A non-government entity
Medica Advantage Solution H8889-008 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H8889-008 (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 H8889-008 (PPO) in 2026, please refer to our full plan details page.
Medica Advantage Solution H8889-008 (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 H8889-008 (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 H8889-008 (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 H8889-008 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.00. 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 $6200.00 (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 $6200.00 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 H8889-008 (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 H8889-008 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs up to $30 for a 3-month supply. Tier 2 generic medications require a low copay starting at $9 for a 1-month supply at standard pharmacies and preferred mail order, or up to $60 for a 3-month supply via standard mail order. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brand drugs requiring a 17% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs carry a 50% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. This structure helps you estimate your out-of-pocket prescription costs based on the specific drug tier and your preferred fulfillment method.
Additional Benefits
The Medica Advantage Solution H8889-008 (PPO) plan offers robust core medical coverage, including doctor visits with no copay for primary care and a $55 copay for specialists. Preventive services, home health care, and routine hearing exams are also fully covered with no copay or coinsurance. For hospital care, inpatient stays require a $495 daily copay for the first five days and no copay for days 6 through 90, while outpatient services feature copays ranging from no copay up to $475. Supplemental benefits include dental care with no copay up to a $300 annual limit and vision exams with copays up to $55, alongside a $75 annual eyewear allowance. Members also receive an over-the-counter item allowance of $35 every six months with no copay. Other essential services, such as emergency room visits and ground ambulance transport, are covered with copays of $130 and $395, respectively, with no coinsurance.
Inpatient Hospital See details
Medica Advantage Solution H8889-008 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $495 daily copay for days 1 to 5 and no copay for days 6 to 90, while psychiatric stays require a $465 daily copay for days 1 to 5 and no copay for days 6 to 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Medica Advantage Solution H8889-008 (PPO) with no coinsurance, featuring a $0 to $475 copay for outpatient hospital services, a $495 daily copay for observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services are also covered with no coinsurance, carrying a $45 copay for individual sessions and a $35 copay for group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by Medica Advantage Solution H8889-008 (PPO) with a $120.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Medica Advantage Solution H8889-008 (PPO), which offers ground ambulance services for a $395 copay and air ambulance services for a $475 copay with no coinsurance for either. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Medica Advantage Solution H8889-008 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $30 to $50 copay with no coinsurance, while worldwide emergency and transportation services are partially covered with no copay and a 20% coinsurance, though worldwide urgent care is not covered.
Primary Care See details
Medica Advantage Solution H8889-008 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Additional covered services like therapy, mental health, and telehealth sessions have copays ranging from $0 to $55 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Medica Advantage Solution H8889-008 (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. While fitness benefits and remote access technologies are covered, several additional preventive services—such as health education, personal emergency response systems (PERS), and nutritional benefits—are not covered.
Hearing Services See details
Medica Advantage Solution H8889-008 (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 $549.00 to $1,299.00 copay—excluding inner ear, outer ear, and over the ear models—while over-the-counter (OTC) hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Solution H8889-008 (PPO) covers annual routine and diagnostic eye exams with a $0 to $55 copay and no coinsurance. Eyewear, including lenses, frames, and contact lenses, is covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $75 per year.
Dental Services See details
Dental Services are partially covered by Medica Advantage Solution H8889-008 (PPO), featuring no copay and no coinsurance for most preventive and comprehensive dental care up to a $300 annual limit for both in- and out-of-network services. Medicare-covered dental services have a copay ranging from $0 to $55 with no coinsurance, but orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medica Advantage Solution H8889-008 (PPO) 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 have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Medica Advantage Solution H8889-008 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Solution H8889-008 (PPO) covers medical equipment with no copay, though prior authorization and coinsurance may apply. Durable medical equipment and diabetic supplies range from no coinsurance up to 20% coinsurance, while prosthetics, medical supplies, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Medica Advantage Solution H8889-008 (PPO) partially covers diagnostic and radiological services with no coinsurance and required prior authorization, though lab services are not covered. Covered diagnostic procedures range from no copay up to $140, while radiological services require no copay for diagnostic radiology, a $40 copay for outpatient X-rays, and a minimum $85 copay for therapeutic radiology.
Home Health Services See details
Medica Advantage Solution H8889-008 (PPO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medica Advantage Solution H8889-008 (PPO) covers Cardiac Rehabilitation Services with no coinsurance. Members are responsible for a $35 copay for cardiac, intensive cardiac, and pulmonary rehabilitation services, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Medica Advantage Solution H8889-008 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 51 to 100, while days 21 to 50 require a daily copay of $218.
Other Services See details
Other Services are partially covered by Medica Advantage Solution H8889-008 (PPO), which features over-the-counter (OTC) items with no copay and no coinsurance up to a $35 reimbursement limit every six months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone 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