Wisconsin

Obamacare 2018 Rates

Wisconsin Obamacare 2018 Rates

 
Hudson, WI

Obamacare 2018 Rates and Health Insurance Providers for Saint Croix County,Hudson,WI


The health insurance rates listed below are for calendar year 2018.

2018 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Saint Croix County, Wisconsin.

Obamacare Providers, Plans and 2018 Rates for Saint Croix County

Saint Croix County is in “Rating Area 3” of Wisconsin.

Currently, there are 21 plans offered in Rating Area 3.

Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must either

  • contact a licensed health insurance agent (by contacting one of the advertisers you see on this website)
  • complete an application at HealthCare.gov, or
  • contact the provider directly.

The table below shows premiums for the following scenarios for:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Hudson, WI area accept this insurance coverage as within the plan's "network".

2018 Obamacare Rates Providers, Plans for Saint Croix County

HealthPartners Insurance Company

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887

TTY: 1-952-883-6060

Bronze

Plan: (PPO) Atlas Individual $6600 HSA Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Bronze 21
30
40
50
60		 $321.14
$364.49
$410.42
$573.56
$871.57		 $642.28
$728.98
$820.84
$1,147.12
$1,743.14		 $887.95
$974.65
$1,066.51
$1,392.79		 $1,133.62
$1,220.32
$1,312.18
$1,638.46		 $1,379.29
$1,465.99
$1,557.85
$1,884.13		 $566.81
$610.16
$656.09
$819.23		 $812.48
$855.83
$901.76
$1,064.90		 $1,058.15
$1,101.50
$1,147.43
$1,310.57		 $245.67

Gold

Plan: (PPO) Atlas Individual $1000 w/Copay Gold

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Gold 21
30
40
50
60		 $462.09
$524.47
$590.55
$825.29
$1,254.11		 $924.18
$1,048.94
$1,181.10
$1,650.58
$2,508.22		 $1,277.68
$1,402.44
$1,534.60
$2,004.08		 $1,631.18
$1,755.94
$1,888.10
$2,357.58		 $1,984.68
$2,109.44
$2,241.60
$2,711.08		 $815.59
$877.97
$944.05
$1,178.79		 $1,169.09
$1,231.47
$1,297.55
$1,532.29		 $1,522.59
$1,584.97
$1,651.05
$1,885.79		 $353.50

Silver

Plan: (PPO) Atlas Individual $2300 Plus Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $2,300 : Family: $4,600
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Silver 21
30
40
50
60		 $458.22
$520.08
$585.61
$818.38
$1,243.61		 $916.44
$1,040.16
$1,171.22
$1,636.76
$2,487.22		 $1,266.98
$1,390.70
$1,521.76
$1,987.30		 $1,617.52
$1,741.24
$1,872.30
$2,337.84		 $1,968.06
$2,091.78
$2,222.84
$2,688.38		 $808.76
$870.62
$936.15
$1,168.92		 $1,159.30
$1,221.16
$1,286.69
$1,519.46		 $1,509.84
$1,571.70
$1,637.23
$1,870.00		 $350.54

Expanded Bronze

Plan: (PPO) Atlas Individual $6000 Plus Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Expanded Bronze 21
30
40
50
60		 $352.54
$400.13
$450.55
$629.64
$956.79		 $705.08
$800.26
$901.10
$1,259.28
$1,913.58		 $974.77
$1,069.95
$1,170.79
$1,528.97		 $1,244.46
$1,339.64
$1,440.48
$1,798.66		 $1,514.15
$1,609.33
$1,710.17
$2,068.35		 $622.23
$669.82
$720.24
$899.33		 $891.92
$939.51
$989.93
$1,169.02		 $1,161.61
$1,209.20
$1,259.62
$1,438.71		 $269.69

