SimpliveraCoverage Companion

Engage by Medica Silver Copay (First 3)

Medica Insurance Company · 2027 plan year

Silver
Ind. deductible
$750
Family deductible
$1,500
Ind. OOP max
$3,000
Family OOP max
$6,000

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver Off Exchange PlanStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More Medica Insurance Company plans in MN

Medica Applause Silver HSAMedica Applause Bronze HSA

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$10.00 Copay with deductible + 25.00% Coinsurance after deductible

Specialist

BenefitIn-network
Specialist Visit$10.00 Copay with deductible + 25.00% Coinsurance after deductible

Hospital

BenefitIn-network
Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible
Urgent Care Centers or Facilities$10.00 Copay with deductible + 25.00% Coinsurance after deductible

Pharmacy

BenefitIn-network
Generic Drugs$10.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$90.00
Specialty Drugs60.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$10.00 Copay with deductible + 25.00% Coinsurance after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is Prohibited25.00% Coinsurance after deductible
Accidental Dental25.00% Coinsurance after deductible
Allergy Testing25.00% Coinsurance after deductible
Chemotherapy$10.00 Copay with deductible + 25.00% Coinsurance after deductible
Chiropractic Care$10.00 Copay with deductible + 25.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Diabetes EducationNo charge
Dialysis25.00% Coinsurance after deductible
Durable Medical Equipment25.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for Children25.00% Coinsurance after deductible
Gender Affirming Care25.00% Coinsurance after deductible
Habilitation Services25.00% Coinsurance after deductible
Hearing Aids25.00% Coinsurance after deductible
Home Health Care Services25.00% Coinsurance after deductible
Hospice Services25.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)25.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
Nutritional Counseling25.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$10.00 Copay with deductible + 25.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation Services25.00% Coinsurance after deductible
Prenatal and Postnatal Care25.00% Coinsurance after deductible
Prosthetic Devices25.00% Coinsurance after deductible
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy25.00% Coinsurance after deductible
Rehabilitative Speech Therapy25.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$10.00 Copay with deductible + 25.00% Coinsurance after deductible
Transplant25.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders25.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible

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