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Medica Prime Solution Core w/Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Core w/Rx (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 w/Rx (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Core w/Rx (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 w/Rx (Cost) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica Prime Solution Core w/Rx (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 w/Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $221.70. 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.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 w/Rx (Cost)
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Drug Coverage
The Medica Prime Solution Core w/Rx (Cost) Medicare plan has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay at standard pharmacies and through preferred mail order. Tier 2 generic drugs require a low copay starting at $9 for a one-month supply at standard pharmacies and preferred mail order, up to $57 for a three-month standard mail order. For brand-name and specialty prescriptions, cost sharing is based on coinsurance rather than flat copayments. Tier 3 preferred brands require a 16% coinsurance, and Tier 4 non-preferred drugs have a 50% coinsurance across all pharmacy options. Specialty drugs in Tier 5 carry a 25% coinsurance for a one-month supply at standard pharmacies and mail order services.
Additional Benefits
The Medica Prime Solution Core w/Rx (Cost) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays for primary care visits, home health services, dialysis, and routine preventive care. Inpatient hospital stays require a $300 copay per stay, while outpatient hospital services range from no copay up to a $150 copay. Specialist visits, physical therapy, and urgent care are highly affordable with a $15 to $20 copay, and all of these core services feature no coinsurance. This plan also includes valuable everyday benefits, such as preventive and comprehensive dental care up to $400 annually with no copays or coinsurance. Routine hearing and vision exams feature little to no copays, and members receive a $50 allowance every six months for over-the-counter health items. Emergency care is covered with a $50 copay both locally and worldwide, ensuring affordable protection wherever you are.
Inpatient Hospital See details
Medica Prime Solution Core w/Rx (Cost) partially covers inpatient hospital services with a $300 copayment per Medicare-covered stay and no coinsurance for both acute and psychiatric care. Unlimited additional days are covered for acute stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medica Prime Solution Core w/Rx (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 individual and group sessions carry a $15 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Medica Prime Solution Core w/Rx (Cost) with a $20.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Medica Prime Solution Core w/Rx (Cost), which offers ground ambulance services for a $50 copay and air ambulance services for a $100 copay, with no coinsurance for either. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Medica Prime Solution Core w/Rx (Cost) covers emergency services with a $50 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, and urgent care with a $20 copay and no coinsurance. Worldwide emergency services are partially covered with a $50 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Medica Prime Solution Core w/Rx (Cost) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and psychiatric services require a $15 copay and no coinsurance. Chiropractic, mental health specialty, podiatry, and telehealth services are not covered.
Preventive Services See details
Preventive Services are partially covered by Medica Prime Solution Core w/Rx (Cost) with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, glaucoma screenings, and fitness benefits. However, several supplemental benefits are not covered, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are covered by Medica Prime Solution Core w/Rx (Cost), offering routine annual exams and fitting evaluations with no deductible, no copay, and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549.00 to $1,299.00, though inner ear, outer ear, and over-the-ear models are not covered. OTC hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Prime Solution Core w/Rx (Cost) covers vision services with no deductibles, including annual eye exams with no coinsurance and a copay ranging from no copay to $15. Eyewear is also covered with no coinsurance and a $30 copay for contact lenses, up to a combined maximum benefit of $150 per year for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Medica Prime Solution Core w/Rx (Cost) covers Medicare-approved dental services with a $0 to $15 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum benefit of $400 every year.
Home Infusion bundled Services See details
Medica Prime Solution Core w/Rx (Cost) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are fully covered under the Medica Prime Solution Core w/Rx (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Core w/Rx (Cost) covers medical equipment with no copays, though coinsurance ranges from 0% to 20% depending on the item. 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 partially covered by Medica Prime Solution Core w/Rx (Cost) because lab services are not covered. Covered diagnostic procedures and tests have no coinsurance and range from no copay to a $15 copay, while outpatient X-rays carry a $10 copay and no coinsurance. Diagnostic radiological services require a minimum $125 copay and therapeutic radiological services require a minimum $30 copay, both with no coinsurance.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Core w/Rx (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medica Prime Solution Core w/Rx (Cost) with no coinsurance, though only some services are covered; standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered. These non-covered rehabilitation services carry a $15 copay, while the non-covered SET for PAD services have a $10 copay.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Core w/Rx (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring 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-covered limit are not covered.
Other Services See details
Other services are partially covered by Medica Prime Solution Core w/Rx (Cost), featuring Hospice Consultation Services and Over-the-Counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered, and the OTC benefit provides up to $50 of coverage every six months.
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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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