Medica Prime Solution Enhanced w/Rx 2 (Cost)

Medica Prime Solution Enhanced 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 3.5 out of 5 stars in 2026.

It's important to know that Medica Prime Solution Enhanced 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 Enhanced 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.

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:

Drug Coverage

The Medica Prime Solution Enhanced w/Rx 2 (Cost) plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order carries a $10 copay for a one-month supply. Tier 2 generic drugs are available with a $9 copay for a one-month supply at standard pharmacies and preferred mail order, or a $19 copay via standard mail order. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 preferred brands require 20% coinsurance, and Tier 4 non-preferred drugs require 50% coinsurance across standard pharmacies, preferred mail order, and standard mail order. Tier 5 specialty drugs are covered with 30% coinsurance for a one-month supply through all available pharmacy and mail order channels.

Additional Benefits

The Medica Prime Solution Enhanced w/Rx 2 (Cost) plan provides comprehensive medical coverage with many essential services requiring no copay and no coinsurance, including inpatient hospital stays, primary care visits, and home health care. Specialist visits, urgent care, and partial hospitalization are highly affordable with a low $10 copay and no coinsurance. Emergency room visits carry a $75 copay that is waived upon hospital admission, while outpatient hospital services feature a copay ranging from no copay up to $100. For routine and supplemental care, this plan offers preventive dental services and routine hearing exams with no copay and no coinsurance. Vision exams require a copay of up to $10, and beneficiaries receive a $200 annual allowance for eyewear alongside a $30 copay for contact lenses. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days and a $50 daily copay for days 21 through 100, while durable medical equipment carries no copay and 0% to 20% coinsurance.