What is the individual medical deductible?

The cited 2026 California Silver 73 Ambetter HMO SBC lists $5,200 per individual per calendar year. Confirm the official SBC for your exact plan.

What is the annual out-of-pocket limit?

The cited California SBC lists $8,100 for an individual and $16,200 for a family per calendar year. Premiums and non-covered services are not included.

How much is a specialist visit?

The published California plan overview lists a $90 in-network specialist consultation copayment. A referral is required under the published plan terms.

Is there a prescription drug deductible?

Yes. The cited California SBC lists a $50 individual/$100 family pharmacy deductible for Tiers 2–4. Check the formulary for medication-specific costs.

Can I see an out-of-network doctor?

Routine non-emergency out-of-network care may have limited or no coverage under the HMO policy. Review the policy for exceptions and emergency-care protections.

What is the monthly premium?

The premium depends on the exact plan, service area, household details and applicable financial assistance. A verified quote is required to state the amount.

Where can I verify the official benefits?

Use Ambetter from Health Net’s 2026 plan materials for Covered California and review the Silver 73 Ambetter HMO SBC and coverage documents for the exact plan.

Silver 73 Ambetter HMO CSR (2026) | Benefits

Q: How much is a primary-care visit?

The published California plan overview lists a $50 in-network office visit copayment with the deductible waived for the specified service.

Silver 73 Ambetter HMO (CSR) Overview

Silver 73 Ambetter HMO (CSR) is a 2026 Silver-tier individual and family health plan offered through Covered California by Health Net of California, part of Centene Corporation. The CSR variant is designed for eligible Marketplace enrollees who qualify for cost-sharing reductions. The published California HMO Summary of Benefits and Coverage lists a $5,200 individual/$10,400 family medical deductible and an $8,100 individual/$16,200 family out-of-pocket limit. A separate pharmacy deductible applies to Tiers 2–4. Benefits, provider network, eligibility and premiums must be confirmed for the exact service area and enrollee.

Silver 73 HMO with cost-sharing reduction design for eligible enrollees

Expert Review of Silver 73 Ambetter HMO (CSR)

The California 2026 plan documents list $50 primary-care office visits and $90 specialist visits, with deductible-waived cost-sharing for the listed services. The plan requires a referral for specialist care. Before enrolling, check eligibility for the CSR variant, the official Summary of Benefits and Coverage, prescription formulary and provider directory. The amounts shown here are California-specific and should not be applied to a different state or plan variant.

Pros

The CSR variant is designed for Marketplace enrollees who meet the applicable cost-sharing reduction eligibility rules.
The published California plan documents provide defined medical deductible and annual out-of-pocket limits.
The California plan overview lists specific primary-care and specialist visit copayments.
Eligible preventive services may be covered without cost-sharing under applicable ACA requirements.
The HMO network structure can support coordinated care through participating providers.

Cons

CSR benefits are subject to eligibility requirements; the variant is not automatically available to every enrollee.
The published California SBC lists a $5,200 individual medical deductible.
The published California SBC lists an $8,100 individual annual out-of-pocket limit.
The HMO structure limits routine care to the applicable network, subject to policy exceptions.
A referral is required for specialist care under the published California plan terms.

About Centene Corporation (Insurer Profile)

Centene Corporation

Key Insights

Founded

1984

Centene Corporation was established 42 years ago and has built strong credibility over time, backed by its long-standing presence in the market.

Claims Experience

0% CSR, calculated as a 3-year average

Centene Corporation settles 0% of all claims it receives.

Network Hospitals

140+

Centene Corporation has a network of 140+ hospitals, ensuring wide accessibility and convenience for policyholders.

Silver 73 Ambetter HMO (CSR) Features and Benefits

Medical deductible

The published 2026 California Silver 73 Ambetter HMO SBC lists a $5,200 individual and $10,400 family medical deductible per calendar year.

These amounts apply to the cited California plan document and may not match other locations or variants.

Annual out-of-pocket limit

The published California SBC lists an $8,100 individual and $16,200 family annual out-of-pocket limit for covered services.

Premiums and services the plan does not cover are not included in this limit.

Primary-care visits

The California plan overview lists a $50 in-network office visit copayment with the deductible waived for the specified service.

Confirm the service definition and current benefit schedule before receiving care.

Specialist consultations

The published California plan overview lists a $90 in-network specialist consultation copayment with the deductible waived.

A referral is required for specialist care under the published plan terms.

Prescription drug benefits

The published California SBC lists a $50 individual/$100 family pharmacy deductible for drug Tiers 2–4.

Drug coverage and member cost-sharing depend on the current formulary and applicable tier.

Preventive care

Eligible preventive services may be covered without cost-sharing under applicable ACA requirements and the plan terms.

Diagnostic or follow-up services may have different cost-sharing.

HMO network and referrals

The plan uses a designated provider network and requires a referral before covered specialist care, as described in the published California SBC.

Confirm network participation and referral requirements for the exact plan.

Add-ons of Silver 73 Ambetter HMO (CSR)

Optional Vision Coverage

Separate vision coverage may be available to eligible Ambetter members. Vision benefits may help with eligible eye-care services according to the applicable supplemental policy.

Confirm availability for this exact plan and state, additional premium, provider network, covered services and benefit limits before publishing this as an available option.

What Silver 73 Ambetter HMO (CSR) Does Not Cover (Exclusions)

Conditions or treatments that the policy clearly says it will not cover.

Services not covered under the applicable policy are not payable benefits.
Non-emergency out-of-network services may have limited or no coverage under the HMO policy.
Prescription drugs excluded by the applicable formulary may not be covered unless an exception is approved.
Services that do not meet applicable medical-necessity or benefit requirements may not be covered.
Cosmetic or other non-essential services may be excluded unless specifically covered by the policy.

Disclaimer: For illustration purposes only - exact terms are in the policy wording.

What's missing in Silver 73 Ambetter HMO (CSR)

Provider access depends on the plan network. Confirm that your preferred doctors, hospitals and facilities participate before enrolling.
Your actual out-of-pocket costs depend on the plan deductible, copays, coinsurance and out-of-pocket maximum. Review the official plan documents for your exact plan.
Prescription coverage depends on the applicable drug formulary, drug tier and utilization requirements. Check your medicines against the current plan formulary.

Silver 73 Ambetter HMO (CSR) FAQs

What is Silver 73 Ambetter HMO CSR?

It is the 2026 Silver 73 Ambetter HMO cost-sharing reduction variant listed for California’s Covered California marketplace. Confirm the exact service area and plan documents before enrolling.

What does CSR mean?

CSR means cost-sharing reduction. Eligible Marketplace enrollees may receive reduced deductibles, copayments or other out-of-pocket costs through a qualifying Silver plan.

Who can qualify for CSR?

Eligibility depends on Marketplace rules, household income and other applicable requirements. Check your Covered California application and eligibility determination.