Ambetter Health
Complete Silver
Plan ID72001KY0020005
Plan year2026Sold on kynect
Plan typeHMONo referral needed
Metal levelSilverNot HSA-eligible
Sold in108 countiesof 120 in Kentucky
These are the plan's 2026 details. Kentucky's 2027 plan details are not public yet, so prices, benefits or doctors may change for 2027. Check kynect before you enroll.
Deductible$5,950$11,900 family
Out-of-pocket max$8,850$17,700 family
Coinsurance40%after the deductible
Having a baby$7,510CMS example
16,756 Kentucky doctors and facilities in this plan's network · Directory updated Nov 4, 2026 · Monthly premiums are not shown: they depend on age, county and income. kynect lists them for your household.
Find a doctor in this plan
Where do you want to see a doctor?
What kind of doctor in ?
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Listed in Ambetter Health's provider directory. Directories can be out of date, so call the office to confirm they take this plan.
What you pay with this plan
Which services this plan covers, from the plan files kynect sends to CMS. Those files do not include copays; the plan's Summary of Benefits and Coverage from Ambetter Health or kynect lists them.
Doctor visits
- Primary care visit
- Covered
- Specialist visit
- Covered
- Nurse practitioner or PA visit
- Covered
- Preventive care and vaccines
- Covered
- Urgent care
- Covered
Prescription drugs
- Generic drugs
- Covered
- Preferred brand drugs
- Covered
- Non-preferred brand drugs
- Covered
- Specialty drugs
- Covered
Tests and imaging
- Lab work
- Covered
- X-rays
- Covered
- MRI, CT and PET scans
- Covered
Emergencies and hospital
- Emergency room
- Covered
- Ambulance
- Covered
- Hospital stay
- Covered
- Outpatient surgery (facility)
- Covered
Mental health
- Therapy and counseling visits
- Covered
- Inpatient mental health care
- Covered
Pregnancy
- Prenatal and postnatal care
- Covered
- Delivery and hospital stay
- Covered
Other care
- Physical and occupational therapyLimit: 25 visits a year
- Covered
- Chiropractic careLimit: 20 visits a year
- Covered
- Eye exam for childrenLimit: 1 exam a year
- Covered
- Glasses for childrenLimit: 1 item a year
- Covered
- Adult dental
- Not covered
$7,510Having a baby (CMS example)
$2,120Managing type 2 diabetes for a year
$2,400A simple fracture
Every service in the plan file (78)
| Service | You pay | Limits and notes |
|---|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered | |
| Accidental Dental | Covered | |
| Acupuncture | Not covered | |
| Allergy Testing | Covered | |
| Bariatric Surgery | Not covered | |
| Basic Dental Care - Adult | Not covered | |
| Basic Dental Care - Child | Not covered | |
| Chemotherapy | Covered | |
| Chiropractic Care | Covered | 20 visits a year |
| Cosmetic Surgery | Not covered | |
| Delivery and All Inpatient Services for Maternity Care | Covered | |
| Dental Check-Up for Children | Not covered | |
| Diabetes Education | Covered | |
| Dialysis | Covered | |
| Durable Medical Equipment | Covered | |
| Emergency Room Services | Covered | |
| Emergency Transportation/Ambulance | Covered | |
| Eye Glasses for Children | Covered | 1 item a year |
| Generic Drugs | Covered | |
| Habilitation Services | Covered | 25 visits a year |
| Hearing Aids | Covered | 2 items every 3 years |
| Home Health Care Services | Covered | 100 visits a year |
| Hospice Services | Covered | |
| Imaging (CT/PET Scans, MRIs) | Covered | |
| Infertility Treatment | Not covered | |
| Infusion Therapy | Covered | |
| Inpatient Hospital Services (e.g., Hospital Stay) | Covered | |
| Inpatient Physician and Surgical Services | Covered | |
| Laboratory Outpatient and Professional Services | Covered | |
| Long-Term/Custodial Nursing Home Care | Not covered | |
| Major Dental Care - Adult | Not covered | |
| Major Dental Care - Child | Not covered | |
| Mental/Behavioral Health Emergency Room | Covered | |
| Mental/Behavioral Health Emergency Transportation/Ambulance | Covered | |
| Mental/Behavioral Health ER Physician Fee | Covered | |
| Mental/Behavioral Health Inpatient Services | Covered | |
| Mental/Behavioral Health Outpatient Other Services | Covered | |
| Mental/Behavioral Health Outpatient Services | Covered | |
| Mental/Behavioral Health Urgent Care | Covered | |
| Non-Preferred Brand Drugs | Covered | |
| Nutritional Counseling | Covered | |
| Orthodontia - Adult | Not covered | |
| Orthodontia - Child | Not covered | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | Covered | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Covered | |
| Outpatient Rehabilitation Services | Covered | 25 visits a year |
| Outpatient Surgery Physician/Surgical Services | Covered | |
| Preferred Brand Drugs | Covered | |
