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Texas · 2026

Community Premier Silver 020 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)

Community Health Choice

How to read this plan

This is the official Marketplace filing for Community Premier Silver 020 (No deductible for PCP, Specialist, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) (Community Health Choice, Texas, 2026). Everything below comes from the data the carrier filed with CMS for this plan year — premium pricing personalized to you, deductibles and out-of-pocket maximums, covered benefits with their cost-sharing, quality ratings, the formulary, and the network.

Three sections do most of the work when you're deciding whether a plan fits:

  • Deductibles and Maximum Out-of-Pocket tell you the cost ceiling. The deductible is what you pay before the plan starts sharing costs; the out-of-pocket max is the most you can pay in a year for in-network covered care. The out-of-pocket max is your real downside number.
  • Covered Benefits shows what you pay for each service line — primary care, specialists, ER, imaging, hospital stays, mental health. This is where two plans with identical deductibles can produce very different bills.
  • Prescription Drug Benefits and the linked formulary tell you which tier your medications fall on. Tier 3 and 4 drugs can blow past the deductible on a single fill, so don't skim this section if you take regular prescriptions.

Two things this page can't tell you on its own: (1) what your actual monthly premium will be after subsidies — that depends on your income and household; and (2) whether your specific doctors are in this plan's network — that requires cross-checking the provider directory.

Premium & Pricing

Your price depends on you.

Marketplace premiums are personalized based on your age, household size, income, tobacco use, and zip code. Most households qualify for a premium tax credit that lowers the monthly cost — often by a lot.

Share a few details and we'll show you the real monthly price for this plan, including any subsidy you're eligible for.

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Deductibles

The most you'll have to pay for covered services in a plan year. Once you reach this amount, the plan pays 100% of covered services for the rest of the year. Premiums and out-of-network charges don't count toward this limit.

Combined Medical and Drug EHB Deductible

In-Network · Individual

$6,000

Maximum Out-of-Pocket

The most you'll have to pay for covered services in a plan year. Once you reach this amount, the plan pays 100% of covered services for the rest of the year. Premiums and out-of-network charges don't count toward this limit.

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total)

In-Network · Individual

$8,900

Plan Classification

Metal Level
Silver

Bronze, Silver, Gold, and Platinum plans balance monthly premiums against out-of-pocket costs. Higher metal levels cost more per month but pay more of your care.

Plan Type
HMO

HMO, PPO, EPO, POS, and Indemnity plans differ in how they handle networks and referrals. PPOs and POS plans give you more freedom; HMOs and EPOs trade flexibility for lower costs.

Market
Individual

Individual plans are bought directly by consumers. SHOP plans are offered through small employers.

HSA Eligible
No

If Yes, you can pair this plan with a Health Savings Account to set aside pre-tax money for medical expenses.

Simple Choice
No

Simple Choice (Standardized) plans follow a common cost-sharing template defined by CMS, making it easier to compare plans side by side.

Sample Bill Estimates

Sample bill estimates are not available for this plan.

Covered Benefits

A sampling of the benefits this plan covers, what they mean, and what you'll pay. The full list of covered services is in the plan's Summary of Benefits.

Specialist Visit

Covered

What this is:

Your Cost

  • In-Network$80
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Emergency Room Services

Covered

What this is:

Your Cost

  • In-Network40% Coinsurance after deductible
  • Out-of-Network40% Coinsurance after deductible

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Mental/Behavioral Health Outpatient Services

Covered

What this is:

Your Cost

  • In-Network$40
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Primary Care Visit to Treat an Injury or Illness

Covered

What this is:

Your Cost

  • In-Network$40
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Mental/Behavioral Health Inpatient Services

Covered

What this is:

Your Cost

  • In-Network40% Coinsurance after deductible
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Generic Drugs

Covered

What this is:

Your Cost

  • In-Network$20
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Urgent Care Centers Or Facilities

Covered

What this is:

Your Cost

  • In-Network$60
  • Out-of-NetworkNot Covered

A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.

Quality Rating

Overall (2026)
★★★★★3/5

CMS combines member experience, clinical quality, and plan efficiency into a single 5-star overall rating. Higher is better.

Clinical Quality Management
★★★★★3/5

Measures how well the plan helps members get recommended care — things like preventive screenings, chronic disease management, and behavioral health follow-ups.

Enrollee Experience
Insufficient data to calculate a score according to the QRS rating methodology

Reflects surveyed members' experience with their plan and providers — access to care, customer service, and overall satisfaction.

Plan Efficiency
★★★★★3/5

Measures how efficiently the plan delivers care — use of appropriate services, avoiding unnecessary hospitalizations, and network stability.

Network & Access

National Network
No

A Yes means you have in-network coverage when traveling outside your state. Most Marketplace plans are regional only.

Specialist Referral Required
No

When Yes, you must see a primary care provider first for a referral before the plan covers specialist visits.

Disease Management Programs

Free programs to help members manage specific chronic conditions. They typically include nurse coaching, medication support, and educational resources.

No disease management programs are listed for this plan.

Prescription Drug Benefits

90-Day Mail Order
No

When Yes, you can get a 90-day supply of maintenance medications delivered by mail — usually cheaper than filling three 30-day prescriptions at a retail pharmacy.

Eligibility & Coverage Rules

Maximum Child Age
26

The oldest a dependent child can be and still stay on this plan. The ACA generally allows coverage up to age 26.

Covers Non-Hyde Abortion Services
No

Indicates whether the plan covers abortion services beyond the narrow exceptions (rape, incest, life of the mother) allowed under the Hyde Amendment.

Currently Available
Yes

Whether this plan is currently open to new enrollment. Some plans are shown for informational purposes only.

Issuer Information

Issuer
Community Health Choice

The insurance company that underwrites and administers this plan. You'll deal with them for ID cards, claims, and customer service.

Licensed State
TX

The state in which the issuer is licensed to sell this product.

TTY
1-855-315-5386

Text Telephone number for members who are deaf, hard of hearing, or have a speech disability.

Individual Site
Visit

The issuer's website for individual (non-group) members.

Resources & Documents

Summary of BenefitsPlan BrochureProvider NetworkDrug Formulary