Understand your Ameristead® Health plan options.
Compare the benefits outlined in the supplied 2026 plan materials, review prescription information, and learn what to discuss before applying. Dave can help you understand the details and confirm which options may be available to you.
Plan information explained clearly. Personal guidance when you need it.
This page summarizes supplied 2026 materials. Benefits, rates, eligibility, and document versions should be confirmed before enrollment.
What would you like to understand?
What do the Ameristead® materials include?
The supplied Ameristead® Health materials describe seven plan options: HSA 9000, Bronze, HSA 6000, Silver, Gold, Platinum, and Diamond. They identify a Cigna provider network and outline deductibles, medical cost sharing, prescription benefits, and application questions. Availability and individual coverage details require confirmation.
Different deductible and cost-sharing structures.
The supplied chart identifies Cigna PPO. Confirm the exact network and each provider's participation before enrolling.
A provider network is not the same as the insurer or plan sponsor.
Discuss the documents, your priorities, and the questions that need answers before choosing coverage.
Ameristead® plans are built for business owners and their people.
Ameristead® products are specifically designed for employer groups, business owners, sole proprietors, the self-employed, and employees being sponsored by an employer (where the employer contributes to your monthly health insurance premium).
You are a sole proprietor.
You are an employer offering coverage to employees.
You are an employee obtaining coverage through your employer.
You are a small business owner.
All 50 states
Ameristead® plan materials reference availability across all 50 states. Confirm the specific plan, network, and enrollment rules for your state before applying.
Founded on the principle that entrepreneurs and small business owners deserve the same quality health coverage as large corporations, Ameristead® serves the small-to-medium business community and large employer groups with reliable, comprehensive insurance plans.
Whether you're a sole proprietor, a small business owner, or an employer providing coverage to your employees, Ameristead® offers coverage options that scale with your needs — from individual plans to full family coverage, with clear plan structures, transparent pricing, and responsive customer service.
Underwriting: Health screen / medical underwriting is possibly required for enrollment. Acceptance is not guaranteed. Dave reviews your situation honestly before any application is submitted.
Compare the seven listed plan options
Start with the deductible and your share of covered costs. Then review office visits, prescriptions, network access, and the rules that apply to your household.
| Plan | Individual deductible | Family deductible | Member coinsurance (many covered services) | Individual out-of-pocket max | Family out-of-pocket max |
|---|---|---|---|---|---|
| HSA 9000 | $9,000 | $18,000 | 30% after deductible | $10,100 | $20,200 |
| Bronze | $8,000 | $16,000 | 30% after deductible | $8,700 | $17,400 |
| HSA 6000 | $6,000 | $12,000 | 30% after deductible | $7,000 | $14,000 |
| Silver | $5,000 | $10,000 | 30% after deductible | $8,700 | $17,400 |
| Gold | $3,000 | $6,000 | 20% after deductible | $8,700 | $17,400 |
| Platinum | $250 | $500 | 20% after deductible | $1,250 | $2,500 |
| Diamond | $0 | $0 | 30% for the listed major medical services | $6,000 | $12,000 |
Swipe horizontally to view all plan columns →
Source: supplied Ameristead® Plan Chart and Plan Comparison Summary, effective January 1, 2026. Out-of-pocket figures are taken from the supplied chart and require confirmation against the governing plan documents.
Family coverage: the summary describes aggregate family deductible and out-of-pocket rules. Do not assume an individual limit applies separately to each person enrolled in family coverage.
Network rules: the summary states that in-network and out-of-network deductibles and out-of-pocket limits are separate and do not cross-accumulate.
Office visits and urgent care
| Plan | Primary care | Specialist | Urgent care |
|---|---|---|---|
| HSA 9000 | 30% after deductible | 30% after deductible | 30% after deductible |
| Bronze | $50 listed copay | $120 listed copay | $100 listed copay |
| HSA 6000 | 30% after deductible | 30% after deductible | 30% after deductible |
| Silver | $40 listed copay | $80 listed copay | $60 listed copay |
| Gold | $35 listed copay | $55 listed copay | $55 listed copay |
| Platinum | $25 listed copay | $45 listed copay | $45 listed copay |
| Diamond | $25 listed copay | $50 listed copay | $50 listed copay |
Confirm when copays apply and whether additional services during a visit are billed separately. The documents do not clearly establish all deductible conditions for office copays.
