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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 2026, 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 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 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 $4900.00 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 robust coverage for essential medical services with no coinsurance for most care, relying instead on predictable copays. Primary care visits require a $10 copay, specialists are $25, and inpatient hospital stays carry a $400 copay per stay. Emergency care is available with a $125 copay, while skilled nursing facility stays feature no copay for the first 20 days. This plan also provides valuable supplemental benefits, including preventive dental care and dialysis with no copay or coinsurance. Routine eye and hearing exams are covered with low copays, and members receive a $150 annual eyewear allowance alongside an over-the-counter benefit of up to $50 every six months. Standard preventive services and home health care are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Medica Prime Solution Core (Cost) partially covers inpatient hospital services with a $400 copay per Medicare-covered stay and no coinsurance for both acute and psychiatric care. 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
Outpatient services are covered under the Medica Prime Solution Core (Cost) plan with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $150 (including a $150 copay per stay for observation services), while outpatient substance abuse individual and group sessions carry a $15 copay.
Partial Hospitalization See details
Medica Prime Solution Core (Cost) covers partial hospitalization benefits with a $20.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Core (Cost) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $50 copay and air ambulance services require a $100 copay, with no coinsurance for either service.
Emergency Services See details
Emergency services are covered by Medica Prime Solution Core (Cost) with a $125 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency services are partially covered with a $125 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits under the Medica Prime Solution Core (Cost) plan are partially covered with no coinsurance for all covered services, requiring a $10 copay for primary care and mental health visits, a $15 copay for opioid treatment, and a $25 copay for specialists, psychiatric care, and therapy services. Podiatry, additional telehealth, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered under the Medica Prime Solution Core (Cost) plan with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, excluding in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Medica Prime Solution Core (Cost) covers routine hearing exams with a $10 copay and no coinsurance, and OTC hearing aids with a $499.50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549.00 to $1,299.00, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Medica Prime Solution Core (Cost) covers vision services with no deductibles or coinsurance, including routine eye exams with a $10.00 to $25.00 copay. Eyewear is also covered with no coinsurance, a $30.00 copay for contact lenses, and a combined annual maximum benefit of $150.00 for contacts, frames, and lenses.
Dental Services See details
Medica Prime Solution Core (Cost) covers Medicare-covered dental services with a $10.00 to $25.00 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, exams, and orthodontics, are covered with no copay and no coinsurance up to a maximum benefit of $400.00 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medica Prime Solution Core (Cost) with no copay, while covered Medicare Part B insulin drugs require a $35 copay and no coinsurance. Other covered Medicare Part B drugs, including chemotherapy and radiation drugs, have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Medica Prime Solution Core (Cost) covers Dialysis Services with no copay and no coinsurance.
Medical Equipment See details
Medica Prime Solution Core (Cost) partially covers medical equipment with no copays, though diabetic supplies are not covered. Durable medical equipment and medical supplies range from no coinsurance to 20% coinsurance, while prosthetic devices and diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medica Prime Solution Core (Cost) with no coinsurance, as lab services are not covered. Covered services require copays of $10.00 to $25.00 for diagnostic procedures, $10.00 for outpatient X-rays, at least $30.00 for therapeutic radiology, and at least $125.00 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Medica Prime Solution Core (Cost) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided under Medica Prime Solution Core (Cost) with no coinsurance, but only some services are covered. Standard cardiac, intensive cardiac, and pulmonary rehabilitation services are not covered and carry a $15 copay, while supervised exercise therapy for peripheral artery disease is not covered and carries a $10 copay.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Core (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $150 daily copay for days 21 through 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica Prime Solution Core (Cost) provides partial coverage for other services, offering hospice consultation and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $50 of coverage every six months, while acupuncture and meal benefits are not covered.
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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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