A non-government entity
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 2026, 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. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $5900.00 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 Standard (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 Standard (Cost).
Additional Benefits
The Medica Prime Solution Standard (Cost) plan offers comprehensive medical coverage with predictable copays and mostly no coinsurance for key services. Primary care visits require a $15 copay, while specialist visits cost $60, both with no coinsurance. For hospital stays, inpatient care features a $400 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $125 copay that is waived if you are admitted. This plan also includes essential supplemental benefits, such as routine dental care with no copay up to a $400 annual limit, and routine vision exams with copays ranging from $15 to $60. Skilled nursing facility care requires no copay for the first 20 days, followed by a $218 daily copay up to day 100. Additionally, Medicare Part B drugs carry up to a 20% coinsurance with no copay, while home health services and select preventive care are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Medica Prime Solution Standard (Cost) partially covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1 through 5 and no copay for days 6 through 90. Acute care includes unlimited additional days, but upgrades and non-Medicare-covered stays are not covered, while psychiatric care excludes additional days and non-Medicare-covered stays.
Outpatient Services See details
Medica Prime Solution Standard (Cost) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $500 copay and observation services with a $500 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Medica Prime Solution Standard (Cost) covers partial hospitalization services with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Standard (Cost) covers ground ambulance services with a $350 copay and air ambulance services with a $500 copay, with no coinsurance for either service. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under Medica Prime Solution Standard (Cost) with a $125 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are partially covered with a $125 copay and no coinsurance, excluding worldwide urgent coverage and emergency transportation.
Primary Care See details
Medica Prime Solution Standard (Cost) covers primary care visits with a $15 copay and specialist visits with a $60 copay, both featuring no coinsurance. Covered therapy, mental health, psychiatric, and opioid treatment services require copays ranging from $30 to $60 and no coinsurance. Chiropractic, podiatry, and telehealth services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered under the Medica Prime Solution Standard (Cost) plan with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and select fitness benefits. Uncovered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Medica Prime Solution Standard (Cost) partially covers hearing services, offering routine hearing exams for a $60 copay and no coinsurance, and OTC hearing aids for a $499.50 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $549.00 to $1299.00 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Medica Prime Solution Standard (Cost) covers annual routine eye exams with a $15.00 to $60.00 copay, no coinsurance, and no deductible. Eyewear is also covered with no deductible or coinsurance, featuring a $45.00 copay for contact lenses and a combined maximum benefit of $100.00 per year.
Dental Services See details
Medica Prime Solution Standard (Cost) covers Medicare-approved dental services with a $15.00 to $60.00 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, exams, and implants, are covered with no copay and no coinsurance up to a maximum benefit of $400.00 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Medica Prime Solution Standard (Cost) with no copay and no coinsurance. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 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 Standard (Cost) with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Prime Solution Standard (Cost) covers durable medical equipment and medical supplies with no copay and no coinsurance to 30% coinsurance. Prosthetic devices are covered with no copay and 30% coinsurance, while diabetic supplies require a $25 copay and diabetic therapeutic shoes or inserts carry a 30% coinsurance.
Diagnostic and Radiological Services See details
Medica Prime Solution Standard (Cost) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures and tests require a $15 to $60 copay, while radiological services carry copays of $60 for X-rays, at least $80 for therapeutic radiology, and at least $200 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Medica Prime Solution Standard (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Medica Prime Solution Standard (Cost) feature no coinsurance, and while some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Copayments for these services range from $10 to $40 depending on the specific therapy.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Medica Prime Solution Standard (Cost) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered by Medica Prime Solution Standard (Cost), offering hospice consultation services and Over-the-Counter (OTC) items with no copay and no coinsurance, including a $25 benefit limit every six months for OTC purchases. Acupuncture and meal benefits are not covered under this plan.
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