SimpliveraCoverage Companion

Medica Applause Silver Copay (First 3)

Medica Insurance Company · 2027 plan year

Silver
Ind. deductible
$2,600
Family deductible
$5,200
Ind. OOP max
$8,500
Family OOP max
$17,000

Other cost-sharing reduction variants for this plan:

87% 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$25.00 Copay with deductible + 30.00% Coinsurance after deductible

Specialist

BenefitIn-network
Specialist Visit$25.00 Copay with deductible + 30.00% Coinsurance after deductible

Hospital

BenefitIn-network
Emergency Room Services30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$25.00 Copay with deductible + 30.00% Coinsurance after deductible

Pharmacy

BenefitIn-network
Generic Drugs$10.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$120.00
Specialty Drugs60.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$25.00 Copay with deductible + 30.00% Coinsurance after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is Prohibited30.00% Coinsurance after deductible
Accidental Dental30.00% Coinsurance after deductible
Allergy Testing30.00% Coinsurance after deductible
Chemotherapy$25.00 Copay with deductible + 30.00% Coinsurance after deductible
Chiropractic Care$25.00 Copay with deductible + 30.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Diabetes EducationNo charge
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for Children30.00% Coinsurance after deductible
Gender Affirming Care30.00% Coinsurance after deductible
Habilitation Services30.00% Coinsurance after deductible
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
Nutritional Counseling30.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$25.00 Copay with deductible + 30.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services30.00% Coinsurance after deductible
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy30.00% Coinsurance after deductible
Rehabilitative Speech Therapy30.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$25.00 Copay with deductible + 30.00% Coinsurance after deductible
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

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