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Medica Advantage Solution H8889-009 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Solution H8889-009 (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 H8889-009 (PPO) in 2026, please refer to our full plan details page.
Medica Advantage Solution H8889-009 (PPO) is a PPO plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in IA, MN, NE, ND and SD. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medica Advantage Solution H8889-009 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica Advantage Solution H8889-009 (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 H8889-009 (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. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Medica Advantage Solution H8889-009 (PPO).
Additional Benefits
The Medica Advantage Solution H8889-009 (PPO) plan offers robust core medical coverage, featuring no copays and no coinsurance for primary care visits, preventive services, annual physicals, and home health services. Specialist visits and physical therapies require a $50 copay, while inpatient hospital stays carry a $405 daily copay for the first six days with no copay thereafter. Emergency care is accessible with a $130 copay, which is waived upon admission, and urgent care visits range from no copay up to $45. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to an $800 annual limit, and routine vision exams with eyewear coverage up to $100 annually. Routine hearing exams feature no copay, though prescription hearing aids require copays ranging from $549.00 to $1,299.00. Additionally, members benefit from no copays on home infusion services and receive a $50 allowance every six months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Medica Advantage Solution H8889-009 (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for all stays. Medicare-covered acute stays require a copay of $405 for days 1-6 and no copay for day 7 and beyond, while psychiatric stays require a copay of $345 for days 1-6 and no copay for days 7-90; hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medica Advantage Solution H8889-009 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $375, observation services require a $405 daily copay, and outpatient substance abuse sessions carry a copay of $30 for group or $40 for individual visits.
Partial Hospitalization See details
Partial hospitalization is covered by Medica Advantage Solution H8889-009 (PPO) with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Solution H8889-009 (PPO) covers ground ambulance services with a $395 copay and air ambulance services with a $475 copay, both with no coinsurance. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Medica Advantage Solution H8889-009 (PPO) covers emergency services with a $130 copay—waived if admitted to the hospital within one day—and no coinsurance, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and transportation services are partially covered with no copay and a 20% coinsurance, but worldwide urgent coverage is not covered.
Primary Care See details
Medica Advantage Solution H8889-009 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, or speech therapies require a $50 copay and no coinsurance. Mental health and psychiatric individual sessions have a $40 copay (group sessions have a $30 copay) with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Medica Advantage Solution H8889-009 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. This benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Medica Advantage Solution H8889-009 (PPO) hearing services include annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549.00 to $1,299.00, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter hearing aids are covered with no coinsurance and a $499.50 copay.
Vision Services See details
Medica Advantage Solution H8889-009 (PPO) covers routine and refraction eye exams with a $0 to $50 copay and no coinsurance. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay and no coinsurance up to a combined yearly maximum of $100.
Dental Services See details
Dental services are partially covered by Medica Advantage Solution H8889-009 (PPO), offering most preventive and comprehensive care with no copay and no coinsurance up to an annual maximum of $800, though orthodontics is not covered. Medicare-covered dental services require a $0 to $50 copay and no coinsurance.
Home Infusion bundled Services See details
Medica Advantage Solution H8889-009 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Medica Advantage Solution H8889-009 (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Solution H8889-009 (PPO) covers medical equipment with no copays, though coinsurance costs apply depending on the item. Durable medical equipment and diabetic supplies feature no coinsurance to 20% coinsurance, while medical supplies, prosthetic devices, and diabetic shoes require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medica Advantage Solution H8889-009 (PPO), requiring prior authorization and featuring no coinsurance across all covered services. Outpatient diagnostic procedures have copays ranging from no copay up to $90, while lab services are not covered. Radiological copays start with no copay for diagnostic radiology, start at $80 for therapeutic radiology, and are $25 for outpatient X-rays.
Home Health Services See details
Home health services are covered by Medica Advantage Solution H8889-009 (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Medica Advantage Solution H8889-009 (PPO) plan. While the overall category technically features no coinsurance, all specific sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Medica Advantage Solution H8889-009 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 53 to 100, but a $218 copay applies for days 21 to 52, with prior authorization required and additional days beyond Medicare limits not covered.
Other Services See details
Medica Advantage Solution H8889-009 (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. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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