The supplied materials list no charge for preventive care and telehealth across these options, subject to covered-service definitions, designated providers, and plan terms.
Understand the terms
Deductible
The amount you pay for covered services before specified plan benefits begin sharing costs, subject to the plan's rules.
Copay
A stated amount you pay for a covered service. Whether the deductible applies first depends on the plan.
Coinsurance
Your percentage of the allowed cost for a covered service, often after the deductible.
Out-of-pocket maximum
A limit on qualifying member cost sharing under the plan's rules. Premiums, excluded services, and some other charges may not count toward it.
What will my coverage cost?
The supplied chart includes premium figures for employee-only, employee-plus-spouse, employee-plus-children, and family coverage. Ask Dave for current pricing and confirmation of the plan, household category, contribution requirements, and effective date.
GLP-1 Prescriptions (Ozempic, Mounjaro...): As indicated on the chart notes, preauthorization is required every 6 months, A1C must be 6 or more, and distribution is via mail order only.
Ameristead® Plan Chart & Rate Sheet (Marpai · Cigna PPO)
Official summary snapshot of deductibles, cost sharing, and monthly premiums by tier
Monthly Premiums Breakdown (From Rate Sheet)
| Coverage Tier | HSA 9000 | Bronze | HSA 6000 | Silver | Gold | Platinum | Diamond |
|---|---|---|---|---|---|---|---|
| Employee Only | $426 | $544 | $640 | $674 | $941 | $1,003 | $873 |
| Employee + Spouse | $589 | $856 | $1,012 | $1,067 | $1,493 | $1,632 | $1,372 |
| Employee + Child(ren) | $549 | $753 | $889 | $945 | $1,309 | $1,563 | $1,243 |
| Employee + Family | $789 | $1,134 | $1,340 | $1,413 | $1,981 | $2,993 | $1,687 |
Rates shown above reflect the supplied Marpai/Ameristead® sheet. Actual applicable rates, contribution requirements, and final pricing must be verified with Dave.
How to review your prescription coverage
The supplied formulary is a reference list, not a guarantee that a medication is covered under your specific plan. Coverage can depend on the drug, formulation, indication, plan exclusions, authorization requirements, and pharmacy benefit rules.
Dated reference: this formulary states an effective period of January 1–June 30, 2026. Request the current version before making a coverage decision.
How to read the legend
- PAPrior authorization requirement.
- STStep therapy requirement.
- SPListed on a specialty tier.
Formulary Source Details (Phoenix PBM 2026 Base Impact Formulary):
The supplied formulary also includes an Indication Based Management section (e.g., Rheumatoid Arthritis, Psoriasis, Crohn's Disease, Ulcerative Colitis) with non-preferred/excluded medications versus preferred alternatives, and specific tier-step rules (e.g. requires step through one, two, or three preferred biologics).
Finding a drug name anywhere in the PDF does not establish coverage.
Locate the exact medication name, strength, and formulation in the document.
Check which section it appears in and review any PA, ST, or SP notation.
Confirm current coverage, restrictions, and member cost with the pharmacy benefit administrator or Dave before enrolling.
The supplied chart and full summary differ on some generic prescription copays. Current prescription costs should be confirmed for the selected plan.
The application questionnaire also asks applicants to acknowledge PBM-managed alternative sourcing for medications with a gross monthly cost of $700 or more. Ask how this process applies to your prescriptions. PBM stands for "pharmacy benefit manager."
Not every county offers the same plan types.
The ACA Marketplace (also called Obamacare) lists different plans depending on your county and state — and the mix of HMO, EPO, PPO, and POS options varies widely. In some areas, a PPO is only available through an employer or off the exchange entirely.
