Balance by Medica Gold Share
Gold · EPO · Medica · Missouri
At age 40 it costs between $574.69 and $783.40 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 | 53461MO0080074 |
|---|---|
| Insurer | Medica |
| Metal level | Gold |
| Plan type | EPO |
| Deductible (individual) | $2,500 |
| Deductible (family) | $5,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $5,900 |
| Family maximum | $11,800 |
| Primary care visit | $30 |
| Specialist visit | $90 |
| Emergency room | 20% Coinsurance after deductible |
| Inpatient stay | 20% Coinsurance after deductible |
| Generic drugs | $15 |
| Preferred brand drugs | $80 |
| 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 | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Jefferson County | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Lincoln County | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Saint Charles County | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Saint Louis County | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Saint Louis City | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Warren County | $449.68 | $510.39 | $574.69 | $803.13 | $1,220.44 |
| Barry County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Cedar County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Christian County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Dade County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Dallas County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Douglas County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Greene County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Hickory County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Laclede County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Lawrence County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Ozark County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Polk County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Stone County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Taney County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Webster County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Wright County | $464.34 | $527.03 | $593.43 | $829.32 | $1,260.23 |
| Barton County | $503.46 | $571.42 | $643.42 | $899.17 | $1,366.38 |
| Jasper County | $503.46 | $571.42 | $643.42 | $899.17 | $1,366.38 |
| McDonald County | $503.46 | $571.42 | $643.42 | $899.17 | $1,366.38 |
| Newton County | $503.46 | $571.42 | $643.42 | $899.17 | $1,366.38 |
| Howell County | $512.84 | $582.08 | $655.41 | $915.94 | $1,391.85 |
| Texas County | $512.84 | $582.08 | $655.41 | $915.94 | $1,391.85 |
| Saint Clair County | $612.99 | $695.74 | $783.40 | $1,094.79 | $1,663.64 |
| Vernon County | $612.99 | $695.74 | $783.40 | $1,094.79 | $1,663.64 |
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.