Catastrophic

Plan: (PPO) Atlas Individual $7350 Catastrophic

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Catastrophic 21
30
40
50
60		 $228.88
$259.78
$292.51
$408.78
$621.18		 $457.76
$519.56
$585.02
$817.56
$1,242.36		 $632.85
$694.65
$760.11
$992.65		 $807.94
$869.74
$935.20
$1,167.74		 $983.03
$1,044.83
$1,110.29
$1,342.83		 $403.97
$434.87
$467.60
$583.87		 $579.06
$609.96
$642.69
$758.96		 $754.15
$785.05
$817.78
$934.05

Silver

Plan: (PPO) Atlas Individual $3000 HSA Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Silver 21
30
40
50
60		 $433.34
$491.84
$553.81
$773.95
$1,176.08		 $866.68
$983.68
$1,107.62
$1,547.90
$2,352.16		 $1,198.19
$1,315.19
$1,439.13
$1,879.41		 $1,529.70
$1,646.70
$1,770.64
$2,210.92		 $1,861.21
$1,978.21
$2,102.15
$2,542.43		 $764.85
$823.35
$885.32
$1,105.46		 $1,096.36
$1,154.86
$1,216.83
$1,436.97		 $1,427.87
$1,486.37
$1,548.34
$1,768.48		 $331.51

Medica Health Plans of Wisconsin

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211

TTY: 1-800-855-2880

Catastrophic

Plan: (PPO) Medica Individual Choice Catastrophic

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Catastrophic 21
30
40
50
60		 $237.87
$269.98
$303.99
$424.83
$645.56		 $475.74
$539.96
$607.98
$849.66
$1,291.12		 $657.71
$721.93
$789.95
$1,031.63		 $839.68
$903.90
$971.92
$1,213.60		 $1,021.65
$1,085.87
$1,153.89
$1,395.57		 $419.84
$451.95
$485.96
$606.80		 $601.81
$633.92
$667.93
$788.77		 $783.78
$815.89
$849.90
$970.74		 $181.97

HealthPartners Insurance Company

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887

TTY: 1-952-883-6060

Silver

Plan: (PPO) Atlas Individual $3500 Plus Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (HealthPartners Insurance Company)
Customer Service Phone: 1-855-813-3887

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Silver 21
30
40
50
60		 $451.24
$512.16
$576.68
$805.91
$1,224.67		 $902.48
$1,024.32
$1,153.36
$1,611.82
$2,449.34		 $1,247.68
$1,369.52
$1,498.56
$1,957.02		 $1,592.88
$1,714.72
$1,843.76
$2,302.22		 $1,938.08
$2,059.92
$2,188.96
$2,647.42		 $796.44
$857.36
$921.88
$1,151.11		 $1,141.64
$1,202.56
$1,267.08
$1,496.31		 $1,486.84
$1,547.76
$1,612.28
$1,841.51		 $345.20
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Medica Health Plans of Wisconsin

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211

TTY: 1-800-855-2880

Gold

Plan: (PPO) Medica Individual Choice Gold Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $750 : Family: $2,250
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Gold 21
30
40
50
60		 $466.96
$529.99
$596.76
$833.97
$1,267.30		 $933.92
$1,059.98
$1,193.52
$1,667.94
$2,534.60		 $1,291.14
$1,417.20
$1,550.74
$2,025.16		 $1,648.36
$1,774.42
$1,907.96
$2,382.38		 $2,005.58
$2,131.64
$2,265.18
$2,739.60		 $824.18
$887.21
$953.98
$1,191.19		 $1,181.40
$1,244.43
$1,311.20
$1,548.41		 $1,538.62
$1,601.65
$1,668.42
$1,905.63		 $357.22

Silver

Plan: (PPO) Medica Individual Choice Silver Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $3,500 : Family: $10,500
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Silver 21
30
40
50
60		 $474.64
$538.71
$606.58
$847.70
$1,288.16		 $949.28
$1,077.42
$1,213.16
$1,695.40
$2,576.32		 $1,312.38
$1,440.52
$1,576.26
$2,058.50		 $1,675.48
$1,803.62
$1,939.36
$2,421.60		 $2,038.58
$2,166.72
$2,302.46
$2,784.70		 $837.74
$901.81
$969.68
$1,210.80		 $1,200.84
$1,264.91
$1,332.78
$1,573.90		 $1,563.94
$1,628.01
$1,695.88
$1,937.00		 $363.10

