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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 2026, 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 and IA. 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 (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 $4200.00 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:
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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 provides comprehensive coverage with no copays and no coinsurance for primary care, specialist visits, preventive care, and home health services. Inpatient hospital stays require a $300 copay per benefit period with no coinsurance, while outpatient hospital services feature copays ranging from no copay up to $150. Emergency services incur a $100 copay, which is waived upon admission, and ambulance transports require a $50 copay. Routine dental, vision, and hearing exams are covered with no copays or coinsurance, though certain limits apply, including a $400 annual dental maximum and a $200 annual eyewear allowance. Prescription hearing aids require copays between $549 and $1,299, and medical equipment is covered with no copay and up to 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $125 daily copay for days 21 through 100.
Inpatient Hospital See details
Medica Prime Solution Premier (Cost) partially covers inpatient hospital care with a $300 copay per Medicare-defined benefit period and no coinsurance for acute and psychiatric stays. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medica Prime Solution Premier (Cost) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $150, while ambulatory surgical center and blood services feature no copays or coinsurance. Outpatient substance abuse services are covered with no copay or coinsurance, although individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is fully covered under the Medica Prime Solution Premier (Cost) plan, requiring no copay and no coinsurance from members.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Medica Prime Solution Premier (Cost), featuring a $50 copay and no coinsurance for both ground and air ambulance services. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under Medica Prime Solution Premier (Cost) are covered with a $100 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours, and urgently needed services are covered with no copay and no coinsurance. Worldwide emergency services are partially covered, featuring a $100 copay and no coinsurance for emergency care, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under Medica Prime Solution Premier (Cost) are covered with no copay and no coinsurance for primary care, specialist, occupational therapy, physical therapy, speech-language pathology, and opioid treatment services. Podiatry and additional telehealth are not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care, individual and group mental health sessions, and individual and group psychiatric sessions are not covered.
Preventive Services See details
Preventive services are partially covered by Medica Prime Solution Premier (Cost) with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and fitness benefits. However, several services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Medica Prime Solution Premier (Cost) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $549 and $1,299, but inner ear, outer ear, and over the ear types are not covered. Over-the-counter hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Vision services are covered under Medica Prime Solution Premier (Cost) with no copay and no coinsurance, including one routine eye exam and one refraction exam every year. Eyewear, including contacts, lenses, frames, and upgrades, is also covered with no copay or coinsurance up to a combined maximum of $200 annually.
Dental Services See details
Dental services are covered by Medica Prime Solution Premier (Cost) with no copay and no coinsurance for preventive, restorative, and orthodontic care. Covered services, including oral exams, cleanings, implants, and surgeries, are subject to a maximum annual plan benefit of $400.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medica Prime Solution Premier (Cost) with no copay. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medica Prime Solution Premier (Cost) plan with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Premier (Cost) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and up to 10% coinsurance for prosthetics and medical supplies. Diabetic equipment is also covered with no copay or coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medica Prime Solution Premier (Cost) with no coinsurance, though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered services require a $100 copay for diagnostic radiological services and a $30 copay for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Medica Prime Solution Premier (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medica Prime Solution Premier (Cost) offers some coverage for Cardiac Rehabilitation Services with no copay and no coinsurance, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Premier (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $125 daily copay for days 21 through 100. This benefit is partially covered because it requires a prior three-day inpatient hospital stay and does not cover additional days beyond the Medicare-covered limit.
Other Services See details
Medica Prime Solution Premier (Cost) partially covers other services, offering hospice consultations and over-the-counter items up to $50 every six months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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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.
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