A non-government entity
Medica Prime Solution Enhanced w/Rx 2 (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Enhanced 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 Enhanced w/Rx 2 (Cost) in 2025, please refer to our full plan details page.
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 4 out of 5 stars in 2025.
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.
For Medica Prime Solution Enhanced w/Rx 2 (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $270.70. 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 $3000.00 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:
Sign up for Medica Prime Solution Enhanced w/Rx 2 (Cost)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Medica Prime Solution Enhanced 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 the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies. This plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy (LIS), your Part D premium will be reduced. 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 Enhanced w/Rx 2 (Cost) plan offers a range of benefits with varying cost-sharing. It provides coverage for inpatient and outpatient hospital services, with copays ranging from $10 to $50. Primary care, preventive, and hearing services are included, with hearing exams at no copay and hearing aids covered up to $400 annually. Vision services offer eye exams with $0-$10 copays and eyewear coverage. Additionally, the plan covers dental services up to $400 per year, home infusion, dialysis, and home health services with no copays or coinsurance. Emergency services have a $50 copay, while skilled nursing facilities have a $0 copay for days 1-20 and a $25 copay for days 21-100. The plan also includes coverage for medical equipment, diagnostic services, and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital and Observation Services have a $50 copay, while Individual and Group Sessions for Outpatient Substance Abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medica Prime Solution Enhanced w/Rx 2 (Cost) plan, with a copay of $10.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Medica Prime Solution Enhanced w/Rx 2 (Cost) plan. Air Ambulance Services have a $50 copay, while Medicare-covered Ground Ambulance Services are covered with a copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services have a $50 copay, and Urgently Needed Services have a copay between $0 and $10; both have no coinsurance. Worldwide Emergency Coverage has a $50 copay, and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The "Medica Prime Solution Enhanced w/Rx 2 (Cost)" plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, physical therapy, speech-language pathology services, psychiatric services, and opioid treatment program services. Chiropractic services and physician specialist services have a $10 copay, and the plan does not cover routine chiropractic care, individual sessions for mental health specialty services, group sessions for mental health specialty services, podiatry services, and additional telehealth benefits.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. 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, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a plan-specified amount of $400 per year, and OTC hearing aids are also covered.
Vision Services See details
The "Medica Prime Solution Enhanced w/Rx 2 (Cost)" plan covers vision services, including eye exams with a copay of $0-$10, and eyewear with a $30 copay for contact lenses, with a combined maximum benefit of $200 per year. Routine eye exams and other eye exam services are covered every year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a copay of $0-$10, while other dental services have a maximum plan benefit of $400 per year. The plan also covers 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, with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services includes coverage for Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. The plan does not have a service specific maximum out-of-pocket cost.
Dialysis Services See details
Dialysis Services are covered by the plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), with no copay or coinsurance, although DME for use outside the home is not covered. Prosthetics/Medical Supplies are covered with no copay or coinsurance, but prosthetic devices and medical supplies are not covered. Diabetic Equipment includes coverage for Diabetic Supplies with a coinsurance between 0% and 20%, but Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Medica Prime Solution Enhanced w/Rx 2 (Cost) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $10, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $50, with a minimum copay of $10, and Therapeutic Radiological Services have a copay of at most $10, with a minimum copay of $10; Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Enhanced w/Rx 2 (Cost) plan with no copay or 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for these services; however, the specific amount is not listed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Enhanced w/Rx 2 (Cost) plan. There is no copay for days 1-20, and a $25 copay for days 21-100.
Other Services See details
Other Services coverage includes Over-the-Counter (OTC) Items, with a maximum benefit of $50.00 every six months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
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.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved