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Medica with CHI Health Gold Copay
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Medica with CHI Health Gold Copay

Overview
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Medica with CHI Health Gold 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 Hall 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
20305NE0050001
Coverage area
Hall 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
$750
Out-of-pocket maximum
$6,500
Generic drug co-pay
$15
Preferred brand drug co-pay
$70
Primary care physician visit cost
$30
Specialist doctor visit cost
$60
Doctor Visits
Primary Care Visit $30
Specialist Visit $60
Emergency Room Visit 30% Coinsurance after deductible
Inpatient Facility Visit 30% Coinsurance after deductible
Inpatient Physician Visit 30% 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) $750
Medical Maximum Out Of Pocket (Individual) $6,500
Medical Deductible (Family) $2,250
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 0-14 378
Premium Child Age 18 451
Premium Adult Individual Age 21 494
Premium Adult Individual Age 27 517
Premium Adult Individual Age 30 560
Premium Adult Individual Age 40 631
Premium Adult Individual Age 50 882
Premium Adult Individual Age 60 1,341
Premium Couple 21 988
Premium Couple 30 1,121
Premium Couple 40 1,263
Premium Couple 50 1,765
Premium Couple 60 2,682
Couple+1 child, Age 21 1,366
Couple+1 child, Age 30 1,499
Couple+1 child, Age 40 1,641
Couple+1 child, Age 50 2,143
Couple+2 children, Age 21 1,744
Couple+2 children, Age 30 1,877
Couple+2 children, Age 40 2,019
Couple+2 children, Age 50 2,521
Couple+3 or more Children, Age 21 2,122
Couple+3 or more Children, Age 30 2,255
Couple+3 or more Children, Age 40 2,397
Couple+3 or more Children, Age 50 2,899
Individual+1 child, Age 21 872
Individual+1 child, Age 30 938
Individual+1 child, Age 40 1,009
Individual+1 child, Age 50 1,260
Individual+2 children, Age 21 1,250
Individual+2 children, Age 30 1,316
Individual+2 children, Age 40 1,387
Individual+2 children, Age 50 1,638
Individual+3 or more children, Age 21 1,628
Individual+3 or more children, Age 30 1,694
Individual+3 or more children, Age 40 1,765
Individual+3 or more children, Age 50 2,016
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