Anthem Blue Cross and Blue Shield
Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives)
Plan ID79475WI0550002
Plan year2027Sold on HealthCare.gov
Plan typeHMONo referral needed
Metal levelExpanded BronzeWorks with an HSA
Sold in14 countiesof 72 in Wisconsin
Deductible$5,000$10,000 family
Out-of-pocket max$12,000$24,000 family
Primary care visit$0 + 40% after deductiblein network
Generic drugs$10per prescription
14,389 Wisconsin doctors and facilities in this plan's network · Directory updated Nov 5, 2026 · Monthly premiums are not shown: they depend on age, county and income. NPI Profile does not sell insurance; HealthCare.gov lists premiums and handles enrollment.
Find a doctor in this plan
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Listed in Anthem Blue Cross and Blue Shield'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 Directories can be out of date, so call the office to confirm they take this plan.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
In-network costs for one person, from the CMS plan files for 2027. "After deductible" means you pay the full cost until you reach the $5,000 deductible.
Doctor visits
- Primary care visit
- $0 + 40% after deductible
- Specialist visit
- $60 + 40% after deductible
- Nurse practitioner or PA visit
- $0 + 40% after deductible
- Preventive care and vaccines
- Free
- Urgent care
- $50
Prescription drugs
- Generic drugs
- $10
- Preferred brand drugs
- 30% after deductible
- Non-preferred brand drugs
- 40% after deductible
- Specialty drugs
- 45% after deductible
Tests and imaging
- Lab work
- 40% after deductible
- X-rays
- 40% after deductible
- MRI, CT and PET scans
- 40% after deductible
Emergencies and hospital
- Emergency room
- $500 after deductible + 40% after deductible
- Ambulance
- 40% after deductible
- Hospital stay
- $1500 a stay after deductible + 40% after deductible
- Outpatient surgery (facility)
- 40% after deductible
Mental health
- Therapy and counseling visits
- 40% after deductible
- Inpatient mental health care
- $1500 a stay after deductible + 40% after deductible
Pregnancy
- Prenatal and postnatal care
- 40% after deductible
- Delivery and hospital stay
- $1500 after deductible + 40% after deductible
Other care
- Physical and occupational therapyLimit: 40 visits a year
- 40% after deductible
- Chiropractic care
- Free + 40% after deductible
- Eye exam for childrenLimit: 1 visit a year
- Free
- Glasses for childrenLimit: 1 item a year
- Free
- Adult dental
- Not covered
$8,070Having a baby (CMS example)
$4,420Managing type 2 diabetes for a year
$2,810A simple fracture
Every service in the plan file (67)
| Service | You pay | Limits and notes |
|---|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered | |
| Accidental Dental | $1500 after deductible + 40% after deductible | $3,000 a episode |
| Acupuncture | Not covered | |
| Allergy Testing | Not covered | |
| Bariatric Surgery | Not covered | |
| Basic Dental Care - Adult | Not covered | |
| Basic Dental Care - Child | Not covered | |
| Chemotherapy | 40% after deductible | |
| Chiropractic Care | Free + 40% after deductible | |
| Cosmetic Surgery | Not covered | |
| Delivery and All Inpatient Services for Maternity Care | $1500 after deductible + 40% after deductible | |
| Dental Check-Up for Children | Not covered | |
| Diabetes Education | $60 + 40% after deductible | |
| Dialysis | 40% after deductible | |
| Durable Medical Equipment | 40% after deductible | 1 item every 3 years |
| Emergency Room Services | $500 after deductible + 40% after deductible | |
| Emergency Transportation/Ambulance | 40% after deductible | |
| Eye Glasses for Children | Free | 1 item a year |
| Generic Drugs | $10 | |
| Habilitation Services | 40% after deductible | 60 visits a year |
| Hearing Aids | 40% after deductible | 1 item every 3 years |
| Home Health Care Services | 40% after deductible | 60 visits a year |
| Hospice Services | 40% after deductible | |
| Imaging (CT/PET Scans, MRIs) | 40% after deductible | |
| Infertility Treatment | Not covered | |
| Infusion Therapy | 40% after deductible | |
| Inpatient Hospital Services (e.g., Hospital Stay) | $1500 a stay after deductible + 40% after deductible | |
| Inpatient Physician and Surgical Services | 40% after deductible | |
| Laboratory Outpatient and Professional Services | 40% after deductible | |
| Long-Term/Custodial Nursing Home Care | Not covered | |
| Major Dental Care - Adult | Not covered | |
| Major Dental Care - Child | Not covered | |
| Mental/Behavioral Health Inpatient Services | $1500 a stay after deductible + 40% after deductible | |
| Mental/Behavioral Health Outpatient Services | 40% after deductible | |
| Non-Preferred Brand Drugs | 40% after deductible | |
| Nutritional Counseling | Not covered | |
| Orthodontia - Adult | Not covered | |
| Orthodontia - Child | Not covered | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $0 + 40% after deductible | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 40% after deductible | |
| Outpatient Rehabilitation Services | 40% after deductible | 60 visits a year |
