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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 2025, 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 2025.
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 $89.00. 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 $295.00 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 $2800.00 (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 $2800.00 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 has a $295.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay an $11.00 copay at a preferred pharmacy, and $20.00 at a standard pharmacy. For standard generic drugs, you pay 22% coinsurance, and for preferred brand drugs, you pay 50% coinsurance. Non-preferred drugs have 29% coinsurance.
Additional Benefits
The Medica Advantage Solution H8889-001 (PPO) plan offers coverage for a variety of services with varying costs. You can expect a $150 copay for inpatient hospital stays, and copays for outpatient services range from $0 to $275. The plan also covers emergency services with a $125 copay, primary care with copays between $0 and $45, and offers no copay for preventive and home health services. Additional benefits include hearing and vision coverage, including eye exams, eyewear, and hearing exams with no copay. Dental services are covered with a maximum benefit of $1000 per year. There is coverage for ambulance services with a $295 copay for ground, and $375 for air, as well as $0 copay for days 1-20 and days 35-100 of Skilled Nursing Facility (SNF) services, with a $214 copay for days 21-34.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $150 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a $150 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services. Outpatient substance abuse services have a $35 copay for individual sessions and a $25 copay for group sessions, and outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $95.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $295 copay, and air ambulance services have a $375 copay, with no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medica Advantage Solution H8889-001 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $45; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Emergency Transportation have a 20% coinsurance, while Worldwide Urgent Coverage is not covered.
Primary Care See details
The Medica Advantage Solution H8889-001 (PPO) plan covers primary care physician services, chiropractic services with a $20 copay for routine care, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $25-$35 copay, other health care professional services with a $0-$35 copay, psychiatric services with a $25-$35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $0-$45 copay, and opioid treatment program services with a $35 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Some additional preventive services, such as health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with a copay between $549 and $1299. OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$35 and eyewear with a combined maximum benefit of $300 per year. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Medico Advantage Solution H8889-001 (PPO) plan covers dental services, including oral exams and dental X-rays, with a maximum benefit of $1000 per year, and a copay ranging from $0 to $35. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medica Advantage Solution H8889-001 (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a minimum copay of $0 and a maximum copay of $85, Diagnostic Radiological Services with a maximum copay of $85, Therapeutic Radiological Services with a copay of $80, and Outpatient X-Ray Services with a copay of $20. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. 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 Advantage Solution H8889-001 (PPO) plan. While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Advantage Solution H8889-001 (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 35-100, but there is a $214 copay for days 21-34. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF), and Non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The "Medica Advantage Solution H8889-001 (PPO)" plan covers Over-the-Counter (OTC) items, with a maximum benefit of $75 every six months. 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.
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