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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 2025, 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 4 out of 5 stars in 2025.
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:
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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 a range of benefits with varying cost-sharing. Inpatient and outpatient services are covered with copays, and emergency services have copays with no coinsurance. The plan also includes coverage for primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic, home health, and skilled nursing facility services. Many services have no copay, including preventive services, hearing exams, and home health services. The plan provides a $50 benefit for over-the-counter items every six months. However, some services, such as cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
The Medica Prime Solution Enhanced (Cost) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $50 copay, observation services with a $50 copay, ambulatory surgical center services, outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services. This plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan and costs a $10 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Enhanced (Cost) plan, with no coinsurance for any ambulance services. Medicare-covered ground ambulance services have a copay, and air ambulance services have a $50 copay, while ground and health-related transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the plan. Emergency Services have a $50 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $10 and no coinsurance. Worldwide Emergency Coverage has a $50 copay and no coinsurance, but Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Primary Care benefit covers services such as Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist, Psychiatric, and Physical Therapy services. Chiropractic services have a $10 copay, while Occupational Therapy, Physician Specialist, Psychiatric, and Physical Therapy services have a $10 copay. Routine Chiropractic Care, Individual and Group Mental Health, Podiatry, and Additional Telehealth benefits are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and other preventive services, with no copay. Health Education, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System (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, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams (1 per year), fitting/evaluation for hearing aids, and OTC hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $400 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Medica Prime Solution Enhanced (Cost) plan covers vision services, including eye exams with a copay of $0-$10, and eyewear with a $30 copay for contact lenses and a combined maximum benefit of $200 per year. The plan also covers routine eye exams and other eye exam services once per year.
Dental Services See details
The Medica Prime Solution Enhanced (Cost) plan covers dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay. Other covered services include prophylaxis (cleaning), fluoride treatment, and other preventive dental services. The plan also covers orthodontic services and other restorative services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medica Prime Solution Enhanced (Cost) plan. This 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 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Diabetic Equipment, with diabetic supplies covered with 0-20% coinsurance, while Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The "Medica Prime Solution Enhanced (Cost)" plan covers diagnostic and radiological services, with a copay for some services. Diagnostic Procedures/Tests have a copay between $0 and $10, while Diagnostic Radiological Services have a copay up to $50, and Therapeutic Radiological Services have a copay up to $10. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Enhanced (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 Enhanced (Cost) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Enhanced (Cost) plan. There is no copay for days 1-20, and a $25 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 "Other Services" benefit of the Medica Prime Solution Enhanced (Cost) plan includes Over-the-Counter (OTC) items, with a maximum benefit of $50.00 every six months, and 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.
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