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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 2025, 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, SD and WY. This plan received an overall rating of 4 out of 5 stars in 2025.
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)
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Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Core (Cost).
Additional Benefits
The Medica Prime Solution Core (Cost) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $100 to $300. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, with some services having no copay and others with copays between $0 and $50. Additional benefits include ambulance services with copays, home infusion, dialysis, medical equipment with coinsurance, and home health services with no copay. The plan also provides coverage for partial hospitalization, diagnostic and radiological services with copays, and skilled nursing facility stays with a copay after the first 20 days. This plan offers limited coverage for other services, such as over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $300 copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered, and Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a $150 copay, observation services with a $150 copay, ambulatory surgical center (ASC) services with a $100 copay, outpatient substance abuse services with a $15 copay for individual and group sessions, and outpatient blood services. The plan waives the three (3) pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medica Prime Solution Core (Cost) plan. There is a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $50 copay, while air ambulance services have a $100 copay; there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Medica Prime Solution Core (Cost) plan. Emergency Services have a $50 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $20 with no coinsurance. Worldwide Emergency Coverage has a $50 copay and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Medca Prime Solution Core (Cost) plan covers primary care physician services, chiropractic services (with a $15 copay for routine care), occupational therapy (with a $15 copay), physician specialist services (with a $15 copay), and physical therapy and speech-language pathology services (with a $15 copay). The plan also covers psychiatric services, including individual and group sessions (with a $15 copay), and Opioid Treatment Program Services (with a $15 copay). Routine chiropractic care, individual and group sessions for mental health specialty services, additional telehealth benefits, and podiatry services are not covered.
Preventive Services See details
The Medcia Prime Solution Core (Cost) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, but does not cover 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 smoking cessation, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams with no copay for one exam per year, fitting/evaluation for hearing aids, and prescription hearing aids up to $400 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are also covered.
Vision Services See details
The Medcia Prime Solution Core (Cost) plan covers vision services, including routine eye exams with a copay between $0 and $15, and eyewear with a $30 copay for contact lenses. Eyewear coverage includes a combined maximum benefit of $100 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a maximum benefit of $300 per year. Medicare Dental Services have a copay between $0 and $15, and other services include 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.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B drugs have a 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) with 20% coinsurance, Prosthetics/Medical Supplies with 0-20% coinsurance, and Diabetic Equipment with 0-20% coinsurance for covered services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $15, and Diagnostic Radiological Services with a copay up to $150, Therapeutic Radiological Services with a copay up to $30, and Outpatient X-Ray Services with a $10 copay. Lab Services are not covered.
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 not covered by the Medica Prime Solution Core (Cost) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
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
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $50.00 every six months, but acupuncture, meal benefits, and several other services are not covered.
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