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Medica with CHI Health Silver Copay
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Medica with CHI Health Silver Copay

Overview
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Medica with CHI Health Silver 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 Nance 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
20305NE0050003
Coverage area
Nance 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
$3,700
Out-of-pocket maximum
$7,600
Generic drug co-pay
$20
Preferred brand drug co-pay
$120
Primary care physician visit cost
$30
Specialist doctor visit cost
$60
Doctor Visits
Primary Care Visit $30
Specialist Visit $60
Emergency Room Visit 40% Coinsurance after deductible
Inpatient Facility Visit 40% Coinsurance after deductible
Inpatient Physician Visit 40% Coinsurance after deductible
Prescription Drugs
Generic Drugs $20
Preferred Brand Drugs $120
Non-preferred Brand Drugs 60% Coinsurance after deductible
Specialty Drugs $550
Medical Deductible
Medical Deductible (Individual) $3,700
Medical Maximum Out Of Pocket (Individual) $7,600
Medical Deductible (Family) $11,100
Medical Maximum Out Of Pocket (Family) $15,200
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 0-14 444
Premium Child Age 18 530
Premium Adult Individual Age 21 581
Premium Adult Individual Age 27 609
Premium Adult Individual Age 30 659
Premium Adult Individual Age 40 742
Premium Adult Individual Age 50 1,038
Premium Adult Individual Age 60 1,577
Premium Couple 21 1,162
Premium Couple 30 1,319
Premium Couple 40 1,485
Premium Couple 50 2,076
Premium Couple 60 3,155
Couple+1 child, Age 21 1,607
Couple+1 child, Age 30 1,764
Couple+1 child, Age 40 1,930
Couple+1 child, Age 50 2521
Couple+2 children, Age 21 2,051
Couple+2 children, Age 30 2,208
Couple+2 children, Age 40 2,375
Couple+2 children, Age 50 2,965
Couple+3 or more Children, Age 21 2,496
Couple+3 or more Children, Age 30 2,653
Couple+3 or more Children, Age 40 2,819
Couple+3 or more Children, Age 50 3,410
Individual+1 child, Age 21 1,025
Individual+1 child, Age 30 1,104
Individual+1 child, Age 40 1,187
Individual+1 child, Age 50 1,482
Individual+2 children, Age 21 1,470
Individual+2 children, Age 30 1,549
Individual+2 children, Age 40 1,632
Individual+2 children, Age 50 1,927
Individual+3 or more children, Age 21 1,915
Individual+3 or more children, Age 30 1,993
Individual+3 or more children, Age 40 2,076
Individual+3 or more children, Age 50 2,372
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