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Medica Prime Solution Standard w/Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Prime Solution Standard w/Rx (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 w/Rx (Cost) in 2026, please refer to our full plan details page.
Medica Prime Solution Standard w/Rx (Cost) is a Cost plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in MN ND 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 w/Rx (Cost) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica Prime Solution Standard w/Rx (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 w/Rx (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.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 w/Rx (Cost)
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Drug Coverage
The Medica Prime Solution Standard w/Rx (Cost) plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay when using standard pharmacies or preferred mail order. Tier 2 generic drugs have copays starting at $16 for a one-month supply at standard pharmacies and preferred mail order, and up to $60 for a three-month supply via standard mail order. For brand-name and specialty medications, costs are determined by coinsurance rather than set copays. Tier 3 preferred brand drugs require an 18% coinsurance, Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance. These percentage-based costs apply across standard pharmacies, preferred mail order, and standard mail order channels.
Additional Benefits
The Medica Prime Solution Standard w/Rx (Cost) plan provides comprehensive medical coverage with no coinsurance for inpatient hospital stays, outpatient services, and doctor visits. Inpatient care requires a $400 daily copay for days 1 through 5 and no copay for days 6 through 90, while primary care visits have a $15 copay and specialist visits cost $60. Emergency room care has a $125 copay that is waived upon admission, and urgent care services require a $50 copay. For routine wellness, the plan features no copay and no coinsurance for home health services, preventive dental care, and annual physical exams. Vision exams have a $15 to $60 copay, while prescription hearing aids and diagnostic radiology services are covered with varying copayments and no coinsurance. Additionally, dialysis services require a 20% coinsurance with no copay, and durable medical equipment is covered with no copay and up to 30% coinsurance.
Inpatient Hospital See details
Medica Prime Solution Standard w/Rx (Cost) covers inpatient hospital services with no coinsurance and a copay of $400 per day for days 1 through 5, and no copay for days 6 through 90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Medica Prime Solution Standard w/Rx (Cost) with no coinsurance, featuring copays ranging from $0 to $500 for outpatient hospital services and $500 per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $30 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Medica Prime Solution Standard w/Rx (Cost) with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Standard w/Rx (Cost) covers ambulance services with no coinsurance, requiring a $350 copay for ground transport and a $500 copay for air transport, while transportation services are not covered.
Emergency Services See details
Medica Prime Solution Standard w/Rx (Cost) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 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
Medica Prime Solution Standard w/Rx (Cost) covers primary care physician services for a $15 copay and specialist visits for a $60 copay, both with no coinsurance. Physical, occupational, and speech therapy are covered with copays from $45 to $60 and no coinsurance, while podiatry and telehealth are not covered. Some chiropractic services are covered, but routine and other chiropractic services are not.
Preventive Services See details
Medica Prime Solution Standard w/Rx (Cost) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as 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, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Medica Prime Solution Standard w/Rx (Cost) covers hearing exams for a $60 copay and no coinsurance, and over-the-counter hearing aids for a $499.50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549 to $1,299, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are covered by Medica Prime Solution Standard w/Rx (Cost) with no deductibles and no coinsurance, requiring a $15.00 to $60.00 copay for annual eye exams. Covered eyewear also has no deductible or coinsurance, requiring a $45.00 copay for contact lenses and offering a $100.00 annual maximum benefit.
Dental Services See details
Dental services are covered under the Medica Prime Solution Standard w/Rx (Cost) plan, with Medicare-covered dental services requiring a $15 to $60 copay and no coinsurance. Other preventive and comprehensive dental benefits, such as cleanings, exams, and implants, are covered with no copay and no coinsurance up to an annual maximum of $400.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Medica Prime Solution Standard w/Rx (Cost) with no copay, though associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance. Covered Medicare Part B insulin has a $35 copay with no coinsurance, and Part D home infusion drugs are included as a bundled benefit.
Dialysis Services See details
Medica Prime Solution Standard w/Rx (Cost) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Prime Solution Standard w/Rx (Cost) covers durable medical equipment and medical supplies with no copay and 0% to 30% coinsurance. Prosthetic devices are covered with no copay and 30% coinsurance, while diabetic supplies have a $25 copay with no coinsurance, and diabetic therapeutic shoes or inserts have 30% coinsurance with no copay.
Diagnostic and Radiological Services See details
Medica Prime Solution Standard w/Rx (Cost) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Covered services require copays, including $15.00 to $60.00 for diagnostic procedures, $60.00 for outpatient X-rays, a minimum of $80.00 for therapeutic radiology, and a minimum of $200.00 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Standard w/Rx (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Medica Prime Solution Standard w/Rx (Cost) plan with no coinsurance, though only some services are covered. Specifically, standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Medica Prime Solution Standard w/Rx (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring 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 days are not covered.
Other Services See details
Medica Prime Solution Standard w/Rx (Cost) partially covers other services, including hospice consultation and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered, and the OTC benefit is limited to a maximum of $25 every six months.
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