Medica Individual Choice Silver $0 Copay PCP Visits

73751ND0130047
Silver
HMO

Medica Individual Choice Silver $0 Copay PCP Visits is a Silver HMO plan by Medica.

Locations

Medica Individual Choice Silver $0 Copay PCP Visits is offered in the following counties.

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Plan Overview

This is a plan overview for 2025 version of Medica Individual Choice Silver $0 Copay PCP Visits 73751ND0130047.
Insurer: Medica
Network Type: HMO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 73751ND0130047

Cost-Sharing Overview

Medica Individual Choice Silver $0 Copay PCP Visits offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Medica Individual Choice Silver $0 Copay PCP Visits?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Medica Individual Choice Silver $0 Copay PCP Visits offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Medica Individual Choice Silver $0 Copay PCP Visits covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Services
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency Services
National Network: No

Additional Benefits and Cost-Sharing

Medica Individual Choice Silver $0 Copay PCP Visits includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$0.00 Not ApplicableNot Applicable 100.00% Virtual visits are unlimited with a $0 copayment when provided by a designated in-network virtual care provider for non-urgent medical symptoms for common illnesses.
Specialist Visit
Covered
$80.00 Not ApplicableNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$0.00 Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Hospice Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$0.00 Not Applicable$0.00 Not Applicable
Home Health Care Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%40.0 Visit(s) per Benefit Period See policy or plan document for additional benefit explanation.
Emergency Room Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 40.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Bariatric Surgery
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Procedure(s) per Lifetime
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Days per Benefit Period See policy or plan document for additional benefit explanation.
Prenatal and Postnatal Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$0.00 Not ApplicableNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$0.00 Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Generic Drugs
Covered
$25.00 Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
$125.00 Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
$225.00 Not ApplicableNot Applicable 100.00%
Specialty Drugs
Covered
$700.00 Not ApplicableNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Benefit Period See policy or plan document for additional benefit explanation.
Habilitation Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Benefit Period See policy or plan document for additional benefit explanation.
Chiropractic Care
Covered
$0.00 Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Benefit Period
Durable Medical Equipment
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Hearing Aids
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Item(s) per 3 Years
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% See policy or plan document for additional benefit explanation.
Preventive Care/Screening/Immunization
Covered
Not Applicable No ChargeNot Applicable 100.00%
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
$0.00 Not ApplicableNot Applicable 100.00%1.0 Exam(s) per Benefit Period
Eye Glasses for Children
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Item(s) per Benefit Period See policy or plan document for additional benefit explanation.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year See policy or plan document for additional benefit explanation.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year See policy or plan document for additional benefit explanation.
Well Baby Visits and Care
Covered
Not Applicable No ChargeNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Routine or chronic dental service not covered Coverage for diagnosis and treatment of periodontal disease in acute or chronic disease state if recommended by a board-certified medical practitioner based on health-related impacts or on further deterioration in disease state due to gum disease.
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Exam(s) per Transplant See policy or plan document for additional benefit explanation.
Accidental Dental
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Dialysis
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Allergy Testing
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Chemotherapy
Covered
$80.00 Not ApplicableNot Applicable 100.00%
Radiation
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Diabetes Education
Covered
Not Applicable No ChargeNot Applicable 100.00%
Prosthetic Devices
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%2.0 Treatment(s) per Lifetime See policy or plan document for additional benefit explanation.
Nutritional Counseling
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%12.0 Visit(s) per Benefit Period
Reconstructive Surgery
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Gender Affirming Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following Medica Individual Choice Silver $0 Copay PCP Visits preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Medica Individual Choice Silver $0 Copay PCP Visits including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Medica Individual Choice Silver $0 Copay PCP Visits?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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