| Prenatal and Postnatal Care | Covered | |
| Preventive Care/Screening/Immunization | Covered | |
| Primary Care Visit to Treat an Injury or Illness | Covered | |
| Private-Duty Nursing | Covered | 250 visits a year |
| Prosthetic Devices | Covered | |
| Radiation | Covered | |
| Reconstructive Surgery | Covered | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | Covered | 25 visits a year |
| Rehabilitative Speech Therapy | Covered | 25 visits a year |
| Routine Dental Services (Adult) | Not covered | |
| Routine Eye Exam (Adult) | Not covered | |
| Routine Eye Exam for Children | Covered | 1 exam a year |
| Routine Foot Care | Covered | |
| Skilled Nursing Facility | Covered | 150 days a year |
| Specialist Visit | Covered | |
| Specialty Drugs | Covered | |
| Substance Abuse Disorder Inpatient Services | Covered | |
| Substance Abuse Disorder Outpatient Services | Covered | |
| Substance Use Disorder Emergency Room | Covered | |
| Substance Use Disorder Emergency Transportation/Ambulance | Covered | |
| Substance Use Disorder ER Physician Fee | Covered | |
| Substance Use Disorder Outpatient Other Services | Covered | |
| Substance Use Disorder Urgent Care | Covered | |
| Tier 1b Generic Drugs | Covered | |
| Transplant | Covered | |
| Treatment for Temporomandibular Joint Disorders | Covered | |
| Urgent Care Centers or Facilities | Covered | |
| Weight Loss Programs | Not covered | |
| Well Baby Visits and Care | Covered | |
| X-rays and Diagnostic Imaging | Covered |
How this plan works
HMO: You pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies.
- Referral for specialists
- Not required
- Coinsurance
- 40% after the deductible
- Works with an HSA
- No
- Network
- Premier (KYN001)
- Sold in
- 108 Kentucky counties
Other Ambetter Health plans on the same network
The same doctors and hospitals, with different costs.
| Plan | Metal | Deductible | Out-of-pocket max |
|---|---|---|---|
| Everyday Gold HMO | Gold | $800 | $7,250 |
| Everyday Gold + Vision + Adult Dental HMO | Gold | $800 | $7,250 |
| Complete Gold HMO | Gold | $1,450 | $7,700 |
| Complete Gold + Vision + Adult Dental HMO | Gold | $1,450 | $7,700 |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options HMO | Silver | $5,900 | $8,350 |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental HMO | Silver | $5,900 | $8,350 |
| Complete Silver + Vision + Adult Dental HMO | Silver | $5,950 | $8,850 |
| Focused Silver HMO | Silver | $6,300 | $8,400 |
| Focused Silver + Vision + Adult Dental HMO | Silver | $6,300 | $8,400 |
| Clear Silver HMO | Silver | $7,000 | $7,000 |
| Clear Silver + Vision + Adult Dental HMO | Silver | $7,000 | $7,000 |
| Choice Bronze HSA HMO | Expanded Bronze | $7,250 | $7,250 |
| Choice Bronze HSA + Vision + Adult Dental HMO | Expanded Bronze | $7,250 | $7,250 |
| Everyday Bronze HMO | Expanded Bronze | $8,450 | $10,150 |
| Everyday Bronze + Vision + Adult Dental HMO | Expanded Bronze | $8,450 | $10,150 |
Questions about Complete Silver
Does Complete Silver cover my doctor?
Use "Find a doctor in this plan" on this page: choose the city, then the kind of doctor. The list shows providers Ambetter Health lists in this plan's network. Directories can be out of date, so call the office to confirm before your visit.
What kind of plan is Complete Silver?
It is an HMO plan: you pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies. It is a Silver plan.
How much is a doctor visit with Complete Silver?
A primary care visit costs Covered. A specialist visit costs Covered. These are in-network costs for one person. "After deductible" means you pay the full cost until you reach the $5,950 deductible.
Where is Complete Silver sold?
It is sold to people who live in 108 Kentucky counties, through kynect. Ambetter Health's directory can also list providers outside these counties, such as pharmacies and specialists, but the plan itself is only for people who live in its area.
Why is there no monthly premium on this page?
Premiums depend on your age, county, household size and income, and most people get a subsidy, so a single price would mislead. kynect shows the price for your household.
About this data
- Plan, costs and counties: the kynect plan files CMS publishes for state-run exchanges, plan year 2026. Costs are for the standard version of the plan; people who qualify for cost-sharing reductions pay less.
- Doctors: Ambetter Health's machine-readable provider directory, matched to the NPPES NPI registry. Only providers with an address in Kentucky are counted. Updated November 8, 2026.
- Accuracy: confirm costs in the plan documents and with the insurer. NPI Profile is not affiliated with CMS, kynect or Ambetter Health.
