Medica Prime Solution Standard (Cost)

H2450 - 050 - 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 – 050 – 0 available in Select counties in WI.

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 $15.00 $ $
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

Diagnostic procedures/lab services/imaging

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

Doctor visits

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

Emergency care/Urgent care

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

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

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

  • Diabetes supplies
    • $25 copay or 0-20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 30% coinsurance per item
  • Prosthetics (e.g., braces, artificial limbs)
    • 30% 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 group therapy visit
    • $35 copay
  • Outpatient individual therapy visit
    • $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • $60 copay
  • Outpatient group therapy visit with a psychiatrist
    • $60 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

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

Skilled Nursing Facility

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

Transportation

    • Not covered

Vision

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

Table of Contents