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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 2026, 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 3.5 out of 5 stars in 2026.
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 comprehensive coverage with predictable cost-sharing, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $200 copay per stay with no coinsurance, while outpatient hospital services range from no copay up to a $150 copay. Emergency room visits require a $100 copay, which is waived if admitted, and urgently needed care is available with a $20 copay. Specialized benefits include dental care with no copay for preventive and comprehensive services up to $400 annually, and hearing services featuring routine exams with no copay. Vision care is highly affordable with no deductible and exams costing up to a $15 copay, plus a $150 annual allowance for eyewear. Additionally, skilled nursing facility stays offer no copay for the first 20 days, and medical equipment is covered with no copay and coinsurance up to 20%.
Inpatient Hospital See details
Medica Prime Solution Basic (Cost) covers inpatient hospital services, including acute and psychiatric stays, with a $200 copayment per Medicare-covered stay and no coinsurance. This benefit is partially covered, as unlimited additional days are included for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medica Prime Solution Basic (Cost) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
Medica Prime Solution Basic (Cost) covers partial hospitalization services with a $20.00 copay and no coinsurance. This benefit ensures affordable access to structured, intensive outpatient mental health care when you need it most.
Ambulance and Transportation Services See details
Medica Prime Solution Basic (Cost) covers ground and air ambulance services with a $100 copay and no coinsurance, and this copay is not waived if you are admitted to the hospital. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Medica Prime Solution Basic (Cost) covers emergency services with a $100 copay and no coinsurance, which is waived if you are 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 for emergency care, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Medica Prime Solution Basic (Cost) covers primary care physician services with no copay and no coinsurance, while specialist, psychiatric, occupational/physical therapy, and opioid treatment services require a $15 copay and no coinsurance. Chiropractic, podiatry, telehealth, and mental health specialty services are not covered under this plan.
Preventive Services See details
Preventive services are covered by Medica Prime Solution Basic (Cost) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are partially covered under this plan, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Medica Prime Solution Basic (Cost), including routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $549.00 to $1,299.00 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. Over-the-counter (OTC) hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Vision services are covered under Medica Prime Solution Basic (Cost) with no deductible or coinsurance, featuring eye exams with no copay to a $15 copay. Eyewear is also covered with no coinsurance and a $30 copay for contact lenses, up to a combined maximum plan benefit of $150 per year.
Dental Services See details
Medica Prime Solution Basic (Cost) covers Medicare dental services with a copay of $0 to $15 and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, up to an annual maximum plan benefit of $400.
Home Infusion bundled Services See details
Medica Prime Solution Basic (Cost) covers home infusion bundled services with no copay, which includes mandatory Part D home infusion drugs. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Medica Prime Solution Basic (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Basic (Cost) covers medical equipment with no copays, though coinsurance ranges from no coinsurance up to 20% depending on the service. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Medica Prime Solution Basic (Cost) with no coinsurance, though diagnostic services are partially covered because lab services are not covered. Diagnostic procedures and tests have a copay of up to $15 or no copay, while radiological services require copays of $10 for outpatient X-rays, at least $25 for therapeutic radiology, and at least $100 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Basic (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medica Prime Solution Basic (Cost) with no coinsurance, but only some services are covered in practice. Specifically, cardiac, intensive cardiac, and pulmonary rehabilitation services are not covered and require a $15 copay, while supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) is not covered and requires a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medica Prime Solution Basic (Cost) with no coinsurance, featuring no copay for days 1 through 20 and a $100 copay for days 21 through 100. This benefit requires a prior three-day inpatient hospital stay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Medica Prime Solution Basic (Cost) plan are partially covered, featuring hospice consultation services and over-the-counter (OTC) items with no copay and no coinsurance. OTC items have a maximum benefit limit of $50 every six months, while acupuncture and meal benefits are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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