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Medica Insure Bronze HSA
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Medica Insure Bronze HSA

Overview
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Medica Insure Bronze HSA 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 Polk 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
20305NE0040011
Coverage area
Polk 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
$6,200
Out-of-pocket maximum
$6,750
Generic drug co-pay
20% Coinsurance after deductible
Preferred brand drug co-pay
20% Coinsurance after deductible
Primary care physician visit cost
20% Coinsurance after deductible
Specialist doctor visit cost
20% Coinsurance after deductible
Doctor Visits
Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Emergency Room Visit 20% Coinsurance after deductible
Inpatient Facility Visit 20% Coinsurance after deductible
Inpatient Physician Visit 20% Coinsurance after deductible
Prescription Drugs
Generic Drugs 20% Coinsurance after deductible
Preferred Brand Drugs 20% Coinsurance after deductible
Non-preferred Brand Drugs 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $6,200
Medical Maximum Out Of Pocket (Individual) $6,750
Medical Deductible (Family) $12,400
Medical Maximum Out Of Pocket (Family) $13,500
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 0-14 386
Premium Child Age 18 461
Premium Adult Individual Age 21 505
Premium Adult Individual Age 27 529
Premium Adult Individual Age 30 573
Premium Adult Individual Age 40 646
Premium Adult Individual Age 50 903
Premium Adult Individual Age 60 1,372
Premium Couple 21 1,011
Premium Couple 30 1,147
Premium Couple 40 1,292
Premium Couple 50 1,806
Premium Couple 60 2,744
Couple+1 child, Age 21 1,398
Couple+1 child, Age 30 1,534
Couple+1 child, Age 40 1,679
Couple+1 child, Age 50 2,192
Couple+2 children, Age 21 1,784
Couple+2 children, Age 30 1,921
Couple+2 children, Age 40 2066
Couple+2 children, Age 50 2,579
Couple+3 or more Children, Age 21 2,171
Couple+3 or more Children, Age 30 2,308
Couple+3 or more Children, Age 40 2,452
Couple+3 or more Children, Age 50 2,966
Individual+1 child, Age 21 892
Individual+1 child, Age 30 960
Individual+1 child, Age 40 1033
Individual+1 child, Age 50 1,289
Individual+2 children, Age 21 1,279
Individual+2 children, Age 30 1,347
Individual+2 children, Age 40 1,419
Individual+2 children, Age 50 1,676
Individual+3 or more children, Age 21 1,666
Individual+3 or more children, Age 30 1,734
Individual+3 or more children, Age 40 1,806
Individual+3 or more children, Age 50 2,063
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