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Medica Prime Solution Premier (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Premier (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 Premier (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Premier (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 Premier (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 Premier (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 Premier (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 Premier (Cost)
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Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Premier (Cost).
Additional Benefits
The Medica Prime Solution Premier (Cost) plan offers robust coverage with no copay and no coinsurance for many essential services, including primary care visits, preventive care, home health, and dialysis. Outpatient hospital services feature low copays ranging from no copay to $100, while emergency care and air ambulance services require a modest $50 copay. Inpatient hospital stays are partially covered with a $200 copay per stay and no coinsurance. Specialized benefits under this plan include vision services with no copays, coinsurance, or deductibles, alongside a $200 annual eyewear allowance. Dental care is also covered with no copay up to a $400 annual maximum for non-Medicare services, while skilled nursing facilities require no copay for the first 20 days and a $50 daily copay for days 21 to 100. Hearing exams feature no copay, though prescription hearing aids require copays ranging from $549 to $1,299.
Inpatient Hospital See details
Inpatient Hospital services under the Medica Prime Solution Premier (Cost) plan are partially covered, requiring a $200.00 copay and no coinsurance for Medicare-covered acute and psychiatric stays. While unlimited additional acute care days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medica Prime Solution Premier (Cost) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $100, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance. Outpatient substance abuse services are not covered under this plan.
Partial Hospitalization See details
Partial hospitalization is covered under the Medica Prime Solution Premier (Cost) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Medica Prime Solution Premier (Cost), which offers air ambulance services with a $50 copay and no coinsurance. Ground ambulance services and transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under Medica Prime Solution Premier (Cost) with a $50 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay or coinsurance, while worldwide emergency services are partially covered with a $50 copay and no coinsurance, as worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits under Medica Prime Solution Premier (Cost) are covered with no copay and no coinsurance for primary care visits, occupational therapy, physical therapy, speech-language pathology, and opioid treatment, while specialist visits require a $10 copay and no coinsurance. Podiatry and telehealth services are not covered. Some chiropractic, mental health, and psychiatric services are covered with no copay and no coinsurance, but routine chiropractic care, individual and group mental health sessions, and individual and group psychiatric sessions are not covered.
Preventive Services See details
Preventive Services are partially covered under the Medica Prime Solution Premier (Cost) plan with no copay and no coinsurance for covered services like annual physicals, kidney disease education, health education, fitness benefits, and remote access technologies. Non-covered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Medica Prime Solution Premier (Cost) covers hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $549 to $1,299, excluding inner ear, outer ear, and over the ear models, while over-the-counter hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Prime Solution Premier (Cost) covers vision services with no copays, no coinsurance, and no deductibles. This benefit includes one routine eye exam and one refraction exam annually, as well as a $200 yearly allowance for eyewear, including contacts, frames, lenses, and upgrades.
Dental Services See details
Dental Services are covered by Medica Prime Solution Premier (Cost) with no copay and no coinsurance for both Medicare-covered and other dental services, including preventive, restorative, and surgical care. Other dental services are subject to a maximum plan benefit coverage of $400 every year.
Home Infusion bundled Services See details
Medica Prime Solution Premier (Cost) covers Home Infusion bundled Services with no copay, though Medicare Part B chemotherapy, radiation, and other drugs are subject to a coinsurance ranging from no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are 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 Premier (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Premier (Cost) partially covers medical equipment, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance. While some prosthetic and diabetic equipment services are covered with no copay and no coinsurance, specific sub-services including prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Medica Prime Solution Premier (Cost) with no coinsurance. Diagnostic services have no copay but exclude lab services and diagnostic procedures or tests, while radiological services require a minimum $100 copay for diagnostic and a $30 copay for therapeutic services, with outpatient X-ray services not covered.
Home Health Services See details
Home Health Services are covered under the Medica Prime Solution Premier (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Medica Prime Solution Premier (Cost) plan, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Premier (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $50 daily copay for days 21 to 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
Medica Prime Solution Premier (Cost) partially covers Other Services, offering hospice consultation and over-the-counter (OTC) items with no copay and no coinsurance, with OTC items limited to $50 every six months. Acupuncture and meal benefits are not covered under this plan.
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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.
* 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.
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