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Medica Advantage Solution H6154-001 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H6154-001 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica Advantage Solution H6154-001 (HMO-POS) in 2026, please refer to our full plan details page.
Medica Advantage Solution H6154-001 (HMO-POS) is a HMO-POS plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select Counties in MN. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medica Advantage Solution H6154-001 (HMO-POS) 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 Advantage Solution H6154-001 (HMO-POS).
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 Advantage Solution H6154-001 (HMO-POS), 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 $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 combined Maximum Out-Of-Pocket cost of $6750.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6750.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Advantage Solution H6154-001 (HMO-POS) prescription drug plan has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay when filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost a $7 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order copays range from $20 to $60 depending on the supply duration. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require 16% coinsurance, while Tier 4 non-preferred drugs require 50% coinsurance across all fulfillment options. Tier 5 specialty drugs are covered at 25% coinsurance for a one-month supply at standard pharmacies and mail-order services.
Additional Benefits
The Medica Advantage Solution H6154-001 (HMO-POS) plan offers comprehensive medical coverage with no copays for primary care doctor visits, annual physicals, and home health services. For specialist visits, members pay a $65 copay, while inpatient hospital stays require a $550 copay for the first five days and no copay for days six through 90. Emergency services carry a $130 copay, which is waived if admitted within one day, with no coinsurance required. This plan also features essential vision, dental, and hearing benefits to help reduce your out-of-pocket expenses. Dental and vision care feature no copays or coinsurance up to specified annual maximums, and routine hearing exams are covered with no copay. Additionally, members can take advantage of a $45 over-the-counter reimbursement benefit every six months with no copay or coinsurance.
Inpatient Hospital See details
Medica Advantage Solution H6154-001 (HMO-POS) covers inpatient acute hospital stays with a $550 copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Inpatient psychiatric stays are also covered with a $468 copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance, though upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medica Advantage Solution H6154-001 (HMO-POS) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services, and copays ranging from $0 to $525 for outpatient hospital services. Observation services require a $550 daily copay, while outpatient substance abuse individual and group sessions carry copays of $60 and $55 respectively, with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Medica Advantage Solution H6154-001 (HMO-POS) plan with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Solution H6154-001 (HMO-POS) covers ground ambulance services with a $375 copay and air ambulance services with a $475 copay, both with no coinsurance. Although some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Medica Advantage Solution H6154-001 (HMO-POS) with a $130 copay, which is waived if admitted to the hospital within one day, and no coinsurance, while urgently needed services require a $0 to $40 copay and no coinsurance. Worldwide emergency and transportation services are partially covered with no copay and a 20% coinsurance, though worldwide urgent care is not covered.
Primary Care See details
Primary care services are covered under the Medica Advantage Solution H6154-001 (HMO-POS) plan with no copay and no coinsurance for primary care doctor visits, and a $65 copay and no coinsurance for specialists. Other benefits such as occupational therapy, physical therapy, and mental health services are covered with copays ranging from $50 to $65 and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Medica Advantage Solution H6154-001 (HMO-POS) preventive services are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and other select screenings. This benefit is partially covered, as sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and nutritional or dietary benefits are not covered.
Hearing Services See details
Medica Advantage Solution H6154-001 (HMO-POS) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $549.00 to $1,299.00 copay—excluding inner ear, outer ear, and over the ear models—while OTC hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Vision services are covered by Medica Advantage Solution H6154-001 (HMO-POS), featuring routine and additional eye exams with a $0 to $65 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $100 annual maximum, with no deductibles applying to any vision services.
Dental Services See details
Dental services are partially covered by Medica Advantage Solution H6154-001 (HMO-POS), with orthodontics not being covered. Preventive and comprehensive dental services feature no copay and no coinsurance up to a $300 annual maximum, while Medicare-covered dental services require a $0 to $65 copay and no coinsurance.
Home Infusion bundled Services See details
Medica Advantage Solution H6154-001 (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Medica Advantage Solution H6154-001 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Medica Advantage Solution H6154-001 (HMO-POS) plan with no copays, and coinsurance ranging from no coinsurance up to 20%. This coverage includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with certain items requiring prior authorization or subject to manufacturer limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Medica Advantage Solution H6154-001 (HMO-POS) with no coinsurance, though prior authorization is required and lab services are not covered. Covered diagnostic procedures range from no copay up to $250, while radiological services require a $50 copay for outpatient X-rays and a minimum $85 copay for therapeutic services.
Home Health Services See details
Medica Advantage Solution H6154-001 (HMO-POS) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medica Advantage Solution H6154-001 (HMO-POS) with no coinsurance, though some services are not covered in practice. Specifically, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Medica Advantage Solution H6154-001 (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 53 through 100, a $218 daily copay for days 21 through 52, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica Advantage Solution H6154-001 (HMO-POS) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to $45 every six months via reimbursement. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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