Is a specialist referral required?

No. The cited SBC states that a referral is not required to see a specialist.

Does the plan have a published monthly premium?

The SBC says premium information is provided separately. Obtain an official quote for the applicable location and applicant.

Anthem Bronze Pathway HMO 5000 S03 Benefits and Costs

Q: How much is an in-network primary-care visit?

The SBC lists $45 per visit for non-IHCP in-network primary care, with no deductible applied.

Anthem Bronze Pathway HMO 5000 Overview

Anthem Bronze Pathway HMO 5000 $45 $0 Virtual PCP $0 Select Drugs S03 is a 2026 Individual and Family HMO plan documented for Georgia/Indiana. The official Summary of Benefits and Coverage lists a $5,000 individual or $10,000 family deductible for non-Indian Health Care Provider (IHCP) in-network care. The in-network out-of-pocket limit is $10,600 per individual or $21,200 per family for non-IHCP providers. IHCP and qualifying referral arrangements have different cost-sharing rules.

2026 Bronze Pathway HMO with a $5,000 individual deductible, $45 primary care and select drug benefits.

Expert Review of Anthem Bronze Pathway HMO 5000

The plan provides a $45 in-network primary-care visit without applying the deductible, no-charge preventive care, and select prescription-drug benefits. Specialist visits and many diagnostic or outpatient services have coinsurance after the deductible. Emergency-room care, inpatient hospital facility services and some imaging can involve substantial cost sharing. Routine out-of-network care is generally not covered, although the SBC lists certain emergency services as covered in-network. Review the full SBC and provider network before enrollment.

Pros

$45 in-network primary-care visit with no deductible applied.
Listed preventive care is covered at no charge in-network.
No specialist referral is required under the cited SBC.

Cons

The $5,000 individual deductible can leave members paying substantial costs for many services.
Hospital facility services can involve $500 per admission plus 50% coinsurance.
Routine non-emergency out-of-network services are generally not covered under the SBC.

About Elevance Health (Insurer Profile)

Elevance Health

Key Insights

Founded

1944

Elevance Health was established 82 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

Elevance Health settles 0% of all claims it receives.

Network Hospitals

9000+

Elevance Health has a network of 9000+ hospitals, ensuring wide accessibility and convenience for policyholders.

Anthem Bronze Pathway HMO 5000 Features and Benefits

Primary care

In-network non-IHCP primary-care visit costs $45 per visit; the deductible does not apply.

Virtual visit benefits are available; confirm applicable virtual-care terms.

Preventive care

Listed in-network preventive care, screening and immunization services are shown at no charge.

Services not classified as preventive may have cost sharing.

Specialist care

In-network non-IHCP specialist visits are subject to 25% coinsurance after the deductible.

No specialist referral is required under the cited SBC.

Prescription drugs

The SBC lists select drug benefits and separate cost sharing for generic, preferred brand, non-preferred brand and specialty tiers.

Check the current Select Drug List and retail/home-delivery rules.

Emergency care

The SBC lists $500 per emergency-room visit followed by 50% coinsurance for non-IHCP in-network care; emergency out-of-network care is covered as in-network.

Cost sharing and service rules are subject to the official policy.

Hospital services

In-network non-IHCP hospital facility care is listed at $500 per admission followed by 50% coinsurance.

Deductible and service limits may apply; review the full SBC.

Waiting Periods in Anthem Bronze Pathway HMO 5000

The SBC does not specify a general medical waiting period. Enrollment windows, effective dates, prior authorization and service-specific rules may apply; confirm details in the full policy.

What Anthem Bronze Pathway HMO 5000 Does Not Cover (Exclusions)

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

Adult dental care is generally not covered.
Adult routine eye care is generally not covered.
Infertility treatment is generally not covered.
Cosmetic surgery is generally not covered.
Long-term care is generally not covered.
Weight-loss programs and bariatric surgery are generally not covered.
Non-emergency care while travelling outside the United States is generally not covered.
Private-duty nursing is generally not covered.

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

What's missing in Anthem Bronze Pathway HMO 5000

The SBC does not provide a monthly premium; obtain an official quote for the applicant's location and circumstances.
Adult routine dental and adult routine eye care are not included as covered services in the cited SBC.
Review the current Summary of Benefits and Coverage for exclusions, prior authorization requirements and service-specific limitations.

Anthem Bronze Pathway HMO 5000 FAQs

What is the individual deductible?

The cited 2026 SBC lists $5,000 for non-IHCP in-network care. IHCP or qualifying referral arrangements have different rules.

What is the family deductible?

The cited 2026 SBC lists $10,000 for non-IHCP in-network care.

What is the out-of-pocket limit?

The cited SBC lists $10,600 per individual and $21,200 per family for non-IHCP in-network care.

How much is an in-network primary-care visit?