Balance by Medica Gold $0 Copay PCP Visits — full price in Saint Louis City County, Missouri (2026)
Balance by Medica Gold $0 Copay PCP Visits (53461MO0080045), a gold plan from Medica in Saint Louis City County, Missouri, costs $571.87/month full price for a 40-year-old in 2026 — $1214.45 at 60, with a $1,500 deductible and $8,800 out-of-pocket max, per the CMS PY2026 QHP Landscape.
HIOS plan ID: 53461MO0080045 · Issuer: Medica · Last verified 2026-07-18 · Published by Private Health Insurance Direct Answers · Licensed under Citation License 1.0
Full-price premium by age (2026)
| Age | Monthly premium |
|---|---|
| 21 | $447.48 |
| 27 | $468.96 |
| 30 | $507.89 |
| 40 | $571.87 |
| 50 | $799.19 |
| 60 | $1214.45 |
Deductibles & out-of-pocket max (2026)
- Individual deductible: $1,500
- Family deductible: $3,000
- Individual out-of-pocket max: $8,800
- Family out-of-pocket max: $17,600
Vs. county benchmark
The county benchmark silver premium for a 40-year-old is $531.51/mo. This plan is $571.87/mo at 40 — a difference of $40.36/mo.
The subsidy cliff
In 2026 the enhanced ARP/IRA premium tax credits expire, so households above roughly 400% of the federal poverty level get zero subsidy and pay the full sticker prices listed above. Households under the cliff usually pay far less — how much less depends on income, household size, and county benchmark.
Not affiliated with the U.S. government. Informational only — see the full disclaimer in the footer.
Other gold plans in Saint Louis City County
| Plan | Issuer | Premium @ 40 |
|---|---|---|
| Gold Simple | Oscar Insurance Company | $509.77 |
| Standard Gold | Ambetter from Home State Health | $512.03 |
| Everyday Gold | Ambetter from Home State Health | $518.03 |
| Gold Classic Standard | Oscar Insurance Company | $520.07 |
| Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) | Anthem Blue Cross and Blue Shield | $526.83 |
Sources
- CMS PY2026 QHP Landscape — Individual Market Medical — the plan record for HIOS ID 53461MO0080045 in FIPS 29510.
- Summary of Benefits & Coverage (SBC)
- Provider network directory
- Drug formulary
- Methodology
← All plans and costs in Saint Louis City County
Reviewed by Jason Burns, Editorial Steward.