Altru Prime by Medica Gold Copay Plus
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | Altru Prime by Medica Gold Copay Plus |
| Plan ID | hhs-31616MN0410019 |
| Insurance Provider | Medica |
| Metal Level | Gold |
| Plan Type | PPO |
| Deductible | $1,000 |
| Out-of-Pocket Maximum | $5,000 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $30 Copay |
| Specialist Visit | $30 Copay |
| Laboratory Outpatient and Professional Services | $30 Copay |
| X-rays and Diagnostic Imaging | $30 Copay |
| Diagnostic Imaging such as MRIs, CT, and PET scans | $250 Copay |
| Deductible - Family | $3000 per group |
| Out-of-Pocket Maximum - Family | $10000 per group |
Prescription drug coverage | |
|---|---|
| Generic Drugs | $5 Copay |
| Preferred Brand Drugs | $35 Copay |
| Non-Preferred Brand Drugs | $150 Copay |
| Specialty Drugs | $250 Copay |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | http://www.medica.com |
| Does this plan have access to a national provider network? | Yes |
| Is a referral required to see a Specialist? | Not Covered |
| Does this plan cover services outside plan service area? | Yes - Out of network benefit |
| Does this plan cover services outside the country? | Yes - Emergency Services |
Hospital services | |
|---|---|
| Emergency Room Services | $150 Copay |
| Inpatient Hospital Services (e.g., Hospital Stay) | $250 Copay per Day |
| Inpatient Physician and Surgical Services | 30.00% Coinsurance after deductible |
| Emergency Transportation or Ambulance Service | 30.00% Coinsurance after deductible |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | No Charge |
| Delivery and all inpatient services for maternity care | 30.00% Coinsurance after deductible |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | $30 Copay |
| Mental/Behavioral Health Inpatient Services | $250 Copay per Day |
| Substance use disorder outpatient services | $30 Copay |
| Substance use disorder inpatient services | $250 Copay per Day |
Medical Management Programs | |
|---|---|
| Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| Does this plan offer a wellness program? | Not Covered |
Vision Coverage | |
|---|---|
| Routine Eye Exam for Children | Included |
| Eye Glasses for Children | Included |
| Routine Eye Exam for Adults | Not Covered |
Child Dental Coverage | |
|---|---|
| Child Dental Coverage - Routine Dental Care | Not Covered |
| Child Dental Coverage - Basic Dental Care | Not Covered |
| Child Dental Coverage - Orthodontia | Not Covered |
| Child Dental Coverage - Major Dental Care | Not Covered |
Adult Dental Coverage | |
|---|---|
| Adult Dental Coverage - Routine Dental Care | Not Covered |
| Adult Dental Coverage - Basic Dental Care | Not Covered |
| Adult Dental Coverage - Orthodontia | Not Covered |
| Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
|---|---|
| More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Chiropractic Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care |
| More Limited Benefits | Skilled Nursing Facility Hearing Aids Inpatient Physician and Surgical Services Home Health Care Services Hospice Services |
| More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited |
Gold plan frequently asked questions (FAQ)
What is the Gold Plan?
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
How are Gold Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.
How much does a Gold Plan cost?
The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.
When Can I Enroll in a Gold Plan?
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.
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