Palm Beach County, FL
- EPO29
- HMO142
- PPO14
- POS10
Not all counties or states have the same options.
New York (ZIP 11697)
- EPO12
- HMO73
- PPONone
- POSNone
Residents here can only get a PPO through their employer or by finding a plan off the exchange.
“I specialize in plans that are not on the exchange — also known as Obamacare, ACA, or the Marketplace.”
Off-exchange and private options can offer network structures and enrollment timing the Marketplace doesn't. Dave helps you understand the difference and confirm what's actually available where you live and work.
What should you discuss before applying?
The supplied application questionnaire asks about medical history, current or planned care, certain medications, and employment or business status. Reviewing these topics with Dave can help you understand the application process. This page does not determine eligibility.
Specified cardiovascular conditions, cancer, and organ disorders.
Certain mental health conditions, counseling, and substance dependency history.
Recent overnight hospitalization.
Pregnancy, adoption, surrogacy, and fertility treatment.
Diabetes, autoimmune conditions, and neurological disorders.
Pending diagnostic results, recommended procedures, or planned treatment.
High-cost prescription sourcing.
Self-employment, sole-proprietor or EIN-holder status, or employer-sponsored W-2 employment.
The questions use different time periods and definitions. Read the original questionnaire for the exact wording.
The questionnaire includes an accuracy attestation and describes potential consequences for misrepresentation. Discuss any unclear question before completing an application.
Important details beyond the comparison chart
Preauthorization
The summary states that certain services require preauthorization or precertification and that failure to obtain it can result in denial of benefits. Examples include hospital admissions, advanced imaging, outpatient surgery, and certain therapies. Review the complete requirements before receiving care.
Plan allowable amounts
Benefits are subject to the plan allowable amount and other plan terms. A listed coinsurance percentage should not be interpreted as a percentage of every provider's billed charge.
Family accumulation rules
Confirm how deductible and out-of-pocket amounts accumulate for the people on your plan.
Benefits and exclusions
The supplied summary is not the complete governing plan document. Review the official terms, limitations, exclusions, and service-specific requirements.
Details needing clarification
Some supplied materials differ or use unclear wording. Dave can help obtain clarification before you rely on a particular benefit or cost.
Review the source documents
Ameristead® Plan Chart & Rate Sheet
Official summary snapshot of plan benefits, deductibles, coinsurance, copays, and monthly premium rates by tier (Employee, +Spouse, +Children, Family).
Status: Supplied reference; Marpai Administrator · Cigna PPO Network.
Open PDFFull Ameristead® Plan Summary
Detailed benefit categories, cost sharing, and plan conditions.
Status: Effective January 1, 2026; confirm applicability.
Link pending document uploadPrescription Formulary
Drug listings, authorization notation, and non-preferred/excluded sections.
Status: January 1–June 30, 2026 reference; updated version needed.
Link pending document uploadMedical Questions
Application questions and attestations to discuss before applying.
Status: Supplied 2026 application reference.
Link pending document uploadThe five source documents (Ameristead® Plan Chart, Full Ameristead® Plan Summary, Prescription Formulary, Medical Questions, and Rate Sheet) will be linked here once uploaded to hosting. The summaries on this page remain available in HTML without requiring a PDF viewer.
Frequently asked questions
This page provides an educational summary of supplied Ameristead® Health materials and is not a policy, coverage determination, or enrollment approval. Benefits, eligibility, pricing, provider participation, prescription coverage, and availability must be confirmed for the selected plan. Governing plan documents control. Some supplied documents contain differences or dated information.
Dave Gagleard
Health Insurance Broker · Dave Knows Health®
Let's make the details easier to understand.
You don't have to work through every deductible, prescription rule, and application question alone. Talk with Dave about your priorities and the details you want confirmed before choosing coverage.
Questions? Speak with Dave Gagleard
Personal review of your plan details, prescription questions, and application preparation — no automated decisions, no pressure.