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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 2026, 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. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $71.00. 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 $325.00 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 $4200.00 (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 $4200.00 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) prescription drug plan features an annual drug deductible of $325. For Tier 1 preferred generic drugs, members pay no copay when using a standard pharmacy or preferred mail order services. Tier 2 generic drugs are also budget-friendly, requiring an $8 copay for a one-month supply at standard pharmacies and preferred mail order, or up to a $60 copay for a three-month standard mail order. Higher-tier medications under this plan utilize coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The Medica Advantage Select (PPO) plan offers robust coverage with predictable costs, featuring no copays and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, members pay a $50 copay, while inpatient hospital stays require a $425 copay per admission with no coinsurance. Outpatient hospital services and diagnostic tests are also covered with no coinsurance, with copays ranging up to $375 depending on the service. This plan also includes valuable supplemental benefits, such as preventive dental care and routine hearing exams with no copays or coinsurance. Vision eyewear is covered up to $150 annually with no copay, and prescription hearing aids are available with copays ranging from $549 to $1,299. Additionally, emergency care carries a $130 copay, while durable medical equipment and dialysis services require up to 20% coinsurance with no copays.
Inpatient Hospital See details
Medica Advantage Select (PPO) covers inpatient acute hospital stays with a $425 copay per admission and no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with a $400 copay per admission and no coinsurance, but additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
Medica Advantage Select (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $375, along with a $425 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services have no coinsurance and copays of $20 for group sessions and $30 for individual sessions.
Partial Hospitalization See details
Medica Advantage Select (PPO) covers partial hospitalization with a $100.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Select (PPO) covers ground ambulance services with a $375 copay and air ambulance services with a $475 copay, with no coinsurance for either service. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Medica Advantage Select (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services feature no copay to a $45 copay and no coinsurance, while worldwide emergency services are partially covered with a 20% coinsurance and no copay for emergency care and transportation, excluding worldwide urgent coverage.
Primary Care See details
Medica Advantage Select (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits and therapy services with a $50 copay and no coinsurance. Additional benefits like mental health, psychiatric, and telehealth services feature copays ranging from $0 to $50 with no coinsurance, though podiatry services, routine chiropractic care, and other chiropractic services are not covered.
Preventive Services See details
Medica Advantage Select (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness benefits and remote access technologies with no copay and no coinsurance, while sub-services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Medica Advantage Select (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 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 a $499.50 copay and no coinsurance.
Vision Services See details
Vision Services are covered by Medica Advantage Select (PPO), offering routine and refraction eye exams with a $0 to $50 copay and no coinsurance. Eyewear, including lenses, frames, and contacts, is covered with no copay and no coinsurance up to a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are partially covered by Medica Advantage Select (PPO), featuring no copay and no coinsurance for most preventive and comprehensive care up to a $600 annual limit, though orthodontics is not covered. Medicare-covered dental services are available with a $0 to $50 copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Medica Advantage Select (PPO) plan with no copay, although prior authorization is required. Under this benefit, Part B chemotherapy and other Part B drugs feature no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Medica Advantage Select (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medica Advantage Select (PPO) covers medical equipment with no copays, though coinsurance and prior authorization may be required for certain items. Durable medical equipment and diabetic supplies feature 0% to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medica Advantage Select (PPO) with no coinsurance, though prior authorization is required and lab services are not covered. Diagnostic tests and procedures have a copay ranging from no copay to $90, while radiological services feature a $25 copay for outpatient X-rays, a minimum $85 copay for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Medica Advantage Select (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Medica Advantage Select (PPO) with no coinsurance; however, only some services are covered, and non-covered services include cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
Medica Advantage Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and days 42 through 100, while a $218 daily copay applies for days 21 through 41.
Other Services See details
Medica Advantage Select (PPO) partially covers other services, which includes an over-the-counter (OTC) benefit with no copay and no coinsurance for up to $40 in reimbursements every six months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone 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.
* 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.
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