Medica
Plan Overviews
Medica is be the most comprehensive provider of individual health insurance for Iowa in 2024.
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| Plan Name | Essential Care 1 (2016) – Standard | Essential Care 5 (2016) with 3 Free PCP Visits – Standard |
| Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | $6,800/$13,600 | $6,800/$13,600 |
| Prescription Drug Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | Integrated with medical ded. | Integrated with medical ded. |
| 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 (Ind/Fam) | $6,800/$13,600 | $6,800/$13,600 |
| Annual Well Visit/ Preventive Care | No charge | No charge |
| PCP Office Visit | No charge after ded. | No charge after ded. |
| Specialist Office Visit | No charge after ded. | No charge after ded. |
| Imaging (CT/PET Scans, MRIs) | No charge after ded. | No charge after ded. |
| X-rays & Diagnostic Imaging | No charge after ded. | No charge after ded. |
| Urgent Care | No charge after ded. | No charge after ded. |
| Emergency Room* | No charge after ded. | No charge after ded. |
| Emergency Transportation* | No charge after ded. | No charge after ded. |
| Inpatient Facility Fee | No charge after ded. | No charge after ded. |
| Inpatient Hospital Physician & Surgical Services | No charge after ded. | No charge after ded. |
| Outpatient Facility Fee | No charge after ded. | No charge after ded. |
| Outpatient Surgery Physician/Surgical Services | No charge after ded. | No charge after ded. |
| Labs & Diagnostics | No charge after ded. | No charge after ded. |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | No charge after ded. | No charge after ded. |
| Rehabilitation Outpatient Services (Includes Speech, Occupational, Physical Therapy) | No charge after ded. | No charge after ded. |
| Skilled Nursing Facility | No charge after ded. | No charge after ded. |
| Pediatric Vision- Routine Eye Exam (1 visit per year) | 100% Covered | 100% Covered |
| Pediatric Vision- Eyeglasses (frames, 1 per year) | 100% Covered | 100% Covered |
| Pedicatric Vision- Lenses (per pair) | 100% Covered | 100% Covered |
| Pharmacy*
(Generic / Preferred / Non-preferred / Specialty) |
$20 / No charge after ded. / No charge after ded. / No charge after ded. | No charge after ded. / No charge after ded. / No charge after ded.
/ No charge after ded. |
| Plan Name | Balanced Care 1 (2016) – Standard | Balanced Care 2 (2016) – Standard | Balanced Care 10 (2016) – Standard |
| Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | $5,500/$11,000 | $6,500/$13,000 | $4,500/$9,000 |
| Prescription Drug Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | Integrated with medical ded. | Integrated with medical ded. | Integrated with medical ded. |
| 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 (Ind/Fam) | $6,500/$13,000 | $6,500/$13,000 | $6,500/$13,000 |
| Annual Well Visit/ Preventive Care | No charge | No charge | No charge |
| PCP Office Visit | 30 | 30 | 20 |
| Specialist Office Visit | 60 | 60 | 40 |
| Imaging (CT/PET Scans, MRIs) | 20% after ded. | No charge after ded. | 20% after ded. |
| X-rays & Diagnostic Imaging | 20% after ded. | No charge after ded. | 20% after ded. |
| Urgent Care | 100 | 100 | 100 |
| Emergency Room* | 20% after ded. | No charge after ded. | 20% after ded. |
| Emergency Transportation* | 20% after ded. | No charge after ded. | 20% after ded. |
| Inpatient Facility Fee | 20% after ded. | No charge after ded. | 20% after ded. |
| Inpatient Hospital Physician & Surgical Services | 20% after ded. | No charge after ded. | 20% after ded. |
| Outpatient Facility Fee | 20% after ded. | No charge after ded. | 20% after ded. |
| Outpatient Surgery Physician/Surgical Services | 20% after ded. | No charge after ded. | 20% after ded. |
| Labs & Diagnostics | 20% after ded. | No charge after ded. | 20% after ded. |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | 30 | 30 | 20 |
| Rehabilitation Outpatient Services (Includes Speech, Occupational, Physical Therapy) | 20% after ded. | No charge after ded. | 20% after ded. |
| Skilled Nursing Facility | 20% after ded. | No charge after ded. | 20% after ded. |
| Pediatric Vision- Routine Eye Exam (1 visit per year) | 100% Covered | 100% Covered | 100% Covered |
| Pediatric Vision- Eyeglasses (frames, 1 per year) | 100% Covered | 100% Covered | 100% Covered |
| Pedicatric Vision- Lenses (per pair) | 100% Covered | 100% Covered | 100% Covered |
| Pharmacy*
(Generic / Preferred / Non-preferred / Specialty) |
$10 / $50 / 20% after Rx ded. / 20% after Rx ded. | $15 / $50 / No charge after ded. / No charge after ded. | $10 / $50 / 20% after ded. / 20% after ded. |
| Plan Name | Secure Care 1 (2016) with 3 Free PCP Visits – Standard |
| Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | $1,000/$2,000 |
| Prescription Drug Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Ind/Fam) | $500/$1,000 |
| 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 (Ind/Fam) | $6,350/$12,700 |
| Annual Well Visit/ Preventive Care | No charge |
| PCP Office Visit | 20% after ded. |
| Specialist Office Visit | 20% after ded. |
| Imaging (CT/PET Scans, MRIs) | 20% after ded. |
| X-rays & Diagnostic Imaging | 20% after ded. |
| Urgent Care | 20% after ded. |
| Emergency Room* | $250 after ded. |
| Emergency Transportation* | 20% after ded. |
| Inpatient Facility Fee | 20% after ded. |
| Inpatient Hospital Physician & Surgical Services | 20% after ded. |
| Outpatient Facility Fee | 20% after ded. |
| Outpatient Surgery Physician/Surgical Services | 20% after ded. |
| Labs & Diagnostics | 20% after ded. |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | 20% after ded. |
| Rehabilitation Outpatient Services (Includes Speech, Occupational, Physical Therapy) | 20% after ded. |
| Skilled Nursing Facility | 20% after ded. |
| Pediatric Vision- Routine Eye Exam (1 visit per year) | 100% Covered |
| Pediatric Vision- Eyeglasses (frames, 1 per year) | 100% covered |
| Pedicatric Vision- Lenses (per pair) | 100% covered |
| Pharmacy*
(Generic / Preferred / Non-preferred / Specialty) |
$10 / $25 after Rx ded. / $75 after Rx ded. / 30% after Rx ded. |
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