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GoldHMO

Community Premier Gold 021 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)

by Community Health Choice in Texas

How we get our data

Our insurance data is sourced directly from the CMS ACA Marketplace (HIOS), the federal database that insurers are required to report to. We process that data to surface standardized out-of-pocket cost estimates based on three SBC scenarios defined by CMS: having a baby, managing diabetes, and treating a fracture. We update our data annually with each new plan year and link to the original SBC documents so you can verify costs directly with the insurer.

Learn more about our data

Deductible (Individual)

$2,000

Max Out-of-Pocket

$8,200

Actuarial Value

78%

Service Areas

1

About This Plan

Community Premier Gold 021 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) is a Gold HMO plan offered by Community Health Choice in Texas for the 2026 plan year with an actuarial value of 78%. The in-network deductible for an individual is $2,000, and the maximum out-of-pocket cost is $8,200.

Compared to the median across 79 other Gold plans in Texas, this plan's estimated out-of-pocket costs are: having a baby ($4,230 — 5% below the median); managing diabetes ($2,820 — 74% above the median); treating a fracture ($2,320 — 14% above the median).

Cost Scenarios

What you'd pay out-of-pocket for three common medical situations with this plan.

Normal delivery

Having a Baby

$4,230
Total Out-of-Pocket
-5% vs median
Deductible$2,000
Copayment$70
Coinsurance$2,100
Limit$60

Type 2, routine care

Managing Diabetes

$2,820
Total Out-of-Pocket
+74% vs median
Deductible$2,000
Copayment$700
Coinsurance$100
Limit$20

ER treatment

Simple Fracture

$2,320
Total Out-of-Pocket
+14% vs median
Deductible$2,000
Copayment$300
Coinsurance$20
Limit$0

Deductibles & Out-of-Pocket Maximums

In-NetworkOut-of-Network
IndividualPer PersonPer GroupIndividualPer PersonPer Group
Deductible$2,000$2000 per person$4000 per groupNot Applicableper person not applicableper group not applicable
MOOP$8,200$8200 per person$16400 per groupNot Applicableper person not applicableper group not applicable

Coinsurance after deductible: 25.00%

Medical & Drug Deductibles IntegratedMedical & Drug MOOP Integrated

Plan Features

Plan TypeHMO
HSA EligibleNo
Referral Required for SpecialistNo
National NetworkNo
Pregnancy Notice RequiredNo
Out-of-Country CoverageNo
Out-of-Service-Area CoverageNo
Child-Only OfferingAllows Adult and Child-Only
Wellness ProgramNo
Inpatient Copayment Max Days0
Plan Effective Date2026-01-01
Plan Expiration Date2026-12-31

Official Documents

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Written by Jayant Panwar | Last reviewed: Q1 2026 | Last updated: January 2026

Insurance Disclaimer: This information is for educational purposes only and does not constitute insurance advice or a recommendation to enroll in this plan. SBC scenarios show standardized cost estimates for normal delivery, routine diabetes care, and emergency fracture treatment — your actual costs will vary based on providers, services, and your specific plan benefits. This is a CMS marketplace plan; other insurance options may be available in Texas. Consult your insurance company for accurate cost estimates and with your healthcare provider for medical decisions.

Data source: CMS ACA Marketplace (HIOS), 2026 plan year. See our data methodology and editorial policy. Found an error? Report an inaccuracy.