A non-government entity
Medica Prime Solution Core (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Core (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 Core (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Core (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in ND and SD. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medica Prime Solution Core (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 Core (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 Core (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 $3750.00 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 Core (Cost)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Core (Cost).
Additional Benefits
The Medica Prime Solution Core (Cost) plan offers robust medical coverage with no copay and no coinsurance for primary care doctor visits, preventive services, dialysis, and home health care. For specialized medical needs, members pay a $15 copay for specialist visits and a $300 copay per benefit period for inpatient hospital stays with no coinsurance. Emergency room services require a $50 copay, while outpatient hospital services feature a copay ranging from no copay up to $150. Supplemental care is highly affordable, featuring no copay for routine dental, vision, and hearing exams, along with a $400 annual limit for dental care and a $150 annual allowance for eyewear. Skilled nursing facility stays require no copay for the first 20 days and a $50 daily copay for days 21 through 100. Additionally, durable medical equipment is covered with no copay and a 0% to 20% coinsurance.
Inpatient Hospital See details
Medica Prime Solution Core (Cost) partially covers inpatient hospital care, requiring a $300 copay per Original Medicare benefit period and no coinsurance for covered acute and psychiatric stays. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered, though unlimited additional acute care days are provided.
Outpatient Services See details
Outpatient services are covered by Medica Prime Solution Core (Cost) with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Outpatient substance abuse sessions require a $15 copay, while ambulatory surgical center and blood services are available with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Medica Prime Solution Core (Cost) plan with a $20.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Core (Cost) covers ground ambulance services with a $50 copay and air ambulance services with a $100 copay, with no coinsurance required for either service. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Medica Prime Solution Core (Cost) covers emergency services with a $50 copay and no coinsurance, which is waived if 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 $50 copay and no coinsurance for emergency care, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits under Medica Prime Solution Core (Cost) feature no copay and no coinsurance for primary care doctor visits, while specialist, therapy, psychiatric, and opioid treatment services require a $15 copay and no coinsurance. Telehealth and podiatry are not covered, and chiropractic services are partially covered, with routine and other chiropractic care not covered. Some mental health specialty services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services offered by Medica Prime Solution Core (Cost) feature no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered to include health education, fitness benefits, and remote access technologies, while services like in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing Services are covered by Medica Prime Solution Core (Cost), featuring annual routine exams and fittings with no copay and no coinsurance. 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 types are not covered. Over-the-counter (OTC) hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Prime Solution Core (Cost) covers annual routine eye exams and refractions with no deductible, no coinsurance, and a copay ranging from no copay to $15. Eyewear is covered up to $150 annually with no deductible or coinsurance, requiring a $30 copay for contact lenses and no copay for eyeglasses.
Dental Services See details
Medica Prime Solution Core (Cost) covers dental services with a $0 to $15 copay and no coinsurance for Medicare-covered dental care. Other preventive and comprehensive dental services, including cleanings, x-rays, and restorative care, are covered with no copay and no coinsurance up to a $400 annual maximum.
Home Infusion bundled Services See details
Medica Prime Solution Core (Cost) covers home infusion bundled services with no copay and no coinsurance, which includes Part D home infusion drugs. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medica Prime Solution Core (Cost) plan with no copay and no coinsurance. This ensures members can access necessary kidney dialysis treatments with zero out-of-pocket costs.
Medical Equipment See details
Medica Prime Solution Core (Cost) partially covers medical equipment with no copays, offering durable medical equipment and medical supplies with a coinsurance ranging from 0% to 20%. Prosthetic devices and diabetic therapeutic shoes are covered with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Medica Prime Solution Core (Cost) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures and tests have no copay to a $15 copay, while radiological services require copays of $10 for X-rays, at least $30 for therapeutic services, and at least $125 for diagnostic radiological services.
Home Health Services See details
Home health services are covered under the Medica Prime Solution Core (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Medica Prime Solution Core (Cost), though some services are covered while cardiac, intensive cardiac, and pulmonary rehabilitation (each requiring a $15 copay) and SET for PAD services (requiring a $10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Core (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 standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by Medica Prime Solution Core (Cost), featuring hospice consultation and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $50 of coverage every six months, though acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved