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Medica Advantage Solution H8889-003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H8889-003 (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 H8889-003 (PPO) in 2026, please refer to our full plan details page.
Medica Advantage Solution H8889-003 (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 H8889-003 (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 H8889-003 (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 H8889-003 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $210.00. 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 $125.00 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 $3800.00 (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 $3800.00 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 H8889-003 (PPO) prescription drug plan features an annual drug deductible of $125. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies or through preferred mail order, though standard mail order copays range from $10 to $30. Tier 2 generic medications carry a $10 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $20. Higher tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 19% coinsurance, and Tier 4 non-preferred drugs carry 50% coinsurance across standard pharmacy and mail order channels. Tier 5 specialty drugs are covered with 31% coinsurance for a one-month supply.
Additional Benefits
The Medica Advantage Solution H8889-003 (PPO) plan offers robust coverage for essential medical services with highly predictable out-of-pocket costs. You will pay no copay and no coinsurance for primary care doctor visits, while specialist consultations require a $20 copay. For more intensive care, inpatient hospital stays carry a $225 copay per admission with no coinsurance, and emergency room visits feature a $150 copay that is waived if you are admitted within one day. This Medicare Advantage plan also provides valuable dental, vision, and hearing benefits to help you maintain your overall well-being. Routine dental care is covered up to an $800 annual limit with no copay for most preventive services, while routine eye exams carry no copay to a $20 copay. Additionally, you can take advantage of no-copay annual hearing exams and up to a $50 reimbursement every six months for over-the-counter items.
Inpatient Hospital See details
Medica Advantage Solution H8889-003 (PPO) covers inpatient acute and psychiatric hospital stays with a $225 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Medica Advantage Solution H8889-003 (PPO) are covered with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $225 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services have no coinsurance and a copay of $10 for group sessions or $20 for individual sessions.
Partial Hospitalization See details
Partial hospitalization services are covered by Medica Advantage Solution H8889-003 (PPO) with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Solution H8889-003 (PPO) covers ground ambulance services with a $195 copay and air ambulance services with a $295 copay, featuring no coinsurance for either service. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services covered by the Medica Advantage Solution H8889-003 (PPO) plan require a $150 copay—which is waived if admitted to the hospital within one day—and no coinsurance, while urgently needed services have a copay of $0 to $30 and no coinsurance. Worldwide emergency services are partially covered with no copay and a 20% coinsurance for emergency care and transportation, though worldwide urgent coverage is not covered.
Primary Care See details
Medica Advantage Solution H8889-003 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits have a $20 copay and no coinsurance. Mental health, psychiatric, and telehealth services carry copays ranging from $0 to $30 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Medica Advantage Solution H8889-003 (PPO) provides coverage for preventive services, including annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. While fitness benefits and remote access technologies are included, these additional preventive services are only partially covered, excluding options like health education, in-home safety assessments, medical nutrition therapy, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Medica Advantage Solution H8889-003 (PPO), offering one routine exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $549.00 and $1,299.00, though inner ear, outer ear, and over-the-ear models are not covered. OTC hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Solution H8889-003 (PPO) covers annual routine eye exams and additional refractions with no coinsurance and a copay ranging from no copay to $20. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay, no coinsurance, and a $200 combined annual limit.
Dental Services See details
Dental services are partially covered by Medica Advantage Solution H8889-003 (PPO) with an annual maximum benefit of $800 for both in-network and out-of-network care. Most preventive and comprehensive services are available with no copay and no coinsurance, while Medicare-covered dental services have a copay of $0 to $20 with no coinsurance, and orthodontics are not covered.
Home Infusion bundled Services See details
Medica Advantage Solution H8889-003 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Medica Advantage Solution H8889-003 (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Solution H8889-003 (PPO) covers medical equipment with no copay, with coinsurance ranging from no coinsurance up to 20% depending on the item. Durable medical equipment and diabetic supplies require between no coinsurance and 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes carry a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Medica Advantage Solution H8889-003 (PPO) plan with no coinsurance, though prior authorization is required. Diagnostic procedures and tests carry a copay of no copay up to $75, diagnostic radiological services have no copay, and therapeutic radiological services require a minimum copay of $50. Outpatient lab services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Medica Advantage Solution H8889-003 (PPO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medica Advantage Solution H8889-003 (PPO) with no coinsurance, though some services are not covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Medica Advantage Solution H8889-003 (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 40 to 100, a $218 daily copay for days 21 to 39, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica Advantage Solution H8889-003 (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum reimbursement of $50 every six months. Sub-services such as acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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