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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 2026, 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 3.5 out of 5 stars in 2026.
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 $206.70. 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 $615.00 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:
Sign up for Medica Prime Solution Basic w/Rx (Cost)
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Drug Coverage
The Medica Prime Solution Basic w/Rx (Cost) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and preferred mail order, though standard mail order costs $10 for a one-month supply. Tier 2 generic medications require an $8 copay for a one-month supply at standard pharmacies and preferred mail order, or $18 through standard mail order. Brand-name and specialty medications are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 16% coinsurance, while Tier 4 non-preferred drugs have a 50% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
The Medica Prime Solution Basic w/Rx (Cost) plan offers comprehensive coverage with no copay for primary care visits, home health care, and dialysis services. Specialist visits and urgent care require a low $15 to $20 copay, while emergency room visits and ambulance services have a $100 copay. Inpatient hospital stays feature a $200 copay per stay with no coinsurance, and outpatient hospital services range from no copay to a $150 copay. For ancillary care, routine vision and hearing exams feature no copay, and preventive dental services are covered with no copay up to a $400 annual limit. Skilled nursing facility stays require no copay for the first 20 days, followed by a $100 copay for days 21 through 100. Additionally, the plan provides a $50 over-the-counter allowance every six months with no copay.
Inpatient Hospital See details
Inpatient hospital care under Medica Prime Solution Basic w/Rx (Cost) is partially covered, featuring a $200 copayment per Medicare-covered stay and no coinsurance for both acute and psychiatric services. Unlimited additional days are covered for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Medica Prime Solution Basic w/Rx (Cost) feature no coinsurance, with no copay for ambulatory surgical center and blood services (which also has no deductible). Medicare-covered outpatient hospital services have a copay of $0 to $150, observation services require a $150 copay per stay, and outpatient substance abuse sessions have a $15 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Medica Prime Solution Basic w/Rx (Cost) plan. Under this plan, you will pay a $20 copay and no coinsurance for covered services.
Ambulance and Transportation Services See details
Medica Prime Solution Basic w/Rx (Cost) covers ground and air ambulance services with a $100 copay and no coinsurance. Transportation services, including trips to plan-approved or any other health-related locations, are not covered under this plan.
Emergency Services See details
Medica Prime Solution Basic w/Rx (Cost) covers emergency services with a $100 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency services are partially covered with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under Medica Prime Solution Basic w/Rx (Cost) are covered with no copay and no coinsurance for primary care provider visits, while specialist, therapy, psychiatric, and opioid treatment services require a $15 copay and no coinsurance. Other health care professional services range from no copay to a $15 copay with no coinsurance, whereas chiropractic, mental health specialty, podiatry, and telehealth services are not covered.
Preventive Services See details
Preventive Services are covered under Medica Prime Solution Basic w/Rx (Cost) with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. This benefit is partially covered, as several additional services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Medica Prime Solution Basic w/Rx (Cost) covers hearing services with no copay and no coinsurance for routine exams and fitting evaluations, and OTC hearing aids are covered with a $499.50 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $549.00 to $1,299.00 and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Medica Prime Solution Basic w/Rx (Cost) covers vision services with no coinsurance, offering annual eye exams for a $0 to $15 copay. Eyewear is covered up to a $150 annual maximum with no coinsurance, featuring a $30 copay for contact lenses and no copay for eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by Medica Prime Solution Basic w/Rx (Cost) with a copay of $0 to $15 and no coinsurance for Medicare-covered care. Other preventive and comprehensive dental services, including cleanings, x-rays, and orthodontics, are covered with no copay and no coinsurance up to a maximum annual benefit of $400.
Home Infusion bundled Services See details
Medica Prime Solution Basic w/Rx (Cost) covers Home Infusion bundled Services with no copay and no coinsurance. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Medica Prime Solution Basic w/Rx (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Basic w/Rx (Cost) covers durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance, and prosthetic devices with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay, which includes therapeutic shoes and inserts at 20% coinsurance, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Medica Prime Solution Basic w/Rx (Cost) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures range from no copay to a $15 copay, while radiological services require copays of $10 for X-rays, a minimum of $25 for therapeutic radiology, and a minimum of $100 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Basic w/Rx (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Medica Prime Solution Basic w/Rx (Cost), but only some services are covered. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and Pulmonary Rehabilitation services (each requiring a $15 copay) as well as SET for PAD services (requiring a $10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medica Prime Solution Basic w/Rx (Cost) with no coinsurance, featuring no copay for days 1 through 20 and a $100 copay for days 21 through 100. A prior three-day inpatient hospital stay is required before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medica Prime Solution Basic w/Rx (Cost) provides partial coverage for other services, offering hospice consultations and over-the-counter (OTC) items with no copay and no coinsurance. While OTC items are covered up to $50 every six months, acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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