Standard Silver + Vision + Adult Dental
Silver · HMO · Ambetter of North Carolina · North Carolina
At age 40 it costs between $615.82 and $783.58 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 | $6,000 | $8,900 | $40 | $20 |
| up to 150% of the federal poverty level | $0 | $2,200 | No Charge | No Charge |
| 150% to 200% | $700 | $3,300 | $20 | $10 |
| 200% to 250% | $3,000 | $7,400 | $40 | $20 |
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 | 77264NC0020056 |
|---|---|
| Insurer | Ambetter of North Carolina |
| Metal level | Silver |
| Plan type | HMO |
| Standardised design | Design 1 — a plan CMS defined the benefits of, so it can be compared like for like |
| Deductible (individual) | $6,000 |
| Deductible (family) | $12,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,900 |
| Family maximum | $17,800 |
| Primary care visit | $40 |
| Specialist visit | $80 |
| Emergency room | 40% Coinsurance after deductible |
| Inpatient stay | 40% Coinsurance after deductible |
| Generic drugs | $20 |
| Preferred brand drugs | $40 |
| Specialty drugs | $350 Copay after deductible |
| Adult dental included | Yes |
| Child dental included | No |
| Share of premium buying essential health benefits | 96.74% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-833-863-1310 · TTY 1-833-863-1310 |
Where it is sold, and what it costs there
47 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 |
|---|---|---|---|---|---|
| Alexander County | $481.87 | $546.92 | $615.82 | $860.61 | $1,307.78 |
| Burke County | $481.87 | $546.92 | $615.82 | $860.61 | $1,307.78 |
| Caldwell County | $481.87 | $546.92 | $615.82 | $860.61 | $1,307.78 |
| Catawba County | $481.87 | $546.92 | $615.82 | $860.61 | $1,307.78 |
| Iredell County | $481.87 | $546.92 | $615.82 | $860.61 | $1,307.78 |
| Franklin County | $506.79 | $575.20 | $647.67 | $905.11 | $1,375.40 |
| Johnston County | $506.79 | $575.20 | $647.67 | $905.11 | $1,375.40 |
| Wake County | $506.79 | $575.20 | $647.67 | $905.11 | $1,375.40 |
| Caswell County | $508.71 | $577.38 | $650.12 | $908.55 | $1,380.62 |
| Durham County | $508.71 | $577.38 | $650.12 | $908.55 | $1,380.62 |
| Lee County | $508.71 | $577.38 | $650.12 | $908.55 | $1,380.62 |
| Orange County | $508.71 | $577.38 | $650.12 | $908.55 | $1,380.62 |
| Person County | $508.71 | $577.38 | $650.12 | $908.55 | $1,380.62 |
| Granville County | $518.29 | $588.24 | $662.36 | $925.64 | $1,406.60 |
| Vance County | $518.29 | $588.24 | $662.36 | $925.64 | $1,406.60 |
| Warren County | $518.29 | $588.24 | $662.36 | $925.64 | $1,406.60 |
| Bladen County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Cumberland County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Harnett County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Hoke County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Richmond County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Robeson County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Sampson County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Scotland County | $524.97 | $595.83 | $670.90 | $937.58 | $1,424.74 |
| Alleghany County | $547.96 | $621.93 | $700.28 | $978.64 | $1,487.14 |
| Wilkes County | $547.96 | $621.93 | $700.28 | $978.64 | $1,487.14 |
| Brunswick County | $554.70 | $629.57 | $708.89 | $990.67 | $1,505.42 |
| Columbus County | $554.70 | $629.57 | $708.89 | $990.67 | $1,505.42 |
| New Hanover County | $554.70 | $629.57 | $708.89 | $990.67 | $1,505.42 |
| Pender County | $554.70 | $629.57 | $708.89 | $990.67 | $1,505.42 |
| Avery County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Buncombe County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Clay County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Graham County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Haywood County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Jackson County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Macon County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Madison County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| McDowell County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Mitchell County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Polk County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Rutherford County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Swain County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Transylvania County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Yancey County | $568.12 | $644.80 | $726.04 | $1,014.64 | $1,541.85 |
| Montgomery County | $613.14 | $695.90 | $783.58 | $1,095.05 | $1,664.03 |
| Moore County | $613.14 | $695.90 | $783.58 | $1,095.05 | $1,664.03 |
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.