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Medica Advantage Solution H8889-005 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H8889-005 (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 H8889-005 (PPO) in 2026, please refer to our full plan details page.
Medica Advantage Solution H8889-005 (PPO) is a PPO 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 H8889-005 (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 H8889-005 (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 H8889-005 (PPO), 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 H8889-005 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a standard pharmacy or preferred mail order, though standard mail order copays range from $10 to $30. Tier 2 generic drugs require a copay of $9 to $27 at standard pharmacies and preferred mail order, or $20 to $60 for standard mail order. For higher-tier medications, cost-sharing transitions from copays to coinsurance. Tier 3 preferred brand drugs require a 17% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance across standard pharmacies and mail order channels. Tier 5 specialty drugs are covered at a 25% coinsurance for a one-month supply.
Additional Benefits
The Medica Advantage Solution H8889-005 (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care physician visits, while specialist visits require a $65 copay. For inpatient hospital stays, members pay a daily copay of $550 for days one through five of acute stays, followed by no copay for the remaining days. Emergency services are covered with a $130 copay, which is waived if the member is admitted to the hospital within one day. Routine healthcare needs are highly accessible, with no copay or coinsurance for annual physicals, routine eye exams, and general dental services up to a $500 annual limit. Eyewear is also covered with no copay up to a $150 annual maximum, and routine hearing exams feature no copay. Additionally, the plan provides a $40 allowance every six months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Medica Advantage Solution H8889-005 (PPO) partially covers inpatient hospital care with no coinsurance, requiring a daily copay of $550 for days 1-5 of acute stays and $468 for days 1-5 of psychiatric stays, followed by no copay for remaining days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Medica Advantage Solution H8889-005 (PPO) with no coinsurance, including ambulatory surgical center and blood services with no copays. Medicare-covered outpatient hospital services require a copay of $0 to $495, while observation services cost $550 per day and outpatient substance abuse sessions have a copay of $45 to $55.
Partial Hospitalization See details
Medica Advantage Solution H8889-005 (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Solution H8889-005 (PPO) partially covers ambulance and transportation services, offering ground ambulance services for a $375 copay and air ambulance services for a $475 copay with no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Medica Advantage Solution H8889-005 (PPO) with a $130 copay—waived if admitted to the hospital within one day—and no coinsurance, while urgently needed services require a $25 to $50 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
Primary care benefits under the Medica Advantage Solution H8889-005 (PPO) plan feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $65 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic services, while podiatry services are not covered. Physical, occupational, and speech therapies, psychiatric services, and telehealth are also covered with copays ranging from $0 to $65 and no coinsurance.
Preventive Services See details
Preventive services are covered by Medica Advantage Solution H8889-005 (PPO) with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, fitness benefits, and remote access technologies. Other additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Medica Advantage Solution H8889-005 (PPO) covers hearing services, offering annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays from $549 to $1,299, but inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Solution H8889-005 (PPO) covers annual routine eye exams with no copay and other eye exams with a copay of $0 to $65, both with no coinsurance or deductibles. Eyewear, including contacts and eyeglasses, is also covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $150 per year.
Dental Services See details
Medica Advantage Solution H8889-005 (PPO) provides partially covered dental services, featuring a $0 to $65 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $500 annual maximum. Orthodontics is not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Medica Advantage Solution H8889-005 (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Medica Advantage Solution H8889-005 (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Solution H8889-005 (PPO) covers medical equipment with no copays, though coinsurance and prior authorization may apply. Durable medical equipment and diabetic supplies range from no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medica Advantage Solution H8889-005 (PPO) with no coinsurance, though prior authorization is required. Diagnostic procedures range from no copay to a $250 copay, outpatient X-rays require a $50 copay, and therapeutic radiological services have a minimum copay of $85, while lab services are not covered.
Home Health Services See details
Home health services are covered under the Medica Advantage Solution H8889-005 (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Medica Advantage Solution H8889-005 (PPO) with no coinsurance. Covered services require a copay, which is $40 for standard cardiac rehabilitation, $35 for intensive cardiac and pulmonary rehabilitation, and $25 for supervised exercise therapy (SET) for symptomatic peripheral artery disease.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Medica Advantage Solution H8889-005 (PPO) with no coinsurance, featuring no copay for days 1-20 and 53-100, and a $218 daily copay for days 21-52. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medica Advantage Solution H8889-005 (PPO) partially covers other services, offering a $40 allowance every six months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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