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Medica Prime Solution Standard (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Standard (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 Standard (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Standard (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in MN, ND, NE, SD, WY. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Medica Prime Solution Standard (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 Standard (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 Standard (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 $5000.00 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 Standard (Cost).
Additional Benefits
The Medica Prime Solution Standard (Cost) plan offers a variety of benefits, including coverage for inpatient hospital stays with a $325 copay for the first four days, and outpatient services with copays ranging from $30 to $500. The plan also covers primary care visits with a $15-$60 copay, preventive services with no copay, and hearing and vision services with copays. Additional benefits include coverage for dental services, home infusion bundled services with varying copays and coinsurance, and medical equipment with 30% coinsurance. The plan also covers ambulance services with copays, emergency services with a $125 copay, and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-4, and no copay for days 5-90; additional days and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered under the Medica Prime Solution Standard (Cost) plan. Outpatient Hospital and Observation Services have a $500 copay, Ambulatory Surgical Center (ASC) Services have a $300 copay, and both individual and group sessions for Outpatient Substance Abuse have a $30 copay. Outpatient Blood Services are also covered, including services not usually covered by Medicare plans, with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medica Prime Solution Standard (Cost) plan with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Standard (Cost) plan. Ground ambulance services have a $350 copay, and air ambulance services have a $500 copay; there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Medica Prime Solution Standard (Cost) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $25 and $55; both have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Medica Prime Solution Standard (Cost) covers primary care physician services with a $15 copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $60 copay, mental health specialty services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $60 copay, and opioid treatment program services with a $30 copay. Routine Chiropractic Care, Podiatry Services, and Additional Telehealth Benefits are not covered.
Preventive Services See details
The "Medica Prime Solution Standard (Cost)" plan covers preventive services, including annual physical exams, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs with no copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, with a copay of $60, including services not usually covered by Medicare plans; routine hearing exams have a copay between $15 and $60 for one exam per year. Fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Medca Prime Solution Standard (Cost) plan covers vision services, including eye exams with a copay of $15-$60, and eyewear with a $45 copay for contact lenses and a combined maximum benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services, including Medicare Dental Services and Other Dental Services, are covered. Oral exams have a copay of $15.00 - $60.00, and other services, including 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 covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Insulin has a $35 copay, while coinsurance for chemotherapy, radiation, and other Medicare Part B drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Standard (Cost) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with 30% coinsurance, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment. Diabetic Supplies have a $25 copay and 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 30% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures/tests with a copay between $15 and $60, and for diagnostic radiological services with a copay up to $155. Therapeutic radiological services have a copay up to $80, and outpatient X-ray services have a $15 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Medica Prime Solution Standard (Cost) plan with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Medica Prime Solution Standard (Cost) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Prime Solution Standard (Cost) plan with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays, are not covered.
Other Services See details
Other Services offered by the Medica Prime Solution Standard (Cost) plan include Over-the-Counter (OTC) Items, with a maximum benefit coverage of $25 every six months. 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 are not covered.
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