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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 2026 to people living in Select Counties in WI. 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 medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for preventive care, annual physicals, and home health services. For standard medical visits, members will pay a low $10 copay for primary care and a $55 copay for specialists, with no coinsurance required for either service. If hospitalization is needed, inpatient stays require a $425 copay for the first five days and no copay for days six through 90. This plan also includes key supplemental benefits, such as routine dental care with no copay or coinsurance up to a $200 annual limit, and low-copay routine vision and hearing exams. Members can access over-the-counter items with no copay up to a $30 allowance every six months, though some specialized services like dialysis and durable medical equipment will require coinsurance up to 20% and 25% respectively. Emergency services are also covered with a $130 copay that is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Medica Prime Solution Core (Cost) covers inpatient hospital acute and psychiatric stays with no coinsurance, requiring a $425 copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days and up to 175 additional psychiatric days are covered, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under Medica Prime Solution Core (Cost) with no coinsurance, featuring a $0 to $400 copay for hospital services and a $400 copay per observation stay. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Medica Prime Solution Core (Cost) plan with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Prime Solution Core (Cost) covers ambulance services with no coinsurance, requiring a $300 copay for ground ambulance and a $500 copay for air ambulance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered under Medica Prime Solution Core (Cost) with a $130 copay—waived if admitted to the hospital within 24 hours—and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance, though worldwide urgent care and emergency transportation are not covered.
Primary Care See details
Medica Prime Solution Core (Cost) covers primary care visits for a $10 copay and specialist visits for a $55 copay, both with no coinsurance. Other services like physical therapy ($55 copay), occupational therapy ($45 copay), mental health ($45 copay), psychiatric ($55 copay), and opioid treatment ($45 copay) require no coinsurance, while telehealth and podiatry are not covered. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Medica Prime Solution Core (Cost) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and fitness benefits. However, specific sub-services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services under Medica Prime Solution Core (Cost) include routine hearing exams for a $10 copay and no coinsurance, and OTC hearing aids for a $499.50 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $549.00 to $1,299.00 and no coinsurance, 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 Core (Cost), including annual routine and refraction eye exams with a $10.00 to $55.00 copay, no coinsurance, and no deductible. Eyewear is also covered with no coinsurance or deductible, featuring a $55.00 copay for contact lenses and a combined maximum benefit of $100.00 per year.
Dental Services See details
Medica Prime Solution Core (Cost) covers dental services, offering preventive and comprehensive care—including exams, cleanings, and restorative services—with no copay and no coinsurance up to a $200 annual maximum. Medicare-covered dental services are also available with a $10.00 to $55.00 copay and no coinsurance.
Home Infusion bundled Services See details
Medica Prime Solution Core (Cost) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance. Medicare Part B insulin is also covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medica Prime Solution Core (Cost) with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Prime Solution Core (Cost) partially covers medical equipment with no copays, though coinsurance ranges from no coinsurance up to 25% for durable medical equipment, medical supplies, prosthetics, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Medica Prime Solution Core (Cost) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures have a $10.00 to $55.00 copay, while radiological services require a $55.00 copay for X-rays, a minimum $85.00 copay for therapeutic services, and a minimum $200.00 copay for diagnostic services.
Home Health Services See details
Home Health Services are covered by Medica Prime Solution Core (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medica Prime Solution Core (Cost) with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered and require copayments ranging from $25 to $50.
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 $218 daily copay for days 21 through 100. Admission requires a prior 3-day inpatient hospital stay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medica Prime Solution Core (Cost) partially covers other services, offering hospice consultations and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $30 of coverage every six months, though acupuncture, meal benefits, nicotine replacement therapy, and naloxone 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.
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