Medica Health Insurance Review
What’s Included with Aetna?
- Most same-day services
- Emergency services
- Prescription drugs
- Laboratory services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Pediatric services
- Rehabilitative and habilitative services and devices
- Mental health and substance abuse services
- Preventive care and chronic disease management
Types of Health Insurance Plans
|
Businesses and Organizations |
Yes |
|
Individuals and Families |
Yes |
|
Short-Term Health Insurance |
Yes |
Other Plans Offered:
- Pet Insurance
- Dental Insurance
- Medicare Insurance
Plans Reviewed
Bronze Plan
- Overall Deductibles: $6,350 per individual for in-network providers, $12,700 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
- No overall annual limit for specific covered services
- Out-of-pocket limit: $6,350 per individual for in-network providers, $12,700 for family coverage. No out-of-pocket maximum out of network.
- Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse
Silver Plan
- Overall deductibles: $2,600 per individual for in-network providers, $7,800 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
- No overall annual limit for selected covered services
- Out-of-pocket limit: $5,750 per individual for in-network providers, $11,500 for family coverage. No out-of-pocket maximum out of network.
- Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse
Gold Plan
- Overall deductibles: $300 per individual for in-network providers, $900 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
- No overall annual limit on specific covered services.
- Out-of-pocket limit: $5,000 per individual for in-network providers, $10,000 for family coverage. No out-of-pocket maximum out of network.
- Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse
*Information stated above are for customers residing in the state of Minnesota
How Much Does It Save You?
|
|
Bronze |
Silver |
Gold |
|||
|
Services Offered |
In-Network (Your Cost) |
Out-of-Network (Your Cost) |
In-Network (Your Cost) |
Out-of-Network (Your Cost) |
In-Network (Your Cost) |
Out-of-Network (Your Cost) |
|
Prescription Drugs (Preferred Drug List) |
Tier 1 drugs: $20 copay deductible Tier 3 drugs: 100% coverage after deductible |
Not covered |
Tier 1 drugs: $10 copay deductible Tier 3 drugs: 40% coverage after deductible |
Not covered |
Tier 1 drugs: $10 copay deductible Tier 3 drugs: 50% coverage after deductible |
Not covered |
|
Outpatient Surgery |
100% coverage after deductible |
Not covered |
60% coverage after deductible |
Not covered |
70% coverage after deductible |
Not covered |
|
Emergency Room Services and Medical Transportation |
100% coverage after deductible |
0% co-insurance |
60% coverage after deductible |
Room services: $500 co-pay per visit Medical transportation: 40% co-insurance |
70% coverage after deductible |
Room services: $250 co-pay per visit Medical transportation: 20% co-insurance |
|
Office and Urgent Care Visits |
$60 copay (No visit limit) |
Not covered |
$30 copay (No visit limit) |
Not covered |
$30 copay (No visit limit) |
Not covered |
|
Convenience Care Visits |
$20 copay for most providers $10 copay for our preferred providers (No visit limit) |
Not covered |
$20 copay for most providers $10 copay for our preferred providers (No visit limit) |
Not covered |
$20 copay for most providers $10 copay for our preferred providers (No visit limit) |
Not covered |
|
Preventive Care Services |
100% coverage (deductible does not apply) |
Not covered |
100% coverage (deductible does not apply) |
Not covered |
100% coverage (deductible does not apply) |
Not covered |
|
Diagnostic Tests and Imaging |
100% coverage after deductible |
Not covered |
60% coverage after deductible |
Not covered |
70% coverage after deductible |
Not covered |
|
Hospitalization |
100% coverage after deductible |
Not covered |
60% coverage after deductible |
Not covered |
70% coverage after deductible |
Not covered |
*Information stated above are for customers residing in the state of Minnesota
Annual maximum
|
Bronze |
None |
|
Silver |
None |
|
Gold |
None |
The Bottom Line
For those who live in the company's service area, Medica is an excellent health insurance choice. High-deductibles and low premium make Medica plans best for healthy consumers that experience few medical expenses in their average year.
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