Medica Prime Solution Thrift w/Rx (Cost)

Medica Prime Solution Thrift w/Rx (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in MN, ND, SD, WI. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Medica Prime Solution Thrift w/Rx (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 Thrift w/Rx (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 Thrift w/Rx (Cost) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generics, you will pay a $7 copay for a 1-month supply at standard pharmacies and preferred mail order, while Tier 2 generics require a $14 copay. Standard mail order options are slightly higher, costing $17 for Tier 1 and $20 for Tier 2 for a 1-month supply. For brand-name and specialty medications, the plan utilizes coinsurance instead of flat copays. Tier 3 preferred brands require a 17% coinsurance, Tier 4 non-preferred drugs carry a 50% coinsurance, and Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply. These coinsurance rates remain the same whether you use a standard pharmacy, preferred mail order, or standard mail order.

Additional Benefits

The Medica Prime Solution Thrift w/Rx (Cost) plan provides comprehensive coverage for essential medical services, often requiring no copays in exchange for a standard coinsurance. For instance, outpatient hospital services, primary care, specialist visits, and diagnostic radiology feature no copays and a 0% to 20% coinsurance. Emergency care is covered with flat copays, specifically $125 for emergency room visits and $25 for urgent care, with no coinsurance. For inpatient hospital stays and skilled nursing facility care, the plan utilizes daily copays instead of coinsurance, charging $350 per day for the first five days of a hospital stay and $218 per day for days 21 through 100 in a skilled nursing facility. While hearing exams and prescription hearing aids are covered with structured copays, routine dental and vision services are generally not covered under this plan.