Balance by Medica Gold Share
Starting at
$545
/month before subsidy
Balance by Medica Gold Share is a 2026 Gold PPO health insurance plan from Medica, sold on the ACA Marketplace in Oklahoma under plan ID 21333OK0060075. The monthly premium starts at $545 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $2,500 ($5,000 for a family), and the individual out-of-pocket maximum is $5,900 ($11,800 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is not HSA-eligible.
- Plan ID
- 21333OK0060075
- Plan year
- 2026
- State
- Oklahoma
- Metal level
- Gold
- Plan type
- PPO
- HSA-eligible
- No
Individual Deductible
$2,500
Family: $5,000
Out-of-Pocket Max
$5,900
Family: $11,800
Coinsurance
20%
You pay after deductible
Network Type
PPO
OKN006
Medical Services
Prescription Drugs
- Medical care
- Member experience
- Not rated
- Plan administration
How well doctors manage and coordinate care
Member-survey satisfaction with the plan
Customer service, billing, and access to information
Having a baby
Normal delivery
$4,270
your estimated cost
- Deductible
- $2,500
- Copays
- $10
- Coinsurance
- $1,700
Managing type 2 diabetes
A year of routine care
$2,300
your estimated cost
- Deductible
- $1,400
- Copays
- $900
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,750
your estimated cost
- Deductible
- $2,500
- Copays
- $200
- Coinsurance
- $50
Enter your ZIP code first to search nearby doctors.
This Gold PPO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.
Consider this plan if you:
- Have ongoing health conditions requiring regular care
- Take multiple prescription medications
- Prefer lower costs at the time of service
- Want peace of mind with comprehensive coverage
This summary is generated based on plan attributes for educational purposes only.
If you max out this year
$1,037/month
Annual Premium
$6,540
OOP Maximum
$5,900
💡 What this means:
With a $2,500 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $5,900 total. Then insurance covers everything else for the year.
More plans from Medica in Oklahoma
- Balance by Medica Bronze $0 Copay PCP Visitsfrom $403/mo
- Balance by Medica Bronze Premierfrom $425/mo
- Balance by Medica Expanded Bronze Standardfrom $411/mo
- Harmony by Medica Bronze $0 Copay PCP Visitsfrom $455/mo
- Harmony by Medica Bronze $0 Copay PCP Visits + Adult Eye Examfrom $646/mo
- Harmony by Medica Bronze Premierfrom $480/mo
- Harmony by Medica Bronze Premier + Adult Eye Examfrom $682/mo
- Harmony by Medica Expanded Bronze Standardfrom $464/mo
Frequently asked questions about Balance by Medica Gold Share
How much does Balance by Medica Gold Share cost per month?
Balance by Medica Gold Share from Medica starts at $545 per month before any subsidy in Oklahoma. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.
What is the deductible for Balance by Medica Gold Share?
The individual medical deductible is $2,500, and the family deductible is $5,000. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.
What is the out-of-pocket maximum for Balance by Medica Gold Share?
The most you would pay in a year for covered in-network care is $5,900 for an individual and $11,800 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.
Is Balance by Medica Gold Share HSA-eligible?
No. Balance by Medica Gold Share is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.
What type of network does Balance by Medica Gold Share use?
Balance by Medica Gold Share is a PPO plan. PPO plans let you see specialists without a referral and use out-of-network providers (at higher cost), offering the most flexibility.
Understand what you'd actually pay
- 2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
- How ACA subsidies work
Premium tax credits and who qualifies
- The 2026 subsidy cliff
Why income near 400% FPL matters again this year
Important Notice
Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.