A non-government entity
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 2025, 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 2025.
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 $43.40. 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 $590.00 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 $9350.00 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 DUAL Solution (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Medica DUAL Solution (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, your cost sharing for prescriptions will vary depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced monthly premium.
Additional Benefits
The Medica DUAL Solution (HMO D-SNP) plan offers coverage for a variety of services, including inpatient and outpatient care, with a 20% coinsurance for many services. Emergency services and ambulance services are covered, with a 20% coinsurance for both, and a $0 copay for emergency services. Preventive, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic, and home health services are also covered, with varying costs and limitations. The plan has additional benefits such as over-the-counter items and nicotine replacement therapy, but some services like cardiac rehabilitation and additional home care hours are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay that varies; however, additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, and additional days for inpatient hospital psychiatric are not covered. Inpatient Hospital Psychiatric benefits are also covered, with a copay that varies, but additional days for inpatient hospital psychiatric and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, which have a minimum of 20% coinsurance and a maximum of 20% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medica DUAL Solution (HMO D-SNP) plan, with a 20% coinsurance and prior authorization required.
Ambulance and Transportation Services See details
The Medica DUAL Solution (HMO D-SNP) plan covers ambulance services with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Medica DUAL Solution (HMO D-SNP) plan with a 20% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Medica DUAL Solution (HMO D-SNP) plan covers Primary Care services, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, with a 20% coinsurance for most services. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. Medicare-covered Zero Dollar Preventive Services are covered with no copay and no coinsurance. Additional preventive services, including health education, are covered and require prior authorization. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have a 20% coinsurance. Other services, such as Re-admission Prevention, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, are covered.
Hearing Services See details
Hearing services are partially covered by the Medica DUAL Solution (HMO D-SNP) plan, with hearing exams covered at a coinsurance of at most 20% and no deductible. However, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and eyewear. Eyewear includes upgrades, but does not cover contact lenses, eyeglasses (lenses and frames), eyeglass lenses, or eyeglass frames.
Dental Services See details
Dental Services are covered under the Medica DUAL Solution (HMO D-SNP) plan, with a 20% coinsurance for Medicare Dental Services. Oral exams are covered once per year, and dental x-rays are covered once every five years. Prophylaxis (cleaning), fluoride treatment, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medica DUAL Solution (HMO D-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medica DUAL Solution (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Medica DUAL Solution (HMO D-SNP) plan. Durable Medical Equipment has a 20% coinsurance, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Medica DUAL Solution (HMO D-SNP) plan. Diagnostic procedures and lab services have no copay, with a coinsurance of at most 20%, while diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services also have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Medica DUAL Solution (HMO D-SNP) plan with no copay and no coinsurance, though authorization is required. However, 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 DUAL Solution (HMO D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not offer Skilled Nursing Facility Services as a supplemental benefit under Part C. Prior authorization is required, and the copay information is available separately. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Medica DUAL Solution (HMO D-SNP)" plan's other services include coverage for Over-the-Counter (OTC) Items, including Nicotine Replacement Therapy (NRT) and other services, while acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved