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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 2026, 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 MN ND NE 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 (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 $6750.00 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 provides coverage for essential medical services, generally requiring no copay and a 20% coinsurance for outpatient care, primary and specialist visits, and diagnostic procedures. For inpatient hospital stays, members pay a $350 daily copay for days one through five and no copay for days six through 90. Emergency room visits carry a $125 copay, while urgent care services require a $25 copay. While home health services are covered with no copay and no coinsurance, other benefits like routine dental, routine vision, and fitness programs are not covered. However, Medicare-covered dental and select vision services are available with a 20% coinsurance, and hearing aids are covered with copays ranging from $499.50 to $1,299. Skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Medica Prime Solution Thrift (Cost) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional hospital days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Medica Prime Solution Thrift (Cost) covers outpatient services with no copays, with coinsurance ranging from no coinsurance to 20% depending on the service. Specifically, outpatient hospital and ambulatory surgical center services carry no copay and no coinsurance to 20% coinsurance, while outpatient observation, substance abuse sessions, and blood services require no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Medica Prime Solution Thrift (Cost) plan with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Medica Prime Solution Thrift (Cost) plan, featuring a 20% coinsurance and no copay for both ground and air ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Medica Prime Solution Thrift (Cost) with a $125 copay and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered under this plan.
Primary Care See details
Medica Prime Solution Thrift (Cost) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and a 20% coinsurance. Podiatry, additional telehealth, and chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Medica Prime Solution Thrift (Cost) with no copay and no coinsurance for zero-dollar preventive services, though a 20% coinsurance applies to kidney disease education and glaucoma screenings. Several key services are not covered under this plan, including the annual physical exam, fitness benefits, health education, and weight management programs.
Hearing Services See details
Medica Prime Solution Thrift (Cost) covers hearing services with no deductible, offering diagnostic exams with no copay and routine exams with a 20% coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549 to $1,299, excluding inner ear, outer ear, and over-the-ear types. Over-the-counter (OTC) hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Prime Solution Thrift (Cost) covers some vision services with no copay and 20% coinsurance, but routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
Medica Prime Solution Thrift (Cost) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Non-Medicare dental services are not covered, including oral exams, cleanings, x-rays, fluoride treatments, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Medica Prime Solution Thrift (Cost) covers Home Infusion bundled Services with no copay, though associated Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%. Covered Part B insulin is subject to a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medica Prime Solution Thrift (Cost) with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Prime Solution Thrift (Cost) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays. Coinsurance ranges from no coinsurance to 20% for durable medical equipment and medical supplies, while prosthetic devices and diabetic supplies require a 20% coinsurance.
Diagnostic and Radiological Services See details
Medica Prime Solution Thrift (Cost) partially covers diagnostic and radiological services, as lab services are not covered. Covered diagnostic procedures, outpatient X-rays, and diagnostic or therapeutic radiological services require no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Thrift (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Medica Prime Solution Thrift (Cost) plan; while there is no copay, sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Medica Prime Solution Thrift (Cost) with no coinsurance, but require a prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20, a $218 copay per day for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Medica Prime Solution Thrift (Cost) partially covers Other Services, offering Hospice Consultation Services with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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