Medica Prime Solution Standard (Cost)

H2450 - 044 - 0
4 out of 5 stars (4 / 5)

medica medicare provider logo

Medica Prime Solution Standard (Cost) is a Medicare Advantage Plan by Medica.

This page features plan details for 2025 Medica Prime Solution Standard (Cost) H2450 – 044 – 0 available in Select counties in MN, ND, NE, SD, WY.

Locations

Medica Prime Solution Standard (Cost) is offered in the following locations.

Plan Overview

Medica Prime Solution Standard (Cost) offers the following coverage and cost-sharing.

Insurer:Medica
Health Plan Deductible:$0
MOOP:$5,000 In-network
Drugs Covered:No

Ready to sign up for Medica Prime Solution Standard (Cost) ?

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 Prime Solution Standard (Cost) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $Not Applicable $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Medica Prime Solution Standard (Cost) 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)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (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)
  • Orthodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

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

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • $55-155 copay
  • Lab services
    • $0 copay
  • Outpatient x-rays
    • $15-60 copay
  • Diagnostic tests and procedures
    • $15-60 copay

Doctor visits

  • Primary
    • $15 copay per visit
  • Specialist
    • $60 copay per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $25-55 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • $60 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • $350 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Not covered
  • Hearing aids – inner ear
    • Not covered
  • Hearing aids OTC
    • Not covered
  • Hearing aids – outer ear
    • Not covered
  • Hearing aids – over the ear
    • Not covered
  • Medicare-Covered Hearing Exam
    • $60 copay

Inpatient hospital coverage

    • $325 per day for days 1 through 4
      $0 per day for days 5 through 90

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

    • $5,000 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 30% coinsurance per item
  • Prosthetics (e.g., braces, artificial limbs)
    • 30% coinsurance per item
  • Diabetes supplies
    • $25 copay or 0-20% coinsurance per item

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance
  • Other Part B drugs
    • 0-20% coinsurance

Mental health services

  • Inpatient hospital – psychiatric
    • $325 per day for days 1 through 4
      $0 per day for days 5 through 90
  • Outpatient individual therapy visit
    • $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • $60 copay
  • Outpatient group therapy visit with a psychiatrist
    • $60 copay
  • Outpatient group therapy visit
    • $35 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $500 copay per visit

Preventive care

    • $0 copay

Rehabilitation services

  • Occupational therapy visit
    • $45 copay
  • Physical therapy and speech and language therapy visit
    • $60 copay

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $214 per day for days 21 through 100

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • $0 copay (Limits Apply)
  • Other
    • $0 copay (Limits Apply)
  • Upgrades
    • $0 copay (Limits Apply)
  • Contact lenses
    • $0 copay (Limits Apply)
  • Eyeglass frames
    • $0 copay (Limits Apply)
  • Routine eye exam
    • $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for Medica Prime Solution Standard (Cost) ?

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 Prime Solution Standard (Cost)? See 2025 Medica Prime Solution Standard (Cost) at MedicareAdvantageRX.com.

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