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Medica Prime Solution Thrift (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Thrift (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 (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Thrift (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in IA KS MN ND NE 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 (Cost) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica Prime Solution Thrift (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 (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Medica Prime Solution Thrift (Cost).
Additional Benefits
The Medica Prime Solution Thrift (Cost) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a $300 copay for the first 4 days, then no copay, while outpatient services, partial hospitalization, ambulance, primary care, vision, dental, dialysis, medical equipment, and diagnostic services all have coinsurance. Preventive services have limited coverage, with some services subject to coinsurance. The plan covers some home health services, skilled nursing facility (SNF) stays, and home infusion bundled services, but does not cover cardiac rehabilitation services or many "Other Services".
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4, there is a $300 copay, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient services are covered by the Medica Prime Solution Thrift (Cost) plan, including outpatient hospital services and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) services and outpatient substance abuse services are also covered with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Thrift (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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medica Prime Solution Thrift (Cost) plan. Emergency Services have a $50 copay and no coinsurance, Urgently Needed Services have a $25 copay and no coinsurance, and Worldwide Emergency Services are not covered.
Primary Care See details
The "Medica Prime Solution Thrift (Cost)" plan covers Primary Care Physician Services, Chiropractic Services (except Routine Care), Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services (Individual and Group Sessions), Other Health Care Professional, Psychiatric Services (Individual and Group Sessions), Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services with a 20% coinsurance. Podiatry Services and Additional Telehealth Benefits are not covered.
Preventive Services See details
The Medica Prime Solution Thrift (Cost) plan covers preventive services, but does not cover annual physical exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (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, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services. Kidney Disease Education Services, Glaucoma Screenings, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits have a 20% coinsurance. Diabetes Self-Management Training is also covered.
Hearing Services See details
The Medca Prime Solution Thrift (Cost) plan's Hearing Services benefit is partially covered, as routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. The plan has a coinsurance of at most 20% for hearing exams, and there is no deductible.
Vision Services See details
Vision Services are covered under the Medica Prime Solution Thrift (Cost) plan, with a 20% coinsurance for eye exams and eyewear. Routine eye exams, 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 (Cost) plan. Medicare Dental Services are covered with a 20% coinsurance, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
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%.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Thrift (Cost) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with 0-20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. 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 (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 (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 (Cost) plan. While the plan mentions coinsurance, it also states that no cardiac rehabilitation services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered by the Medica Prime Solution Thrift (Cost) plan. Specifically, acupuncture, over-the-counter items, meal benefits, 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), 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.
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