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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 2025, 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, 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 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 a variety of benefits. This plan includes coverage for inpatient hospital stays with a $200 copay, outpatient services with copays ranging from $50-$100, and emergency services for a $100 copay. The plan also includes coverage for primary care services, preventive services with no copay, hearing services, vision services with a $200 annual eyewear allowance, and dental services with a $400 annual maximum. Additional benefits include home infusion, dialysis, and skilled nursing facility services with a $0 copay for days 1-20, and a $100 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $200 copay for a Medicare-covered stay.
Outpatient Services See details
Outpatient Services are covered by the Medica Prime Solution Premier (Cost) plan, including Outpatient Hospital Services and Observation Services with a $100 copay, and Ambulatory Surgical Center (ASC) Services with a $50 copay. Outpatient Substance Abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Premier (Cost) plan, with no coinsurance for any ambulance services. Air Ambulance Services have a $50 copay, while Ground Ambulance Services and Transportation Services are not covered.
Emergency Services See details
Emergency Services are covered by the Medica Prime Solution Premier (Cost) plan. Emergency services have a $100 copay and no coinsurance, while urgently needed services have no copay or coinsurance. Worldwide Emergency Coverage has a $100 copay and no coinsurance, but Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The "Medica Prime Solution Premier (Cost)" plan covers Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services. Physician Specialist Services have a $10 copay, while Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance.
Preventive Services See details
The "Medica Prime Solution Premier (Cost)" plan covers preventive services, including an annual physical exam, with no copay. Additional preventive services include Health Education, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams (1 per year), Fitting/Evaluation for Hearing Aids, Prescription Hearing Aids (all types), and OTC Hearing Aids; however, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. Prescription hearing aids have a maximum plan benefit coverage of $400 per year.
Vision Services See details
The Medca Prime Solution Premier (Cost) plan covers vision services, including routine eye exams and other eye exam services with one visit per year, plus eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades; there is a combined maximum benefit of $200 per year for all eyewear.
Dental Services See details
The Medca Prime Solution Premier (Cost) plan covers a range of dental services, including oral exams, X-rays, cleanings, and orthodontics with a $400 annual maximum. Other services such as restorative services, endodontics, periodontics, and more are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services includes coverage for Medicare Part B Insulin Drugs with a $35 copay; Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance; and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Premier (Cost) plan. There is no information about the cost of these services in the provided snippet.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies - Non-Medicare benefit with no copay or coinsurance. Diabetic Equipment includes Diabetic Supplies with a coinsurance between 0% and 20%, but 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
Diagnostic and Radiological Services are covered under the Medica Prime Solution Premier (Cost) plan. Diagnostic Radiological Services have a copay of up to $100, while Therapeutic Radiological Services have a copay of up to $80; however, Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Premier (Cost) plan. There is no copay for days 1-20, and a $100 copay for days 21-100.
Other Services See details
The "Medica Prime Solution Premier (Cost)" plan covers Over-the-Counter (OTC) items with a maximum benefit of $50 every six months. 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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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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