Obamacare 2021 Rates for Pottawattamie County

Obamacare > Rates > Iowa > Pottawattamie County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Pottawattamie County, IA.

The health insurance rates listed below are for calendar year 2021.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 27 Plans and 2021 Rates for Pottawattamie County, Iowa

Below, you’ll find a summary of the 27 plans for Pottawattamie County, Iowa and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Wellmark Health Plan of Iowa, Inc.

Local: 1-800-819-0893 | Toll Free: 1-800-819-0893 | TTY: 1-888-781-4262
Toc - Plan #1 Wellmark Health Plan of Iowa, Inc.
Expanded Bronze

(HMO) Wellmark Bronze Modified HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$8,150 $16,300 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$264,31
$299,99
$337,79
$472,05
$717,33 		$466,51
$502,19
$539,99
$674,25 		$668,71
$704,39
$742,19
$876,45 		$870,91
$906,59
$944,39
$1 078,65 		$202,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$528,62
$599,98
$675,58
$944,10
$1 434,66 		$730,82
$802,18
$877,78
$1 146,30 		$933,02
$1 004,38
$1 079,98
$1 348,50 		$1 135,22
$1 206,58
$1 282,18
$1 550,70 		$202,20
Toc - Plan #2 Wellmark Health Plan of Iowa, Inc.
Expanded Bronze

(HMO) Wellmark Bronze HDHP HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$249,51
$283,19
$318,87
$445,63
$677,17 		$440,39
$474,07
$509,75
$636,51 		$631,27
$664,95
$700,63
$827,39 		$822,15
$855,83
$891,51
$1 018,27 		$190,88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$499,02
$566,38
$637,74
$891,26
$1 354,34 		$689,90
$757,26
$828,62
$1 082,14 		$880,78
$948,14
$1 019,50
$1 273,02 		$1 071,66
$1 139,02
$1 210,38
$1 463,90 		$190,88
Toc - Plan #3 Wellmark Health Plan of Iowa, Inc.
Silver

(HMO) Wellmark Silver Modified HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$8,150 $16,300 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$392,61
$445,62
$501,76
$701,21
$1 065,55 		$692,96
$745,97
$802,11
$1 001,56 		$993,31
$1 046,32
$1 102,46
$1 301,91 		$1 293,66
$1 346,67
$1 402,81
$1 602,26 		$300,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785,22
$891,24
$1 003,52
$1 402,42
$2 131,10 		$1 085,57
$1 191,59
$1 303,87
$1 702,77 		$1 385,92
$1 491,94
$1 604,22
$2 003,12 		$1 686,27
$1 792,29
$1 904,57
$2 303,47 		$300,35
Toc - Plan #4 Wellmark Health Plan of Iowa, Inc.
Gold

(HMO) Wellmark Gold Modified HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$5,250 $10,500 Annual Deductible
$5,250 $10,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$355,96
$404,01
$454,91
$635,74
$966,07 		$628,27
$676,32
$727,22
$908,05 		$900,58
$948,63
$999,53
$1 180,36 		$1 172,89
$1 220,94
$1 271,84
$1 452,67 		$272,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$711,92
$808,02
$909,82
$1 271,48
$1 932,14 		$984,23
$1 080,33
$1 182,13
$1 543,79 		$1 256,54
$1 352,64
$1 454,44
$1 816,10 		$1 528,85
$1 624,95
$1 726,75
$2 088,41 		$272,31
Toc - Plan #5 Wellmark Health Plan of Iowa, Inc.
Expanded Bronze

(HMO) Wellmark Bronze Traditional HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$263,71
$299,31
$337,03
$470,99
$715,72 		$465,45
$501,05
$538,77
$672,73 		$667,19
$702,79
$740,51
$874,47 		$868,93
$904,53
$942,25
$1 076,21 		$201,74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$527,42
$598,62
$674,06
$941,98
$1 431,44 		$729,16
$800,36
$875,80
$1 143,72 		$930,90
$1 002,10
$1 077,54
$1 345,46 		$1 132,64
$1 203,84
$1 279,28
$1 547,20 		$201,74
Toc - Plan #6 Wellmark Health Plan of Iowa, Inc.
Gold

(HMO) Wellmark Gold Traditional HMO

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-819-0893

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$356,05
$404,12
$455,03
$635,91
$966,32 		$628,43
$676,50
$727,41
$908,29 		$900,81
$948,88
$999,79
$1 180,67 		$1 173,19
$1 221,26
$1 272,17
$1 453,05 		$272,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$712,10
$808,24
$910,06
$1 271,82
$1 932,64 		$984,48
$1 080,62
$1 182,44
$1 544,20 		$1 256,86
$1 353,00
$1 454,82
$1 816,58 		$1 529,24
$1 625,38
$1 727,20
$2 088,96 		$272,38

