Standard Gold VALUE
Gold · HMO · Ambetter from Superior HealthPlan · Texas
At age 40 it costs between $541.33 and $621.56 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What CMS publishes about it
| Plan ID | 87226TX0100012 |
|---|---|
| Insurer | Ambetter from Superior HealthPlan |
| Metal level | Gold |
| Plan type | HMO |
| Standardised design | Design 1 — a plan CMS defined the benefits of, so it can be compared like for like |
| Deductible (individual) | $2,000 |
| Deductible (family) | $4,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,200 |
| Family maximum | $16,400 |
| Primary care visit | $30 |
| Specialist visit | $60 |
| Emergency room | 25% Coinsurance after deductible |
| Inpatient stay | 25% Coinsurance after deductible |
| Generic drugs | $15 |
| Preferred brand drugs | $30 |
| Specialty drugs | $250 |
| 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 | 1-877-687-1196 · TTY 1-800-735-2989 |
Where it is sold, and what it costs there
3 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 |
|---|---|---|---|---|---|
| Harris County | $423.59 | $480.76 | $541.33 | $756.51 | $1,149.59 |
| Fort Bend County | $476.66 | $541 | $609.16 | $851.30 | $1,293.64 |
| Montgomery County | $486.36 | $552.01 | $621.56 | $868.63 | $1,319.97 |
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.
Get told when this changes
When this plan’s price or benefits change.
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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.