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Medica Prime Solution Basic (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Basic (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 (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Basic (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 (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 Basic (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 (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 $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 (Cost)
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Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Basic (Cost).
Additional Benefits
The Medica Prime Solution Basic (Cost) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $200 copay, while outpatient services have a $150 copay. Emergency services have a $100 copay, and primary care visits are covered with a $15 copay. Preventive services and home health services are covered with no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual maximums. Additionally, the plan offers coverage for ambulance services, skilled nursing facilities, and medical equipment with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $200 copay for a Medicare-covered stay, while additional days and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered. Additional days for Inpatient Hospital-Acute are covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, are covered by the Medica Prime Solution Basic (Cost) plan with a $150 copay. Ambulatory Surgical Center (ASC) Services have a $100 copay, while Outpatient Substance Abuse Services have a $15 copay for both individual and group sessions. Outpatient Blood Services are also covered.
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 (Cost) plan. Ground ambulance services have a $50 copay, while air ambulance services have a $100 copay, and both have no coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered, with a $100 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $20, with no coinsurance. Worldwide Emergency Coverage has a $100 copay, and no coinsurance, but Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Medca Prime Solution Basic (Cost) plan covers primary care physician, chiropractic, occupational therapy, physician specialist, psychiatric, and physical therapy services. Chiropractic services have a $15 copay, while occupational therapy services have a $15 copay with no coinsurance. Physician specialist services, physical therapy, and speech-language pathology services have a $15 copay. The plan also covers psychiatric services with a $15 copay for individual and group sessions, and opioid treatment program services with a $15 copay. Routine chiropractic care, individual and group sessions for mental health specialty services, and additional telehealth benefits are not covered.
Preventive Services See details
The "Medica Prime Solution Basic (Cost)" plan covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams (1 every year), fitting/evaluation for hearing aids, and OTC hearing aids. Prescription hearing aids (all types) are covered, with a plan-specified amount of $400 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$15, and eyewear with a $30 copay. Eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a copay between $0 and $15, as well as other dental services with a maximum plan benefit of $300 per year. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Medica Prime Solution Basic (Cost) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
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. Prosthetic devices have a 20% coinsurance, and medical supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $15, while lab services are not covered. Diagnostic Radiological Services have a maximum copay of $100, Therapeutic Radiological Services have a maximum copay of $25, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with no copay for days 1-20, and a $50 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
The "Medica Prime Solution Basic (Cost)" plan's other services include Over-the-Counter (OTC) Items with a maximum benefit of $50 every six months. However, acupuncture, 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), 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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