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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-888-516-4692
Toc - Plan #7 Medica
Silver

(EPO) Elevate by Medica Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$407,59
$462,60
$520,89
$727,94
$1 106,17 		$719,39
$774,40
$832,69
$1 039,74 		$1 031,19
$1 086,20
$1 144,49
$1 351,54 		$1 342,99
$1 398,00
$1 456,29
$1 663,34 		$311,80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815,18
$925,20
$1 041,78
$1 455,88
$2 212,34 		$1 126,98
$1 237,00
$1 353,58
$1 767,68 		$1 438,78
$1 548,80
$1 665,38
$2 079,48 		$1 750,58
$1 860,60
$1 977,18
$2 391,28 		$311,80
Toc - Plan #8 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$306,37
$347,71
$391,52
$547,15
$831,45 		$540,73
$582,07
$625,88
$781,51 		$775,09
$816,43
$860,24
$1 015,87 		$1 009,45
$1 050,79
$1 094,60
$1 250,23 		$234,36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$612,74
$695,42
$783,04
$1 094,30
$1 662,90 		$847,10
$929,78
$1 017,40
$1 328,66 		$1 081,46
$1 164,14
$1 251,76
$1 563,02 		$1 315,82
$1 398,50
$1 486,12
$1 797,38 		$234,36
Toc - Plan #9 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$343,67
$390,06
$439,20
$613,78
$932,70 		$606,57
$652,96
$702,10
$876,68 		$869,47
$915,86
$965,00
$1 139,58 		$1 132,37
$1 178,76
$1 227,90
$1 402,48 		$262,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$687,34
$780,12
$878,40
$1 227,56
$1 865,40 		$950,24
$1 043,02
$1 141,30
$1 490,46 		$1 213,14
$1 305,92
$1 404,20
$1 753,36 		$1 476,04
$1 568,82
$1 667,10
$2 016,26 		$262,90
Toc - Plan #10 Medica
Catastrophic

(EPO) Elevate by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$222,34
$252,34
$284,14
$397,08
$603,40 		$392,42
$422,42
$454,22
$567,16 		$562,50
$592,50
$624,30
$737,24 		$732,58
$762,58
$794,38
$907,32 		$170,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$444,68
$504,68
$568,28
$794,16
$1 206,80 		$614,76
$674,76
$738,36
$964,24 		$784,84
$844,84
$908,44
$1 134,32 		$954,92
$1 014,92
$1 078,52
$1 304,40 		$170,08
Toc - Plan #11 Medica
Gold

(EPO) Elevate by Medica Gold Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$700 $2,100 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$439,38
$498,69
$561,52
$784,72
$1 192,46 		$775,50
$834,81
$897,64
$1 120,84 		$1 111,62
$1 170,93
$1 233,76
$1 456,96 		$1 447,74
$1 507,05
$1 569,88
$1 793,08 		$336,12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878,76
$997,38
$1 123,04
$1 569,44
$2 384,92 		$1 214,88
$1 333,50
$1 459,16
$1 905,56 		$1 551,00
$1 669,62
$1 795,28
$2 241,68 		$1 887,12
$2 005,74
$2 131,40
$2 577,80 		$336,12
Toc - Plan #12 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$325,02
$368,89
$415,36
$580,47
$882,08 		$573,65
$617,52
$663,99
$829,10 		$822,28
$866,15
$912,62
$1 077,73 		$1 070,91
$1 114,78
$1 161,25
$1 326,36 		$248,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$650,04
$737,78
$830,72
$1 160,94
$1 764,16 		$898,67
$986,41
$1 079,35
$1 409,57 		$1 147,30
$1 235,04
$1 327,98
$1 658,20 		$1 395,93
$1 483,67
$1 576,61
$1 906,83 		$248,63
Toc - Plan #13 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$323,34
$366,98
$413,22
$577,47
$877,52 		$570,69
$614,33
$660,57
$824,82 		$818,04
$861,68
$907,92
$1 072,17 		$1 065,39
$1 109,03
$1 155,27
$1 319,52 		$247,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$646,68
$733,96
$826,44
$1 154,94
$1 755,04 		$894,03
$981,31
$1 073,79
$1 402,29 		$1 141,38
$1 228,66
$1 321,14
$1 649,64 		$1 388,73
$1 476,01
$1 568,49
$1 896,99 		$247,35
Toc - Plan #14 Medica
Silver