Bronze

Plan: (PPO) Medica Individual Choice Bronze Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Bronze 21
30
40
50
60		 $388.84
$441.32
$496.92
$694.45
$1,055.28		 $777.68
$882.64
$993.84
$1,388.90
$2,110.56		 $1,075.13
$1,180.09
$1,291.29
$1,686.35		 $1,372.58
$1,477.54
$1,588.74
$1,983.80		 $1,670.03
$1,774.99
$1,886.19
$2,281.25		 $686.29
$738.77
$794.37
$991.90		 $983.74
$1,036.22
$1,091.82
$1,289.35		 $1,281.19
$1,333.67
$1,389.27
$1,586.80		 $297.45

Bronze

Plan: (PPO) Medica Individual Choice Bronze H S A

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Bronze 21
30
40
50
60		 $370.81
$420.86
$473.89
$662.26
$1,006.36		 $741.62
$841.72
$947.78
$1,324.52
$2,012.72		 $1,025.29
$1,125.39
$1,231.45
$1,608.19		 $1,308.96
$1,409.06
$1,515.12
$1,891.86		 $1,592.63
$1,692.73
$1,798.79
$2,175.53		 $654.48
$704.53
$757.56
$945.93		 $938.15
$988.20
$1,041.23
$1,229.60		 $1,221.82
$1,271.87
$1,324.90
$1,513.27		 $283.67

Gold

Plan: (PPO) Medica Individual Choice Gold Copay Plus

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Gold 21
30
40
50
60		 $528.64
$600.00
$675.59
$944.14
$1,434.71		 $1,057.28
$1,200.00
$1,351.18
$1,888.28
$2,869.42		 $1,461.68
$1,604.40
$1,755.58
$2,292.68		 $1,866.08
$2,008.80
$2,159.98
$2,697.08		 $2,270.48
$2,413.20
$2,564.38
$3,101.48		 $933.04
$1,004.40
$1,079.99
$1,348.54		 $1,337.44
$1,408.80
$1,484.39
$1,752.94		 $1,741.84
$1,813.20
$1,888.79
$2,157.34		 $404.40

Expanded Bronze

Plan: (PPO) Medica Individual Choice Bronze H S A Plus

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Expanded Bronze 21
30
40
50
60		 $395.10
$448.42
$504.92
$705.62
$1,072.26		 $790.20
$896.84
$1,009.84
$1,411.24
$2,144.52		 $1,092.44
$1,199.08
$1,312.08
$1,713.48		 $1,394.68
$1,501.32
$1,614.32
$2,015.72		 $1,696.92
$1,803.56
$1,916.56
$2,317.96		 $697.34
$750.66
$807.16
$1,007.86		 $999.58
$1,052.90
$1,109.40
$1,310.10		 $1,301.82
$1,355.14
$1,411.64
$1,612.34		 $302.24

Gold

Plan: (PPO) Engage by Medica Gold Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $750 : Family: $2,250
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Gold 21
30
40
50
60		 $420.26
$476.99
$537.09
$750.57
$1,140.57		 $840.52
$953.98
$1,074.18
$1,501.14
$2,281.14		 $1,162.01
$1,275.47
$1,395.67
$1,822.63		 $1,483.50
$1,596.96
$1,717.16
$2,144.12		 $1,804.99
$1,918.45
$2,038.65
$2,465.61		 $741.75
$798.48
$858.58
$1,072.06		 $1,063.24
$1,119.97
$1,180.07
$1,393.55		 $1,384.73
$1,441.46
$1,501.56
$1,715.04		 $321.49

