Balance by Medica Gold $0 Copay PCP Visits
Gold · PPO · Medica · Oklahoma
At age 40 it costs between $537.81 and $691.54 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What CMS publishes about it
| Plan ID | 21333OK0060045 |
|---|---|
| Insurer | Medica |
| Metal level | Gold |
| Plan type | PPO |
| Deductible (individual) | $1,500 |
| Deductible (family) | $3,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,800 |
| Family maximum | $17,600 |
| Primary care visit | No Charge |
| Specialist visit | $75 |
| Emergency room | 30% Coinsurance after deductible |
| Inpatient stay | 30% Coinsurance after deductible |
| Generic drugs | $15 |
| Preferred brand drugs | $75 |
| Specialty drugs | 60% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | No |
| Share of premium buying essential health benefits | 100.00% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-888-592-8211 · TTY 1-800-676-3777 |
Where it is sold, and what it costs there
9 counties. The premium is the price before any tax credit; what you pay depends on your income.
| County | At 21 | At 30 | At 40 | At 50 | At 60 |
|---|---|---|---|---|---|
| Blaine County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Carter County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Johnston County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Kingfisher County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Murray County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Pontotoc County | $420.82 | $477.63 | $537.81 | $751.58 | $1,142.10 |
| Canadian County | $541.11 | $614.16 | $691.54 | $966.42 | $1,468.57 |
| Logan County | $541.11 | $614.16 | $691.54 | $966.42 | $1,468.57 |
| Oklahoma County | $541.11 | $614.16 | $691.54 | $966.42 | $1,468.57 |
Open enrollment for 2026 coverage runs 1 November 2025 to 15 January 2026 in most states. Outside that window you need a qualifying life event — losing other coverage, moving, marrying, having a child — to enrol.
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When this plan’s price or benefits change.
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Premiums, deductibles, out-of-pocket maximums and cost sharing are reproduced from the HealthCare.gov Qualified Health Plan landscape file published by the Centers for Medicare & Medicaid Services for plan year 2026. Nothing on this page is calculated by us. This is not a complete list of your options and it is not advice: to see every plan and to enrol, use HealthCare.gov or call 1-800-318-2596.