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Medica Prime Solution Basic w/Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Basic 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 Basic w/Rx (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Basic 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. 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 (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 (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 (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $160.90. 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 $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 $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 (Cost) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you will pay a $10.00 copay for preferred generic drugs at a preferred pharmacy, or 18% coinsurance for standard generic drugs at any pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Medica Prime Solution Basic w/Rx (Cost) plan offers a range of benefits. This plan covers inpatient hospital stays with a $200 copay, outpatient services with copays ranging from $15 to $150, and partial hospitalization with a $20 copay. Emergency services have a $100 copay, and primary care visits have copays that vary. Preventive services are included, along with hearing and vision services. Hearing exams and hearing aids are covered with no copay, and vision exams have copays between $0-$15. Dental services, home infusion, dialysis services, home health, and skilled nursing facility services are also covered. You'll also have access to durable medical equipment with 20% coinsurance and other services with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $200 copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Medica Prime Solution Basic w/Rx (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 $15 copay per individual or group session. Outpatient blood services are also covered, with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Basic w/Rx (Cost) plan. Ground Ambulance Services have a $50 copay, and Air Ambulance Services have a $100 copay, but there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, are covered by the Medica Prime Solution Basic w/Rx (Cost) plan. Emergency Services have a $100 copay and no coinsurance, while Urgently Needed Services have a copay between $0-$20 and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The "Medica Prime Solution Basic w/Rx (Cost)" plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, psychiatric services, other health care professional services, physical therapy, and speech-language pathology services. Chiropractic services have a $15 copay, and individual and group psychiatric sessions have a $15 copay. Routine Chiropractic Care, individual and group mental health specialty sessions, podiatry services, and additional telehealth benefits are not covered.
Preventive Services See details
The Medica Prime Solution Basic w/Rx (Cost) plan covers a variety of preventive services, including annual physical exams, health education, fitness benefits, and remote access technologies. This plan does not cover 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, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include hearing exams with no copay, and routine hearing exams once per year. Prescription hearing aids (all types) and OTC hearing aids are covered with no copay, and the plan covers up to $400 per year for prescription hearing aids. Fitting/evaluation for hearing aids is also covered. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The "Medica Prime Solution Basic w/Rx (Cost)" plan covers vision services, including eye exams with a copay of $0-$15, and eyewear with a $30 copay for contact lenses and a combined maximum plan benefit coverage of $100 every year.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a copay of $0 - $15, and other dental services. Other dental services have a maximum plan benefit of $300 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. The copay for Medicare Part B Insulin Drugs is $35, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no information about the cost of these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment have a coinsurance, with 0-20% coinsurance for Medical Supplies. Diabetic Supplies have 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $15, and Diagnostic Radiological Services with a copay up to $100 (minimum $25), Therapeutic Radiological Services with a copay up to $25 (minimum $25), and Outpatient X-Ray Services with a $10 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Basic 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 Basic w/Rx (Cost) plan. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Prime Solution Basic w/Rx (Cost) plan. There is no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the "Other Services" benefit, 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. Over-the-counter (OTC) items are covered with a maximum plan benefit coverage amount of $50.00 every six months.
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