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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- Wisconsin Copay Plans
- Wisconsin Copay Plus Plan
- Wisconsin HSA - Compatible Plans
- Wisconsin Catastrophic
- 2017 Out-Of-Network Details
| 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:
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- 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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Contact Us
Phone: (312) 726-6565
Email: [email protected]