
| If your income is | Deductible | Most you could pay in a year | Primary care | Generic drugs |
|---|---|---|---|---|
| Above 250%, or not applied for | $6,500 | $10,000 | No Charge | No Charge |
| up to 150% of the federal poverty level | $0 | $1,550 | No Charge | No Charge |
| 150% to 200% | $800 | $3,350 | No Charge | No Charge |
| 200% to 250% | $4,600 | $8,100 | No Charge | No Charge |
CMS calls these cost-sharing reductions. The percentages are actuarial values, not discounts. HealthCare.gov works out which one you get from the income you report when you apply.
What CMS publishes about it
| Plan ID | 45819IA0010064 |
|---|---|
| Insurer | Oscar Insurance Company |
| Metal level | Silver |
| Plan type | EPO |
| Deductible (individual) | $6,500 |
| Deductible (family) | $13,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $10,000 |
| Family maximum | $20,000 |
| Primary care visit | No Charge |
| Specialist visit | $40 |
| Emergency room | 50% Coinsurance after deductible |
| Inpatient stay | 50% Coinsurance after deductible |
| Generic drugs | No Charge |
| Preferred brand drugs | $75 Copay after deductible |
| Specialty drugs | 50% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | No |
| Share of premium buying essential health benefits | 100.00% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service |
Where it is sold, and what it costs there
48 counties. The premium is the price before any tax credit; what you pay depends on your income.
| County | At 21 | At 30 | At 40 | At 50 | At 60 |
|---|---|---|---|---|---|
| Buena Vista County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Cherokee County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Ida County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Monona County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Palo Alto County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Sac County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Sioux County | $437.96 | $497.07 | $559.70 | $782.18 | $1,188.59 |
| Boone County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Calhoun County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Carroll County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Greene County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Grundy County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Marshall County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Poweshiek County | $447.01 | $507.35 | $571.27 | $798.35 | $1,213.17 |
| Benton County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Buchanan County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Cedar County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Clayton County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Delaware County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Iowa County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Jones County | $461.82 | $524.16 | $590.20 | $824.80 | $1,253.36 |
| Bremer County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Chickasaw County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Floyd County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Howard County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Humboldt County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Wright County | $468.99 | $532.30 | $599.36 | $837.60 | $1,272.82 |
| Adams County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Audubon County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Cass County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Clarke County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Decatur County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Guthrie County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Harrison County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Mills County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Montgomery County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Pottawattamie County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Ringgold County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Shelby County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Union County | $485.87 | $551.45 | $620.93 | $867.74 | $1,318.62 |
| Appanoose County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Jefferson County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Keokuk County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Lucas County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Mahaska County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Van Buren County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Wapello County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
| Wayne County | $504.10 | $572.14 | $644.23 | $900.31 | $1,368.10 |
Open enrollment for 2026 coverage runs 1 November 2025 to 15 January 2026 in most states. Outside that window you need a qualifying life event — losing other coverage, moving, marrying, having a child — to enrol.
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Premiums, deductibles, out-of-pocket maximums and cost sharing are reproduced from the HealthCare.gov Qualified Health Plan landscape file published by the Centers for Medicare & Medicaid Services for plan year 2026. Nothing on this page is calculated by us. This is not a complete list of your options and it is not advice: to see every plan and to enrol, use HealthCare.gov or call 1-800-318-2596.