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Medica Prime Solution Thrift w/Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Thrift w/Rx (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 Thrift w/Rx (Cost) in 2025, please refer to our full plan details page.
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 WY. This plan received an overall rating of 4 out of 5 stars in 2025.
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.
For Medica Prime Solution Thrift w/Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $101.80. 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 $590.00 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 $6700.00 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 Thrift w/Rx (Cost) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $14 copay at a preferred pharmacy and $20 at a standard pharmacy. For standard generic drugs, you pay 20% coinsurance.
Additional Benefits
The Medica Prime Solution Thrift w/Rx (Cost) plan offers coverage for a variety of services. Inpatient hospital stays have a $300 copay for days 1-4, and no copay for days 5-90, while outpatient services, partial hospitalization, ambulance, and primary care services are covered with a 20% coinsurance. Emergency services have a $50 copay, and urgently needed services have a $25 copay. Preventive services are covered with no copay. Hearing, vision, and dental services are partially covered, with varying coinsurance amounts. Home health services have no copay and no coinsurance, while skilled nursing facilities have no copay for days 1-20 and a $214 copay for days 21-100. Some services, such as cardiac rehabilitation and additional home care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the plan. For days 1-4 of inpatient hospital stays, the copay is $300, and there is no copay for days 5-90.
Outpatient Services See details
Outpatient Services are covered under the Medica Prime Solution Thrift w/Rx (Cost) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medica Prime Solution Thrift w/Rx (Cost) plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Thrift w/Rx (Cost) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $50 copay, and no coinsurance for emergency services. Urgently Needed Services are also covered, with a $25 copay, and no coinsurance. Worldwide Emergency Services, including coverage, urgent coverage, and transportation, are not covered.
Primary Care See details
The "Medica Prime Solution Thrift w/Rx (Cost)" plan covers primary care physician, chiropractic, occupational therapy, physician specialist, mental health specialty (individual and group sessions), other health care professional, psychiatric (individual and group sessions), physical therapy and speech-language pathology, and opioid treatment program services. For these services, you will pay 20% coinsurance, except for occupational therapy, mental health, and opioid treatment where the coinsurance is also 20%. Podiatry services and additional telehealth benefits are not covered, and routine chiropractic care is also not covered.
Preventive Services See details
The Medica Prime Solution Thrift w/Rx (Cost) plan covers preventive services, including Medicare-covered services with no copay. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services, glaucoma screenings, barium enemas, digital rectal exams, and EKGs following Welcome Visits have a 20% coinsurance, and diabetes self-management training is covered.
Hearing Services See details
Hearing Services are partially covered under the Medica Prime Solution Thrift w/Rx (Cost) plan. Hearing exams have at most 20% coinsurance, but routine hearing exams and fitting/evaluation for hearing aids are not covered, and prescription hearing aids of any type are not covered.
Vision Services See details
Vision services are covered, but routine eye exams are not covered. For eyewear, there is a 20% coinsurance, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the Medica Prime Solution Thrift w/Rx (Cost) plan. Medicare Dental Services are covered with 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Thrift w/Rx (Cost) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with a 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 are covered under the Medica Prime Solution Thrift w/Rx (Cost) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Thrift w/Rx (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 not covered by the Medica Prime Solution Thrift w/Rx (Cost) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Thrift w/Rx (Cost) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Medica Prime Solution Thrift w/Rx (Cost) plan. Acupuncture, over-the-counter items, meal benefits, and several other services are not covered.
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