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Medica Prime Solution Enhanced (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Enhanced (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 Enhanced (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (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 $3000.00 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 Enhanced (Cost)
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Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Enhanced (Cost).
Additional Benefits
The Medica Prime Solution Enhanced (Cost) plan offers robust coverage with no copays and no coinsurance for essential services like inpatient hospital stays, primary care doctor visits, preventive care, and home health services. For other medical needs, out-of-pocket costs remain low, featuring a $10 copay for specialist visits and urgent care, and a $75 copay for emergency room visits. Outpatient services and diagnostic tests also feature minimal costs, generally ranging from no copay up to $100 depending on the service. This plan also includes valuable supplemental coverage, such as dental care with no copay up to a $400 annual limit, and annual vision exams with no copay or a low $10 copay. Prescription and over-the-counter hearing aids are covered with fixed copays and no coinsurance, while routine hearing exams require no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, and eligible over-the-counter items are covered with no copay up to $50 every six months.
Inpatient Hospital See details
Medica Prime Solution Enhanced (Cost) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance. This benefit is partially covered because upgrades and non-Medicare-covered stays for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Medica Prime Solution Enhanced (Cost) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $100 (including a $100 copay per stay for observation services), while individual and group substance abuse sessions require a $10 copay.
Partial Hospitalization See details
Medica Prime Solution Enhanced (Cost) covers partial hospitalization services with a $10.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Enhanced (Cost) covers ground and air ambulance services with a $50 copay and no coinsurance, and this copay is not waived if you are admitted to the hospital. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Medica Prime Solution Enhanced (Cost) covers emergency services with a $75 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency coverage is also available for a $75 copay and no coinsurance, but worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Medica Prime Solution Enhanced (Cost) offers primary care physician visits with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, psychiatric services, and opioid treatment require a $10 copay and no coinsurance. Some chiropractic and mental health specialty services are covered, but routine chiropractic, other chiropractic, and individual or group mental health sessions are not covered; podiatry and telehealth are also not covered.
Preventive Services See details
Medica Prime Solution Enhanced (Cost) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and health education, but sub-services like in-home safety assessments, personal emergency response systems, weight management, and medical nutrition therapy are not covered.
Hearing Services See details
Medica Prime Solution Enhanced (Cost) covers hearing exams with no copay and no coinsurance, including one routine exam annually and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $549.00 to $1,299.00, though inner ear, outer ear, and over the ear devices are not covered. OTC hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Prime Solution Enhanced (Cost) covers annual routine and refraction eye exams with no coinsurance and a copay ranging from no copay to $10. Eyewear, including lenses, frames, and contact lenses, is covered up to a $200 yearly limit with no coinsurance, requiring a $30 copay for contact lenses and no copay for eyeglasses.
Dental Services See details
Medica Prime Solution Enhanced (Cost) covers a wide range of dental services, including preventive, diagnostic, and restorative care, with no copay and no coinsurance up to a $400 annual maximum. Medicare-covered dental services are also available with a $0 to $10 copay and no coinsurance.
Home Infusion bundled Services See details
Medica Prime Solution Enhanced (Cost) covers home infusion bundled services with no copay, including Part D home infusion drugs. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Medica Prime Solution Enhanced (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Enhanced (Cost) covers durable medical equipment with no copay and 0% to 20% coinsurance. While some prosthetics, medical supplies, and diabetic equipment services are covered with no copay and no coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Medica Prime Solution Enhanced (Cost) with no coinsurance, though lab services and outpatient X-ray services are not covered. Covered diagnostic procedures and tests have a copay ranging from no copay to $10, while diagnostic radiological services have a minimum copay of $50 and therapeutic radiological services have a minimum copay of $10.
Home Health Services See details
Medica Prime Solution Enhanced (Cost) provides coverage for Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Medica Prime Solution Enhanced (Cost) with no coinsurance, but some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Enhanced (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $50 daily copay for days 21 through 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Medica Prime Solution Enhanced (Cost) plan are partially covered, offering Hospice Consultation Services and Over-the-Counter (OTC) items with no copay and no coinsurance. Eligible OTC items are covered up to $50 every six months, but 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.
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