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GoldPPO

Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam

Medica

Starting at

$862

/month before subsidy

Key facts

Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam is a 2026 Gold PPO health insurance plan from Medica, sold on the ACA Marketplace in Oklahoma under plan ID 21333OK0070001. The monthly premium starts at $862 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $1,500 ($3,000 for a family), and the individual out-of-pocket maximum is $8,800 ($17,600 for a family). After the deductible, coinsurance is 30% for covered in-network care. The plan is not HSA-eligible.

Plan ID: 21333OK0070001
Plan year: 2026
State: Oklahoma
Metal level: Gold
Plan type: PPO
HSA-eligible: No

Individual Deductible

$1,500

Family: $3,000

Out-of-Pocket Max

$8,800

Family: $17,600

Coinsurance

30%

You pay after deductible

Network Type

PPO

OKN001

Cost Sharing

What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$0.00

Specialist Visit$75.00

Urgent Care$0.00

Emergency Room30.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$15.00

Brand Name Drugs50.00% Coinsurance after deductible

Specialty Drugs60.00% Coinsurance after deductible

CMS Quality Rating

The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.

1.0overall

Medical care
Member experience: Not rated
Plan administration

What you'd typically pay

Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$4,470

your estimated cost

Deductible: $1,500
Copays: $10
Coinsurance: $2,900

Managing type 2 diabetes

A year of routine care

$1,800

your estimated cost

Deductible: $1,100
Copays: $700
Coinsurance: $0

A simple fracture

ER visit + follow-up

$2,000

your estimated cost

Deductible: $1,500
Copays: $200
Coinsurance: $300

Is your medication or doctor covered?

Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.

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Official Plan Documents

Published by Medica. These are the authoritative source for coverage details.

Summary of Benefits & Coverage (SBC)Standardized cost & coverage summary Plan BrochureFull plan details from the insurer Drug FormularyCovered prescriptions & drug tiers

Who This Plan Is Best For

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.

Worst-Case Monthly Cost

What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,595/month

Annual Premium

$10,344

OOP Maximum

$8,800

💡 What this means:

With a $1,500 deductible, you pay 100% of costs until you've spent that much. After that, you pay 30% (coinsurance) until you hit $8,800 total. Then insurance covers everything else for the year.

More plans from Medica in Oklahoma

View all Marketplace plans in Oklahoma

Frequently asked questions about Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam

How much does Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam cost per month?

Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam from Medica starts at $862 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 Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam?

The individual medical deductible is $1,500, and the family deductible is $3,000. 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 Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam?

The most you would pay in a year for covered in-network care is $8,800 for an individual and $17,600 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam HSA-eligible?

No. Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam 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 Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam use?

Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam 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

Enroll at HealthCare.gov Browse Oklahoma plans

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.