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Medica Prime Solution Premier w/Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Premier 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 Premier w/Rx (Cost) in 2025, please refer to our full plan details page.
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 4 out of 5 stars in 2025.
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.
For Medica Prime Solution Premier w/Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $307.10. 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 $590.00 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 $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 w/Rx (Cost)
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Drug Coverage
The Medica Prime Solution Premier w/Rx (Cost) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy used. For example, in the initial coverage phase, you'll pay $12 for preferred generic drugs at a standard or mail-order pharmacy, or 11% coinsurance for standard generic drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medica Prime Solution Premier w/Rx (Cost) plan offers comprehensive coverage, including inpatient hospital stays with a $200 copay, outpatient services with varying copays, and ambulance services with a copay for air ambulance. Emergency services have a $100 copay, and primary care physician services have a $10 copay. Preventive, hearing, vision, and dental services are covered, with specific annual limits for hearing aids, eyewear, and dental benefits. The plan also provides coverage for home infusion, dialysis, and medical equipment with no copays or coinsurance. Diagnostic and radiological services have copays, while home health and skilled nursing facility services are covered with no or low copays. Other covered benefits include over-the-counter items. However, some services like cardiac rehabilitation, and certain types of transportation and home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $200 copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are also covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center (ASC) services, with a $100 copay for outpatient hospital and observation services, and a $50 copay for ASC services. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Medica Prime Solution Premier w/Rx (Cost) plan. The details of the cost of services are not provided in this snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under the Medica Prime Solution Premier w/Rx (Cost) plan. 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 under the Medica Prime Solution Premier w/Rx (Cost) plan, with a $100 copay for Emergency Services and Worldwide Emergency Coverage, and no coinsurance. Urgently Needed Services are covered with no copay or coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Medica Prime Solution Premier w/Rx (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, and Other Health Care Professional services have a copay between $0 and $10. Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, Additional Telehealth Benefits, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero-dollar preventive services, annual physical exams, and other preventive services. Health Education, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. 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 coverage for routine hearing exams (1 per year), fitting/evaluation for hearing aids, and OTC hearing aids. Prescription hearing aids are covered up to $400 per year, and all types of prescription hearing aids are covered.
Vision Services See details
Vision services with the Medica Prime Solution Premier w/Rx (Cost) plan include coverage for routine eye exams and other eye exam services, each with one visit covered every year. Eyewear benefits include coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $400 per year. 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 are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services includes coverage for Medicare Part B Insulin Drugs with a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), covered with no copay or coinsurance, and Prosthetics/Medical Supplies, covered with no copay or coinsurance. Diabetic Equipment is also covered with a coinsurance between 0% and 20% for Diabetic Supplies, 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 partially covered under the Medica Prime Solution Premier w/Rx (Cost) plan. Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $100, and Therapeutic Radiological Services have a copay of at most $80.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Premier w/Rx (Cost) plan 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 not covered by the Medica Prime Solution Premier w/Rx (Cost) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Prime Solution Premier w/Rx (Cost) plan. There is no copay for days 1-20, and a $100 copay for days 21-100.
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, 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.
* 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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