Choosing a health insurance plan is important. And that goes double for family and individual coverage. It’s a choice you want to make sensibly. So you want a plan that fits your family’s life, and your own personal style. Here in Wisconsin, you’re in luck. Say “hello” to Medica. With Medica, you choose from a wide variety of plans to find the one that works for your needs. And just like your favorite pair of shoes – a Medica plan feels right, fits good. And that’s the way it should be. Medica plans are available as a one-person or family plan through the Health Insurance Marketplace, or directly from Medica. Your insurance agent can assist you in either situation.

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Bronze

Silver Gold
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

Individual plan: $6,850

Family Plan: $13,700 shared family

Individual Plan: $2,600

Family Plan: $7,800 shared family

Individual Plan: $300

Family Plan: $900

Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services

 

Individual Plan: $7,150

Family Plan: $7,150 per family member¹, or $14,300 for the entire family

Individual Plan: $5,750

Family Plan: $5,750 per family member¹, or $11,500 for the entire family

Individual Plan: $5,000

Family Plan: $5,000 per family member¹, or $10,000 for the entire family 

Preventative Care 100% coverage (deductible does not apply) 100% coverage (deductible does not apply)

100% coverage (deductible does not apply)

Primary Care

$80 copay $30 copay $30 copay
Urgent Care $80 copay  $30 copay $30 copay
Specialty Care

$150 copay

$60 copay $60 copay
Prescription Drugs

Preferred generic: $10 copay

Non-preferred generic: $20 copay

Preferred brand: 50% coverage after deductible

Non-preferred brand: 30%coverage after deductible

Preferred generic: $5 copay

Non-preferred generic: $10 copay

Preferred brand: 60% coverage after deductible

Non-preferred brand: 40%coverage after deductible

Preferred generic: $5 copay

Non-preferred generic: $10 copay

Preferred brand: 70% coverage after deductible

Non-preferred brand: 50%coverage after deductible

Convenience Care Visit $20 copay $20 copay 70% coverage after deductible
Emergency Room 50% coverage after deductible 60% coverage after deductible
Hospital Services
Enhanced Imaging Services 
Ambulance
Surgery
Home Health Care
Lab and X-ray 
Services
Maternity
Other Eligible Health Care Services

 

¹Per Member: Family plan has an embedded individual out-of-pocket maximum. This means each covered family member only needs to satisfy their individual out-of-pocket maximum, not the entire family amount, before receiving 100% coverage.

Gold

Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

Individual plan: $1,000

Family Plan: $3,000 shared family

Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services

 

Individual plan: $4,000

Family plan: $4,000 per family member¹, or $8,000 for the entire family

Preventative Care 100% coverage (deductible does not apply) 

Primary Care

$30 copay
Urgent Care $30 copay
Specialty Care

$30 copay

Prescription Drugs

Preferred generic: $5 copay

Non-preferred generic: $5 copay

Preferred brand: $35 copay

Non-preferred brand: $150 copay

Convenience Care Visits $20 copay
Lab and X-ray services $30 copay per day. Copay waived if services performed during an office visit
Emergency Room $150 copay
Hospital Services

$250 copay per day for the first five days; then 100% coverage (deductible does not apply)

Enhanced Imaging Services $150 copay per service
Ambulance 75% coverage after deductible
Surgery 75% coverage after deductible
Home Health Care 75% coverage after deductible
Maternity 75% coverage after deductible
¹Per Member: Family plan has an embedded individual out-of-pocket maximum. This means each covered family member only needs to satisfy their individual out-of-pocket maximum, not the entire family amount, before receiving 100% coverage.

Bronze

Silver
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

Individual plan: $1,300

Family plan: $3,900 shared family

Individual plan: $6,400

Family plan: $12,800 shared family

Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services

 

Individual plan: $6,400

Family plan: $6,400 per family member¹, or $12,800 for the entire family

Individual plan: $5,500

Family plan: $5,500 per family member¹, or $11,000 for the entire family

Preventative Care 100% coverage (deductible does not apply) 100% coverage (deductible does not apply)

Primary Care

100% coverage after deductible 60% coverage after deductible
Urgent Care 100% coverage after deductible 60% coverage after deductible
Specialty Care

100% coverage after deductible

60% coverage after deductible
Prescription Drugs

Preferred generic:

100% coverage after deductible

Non-preferred generic:

100% coverage after deductible

Preferred brand:

100% coverage after deductible

Non-preferred brand:

100% coverage after deductible

Preferred generic:

60% coverage after deductible

Non-preferred generic:

60% coverage after deductible

Preferred brand: 60% coverage after deductible

Non-preferred brand: 60%coverage after deductible

Convenience Care Visit 100% coverage after deductible 60% coverage after deductible
Emergency Room 100% coverage after deductible 60% coverage after deductible
Hospital Services 100% coverage after deductible 60% coverage after deductible
Enhanced Imaging Services 

100% coverage after deductible

60% coverage after deductible
Ambulance 100% coverage after deductible 60% coverage after deductible
Surgery 100% coverage after deductible 60% coverage after deductible
Home Health Care 100% coverage after deductible 60% coverage after deductible
Lab and X-ray 
Services
100% coverage after deductible 60% coverage after deductible
Maternity 100% coverage after deductible 60% coverage after deductible
Other Eligible Health Care Services 100% coverage after deductible 60% coverage after deductible

Bronze

Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

Individual plan: $7,150

Family Plan: $7,150 per family member¹, or $14,300 for the entire family

Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services

 

Individual Plan: $7,150

Family Plan: $7,150 per family member¹, or $14,300 for the entire family

Preventative Care 100% coverage (deductible does not apply)

Primary Care

$30 copay first 3 visits per person per calendar year. After 3rd, 100% coverage after deductible
Prescription Drugs

Preferred generic: 100% coverage after deductible

Non-preferred generic:

100% coverage after deductible

Preferred brand:

100% coverage after deductible

Non-preferred brand:

100% coverage after deductible

Convenience Care Visit $20 copay first 3 visits per person per calendar year. After 3rd visit, 100% coverage after deductible
Specialty Care Office Visits 100% coverage after deductible
Urgent Care Visits
Enhanced Imaging Services
Ambulance
Surgery 
Home Health Care
Lab and X-ray 
Services
Hospital Services
Maternity
Other Eligible Health Care Services
¹Per Member: This plan has an embedded individual deductible and out-of-pocket maximum. This means each covered family member only needs to satisfy their individual deductible and out-of-pocket maximum not the entire family amount before receiving benefits.

Copay Plus,Copay, HSA-Compatible and Catastrophic Plans

Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.

 

Individual plan: $10,000

Family Plan: $20,000

Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services

 

There is no maximum for out-of-network services

Benefit Coverage 50% coverage after deductible

Other Details

If you visit an out-of-network health care provider, certain services may be excluded or limited. Please see a Medica Individual Choice policy on medica.com for details.

Medica is a proud provider in the following Wisconsin counties:

Ashland, Barron, Bayfield, Burnett, Chippewa, Douglas, Dunn, Eau Claire, Pierce, Polk, Sawyer, St. Croix and Washburn.

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Phone: (312) 726-6565

Email: [email protected]

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