A non-government entity
Medica Prime Solution Focus (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Focus (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 Focus (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Focus (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in WI. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medica Prime Solution Focus (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 Focus (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 Focus (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 $4000.00 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 Focus (Cost)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Focus (Cost).
Additional Benefits
The Medica Prime Solution Focus (Cost) plan offers comprehensive coverage for core medical services with many benefits requiring no coinsurance. Primary care doctor visits, home health services, and preventive care are available with no copay, while specialist visits and rehabilitation therapies require a small $15 copay. For inpatient hospital stays, there is no coinsurance and a $400 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Supplemental services like routine dental care and routine hearing exams are covered with no copay, while routine vision exams range from no copay to a $15 copay. Emergency room visits require a $125 copay, which is waived if admitted, and urgent care visits have a $25 copay. Durable medical equipment and select Part B drugs are subject to a 0% to 20% coinsurance, helping to keep overall health costs predictable and manageable.
Inpatient Hospital See details
Medica Prime Solution Focus (Cost) covers inpatient hospital services with no coinsurance and a copay of $400 per day for days 1 to 5, followed by no copay for days 6 to 90. Unlimited additional days are covered for acute stays and up to 175 additional days for psychiatric stays, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medica Prime Solution Focus (Cost) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $300, which includes a $300 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copays and no coinsurance, while outpatient substance abuse individual and group sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Medica Prime Solution Focus (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 Focus (Cost), featuring a $100 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Medica Prime Solution Focus (Cost) covers emergency services with a $125 copay (waived if admitted within 24 hours) and urgently needed services with a $25 copay, both with no coinsurance. Worldwide emergency services are partially covered with a $125 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Medica Prime Solution Focus (Cost) covers primary care physician visits with no copay and no coinsurance, while specialist visits, psychiatric care, and physical, occupational, and speech therapies require a $15 copay and no coinsurance. Some chiropractic and mental health specialty services are covered, but routine chiropractic, individual and group mental health sessions, podiatry, and telehealth are not covered.
Preventive Services See details
Medica Prime Solution Focus (Cost) offers partially covered preventive services with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and kidney disease education. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Medica Prime Solution Focus (Cost), featuring routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription and OTC hearing aids are partially covered with no coinsurance, with copays ranging from $549 to $1,299 for prescription aids and a $499.50 copay for OTC aids, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Medica Prime Solution Focus (Cost) with no deductibles or coinsurance, featuring a $0 to $15 copay for annual routine and refraction eye exams. Eyewear is covered up to a $100 annual combined limit, with a $30 copay for contact lenses and no copay for eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services covered by Medica Prime Solution Focus (Cost) include Medicare-covered dental care with a $0 to $15 copay and no coinsurance, alongside preventive and comprehensive dental services with no copay and no coinsurance. Other dental services, including exams, cleanings, and restorative care, are subject to a maximum plan benefit of $300 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Medica Prime Solution Focus (Cost) with no copay and no coinsurance, which includes mandatory Part D home infusion drugs. Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medica Prime Solution Focus (Cost) with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Focus (Cost) partially covers medical equipment with no copays, though diabetic supplies are not covered under the plan. Covered durable medical equipment and medical supplies have 0% to 20% coinsurance, while prosthetic devices and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Medica Prime Solution Focus (Cost) with no coinsurance, though lab services are not covered. Diagnostic procedures range from no copay to a $15 copay, outpatient X-rays require a $50 copay, and therapeutic and diagnostic radiological services have minimum copays of $80 and $175, respectively.
Home Health Services See details
Home Health Services are covered under the Medica Prime Solution Focus (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Medica Prime Solution Focus (Cost) plan with no coinsurance. Patients will pay a $15 copay for cardiac, intensive cardiac, and pulmonary rehabilitation services, and a $10 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medica Prime Solution Focus (Cost) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Additional days beyond the standard Medicare-covered limit are also covered, and a prior hospital stay of at least three days is required for admission.
Other Services See details
Medica Prime Solution Focus (Cost) partially covers other services, offering hospice consultations and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $50 every six months, but acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved