Prestige Gold Essential + 3Free PCP Visits
Gold · HMO · Network Health · Wisconsin
At age 40 it costs between $669.92 and $742.27 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 | 81413WI0490013 |
|---|---|
| Insurer | Network Health |
| Metal level | Gold |
| Plan type | HMO |
| Deductible (individual) | $1,750 |
| Deductible (family) | $3,500 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $8,950 |
| Family maximum | $17,900 |
| Primary care visit | $20 |
| Specialist visit | $60 |
| Emergency room | $350 |
| Inpatient stay | 20% Coinsurance after deductible |
| Generic drugs | $15 |
| Preferred brand drugs | $60 |
| Specialty drugs | 40% 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 | 1-855-275-1400 · TTY 1-800-947-3529 |
Where it is sold, and what it costs there
6 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 |
|---|---|---|---|---|---|
| Milwaukee County | $524.20 | $594.96 | $669.92 | $936.21 | $1,422.66 |
| Ozaukee County | $529.96 | $601.51 | $677.29 | $946.51 | $1,438.31 |
| Washington County | $529.96 | $601.51 | $677.29 | $946.51 | $1,438.31 |
| Waukesha County | $529.96 | $601.51 | $677.29 | $946.51 | $1,438.31 |
| Kenosha County | $580.81 | $659.22 | $742.27 | $1,037.32 | $1,576.30 |
| Racine County | $580.81 | $659.22 | $742.27 | $1,037.32 | $1,576.30 |
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.