(EPO) Medica Insure Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$470,12
$533,58
$600,80
$839,62
$1 275,88 		$829,76
$893,22
$960,44
$1 199,26 		$1 189,40
$1 252,86
$1 320,08
$1 558,90 		$1 549,04
$1 612,50
$1 679,72
$1 918,54 		$359,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$940,24
$1 067,16
$1 201,60
$1 679,24
$2 551,76 		$1 299,88
$1 426,80
$1 561,24
$2 038,88 		$1 659,52
$1 786,44
$1 920,88
$2 398,52 		$2 019,16
$2 146,08
$2 280,52
$2 758,16 		$359,64
Toc - Plan #15 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$353,37
$401,06
$451,59
$631,10
$959,01 		$623,69
$671,38
$721,91
$901,42 		$894,01
$941,70
$992,23
$1 171,74 		$1 164,33
$1 212,02
$1 262,55
$1 442,06 		$270,32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$706,74
$802,12
$903,18
$1 262,20
$1 918,02 		$977,06
$1 072,44
$1 173,50
$1 532,52 		$1 247,38
$1 342,76
$1 443,82
$1 802,84 		$1 517,70
$1 613,08
$1 714,14
$2 073,16 		$270,32
Toc - Plan #16 Medica
Expanded Bronze

(EPO) Medica Insure Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$396,40
$449,90
$506,58
$707,95
$1 075,79 		$699,64
$753,14
$809,82
$1 011,19 		$1 002,88
$1 056,38
$1 113,06
$1 314,43 		$1 306,12
$1 359,62
$1 416,30
$1 617,67 		$303,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$792,80
$899,80
$1 013,16
$1 415,90
$2 151,58 		$1 096,04
$1 203,04
$1 316,40
$1 719,14 		$1 399,28
$1 506,28
$1 619,64
$2 022,38 		$1 702,52
$1 809,52
$1 922,88
$2 325,62 		$303,24
Toc - Plan #17 Medica
Catastrophic

(EPO) Medica Insure Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$256,45
$291,06
$327,73
$458,00
$695,97 		$452,62
$487,23
$523,90
$654,17 		$648,79
$683,40
$720,07
$850,34 		$844,96
$879,57
$916,24
$1 046,51 		$196,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$512,90
$582,12
$655,46
$916,00
$1 391,94 		$709,07
$778,29
$851,63
$1 112,17 		$905,24
$974,46
$1 047,80
$1 308,34 		$1 101,41
$1 170,63
$1 243,97
$1 504,51 		$196,17
Toc - Plan #18 Medica
Silver

(EPO) Medica Insure Silver Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,400 $4,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$484,67
$550,09
$619,39
$865,60
$1 315,36 		$855,43
$920,85
$990,15
$1 236,36 		$1 226,19
$1 291,61
$1 360,91
$1 607,12 		$1 596,95
$1 662,37
$1 731,67
$1 977,88 		$370,76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$969,34
$1 100,18
$1 238,78
$1 731,20
$2 630,72 		$1 340,10
$1 470,94
$1 609,54
$2 101,96 		$1 710,86
$1 841,70
$1 980,30
$2 472,72 		$2 081,62
$2 212,46
$2 351,06
$2 843,48 		$370,76
Toc - Plan #19 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$374,88
$425,48
$479,09
$669,52
$1 017,40 		$661,66
$712,26
$765,87
$956,30 		$948,44
$999,04
$1 052,65
$1 243,08 		$1 235,22
$1 285,82
$1 339,43
$1 529,86 		$286,78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$749,76
$850,96
$958,18
$1 339,04
$2 034,80 		$1 036,54
$1 137,74
$1 244,96
$1 625,82 		$1 323,32
$1 424,52
$1 531,74
$1 912,60 		$1 610,10
$1 711,30
$1 818,52
$2 199,38 		$286,78
Toc - Plan #20 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$372,95
$423,28
$476,61
$666,06
$1 012,15 		$658,25
$708,58
$761,91
$951,36 		$943,55
$993,88
$1 047,21
$1 236,66 		$1 228,85
$1 279,18
$1 332,51
$1 521,96 		$285,30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$745,90
$846,56
$953,22
$1 332,12
$2 024,30 		$1 031,20
$1 131,86
$1 238,52
$1 617,42 		$1 316,50
$1 417,16
$1 523,82
$1 902,72 		$1 601,80
$1 702,46
$1 809,12
$2 188,02 		$285,30
Toc - Plan #21 Medica
Gold

