Iowa health plan · 2025

Medica Insure Silver Share · 93078IA0060027

Medica Insurance Company offers this marketplace health insurance plan (Plan ID 93078IA0060027) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: EPO CSR: 94% AV Level Silver Plan Issuer: Medica Insurance Company
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 94.02% (5.98% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$327 – $1685

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$1,525

$3050 per group

Review MOOP rules

Office visits

Primary care $5.00
Specialist $35.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $125.00

View formulary tiers

$536 / mo before subsidies

≈ $6433 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1608 / mo before subsidies

≈ $19299 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1964 / mo before subsidies

≈ $23566 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1222 / mo before subsidies

≈ $14665 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

10.00%

Durable Medical Equipment

10.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Iowa). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 94% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

10.00%

Durable Medical Equipment

10.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 93078IA0060027
Coverage year 2025
State Iowa
Issuer Medica Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 93078IA0060027-06
Available variants

Standard Off Exchange Plan · 93078IA0060027-00

Standard On Exchange Plan · 93078IA0060027-01

Open to Indians below 300% FPL · 93078IA0060027-02

Open to Indians above 300% FPL · 93078IA0060027-03

73% AV Silver Plan · 93078IA0060027-04

87% AV Silver Plan · 93078IA0060027-05

94% AV Silver Plan · 93078IA0060027-06
Last plan update Thu, 02 Jan 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Iowa 101
PCPs in Iowa 11
Telehealth support Data pending
Nationwide providers 782
101 doctors statewide 11 PCPs

Provider network(s)

Providers Iowa All US states
All 101 782
PCP 11 135
Allergy N/A N/A
OB/GYN N/A 5
Dentists N/A N/A

Drug coverage overview

3,956 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,177
NON-PREFERRED-BRAND 790
SPECIALTY-DRUGS 620
ZERO-COST-SHARE-PREVENTIVE-DRUGS 369
Prior authorization Drugs
Required 0
Not Required 3,956
Step therapy Drugs
Required 0
Not Required 3,956
Quantity limits Drugs
Has Limit 0
No Limit 3,956

Customer highlights

What stands out for members

  • Issuer: Medica Insurance Company · Plan ID 93078IA0060027 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 93078IA0060027-06 (94% AV Silver Plan ) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Virtual visits are unlimited with a $0 copayment when provided by a designated in-network virtual care provider for non-urgent medical symptoms for common illnesses.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Speech Therapy

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Specialist Visit

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

10.00%
Tier 1 in-network 10.00%
Out-of-network 10.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 10.00%

nan

Exclusions: nan

Emergency Transportation/Ambulance

10.00%
Tier 1 in-network 10.00%
Out-of-network 10.00%

nan

Exclusions: nan

Hospice Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

See policy or plan document for additional benefit explanation.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Benefit Period

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

60.00%
Tier 1 in-network 60.00%
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Brand Drugs

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

nan

Exclusions: nan

Specialty Drugs

$700.00
Tier 1 in-network $700.00
Out-of-network 100.00%

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Elective, induced abortions are not covered, except as medically necessary to protect the life of the mother.

Exclusions: Excludes abortions that are elective, except abortions performed when the life of the mother is at risk.

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Benefit Period

See policy or plan document for additional benefit explanation.

Exclusions: nan

Gender Affirming Care

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Habilitation Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

See policy or plan document for additional benefit explanation.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: See policy or plan document for additional benefit exclusions.

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

Plan refers to home skilled nursing as private duty nursing. Home skilled nursing is intended to provide a safe transition from other levels of care when medically necessary, to provide teaching to caregivers for ongoing care, or to provide short-term treatments that can be safely administered in the home setting.

Exclusions: nan

Reconstructive Surgery

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

nan

Exclusions: nan

Variant attributes

Medica Insure Silver Share · Variant 93078IA0060027-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

93078IA006

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

93078IA0060027-06

Plan Marketing Name

Medica Insure Silver Share

Plan Variant Marketing Name

Medica Insure Silver Share

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

93078

Issuer Marketplace Marketing Name

Medica

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

IAN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Services

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency Services

Service Area ID

IAS002

State Code

IA

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.940233551583102

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,100

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$100

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$300

SBC Scenario, Treatment of a Simple Fracture, Copayment

$80

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

10.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$3050 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$1525 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$1,525

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

IAF008

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-01-02 19:01:44

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

EPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

93078IA0060027

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Iowa?

Medica Insure Silver Share (93078IA0060027) is a Silver EPO from Medica Insurance Company in Iowa for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Medica Insure Silver Share support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Medica Insure Silver Share HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Medica Insure Silver Share support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Medica Insure Silver Share?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Medica Insure Silver Share?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Services

Does Medica Insure Silver Share cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency Services

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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