Medica Individual Choice Gold Standard
Gold · EPO · Medica · Wisconsin
At age 40 it costs between $649.67 and $950.22 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 | 57845WI0040055 |
|---|---|
| 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 1-800-947-3529 |
Where it is sold, and what it costs there
13 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 |
|---|---|---|---|---|---|
| Pierce County | $508.35 | $576.98 | $649.67 | $907.91 | $1,379.66 |
| Polk County | $508.35 | $576.98 | $649.67 | $907.91 | $1,379.66 |
| Saint Croix County | $508.35 | $576.98 | $649.67 | $907.91 | $1,379.66 |
| Ashland County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Bayfield County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Burnett County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Douglas County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Sawyer County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Washburn County | $627.03 | $711.68 | $801.34 | $1,119.88 | $1,701.76 |
| Barron County | $668.25 | $758.47 | $854.03 | $1,193.50 | $1,813.64 |
| Clark County | $668.25 | $758.47 | $854.03 | $1,193.50 | $1,813.64 |
| Rusk County | $668.25 | $758.47 | $854.03 | $1,193.50 | $1,813.64 |
| Marathon County | $743.52 | $843.90 | $950.22 | $1,327.93 | $2,017.92 |
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.
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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.