Silver

Plan: (PPO) Engage by Medica Silver Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $3,500 : Family: $10,500
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Silver 21
30
40
50
60		 $427.17
$484.83
$545.91
$762.91
$1,159.31		 $854.34
$969.66
$1,091.82
$1,525.82
$2,318.62		 $1,181.12
$1,296.44
$1,418.60
$1,852.60		 $1,507.90
$1,623.22
$1,745.38
$2,179.38		 $1,834.68
$1,950.00
$2,072.16
$2,506.16		 $753.95
$811.61
$872.69
$1,089.69		 $1,080.73
$1,138.39
$1,199.47
$1,416.47		 $1,407.51
$1,465.17
$1,526.25
$1,743.25		 $326.78

Bronze

Plan: (PPO) Engage by Medica Bronze Copay

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Bronze 21
30
40
50
60		 $349.94
$397.17
$447.21
$624.98
$949.72		 $699.88
$794.34
$894.42
$1,249.96
$1,899.44		 $967.58
$1,062.04
$1,162.12
$1,517.66		 $1,235.28
$1,329.74
$1,429.82
$1,785.36		 $1,502.98
$1,597.44
$1,697.52
$2,053.06		 $617.64
$664.87
$714.91
$892.68		 $885.34
$932.57
$982.61
$1,160.38		 $1,153.04
$1,200.27
$1,250.31
$1,428.08		 $267.70

Bronze

Plan: (PPO) Engage by Medica Bronze HSA

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Bronze 21
30
40
50
60		 $333.74
$378.78
$426.51
$596.04
$905.74		 $667.48
$757.56
$853.02
$1,192.08
$1,811.48		 $922.78
$1,012.86
$1,108.32
$1,447.38		 $1,178.08
$1,268.16
$1,363.62
$1,702.68		 $1,433.38
$1,523.46
$1,618.92
$1,957.98		 $589.04
$634.08
$681.81
$851.34		 $844.34
$889.38
$937.11
$1,106.64		 $1,099.64
$1,144.68
$1,192.41
$1,361.94		 $255.30

Catastrophic

Plan: (PPO) Engage by Medica Catastrophic

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Catastrophic 21
30
40
50
60		 $214.06
$242.95
$273.56
$382.29
$580.93		 $428.12
$485.90
$547.12
$764.58
$1,161.86		 $591.87
$649.65
$710.87
$928.33		 $755.62
$813.40
$874.62
$1,092.08		 $919.37
$977.15
$1,038.37
$1,255.83		 $377.81
$406.70
$437.31
$546.04		 $541.56
$570.45
$601.06
$709.79		 $705.31
$734.20
$764.81
$873.54		 $163.75

Gold

Plan: (PPO) Engage by Medica Gold Copay Plus

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Gold 21
30
40
50
60		 $475.79
$540.00
$608.04
$849.73
$1,291.25		 $951.58
$1,080.00
$1,216.08
$1,699.46
$2,582.50		 $1,315.55
$1,443.97
$1,580.05
$2,063.43		 $1,679.52
$1,807.94
$1,944.02
$2,427.40		 $2,043.49
$2,171.91
$2,307.99
$2,791.37		 $839.76
$903.97
$972.01
$1,213.70		 $1,203.73
$1,267.94
$1,335.98
$1,577.67		 $1,567.70
$1,631.91
$1,699.95
$1,941.64		 $363.97

Expanded Bronze

Plan: (PPO) Engage by Medica Bronze HSA Plus

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Medica Health Plans of Wisconsin)
Customer Service Phone: 1-888-592-8211

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $6,650 : Family: $13,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
0-14
Expanded Bronze 21
30
40
50
60		 $355.59
$403.59
$454.43
$635.07
$965.05		 $711.18
$807.18
$908.86
$1,270.14
$1,930.10		 $983.20
$1,079.20
$1,180.88
$1,542.16		 $1,255.22
$1,351.22
$1,452.90
$1,814.18		 $1,527.24
$1,623.24
$1,724.92
$2,086.20		 $627.61
$675.61
$726.45
$907.09		 $899.63
$947.63
$998.47
$1,179.11		 $1,171.65
$1,219.65
$1,270.49
$1,451.13		 $272.02

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Saint Croix County here.

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