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Medica Prime Solution Basic w/Rx 2 (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Basic w/Rx 2 (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica Prime Solution Basic w/Rx 2 (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Basic w/Rx 2 (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select Counties in MN. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Medica Prime Solution Basic w/Rx 2 (Cost) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica Prime Solution Basic w/Rx 2 (Cost).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Medica Prime Solution Basic w/Rx 2 (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $213.90. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Medica Prime Solution Basic w/Rx 2 (Cost) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $15 copay at a preferred pharmacy, while standard generic drugs have 18% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medica Prime Solution Basic w/Rx 2 (Cost) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. It also covers primary care, preventive services, hearing, vision, and dental services, with copays ranging from $0 to $15 for many services. Additionally, the plan includes benefits such as home health, skilled nursing, and dialysis services. The plan provides coverage for ambulance services and emergency services with copays, as well as medical equipment and diagnostic services with coinsurance or copays. The plan also offers coverage for home infusion, cardiac rehabilitation, and other services like OTC items. However, some services like transportation, additional hours of care, and certain therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For both, there is a $200 copay for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute are covered.
Outpatient Services See details
Outpatient Services are covered by the Medica Prime Solution Basic w/Rx 2 (Cost) plan, including outpatient hospital services and observation services with a $150 copay, Ambulatory Surgical Center (ASC) Services with a $100 copay, and outpatient substance abuse services with a copay between $15 and $15 for individual and group sessions. Outpatient blood services are also covered, with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medica Prime Solution Basic w/Rx 2 (Cost) plan, with a $20 copay. There is no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Basic w/Rx 2 (Cost) plan. Ground Ambulance Services have a $50 copay, while Air Ambulance Services have a $100 copay, and both have no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Medica Prime Solution Basic w/Rx 2 (Cost) plan. Emergency Services have a $100 copay, with no coinsurance. Urgently Needed Services have a copay between $0 and $20, with no coinsurance. Worldwide Emergency Coverage has a $100 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The "Medica Prime Solution Basic w/Rx 2 (Cost)" plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy services (with a $15 copay), physician specialist services (with a $15 copay), psychiatric services (with a $15 copay), physical therapy and speech-language pathology services (with a $15 copay), and opioid treatment program services (with a $15 copay). Routine chiropractic care, individual and group sessions for mental health specialty services, podiatry services, and additional telehealth benefits are not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services, annual physical exams, and additional preventive services with no copay. Health Education, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) are covered. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay, as well as fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $400 per year, and OTC hearing aids are covered.
Vision Services See details
The "Medica Prime Solution Basic w/Rx 2 (Cost)" plan covers vision services, including eye exams with a copay of $0-$15, and eyewear with a $30 copay for contact lenses. The plan provides coverage for routine eye exams and other eye exam services once per year.
Dental Services See details
The Medca Prime Solution Basic w/Rx 2 (Cost) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. Medicare Dental Services have a copay between $0 and $15. Orthodontic services are covered under Diagnostic and Preventive Dental, with a maximum benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Basic w/Rx 2 (Cost) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with a 20% coinsurance and no copay, and Diabetic Supplies with 0-20% coinsurance and no copay; Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic procedures and tests with a copay between $0 and $15, but lab services are not covered. Radiological Services include coverage for diagnostic radiological services with a maximum copay of $100, therapeutic radiological services with a minimum copay of $25, and outpatient X-ray services with a $10 copay.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Basic w/Rx 2 (Cost) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for these services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Basic w/Rx 2 (Cost) plan. There is no copay for days 1-20, and a $50 copay for days 21-100.
Other Services See details
Other Services include coverage for over-the-counter (OTC) items, with a maximum benefit of $50.00 every six months, and all other services are not covered, including acupuncture, meal benefit, and many others.
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