Balance by Medica Silver $0 Copay PCP Visits
Silver · EPO · Medica · Missouri
At age 40 it costs between $618.77 and $843.48 a month before any subsidy, depending on which county you live in — a marketplace plan is priced per rating area, not per state.
What this Silver plan costs if your income qualifies
Below certain incomes the marketplace improves a Silver plan's cost sharing automatically — you do not apply for it, and it happens on Silver and on no other metal level. The premium does not change; the deductible and what you pay at the doctor do.
| If your income is | Deductible | Most you could pay in a year | Primary care | Generic drugs |
|---|---|---|---|---|
| Above 250%, or not applied for | $3,500 | $10,450 | No Charge | $25 |
| up to 150% of the federal poverty level | $0 | $2,050 | No Charge | $10 |
| 150% to 200% | $850 | $3,350 | No Charge | $10 |
| 200% to 250% | $2,400 | $8,450 | No Charge | $25 |
CMS calls these cost-sharing reductions. The percentages are actuarial values, not discounts. HealthCare.gov works out which one you get from the income you report when you apply.
What CMS publishes about it
| Plan ID | 53461MO0080047 |
|---|---|
| Insurer | Medica |
| Metal level | Silver |
| Plan type | EPO |
| Deductible (individual) | $3,500 |
| Deductible (family) | $7,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $10,450 |
| Family maximum | $20,900 |
| Primary care visit | No Charge |
| Specialist visit | $80 |
| Emergency room | 40% Coinsurance after deductible |
| Inpatient stay | 40% Coinsurance after deductible |
| Generic drugs | $25 |
| Preferred brand drugs | $125 |
| 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 | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Jefferson County | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Lincoln County | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Saint Charles County | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Saint Louis County | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Saint Louis City | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Warren County | $484.17 | $549.53 | $618.77 | $864.73 | $1,314.03 |
| Barry County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Cedar County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Christian County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Dade County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Dallas County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Douglas County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Greene County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Hickory County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Laclede County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Lawrence County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Ozark County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Polk County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Stone County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Taney County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Webster County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Wright County | $499.95 | $567.45 | $638.94 | $892.92 | $1,356.88 |
| Barton County | $542.07 | $615.25 | $692.76 | $968.13 | $1,471.17 |
| Jasper County | $542.07 | $615.25 | $692.76 | $968.13 | $1,471.17 |
| McDonald County | $542.07 | $615.25 | $692.76 | $968.13 | $1,471.17 |
| Newton County | $542.07 | $615.25 | $692.76 | $968.13 | $1,471.17 |
| Howell County | $552.17 | $626.72 | $705.68 | $986.18 | $1,498.60 |
| Texas County | $552.17 | $626.72 | $705.68 | $986.18 | $1,498.60 |
| Saint Clair County | $660 | $749.10 | $843.48 | $1,178.75 | $1,791.23 |
| Vernon County | $660 | $749.10 | $843.48 | $1,178.75 | $1,791.23 |
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.