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Medica DUAL Solution (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica DUAL Solution (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica DUAL Solution (HMO D-SNP) in 2026, please refer to our full plan details page.
Medica DUAL Solution (HMO D-SNP) is a HMO D-SNP plan offered by Medica Holding Company available for enrollment in 2025 to people living in Specific Minnesota counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Medica DUAL Solution (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Medica DUAL Solution (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica DUAL Solution (HMO D-SNP).
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 DUAL Solution (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.50. 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 $615.00 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 $9200.00 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:
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Drug Coverage
The Medica DUAL Solution (HMO D-SNP) features an annual drug deductible of $615. For drugs in Tiers 1 through 5, including generic, brand-name, and specialty medications, you will pay a 25% coinsurance for 1-month and 3-month supplies. This 25% coinsurance applies to standard pharmacies as well as standard and preferred mail-order services. Tier 6 select care drugs feature no copay for 1-month and 3-month supplies when filled at standard pharmacies or through preferred mail order. If you utilize standard mail order for Tier 6 medications, you will pay a $1.00 copay for a 1-month or 3-month supply.
Additional Benefits
The Medica DUAL Solution (HMO D-SNP) plan offers comprehensive medical coverage, with many essential services requiring no copay and a standard twenty percent coinsurance. This cost structure applies to outpatient hospital visits, primary and specialist care, emergency services, dialysis, and durable medical equipment. Additionally, members can access home health services, skilled nursing facility care, diagnostic hearing exams, and over-the-counter items with no copay and no coinsurance. While the plan covers Medicare-defined inpatient hospital stays and diagnostic testing, prior authorization is required for several key services. It is important to note that routine dental care, routine eye exams, hearing aids, and non-emergency transportation services are not covered under this plan. For prescription drugs, Medicare Part B insulin is available with a thirty-five dollar copay and no coinsurance.
Inpatient Hospital See details
Medica DUAL Solution (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance and Medicare-defined copayments, and prior authorization is required for acute stays. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Medica DUAL Solution (HMO D-SNP) are covered with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization services are covered under Medica DUAL Solution (HMO D-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Medica DUAL Solution (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. While transportation services are technically covered, transport to plan-approved or any health-related locations is not covered under this plan.
Emergency Services See details
Medica DUAL Solution (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay, up to a maximum of $115 per visit, and urgently needed services with a 20% coinsurance and no copay, up to $40 per visit. Worldwide emergency services, including emergency care, urgent care, and emergency transportation, are not covered by this plan.
Primary Care See details
Primary care benefits are partially covered by Medica DUAL Solution (HMO D-SNP), featuring no copay and 20% coinsurance for covered services such as primary care, specialist, mental health, therapy, and telehealth visits. Routine chiropractic care and other chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Medica DUAL Solution (HMO D-SNP), with Medicare-covered zero-dollar and select additional services costing no copay and no coinsurance, while kidney education and other screenings have no copay and a 20% coinsurance. Annual physical exams and various supplemental services—including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling—are not covered.
Hearing Services See details
Medica DUAL Solution (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, fitting and evaluation services, and both prescription and OTC hearing aids are not covered under this plan.
Vision Services See details
Vision services are covered by Medica DUAL Solution (HMO D-SNP), but eye exams are not covered, and eyewear is only partially covered. Covered eyewear upgrades have no copay and a 20% coinsurance with no deductible, while contact lenses, eyeglasses, lenses, and frames are not covered.
Dental Services See details
Dental services are partially covered by Medica DUAL Solution (HMO D-SNP), which provides Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery, are not covered.
Home Infusion bundled Services See details
Medica DUAL Solution (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Medica DUAL Solution (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medica DUAL Solution (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Medica DUAL Solution (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with prior authorization required. Members will pay no copay, but a 20% coinsurance applies to all of these covered services.
Home Health Services See details
Home Health Services are covered by Medica DUAL Solution (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice by Medica DUAL Solution (HMO D-SNP) because standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered. These rehabilitation services require a 20% coinsurance and have no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Medica DUAL Solution (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While a three-day prior inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica DUAL Solution (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance, which includes catalogue-ordered nicotine replacement therapy. However, acupuncture, meal benefits, and naloxone coverage are not covered under this plan.
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