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Medica Advantage Preferred (PPO)

H8889 - 013 - 0
3.5 out of 5 stars (3.5 / 5)

medica medicare provider logo

Medica Advantage Preferred (PPO) is a Medicare Advantage Plan by Medica.

This page features plan details for 2025 Medica Advantage Preferred (PPO) H8889 – 013 – 0 available in Select counties in ND and SD.

Locations

Medica Advantage Preferred (PPO) is offered in the following locations.

Brookings County, South Dakota
Burleigh County, North Dakota
Clark County, South Dakota

Click to see more locations

Plan Overview

Medica Advantage Preferred (PPO) offers the following coverage and cost-sharing.

Insurer:Medica
Health Plan Deductible:$0
MOOP:$3,000 In and Out-of-network
$3,000 In-network
Drugs Covered:Yes

Ready to sign up for Medica Advantage Preferred (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Medica Advantage Preferred (PPO) has a monthly premium of $201.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $159.70 $41.30 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Medica Advantage Preferred (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$41.30$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Medica Advantage Preferred (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Oral Exams
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $0-50 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $0 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-50 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-50 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: $0-50 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Specialist
    • Out-of-Network: $20 copay per visit
  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $0 copay
  • Primary
    • Out-of-Network: $10 copay per visit

Emergency care/Urgent care

  • Emergency
    • $0 copay
  • Urgent care
    • $0 copay

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $20 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $0 copay

Ground ambulance

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • Out-of-Network: $549-1,299 copay
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $549-1,299 copay
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $0-20 copay

Inpatient hospital coverage

    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $50 per stay (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $3,000 In and Out-of-network
      $3,000 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 0-20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: $0 copay (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: $0 copay (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $0 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $0 copay
    • Out-of-Network: $20 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $20 copay
    • In-Network: $0 copay
  • Inpatient hospital – psychiatric
    • Out-of-Network: $50 per stay (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: $20 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $0 copay
  • Outpatient individual therapy visit
    • In-Network: $0 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $20 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-50 copay per visit (Authorization Required)
    • Out-of-Network: $0-100 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $0 copay
    • Out-of-Network: $20 copay
  • Occupational therapy visit
    • In-Network: $0 copay
    • Out-of-Network: $20 copay

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $25 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: $50 per day for days 1 through 20
      $50 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Medica Advantage Preferred (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Medica Advantage Preferred (PPO)? See 2025 Medica Advantage Preferred (PPO) at MedicareAdvantageRX.com.

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Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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