Silver Simple Diabetes | with Atrium Health
Silver · HMO · Oscar Health Plan of North Carolina, Inc · North Carolina
At age 40 it costs between $583.68 and $741.80 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 | 69803NC0010064 |
|---|---|
| Insurer | Oscar Health Plan of North Carolina, Inc |
| Metal level | Silver |
| Plan type | HMO |
| 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 | 1-855-672-2755 · TTY 1-855-672-2755 |
Where it is sold, and what it costs there
12 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 |
|---|---|---|---|---|---|
| Anson County | $456.72 | $518.37 | $583.68 | $815.69 | $1,239.52 |
| Cabarrus County | $456.72 | $518.37 | $583.68 | $815.69 | $1,239.52 |
| Mecklenburg County | $456.72 | $518.37 | $583.68 | $815.69 | $1,239.52 |
| Stanly County | $456.72 | $518.37 | $583.68 | $815.69 | $1,239.52 |
| Union County | $456.72 | $518.37 | $583.68 | $815.69 | $1,239.52 |
| Cleveland County | $493 | $559.54 | $630.04 | $880.47 | $1,337.96 |
| Lincoln County | $493 | $559.54 | $630.04 | $880.47 | $1,337.96 |
| Davidson County | $499.37 | $566.77 | $638.18 | $891.85 | $1,355.25 |
| Davie County | $499.37 | $566.77 | $638.18 | $891.85 | $1,355.25 |
| Forsyth County | $499.37 | $566.77 | $638.18 | $891.85 | $1,355.25 |
| Yadkin County | $499.37 | $566.77 | $638.18 | $891.85 | $1,355.25 |
| Wilkes County | $580.45 | $658.80 | $741.80 | $1,036.66 | $1,575.30 |
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.