CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam
Gold · EPO · CareSource (Common Ground Healthcare) · Wisconsin
At age 40 it costs between $618.39 and $803.58 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What CMS publishes about it
| Plan ID | 87416WI0060006 |
|---|---|
| Insurer | CareSource (Common Ground Healthcare) |
| Metal level | Gold |
| Plan type | EPO |
| Deductible (individual) | $3,300 |
| Deductible (family) | $6,600 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,500 |
| Family maximum | $17,000 |
| Primary care visit | $20 |
| Specialist visit | $50 |
| Emergency room | $300 |
| Inpatient stay | 15% Coinsurance after deductible |
| Generic drugs | $2 |
| Preferred brand drugs | $50 |
| Specialty drugs | 50% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | No |
| Share of premium buying essential health benefits | 99.80% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-877-514-2442 · TTY 1-844-472-2442 |
Where it is sold, and what it costs there
13 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 |
|---|---|---|---|---|---|
| Brown County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Door County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Kewaunee County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Manitowoc County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Marinette County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Oconto County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Shawano County | $483.87 | $549.19 | $618.39 | $864.19 | $1,313.22 |
| Ozaukee County | $514.46 | $583.91 | $657.48 | $918.82 | $1,396.24 |
| Washington County | $514.46 | $583.91 | $657.48 | $918.82 | $1,396.24 |
| Waukesha County | $514.46 | $583.91 | $657.48 | $918.82 | $1,396.24 |
| Jefferson County | $618.25 | $701.71 | $790.12 | $1,104.20 | $1,677.93 |
| Walworth County | $618.25 | $701.71 | $790.12 | $1,104.20 | $1,677.93 |
| Green Lake County | $628.78 | $713.67 | $803.58 | $1,123 | $1,706.51 |
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.