A non-government entity
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 2025, 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 2025.
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 $203.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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:
Sign up for Medica Advantage Solution H8889-003 (PPO)
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 Advantage Solution H8889-003 (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. Once your total drug costs reach $2000, you enter the next coverage phase. In the initial coverage phase, you will pay a $10 or $20 copay for preferred generic drugs, depending on the pharmacy. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay coinsurance costs of 25%, 50%, and 33% respectively. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Medica Advantage Solution H8889-003 (PPO) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a $100 copay, while outpatient services have copays ranging from $0 to $150. Emergency services have a $90 copay, and ambulance services have copays of $150 for ground and $250 for air. The plan also covers primary care and specialist visits with a $10 copay, along with vision and dental services. Vision services include routine eye exams with no copay and up to $300 per year for eyewear. Dental services have a $1,000 annual maximum and copays between $0 and $10. Additional benefits include hearing, home health, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $100 copay per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and 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 $150, observation services with a $100 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medica Advantage Solution H8889-003 (PPO) plan. This benefit has a $10 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground ambulance services with a $150 copay and air ambulance services with a $250 copay, but transportation services to any health-related location are not covered. There is no coinsurance for these services.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered. For emergency services, there is a $90 copay, and for worldwide emergency coverage and worldwide emergency transportation, there is a 20% coinsurance.
Primary Care See details
The Medica Advantage Solution H8889-003 (PPO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, and physician specialist services with a $10 copay. Mental health specialty services, including individual and group sessions, have a $10 copay, and physical therapy and speech-language pathology services have a $10 copay. Additional telehealth benefits have a copay between $0 and $10, and Opioid Treatment Program Services have a $10 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Medica Advantage Solution H8889-003 (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services like fitness benefits, remote access technologies, and kidney disease education services. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, 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, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, 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 with a copay between $549 and $1299, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with a copay of $0-$10. Eyewear is covered up to a combined maximum of $300 per year for both in-network and out-of-network services, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Medcia Advantage Solution H8889-003 (PPO) plan offers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery, with a maximum benefit of $1,000 per year and copays ranging from $0 to $10. Orthodontics is not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, and 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 under the Medica Advantage Solution H8889-003 (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay between $0 and $50, and diagnostic radiological services with a copay up to $50; however, lab services, therapeutic radiological services, and outpatient x-ray services are not covered. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Medica Advantage Solution H8889-003 (PPO) plan 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 H8889-003 (PPO) plan. Though the plan covers Cardiac Rehabilitation Services, the specific services of 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 by the Medica Advantage Solution H8889-003 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-40 there is a $150 copay, and for days 41-100, there is no copay.
Other Services See details
The "Medica Advantage Solution H8889-003 (PPO)" plan covers Over-the-Counter (OTC) Items with a maximum benefit of $75 every six months, however, other services like Acupuncture, Meal Benefits, and various other 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