| Outpatient Surgery Physician/Surgical Services | 40% after deductible | |
| Preferred Brand Drugs | 30% after deductible | |
| Prenatal and Postnatal Care | 40% after deductible | |
| Preventive Care/Screening/Immunization | Free | |
| Primary Care Visit to Treat an Injury or Illness | $0 + 40% after deductible | |
| Private-Duty Nursing | Not covered | |
| Prosthetic Devices | 40% after deductible | 1 item every 3 years |
| Radiation | 40% after deductible | |
| Reconstructive Surgery | $1500 after deductible + 40% after deductible | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 40% after deductible | 40 visits a year |
| Rehabilitative Speech Therapy | 40% after deductible | 20 visits a year |
| Routine Dental Services (Adult) | Not covered | |
| Routine Eye Exam (Adult) | Not covered | |
| Routine Eye Exam for Children | Free | 1 visit a year |
| Routine Foot Care | Not covered | |
| Skilled Nursing Facility | 40% after deductible | 30 days a admission |
| Specialist Visit | $60 + 40% after deductible | |
| Specialty Drugs | 45% after deductible | |
| Substance Abuse Disorder Inpatient Services | $1500 a stay after deductible + 40% after deductible | |
| Substance Abuse Disorder Outpatient Services | 40% after deductible | |
| Transplant | $1500 after deductible + 40% after deductible | |
| Treatment for Temporomandibular Joint Disorders | 40% after deductible | |
| Urgent Care Centers or Facilities | $50 | |
| Weight Loss Programs | Not covered | |
| Well Baby Visits and Care | Free | |
| X-rays and Diagnostic Imaging | 40% after deductible |
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
- Yes
- Network
- Pathway and Rx Choice Tiered Network (WIN001)
- Sold in
- 14 Wisconsin counties
- Also filed as
- 79475WI0550011, 79475WI0550012, 79475WI0550013, 79475WI0550054
Summary of Benefits and Coverage (PDF) Plan brochure Covered drugs (formulary)
Other Anthem Blue Cross and Blue Shield plans on the same network
The same doctors and hospitals, with different costs.
| Plan | Metal | Deductible | Out-of-pocket max |
|---|---|---|---|
| Anthem Heart Healthy Bronze Pathway 0 Med Ded HSA ($0 Select Drugs + Incentives) HMO | Expanded Bronze | $0 | $12,000 |
| Anthem Silver Pathway 4000 ($0 PCP Visits + $0 Select Drugs + Incentives) HMO | Silver | $4,000 | $10,400 |
| Anthem Silver Pathway 5500 ($0 Select Drugs + Incentives) HMO | Silver | $5,500 | $10,500 |
| Anthem Bronze Pathway 8000 HSA ($0 Select Drugs + Incentives) HMO | Expanded Bronze | $8,000 | $10,000 |
Questions about Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives)
Does Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives) 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 Anthem Blue Cross and Blue Shield lists in this plan's network for 2027. Directories can be out of date, so call the office to confirm before your visit.
What kind of plan is Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives)?
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 Expanded Bronze plan and works with a health savings account (HSA).
How much is a doctor visit with Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives)?
A primary care visit costs $0 + 40% after deductible. A specialist visit costs $60 + 40% after deductible. These are in-network costs for one person. "After deductible" means you pay the full cost until you reach the $5,000 deductible.
Where is Anthem Bronze Pathway 5000 HSA (3 Free PCP Visits + $0 Select Drugs + Incentives) sold?
It is sold to people who live in 14 Wisconsin counties, through HealthCare.gov. Anthem Blue Cross and Blue Shield'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. HealthCare.gov shows the price for your household.
About this data
NPI Profile is not an insurance company, agent or broker, and it does not sell insurance or enroll anyone in a plan. It is a free reference tool built on public files that CMS and insurers publish, to help you compare Marketplace plans and check whether your current or future doctor is in a plan's network. It is not affiliated with CMS, HealthCare.gov, any state exchange or any insurer. Confirm costs and networks with the insurer and the doctor's office, and enroll on HealthCare.gov.
| Source | What it provides here | Source date |
|---|---|---|
| CMS Marketplace public use files (Plan Attributes, Benefits and Cost Sharing, Service Area) | This plan's costs, covered services, coverage examples and the counties where it is sold | Plan year 2027 |
| Anthem Blue Cross and Blue Shield's provider directory | The doctors and facilities listed in this plan's network. Only providers with an address in Wisconsin are counted. | Updated November 5, 2026 |
| NPPES NPI registry | Provider names, practice addresses and primary specialties | Matched November 8, 2026 |
- Costs are for the standard version of the plan, for one person, in network. People who qualify for cost-sharing reductions pay less.
- Monthly premiums are not shown: they depend on age, county, household and income. HealthCare.gov lists them for your household.
- Confirm costs in the plan documents and with the insurer, and confirm with the doctor's office that they take this plan.
