Medica Prime Solution Premier w/Rx (Cost)

Medica Prime Solution Premier 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 Premier 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 Premier 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.

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:

Drug Coverage

The Medica Prime Solution Premier w/Rx (Cost) plan has a $615 annual drug deductible before coverage begins. Tier 1 preferred generic drugs have no copay at standard pharmacies and preferred mail order, while standard mail order copays range from $10 to $30 depending on the supply. Tier 2 generic drugs incur a $7 monthly copay at standard pharmacies and preferred mail order, or a $17 monthly copay through standard mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs have a 16% coinsurance, and Tier 4 non-preferred drugs require a 50% coinsurance across standard pharmacies and mail order options. Tier 5 specialty drugs are available with a 25% coinsurance for a one-month supply.

Additional Benefits

The Medica Prime Solution Premier w/Rx (Cost) plan offers robust coverage with low out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. If you require inpatient hospital stays, you will pay a $200 copay per stay with no coinsurance, while outpatient hospital services range from no copay to a $100 copay. Emergency room visits carry a $50 copay, which is waived if you are admitted, and urgently needed services are available with no copay. Specialist visits require a low $10 copay, and routine dental, vision, and hearing exams are fully covered with no copays or coinsurance. The plan also includes no-copay coverage for dialysis, partial hospitalization, and home infusion services, though certain medical equipment and select Part B drugs may require up to 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $50 daily copay.