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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 NE, KS, IA. 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 comprehensive coverage with a focus on affordability. You'll find coverage for inpatient hospital stays with a $200 copay, outpatient services with a $100 copay, and emergency services with a $100 copay. Many services, such as partial hospitalization, home health, and dialysis, have no copay. The plan also includes benefits for primary care, preventive care, hearing, vision, and dental services, with a maximum dental benefit of $400 per year. Medical equipment, home infusion, and skilled nursing facilities are covered. The plan also offers coverage for over-the-counter items, with a maximum benefit of $50 every six months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $200 copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a $100 copay per visit, while Ambulatory Surgical Center (ASC) Services have a $50 copay. Outpatient Substance Abuse Services are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
The Medcia Prime Solution Premier (Cost) plan covers ambulance and transportation services, but some services are not covered. Air ambulance services have a $50 copay, while ground ambulance and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency services and worldwide emergency coverage have a $100 copay, while urgently needed services have no copay. Worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
The Primary Care benefit of the Medica Prime Solution Premier (Cost) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance, while Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Podiatry Services are not covered.
Preventive Services See details
The Medica Prime Solution Premier (Cost) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types), and OTC hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered with no limit. Prescription hearing aids (all types) are covered up to a maximum of $400 per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are covered with no limit.
Vision Services See details
The Medcia Prime Solution Premier (Cost) plan covers vision services, including routine eye exams once per year, and other eye exam services once per year. Eyewear is covered with a combined maximum benefit of $200.00 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, with a maximum 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 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 copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the plan, including Durable Medical Equipment (DME) with no copay or coinsurance. Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no copay or coinsurance, but Prosthetic Devices and Medical Supplies are not covered. Diabetic Equipment is covered, with a coinsurance between 0% and 20% for Diabetic Supplies; however, Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered, with no copay for all diagnostic services, but diagnostic procedures/tests and lab services are not covered. Radiological Services are covered, with a copay of up to $100 for diagnostic services and up to $80 for therapeutic services, while 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 covered by the Medica Prime Solution Premier (Cost) plan, however, the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
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, and there is no coinsurance.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $50 every six months, and some other services are not covered, including Acupuncture, Meal Benefit, 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.
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