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Medica Advantage Solution H8889-001 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H8889-001 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica Advantage Solution H8889-001 (PPO) in 2026, please refer to our full plan details page.
Medica Advantage Solution H8889-001 (PPO) is a PPO plan offered by Medica Holding Company available for enrollment in 2025 to people living in Minneapolis/St. Paul Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medica Advantage Solution H8889-001 (PPO) 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 H8889-001 (PPO).
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 H8889-001 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $110.00. 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 $325.00 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 $4200.00 (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 $4200.00 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 H8889-001 (PPO) plan features an annual prescription drug deductible of $325. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order copays start at $10. Tier 2 generic drugs are available for a low $9 copay for a one-month supply at standard pharmacies and preferred mail order, or a $20 copay via standard mail order. For higher-tier medications, you will pay coinsurance instead of a flat copay, starting with a 19% coinsurance for Tier 3 preferred brand drugs. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply across all available pharmacy and mail-order options.
Additional Benefits
The Medica Advantage Solution H8889-001 (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits, preventive services, and routine hearing exams. Dental services are covered with no copay up to a $700 annual limit, while vision benefits include a $200 allowance for eyewear with no copay. Specialist visits require a $50 copay, and prescription hearing aids are available with copays ranging from $549 to $1,299. For hospital and emergency care, the plan features a $350 copay per admission for inpatient stays and a $150 copay for emergency room visits, with no coinsurance required. Urgent care visits carry a copay of up to $45, while home health services are fully covered with no copay. Skilled nursing facility stays feature no copay for the first 20 days, and medical equipment is available with no copay and up to 20% coinsurance.
Inpatient Hospital See details
Medica Advantage Solution H8889-001 (PPO) covers inpatient acute and psychiatric hospital stays with a $350 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered because unlimited additional acute care days are included with no copay, but additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medica Advantage Solution H8889-001 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a copay of $30 for group or $40 for individual sessions.
Partial Hospitalization See details
Medica Advantage Solution H8889-001 (PPO) covers partial hospitalization services with a $100.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Solution H8889-001 (PPO) covers ground ambulance services with a $355 copay and air ambulance services with a $475 copay, with no coinsurance required for either service. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Medica Advantage Solution H8889-001 (PPO) covers emergency services with a $150 copay (waived if admitted within one day) and no coinsurance, and urgently needed services with a $0 to $45 copay and no coinsurance. Worldwide emergency services are partially covered with no copay and a 20% coinsurance for emergency care and transportation, but worldwide urgent coverage is not covered.
Primary Care See details
Medica Advantage Solution H8889-001 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, or speech therapies require a $50 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have copays ranging from $30 to $40 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by Medica Advantage Solution H8889-001 (PPO) with no copay and no coinsurance, including annual physicals, kidney disease education, fitness benefits, and remote access technologies. This benefit is partially covered, as exclusions apply to health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 safety devices, and counseling.
Hearing Services See details
Medica Advantage Solution H8889-001 (PPO) 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 copay ranging from $549.00 to $1,299.00, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter (OTC) hearing aids are also covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Solution H8889-001 (PPO) covers vision services with no deductibles, including annual eye exams with a $0 to $50 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a combined annual limit of $200 for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Medica Advantage Solution H8889-001 (PPO), as orthodontics is not covered. Covered preventive and comprehensive dental benefits feature no copay and no coinsurance up to a $700 annual maximum for both in-network and out-of-network services, while Medicare-covered dental services require no copay to a $50 copay and no coinsurance.
Home Infusion bundled Services See details
Medica Advantage Solution H8889-001 (PPO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Medica Advantage Solution H8889-001 (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Solution H8889-001 (PPO) covers medical equipment with no copays, though coinsurance applies to various items. Durable medical equipment and diabetic supplies have coinsurance ranging from no coinsurance to 20%, while medical supplies, prosthetic devices, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Medica Advantage Solution H8889-001 (PPO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Covered benefits include diagnostic procedures with copays ranging from no copay to $90, outpatient X-rays for a $25 copay, and therapeutic radiology with copays starting at $85, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by Medica Advantage Solution H8889-001 (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Medica Advantage Solution H8889-001 (PPO) cover some services with no coinsurance, though Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered. Applicable services carry a copay of $30 to $35 and no coinsurance.
Skilled Nursing Facility (SNF) See details
Medica Advantage Solution H8889-001 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and days 42 through 100, while a $218 daily copay applies for days 21 through 41, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica Advantage Solution H8889-001 (PPO) partially covers Other Services, which includes an over-the-counter (OTC) benefit of up to $40 every six months with no copay and no coinsurance. Other supplemental services, such as acupuncture, meal benefits, nicotine replacement therapy, and naloxone, are not covered.
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