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Medica Prime Solution Core (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Core (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 Core (Cost) in 2025, please refer to our full plan details page.
Medica Prime Solution Core (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 Core (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 Core (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 Core (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 Core (Cost)
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Drug Coverage
Prescription drugs are not covered by Medica Prime Solution Core (Cost).
Additional Benefits
The Medica Prime Solution Core (Cost) plan offers coverage for a range of services with varying costs. Inpatient hospital stays have a $400 copay, while outpatient services, such as hospital visits and ambulatory surgical center services, have copays ranging from $100 to $150. The plan also includes coverage for ambulance services with copays, emergency services with a $125 copay, and primary care visits with a $10 copay. Preventive services are covered with no copay, and the plan offers benefits for hearing, vision, and dental services with copays. Home health and dialysis services are covered with no copay, and durable medical equipment has 20% coinsurance. Skilled nursing facilities are covered, with no copay for the first 20 days and a $50 per day copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $400 copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital and Observation Services have a $150 copay, Ambulatory Surgical Center (ASC) Services have a $100 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $15 and $15.
Partial Hospitalization See details
Partial Hospitalization is covered under the plan, with a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Prime Solution Core (Cost) plan. Ground Ambulance Services have a $50 copay, while Air Ambulance Services have a $100 copay, but there is no coinsurance for any ambulance service; however, Transportation Services to a 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 Core (Cost) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $10 and $25, and Worldwide Emergency Coverage has a $125 copay; all three services have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The "Medica Prime Solution Core (Cost)" plan covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and individual and group sessions for mental health specialty services with a $10 copay. Physical therapy and speech-language pathology services have a $25 copay, and opioid treatment program services have a $15 copay. Routine chiropractic care and additional telehealth benefits are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, health education, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. Some preventive services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $400 per year, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are also covered with no copay.
Vision Services See details
The Medida Prime Solution Core (Cost) plan covers vision services, including eye exams with a copay of $10 to $25, and eyewear with a $30 copay for contact lenses and a combined maximum plan benefit of $100 per year. Routine eye exams and other eye exam services are limited to one visit per year.
Dental Services See details
Dental Services are covered by the plan, with a copay of $10-$25 for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $300 per year, covering 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including 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. The plan does not have a service-specific maximum out-of-pocket cost.
Dialysis Services See details
Dialysis Services are covered by the Medica Prime Solution Core (Cost) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Medical Supplies have a coinsurance of 0% to 20%. Diabetic Supplies have a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with copays applying to some services. Diagnostic Procedures/Tests have a copay between $10 and $25, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have a copay of at most $30, while Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medica Prime Solution Core (Cost) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Prime Solution Core (Cost) plan. There is no copay for days 1-20, and the copay is $50 per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Medica Prime Solution Core (Cost)" plan does not cover acupuncture, meal benefits, or Dual Eligible SNPs with Highly Integrated Services, but it does cover Over-the-Counter (OTC) Items with a maximum benefit of $50 every six months. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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