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Medica with CHI Health Bronze Copay
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Medica with CHI Health Bronze Copay

Overview
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Medica with CHI Health Bronze Copay 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 Pawnee 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
20305NE0050005
Coverage area
Pawnee 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
$6,850
Out-of-pocket maximum
$7,900
Generic drug co-pay
$30
Preferred brand drug co-pay
$160
Primary care physician visit cost
$80
Specialist doctor visit cost
$150
Doctor Visits
Primary Care Visit $80
Specialist Visit $150
Emergency Room Visit 50% Coinsurance after deductible
Inpatient Facility Visit 50% Coinsurance after deductible
Inpatient Physician Visit 50% Coinsurance after deductible
Prescription Drugs
Generic Drugs $30
Preferred Brand Drugs $160
Non-preferred Brand Drugs 70% Coinsurance after deductible
Specialty Drugs $600
Medical Deductible
Medical Deductible (Individual) $6,850
Medical Maximum Out Of Pocket (Individual) $7,900
Medical Deductible (Family) $13,700
Medical Maximum Out Of Pocket (Family) $15,800
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 0-14 258
Premium Child Age 18 308
Premium Adult Individual Age 21 337
Premium Adult Individual Age 27 353
Premium Adult Individual Age 30 383
Premium Adult Individual Age 40 431
Premium Adult Individual Age 50 603
Premium Adult Individual Age 60 916
Premium Couple 21 675
Premium Couple 30 766
Premium Couple 40 863
Premium Couple 50 1,206
Premium Couple 60 1,832
Couple+1 child, Age 21 933
Couple+1 child, Age 30 1,024
Couple+1 child, Age 40 1,121
Couple+1 child, Age 50 1,464
Couple+2 children, Age 21 1,192
Couple+2 children, Age 30 1,283
Couple+2 children, Age 40 1,379
Couple+2 children, Age 50 1,722
Couple+3 or more Children, Age 21 1,450
Couple+3 or more Children, Age 30 1,541
Couple+3 or more Children, Age 40 1,638
Couple+3 or more Children, Age 50 1,981
Individual+1 child, Age 21 596
Individual+1 child, Age 30 641
Individual+1 child, Age 40 689
Individual+1 child, Age 50 861
Individual+2 children, Age 21 854
Individual+2 children, Age 30 899
Individual+2 children, Age 40 948
Individual+2 children, Age 50 1,119
Individual+3 or more children, Age 21 1,112
Individual+3 or more children, Age 30 1,158
Individual+3 or more children, Age 40 1,206
Individual+3 or more children, Age 50 1,378
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