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.

When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.

In-network providers include:

Mayo Clinic Health System locations in Minnesota and Wisconsin

Employee and Community Health at Mayo Clinic in Rochester and Kasson,

Northfield Hospital & Clinics

Winona Health.

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Phone: (312) 726-6565

Email: [email protected]

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