(EPO) Medica with CHI Health Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,150 $3,450 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$431,83
$490,11
$551,86
$771,22
$1 171,95 		$762,17
$820,45
$882,20
$1 101,56 		$1 092,51
$1 150,79
$1 212,54
$1 431,90 		$1 422,85
$1 481,13
$1 542,88
$1 762,24 		$330,34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$863,66
$980,22
$1 103,72
$1 542,44
$2 343,90 		$1 194,00
$1 310,56
$1 434,06
$1 872,78 		$1 524,34
$1 640,90
$1 764,40
$2 203,12 		$1 854,68
$1 971,24
$2 094,74
$2 533,46 		$330,34
Toc - Plan #22 Medica
Silver

(EPO) Medica with CHI Health Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$394,89
$448,19
$504,66
$705,26
$1 071,71 		$696,98
$750,28
$806,75
$1 007,35 		$999,07
$1 052,37
$1 108,84
$1 309,44 		$1 301,16
$1 354,46
$1 410,93
$1 611,53 		$302,09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789,78
$896,38
$1 009,32
$1 410,52
$2 143,42 		$1 091,87
$1 198,47
$1 311,41
$1 712,61 		$1 393,96
$1 500,56
$1 613,50
$2 014,70 		$1 696,05
$1 802,65
$1 915,59
$2 316,79 		$302,09
Toc - Plan #23 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$296,82
$336,88
$379,33
$530,11
$805,55 		$523,88
$563,94
$606,39
$757,17 		$750,94
$791,00
$833,45
$984,23 		$978,00
$1 018,06
$1 060,51
$1 211,29 		$227,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$593,64
$673,76
$758,66
$1 060,22
$1 611,10 		$820,70
$900,82
$985,72
$1 287,28 		$1 047,76
$1 127,88
$1 212,78
$1 514,34 		$1 274,82
$1 354,94
$1 439,84
$1 741,40 		$227,06
Toc - Plan #24 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$332,97
$377,91
$425,52
$594,66
$903,64 		$587,68
$632,62
$680,23
$849,37 		$842,39
$887,33
$934,94
$1 104,08 		$1 097,10
$1 142,04
$1 189,65
$1 358,79 		$254,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$665,94
$755,82
$851,04
$1 189,32
$1 807,28 		$920,65
$1 010,53
$1 105,75
$1 444,03 		$1 175,36
$1 265,24
$1 360,46
$1 698,74 		$1 430,07
$1 519,95
$1 615,17
$1 953,45 		$254,71
Toc - Plan #25 Medica
Catastrophic

(EPO) Medica with CHI Health Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$215,41
$244,48
$275,28
$384,71
$584,60 		$380,19
$409,26
$440,06
$549,49 		$544,97
$574,04
$604,84
$714,27 		$709,75
$738,82
$769,62
$879,05 		$164,78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$430,82
$488,96
$550,56
$769,42
$1 169,20 		$595,60
$653,74
$715,34
$934,20 		$760,38
$818,52
$880,12
$1 098,98 		$925,16
$983,30
$1 044,90
$1 263,76 		$164,78
Toc - Plan #26 Medica
Expanded Bronze

(EPO) Medica with CHI Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$314,89
$357,39
$402,42
$562,38
$854,60 		$555,78
$598,28
$643,31
$803,27 		$796,67
$839,17
$884,20
$1 044,16 		$1 037,56
$1 080,06
$1 125,09
$1 285,05 		$240,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$629,78
$714,78
$804,84
$1 124,76
$1 709,20 		$870,67
$955,67
$1 045,73
$1 365,65 		$1 111,56
$1 196,56
$1 286,62
$1 606,54 		$1 352,45
$1 437,45
$1 527,51
$1 847,43 		$240,89
Toc - Plan #27 Medica
Expanded Bronze

(EPO) Medica with CHI Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$313,27
$355,55
$400,34
$559,48
$850,18 		$552,91
$595,19
$639,98
$799,12 		$792,55
$834,83
$879,62
$1 038,76 		$1 032,19
$1 074,47
$1 119,26
$1 278,40 		$239,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$626,54
$711,10
$800,68
$1 118,96
$1 700,36 		$866,18
$950,74
$1 040,32
$1 358,60 		$1 105,82
$1 190,38
$1 279,96
$1 598,24 		$1 345,46
$1 430,02
$1 519,60
$1 837,88 		$239,64

‡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 Pottawattamie County here.

Pottawattamie County is in “Rating Area 4” of Iowa.

Currently, there are 27 plans offered in Rating Area 4.

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