Balance by Medica Gold HSA
Starting at
$733
/month before subsidy
Balance by Medica Gold HSA is a 2027 Gold EPO health insurance plan from Medica, sold on the ACA Marketplace in Missouri under plan ID 53461MO0080077. The monthly premium starts at $733 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $3,500 ($7,000 for a family), and the individual out-of-pocket maximum is $4,700 ($9,400 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is HSA-eligible, so it can be paired with a Health Savings Account.
- Plan ID
- 53461MO0080077
- Plan year
- 2027
- State
- Missouri
- Metal level
- Gold
- Plan type
- EPO
- HSA-eligible
- Yes
Individual Deductible
$3,500
Family: $7,000
Out-of-Pocket Max
$4,700
Family: $9,400
Coinsurance
20%
You pay after deductible
Network Type
EPO
MON008
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
$4,760
your estimated cost
- Deductible
- $3,500
- Copays
- $0
- Coinsurance
- $1,200
Managing type 2 diabetes
A year of routine care
$2,800
your estimated cost
- Deductible
- $2,300
- Copays
- $500
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,800
your estimated cost
- Deductible
- $2,800
- Copays
- $0
- Coinsurance
- $0
Enter your ZIP code first to search nearby doctors.
This Gold EPO 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
$1,125/month
Annual Premium
$8,796
OOP Maximum
$4,700
💡 What this means:
With a $3,500 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $4,700 total. Then insurance covers everything else for the year.
More plans from Medica in Missouri
- Balance by Medica Bronze Sharefrom $581/mo
- Medica with MU Health Care Bronze Sharefrom $708/mo
- Balance by Medica Bronze Standardfrom $602/mo
- Medica with MU Health Care Bronze Standardfrom $734/mo
- Balance by Medica Silver HSAfrom $790/mo
- Balance by Medica Silver Sharefrom $781/mo
- Balance by Medica Silver Standardfrom $780/mo
- Medica with MU Health Care Silver HSAfrom $962/mo
Frequently asked questions about Balance by Medica Gold HSA
How much does Balance by Medica Gold HSA cost per month?
Balance by Medica Gold HSA from Medica starts at $733 per month before any subsidy in Missouri. 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 HSA?
The individual medical deductible is $3,500, and the family deductible is $7,000. 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 HSA?
The most you would pay in a year for covered in-network care is $4,700 for an individual and $9,400 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 HSA HSA-eligible?
Yes. Balance by Medica Gold HSA is a qualified high-deductible health plan, so you can pair it with a Health Savings Account (HSA) and pay for eligible medical expenses with pre-tax dollars.
What type of network does Balance by Medica Gold HSA use?
Balance by Medica Gold HSA is a EPO plan. EPO plans cover in-network care only (except emergencies) and usually do not require referrals to see specialists.
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
- The SLCSP benchmark
The Silver plan that sets your subsidy and Form 1095-A
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.