Balance by Medica Gold Standard
Gold · EPO · Medica · Missouri
At age 40 it costs between $583.28 and $795.10 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 | 53461MO0080055 |
|---|---|
| Insurer | Medica |
| Metal level | Gold |
| Plan type | EPO |
| Standardised design | Design 1 — a plan CMS defined the benefits of, so it can be compared like for like |
| Deductible (individual) | $2,000 |
| Deductible (family) | $4,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,200 |
| Family maximum | $16,400 |
| Primary care visit | $30 |
| Specialist visit | $60 |
| Emergency room | 25% Coinsurance after deductible |
| Inpatient stay | 25% Coinsurance after deductible |
| Generic drugs | $15 |
| Preferred brand drugs | $30 |
| Specialty drugs | $250 |
| 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 | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Jefferson County | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Lincoln County | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Saint Charles County | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Saint Louis County | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Saint Louis City | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Warren County | $456.40 | $518.01 | $583.28 | $815.13 | $1,238.67 |
| Barry County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Cedar County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Christian County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Dade County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Dallas County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Douglas County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Greene County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Hickory County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Laclede County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Lawrence County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Ozark County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Polk County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Stone County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Taney County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Webster County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Wright County | $471.28 | $534.90 | $602.29 | $841.70 | $1,279.05 |
| Barton County | $510.98 | $579.96 | $653.03 | $912.61 | $1,386.79 |
| Jasper County | $510.98 | $579.96 | $653.03 | $912.61 | $1,386.79 |
| McDonald County | $510.98 | $579.96 | $653.03 | $912.61 | $1,386.79 |
| Newton County | $510.98 | $579.96 | $653.03 | $912.61 | $1,386.79 |
| Howell County | $520.50 | $590.77 | $665.20 | $929.62 | $1,412.64 |
| Texas County | $520.50 | $590.77 | $665.20 | $929.62 | $1,412.64 |
| Saint Clair County | $622.14 | $706.13 | $795.10 | $1,111.15 | $1,688.49 |
| Vernon County | $622.14 | $706.13 | $795.10 | $1,111.15 | $1,688.49 |
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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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.