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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 2025, 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 2025.
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 $44.00. 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 $590.00 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 $5500.00 (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 $5500.00 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 H8889-008 (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, you will pay $15-$20 for preferred generic drugs, 18% coinsurance for standard generic drugs, 50% coinsurance for preferred brand drugs, and 25% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your prescriptions.
Additional Benefits
The Medica Advantage Solution H8889-008 (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and ambulance services. Primary care visits, hearing exams, and preventive services are available with no copay. This plan also covers dental, vision, and hearing services. Additionally, you'll have access to home health services with no copay, and skilled nursing facility stays with a copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $395 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $495, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual Sessions for Outpatient Substance Abuse with a $50 copay, Group Sessions for Outpatient Substance Abuse with a $40 copay, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medica Advantage Solution H8889-008 (PPO) plan, but requires prior authorization. The copay for this benefit is $95.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground ambulance services have a $325 copay, and air ambulance services have a $375 copay, while other transportation services are not covered.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency Services have a $125 copay, and Urgently Needed Services have a $30-$55 copay, while Worldwide Emergency Coverage and Worldwide Emergency Transportation have 20% coinsurance. Worldwide Urgent Coverage is not covered.
Primary Care See details
The "Medica Advantage Solution H8889-008 (PPO)" plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, and specialist services with a $50 copay. Mental health and psychiatric individual sessions have a $50 copay, and group sessions have a $40 copay. Physical therapy and speech-language pathology services have a $50 copay. Additional telehealth benefits range from no copay to a $55 copay, and opioid treatment program services have a $50 copay.
Preventive Services See details
The Medica Advantage Solution H8889-008 (PPO) plan covers preventive services, including Medicare-covered preventive services with no copay, an annual physical exam, and additional preventive services; however, health education, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), 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 benefit, 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. The plan also covers fitness benefits, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $549 and $1299. Inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $50, and eyewear with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay between $0 and $50, and other dental services with a $400 annual maximum. This plan covers 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, but does not cover orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 H8889-008 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, and Prosthetics/Medical Supplies with a 20% coinsurance, as well as Diabetic Equipment. Diabetic Supplies have a 0-20% coinsurance, while 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 are covered, with prior authorization required. Diagnostic Procedures/Tests have a minimum copay of $0.00 and a maximum copay of $125.00, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $125.00, Therapeutic Radiological Services have a copay of $80.00, and Outpatient X-Ray Services have a copay of $20.00.
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 H8889-008 (PPO) plan. The plan does not cover any of the sub-services, including 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Advantage Solution H8889-008 (PPO) plan, with a prior authorization requirement. For days 1-20 and 48-100, there is no copay, but for days 21-47, the copay is $214.
Other Services See details
Other Services offered by the Medica Advantage Solution H8889-008 (PPO) plan include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50 every six months. Acupuncture, Meal Benefit, 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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