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Elevate by Medica Gold Share
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Elevate by Medica Gold Share

Overview
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Elevate by Medica Gold Share is an individual health health plan issued by Medica Insurance Company and is available for the year 2019. This health plan is offered by the federal government through HealthCare.gov and the Affordable Care Act (ACA).

Where Do I Need to Live to Quality for this Plan?

This plan is available for qualifying individuals who live in Sarpy county, Nebraska.

What Type of Health Plan Is This?

This plan is an EPO plan, which is also known as an "Exclusive Provider Organization." An EPO is a managed care plan where services are covered so long as the the hospitals, dentists, and other health providers in the plan's network are used.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
Medica Insurance Company
Plan ID
20305NE0030025
Coverage area
Sarpy County, Nebraska
Phone
Local Phone: 1-888-592-8211
Toll-Free: 1-888-592-8211
TTY: 1-800-833-7352
Plan type
EPO
Coverage type
Medical deductible
$500
Out-of-pocket maximum
$6,500
Generic drug co-pay
$15
Preferred brand drug co-pay
$70
Primary care physician visit cost
35% Coinsurance after deductible
Specialist doctor visit cost
35% Coinsurance after deductible
Doctor Visits
Primary Care Visit 35% Coinsurance after deductible
Specialist Visit 35% Coinsurance after deductible
Emergency Room Visit 35% Coinsurance after deductible
Inpatient Facility Visit 35% Coinsurance after deductible
Inpatient Physician Visit 35% Coinsurance after deductible
Prescription Drugs
Generic Drugs $15
Preferred Brand Drugs $70
Non-preferred Brand Drugs 50% Coinsurance after deductible
Specialty Drugs $500
Medical Deductible
Medical Deductible (Individual) $500
Medical Maximum Out Of Pocket (Individual) $6,500
Medical Deductible (Family) $1,500
Medical Maximum Out Of Pocket (Family) $13,000
Drug Deductible
Drug Deductible (Individual) Included in Medical
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) Included in Medical
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 100.00%
Premium Child Age 0-14 350
Premium Child Age 18 418
Premium Adult Individual Age 21 458
Premium Adult Individual Age 27 480
Premium Adult Individual Age 30 520
Premium Adult Individual Age 40 585
Premium Adult Individual Age 50 818
Premium Adult Individual Age 60 1,243
Premium Couple 21 916
Premium Couple 30 1,040
Premium Couple 40 1,171
Premium Couple 50 1,637
Premium Couple 60 2,487
Couple+1 child, Age 21 1,267
Couple+1 child, Age 30 1,390
Couple+1 child, Age 40 1,522
Couple+1 child, Age 50 1,987
Couple+2 children, Age 21 1,617
Couple+2 children, Age 30 1,741
Couple+2 children, Age 40 1,872
Couple+2 children, Age 50 2,338
Couple+3 or more Children, Age 21 1,968
Couple+3 or more Children, Age 30 2,092
Couple+3 or more Children, Age 40 2,223
Couple+3 or more Children, Age 50 2,688
Individual+1 child, Age 21 808
Individual+1 child, Age 30 870
Individual+1 child, Age 40 936
Individual+1 child, Age 50 1,169
Individual+2 children, Age 21 1,159
Individual+2 children, Age 30 1,221
Individual+2 children, Age 40 1,286
Individual+2 children, Age 50 1,519
Individual+3 or more children, Age 21 1,510
Individual+3 or more children, Age 30 1,572
Individual+3 or more children, Age 40 1,637
Individual+3 or more children, Age 50 1,870
Reference
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  • HealthCare.gov. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov
  • The 'metal' categories: Bronze, Silver, Gold & Platinum. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plans-categories
  • Health insurance plan & network types: HMOs, PPOs, and more. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plan-types