Balance by Medica Gold $0 Copay PCP Visits
Gold · EPO · Medica · Missouri
At age 40 it costs between $571.87 and $779.55 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 | 53461MO0080045 |
|---|---|
| Insurer | Medica |
| Metal level | Gold |
| Plan type | EPO |
| 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
31 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 |
|---|---|---|---|---|---|
| Franklin County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Jefferson County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Lincoln County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Saint Charles County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Saint Louis County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Saint Louis City | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Warren County | $447.48 | $507.89 | $571.87 | $799.19 | $1,214.45 |
| Barry County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Cedar County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Christian County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Dade County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Dallas County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Douglas County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Greene County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Hickory County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Laclede County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Lawrence County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Ozark County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Polk County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Stone County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Taney County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Webster County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Wright County | $462.07 | $524.44 | $590.52 | $825.25 | $1,254.05 |
| Barton County | $500.99 | $568.62 | $640.26 | $894.76 | $1,359.68 |
| Jasper County | $500.99 | $568.62 | $640.26 | $894.76 | $1,359.68 |
| McDonald County | $500.99 | $568.62 | $640.26 | $894.76 | $1,359.68 |
| Newton County | $500.99 | $568.62 | $640.26 | $894.76 | $1,359.68 |
| Howell County | $510.33 | $579.22 | $652.20 | $911.44 | $1,385.03 |
| Texas County | $510.33 | $579.22 | $652.20 | $911.44 | $1,385.03 |
| Saint Clair County | $609.98 | $692.33 | $779.55 | $1,089.42 | $1,655.48 |
| Vernon County | $609.98 | $692.33 | $779.55 | $1,089.42 | $1,655.48 |
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.
Get told when this changes
When this plan’s price or benefits change.
Double opt-in, one click to unsubscribe. We never sell or share the list, and we are not an insurance agent or broker: this is a notification about published data, not a sales call. Privacy.
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.