Medica - Altru Prime by Medica Silver Copay

North Dakota, 2017

  • Plan Type

    POS

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $5,750

  • Deductible

    $2,600

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $2,600
Deductible (Family) $7,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,750
Out of Pocket Maximum (Family) $11,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $0 Copay per day + 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $0 Copay per day + 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 60% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,400
Deductible (Family) $7,200
Out of Pocket Maximum (Individual) $4,800
Out of Pocket Maximum (Family) $9,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $400
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $1,850
Out of Pocket Maximum (Family) $3,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 5% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 5% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in North Dakota

Plan Altru Prime by Medica Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Medica Applause Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Altru Prime by Medica Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Medica Applause Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Altru Prime by Medica Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Medica Applause Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Altru Prime by Medica Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $2,600
Deductible (Family) $7,800
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,750
Out of Pocket Maximum (Family) $11,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $0 Copay per day + 40% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $0 Copay per day + 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 60% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,400
Deductible (Family) $7,200
Out of Pocket Maximum (Individual) $4,800
Out of Pocket Maximum (Family) $9,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $400
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $1,850
Out of Pocket Maximum (Family) $3,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 5% Coinsurance after deductible
Inpatient Facility $0 Copay per day + 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx 5% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in North Dakota

Plan Altru Prime by Medica Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Medica Applause Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Altru Prime by Medica Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Medica Applause Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Altru Prime by Medica Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Medica Applause Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Altru Prime by Medica Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150