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Medica Advantage Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica Advantage Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica Advantage Select (PPO) in 2025, please refer to our full plan details page.
Medica Advantage Select (PPO) is a PPO plan offered by Medica Holding Company available for enrollment in 2025 to people living in Select counties in ND and SD. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Medica Advantage Select (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 Select (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 Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $66.00. 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 $250.00 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 $3700.00 (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 $3700.00 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 Select (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs at a standard pharmacy, you will pay a $13 copay. For standard generic drugs at a standard pharmacy, you will pay 23% coinsurance.
Additional Benefits
The Medica Advantage Select (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $350 copay per admission, outpatient services with copays varying from $0 to $300, and emergency services with a $125 copay. The plan also includes coverage for primary care, preventive services, hearing and vision services, dental, and home health services. Additional benefits include coverage for ambulance services, home infusion services, and medical equipment. While some services like skilled nursing and dialysis have copays or coinsurance, many preventive services, such as annual physical exams, have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Medica Advantage Select (PPO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a copay of $350 per admission or stay, and additional days for Inpatient Hospital-Acute are covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stays 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 $300, observation services with a $350 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $30 and $20 respectively, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medica Advantage Select (PPO) plan, but requires prior authorization. You will have a $95 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medica Advantage Select (PPO) plan. Ground ambulance services have a $250 copay, and air ambulance services have a $375 copay, with no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Medica Advantage Select (PPO) plan include a $125 copay, with no coinsurance, and the copay is waived if admitted to the hospital within one day. Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Services have a 20% coinsurance for Worldwide Emergency Coverage and Worldwide Emergency Transportation; Worldwide Urgent Coverage is not covered.
Primary Care See details
Under the Medica Advantage Select (PPO) plan, primary care includes coverage for primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits and opioid treatment program services. Chiropractic services have a $20 copay, while occupational therapy services have a $35 copay, and physician specialist services have a $30 copay. Mental health and psychiatric individual sessions have a $30 copay, and group sessions have a $20 copay. Other health care professional services have a copay between $0 and $30. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a $30 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Medica Advantage Select (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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.
Hearing Services See details
The "Medica Advantage Select (PPO)" plan covers hearing exams with no copay. The plan also covers routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered with a copay between $549 and $1299. OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include routine eye exams with a copay of $0-$35 and other eye exam services. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, with a maximum benefit of $800 per year for both in-network and out-of-network services. Medicare Dental Services have a copay between $0 and $35, and other dental services include 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, all of which are covered. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medica Advantage Select (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medica Advantage Select (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with 20% coinsurance and authorization required, and Diabetic Equipment. 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 are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $85, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $85, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Medica Advantage Select (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 Select (PPO) plan. However, the plan mentions that 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 may have a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medica Advantage Select (PPO) plan. For days 1-20, there is no copay; for days 21-38, the copay is $214, and for days 39-100, there is no copay.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, with a maximum benefit of $60 every six months. Acupuncture, meal benefits, 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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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.
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