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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 NE and IA. 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 $37.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3500.00 (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 $3500.00 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 an "Enhanced Alternative" drug benefit. This plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy or standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medica Advantage Select (PPO) plan offers a range of benefits with varying cost-sharing. This plan includes inpatient hospital stays with a copay, outpatient services with copays, and coverage for ambulance services, emergency services, and primary care visits, all with associated copays. Preventative services, home health services, and routine hearing exams have no copay, while vision and dental services are covered with copays. Additional benefits include coverage for hearing aids, durable medical equipment, and home infusion services. This plan also offers coverage for skilled nursing facilities, with copays depending on the length of stay. However, some services such as additional hours of care, personal care services, and certain rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Medica Advantage Select (PPO) plan. For inpatient hospital stays, you'll pay a $295 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $345, observation services with a $295 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with individual sessions having a $35 copay and group sessions with a $25 copay, and outpatient blood services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medica Advantage Select (PPO) plan, with a $95 copay. Prior authorization is required 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 copay of $275, and air ambulance services have a copay of $375; there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Medica Advantage Select (PPO) plan. Emergency Services have a $125 copay, and there is no coinsurance, while Urgently Needed Services have a $0-$35 copay, and no coinsurance. Worldwide Emergency Services include Worldwide Emergency Coverage with a 20% coinsurance, and Worldwide Emergency Transportation with a 20% coinsurance, while Worldwide Urgent Coverage is not covered.
Primary Care See details
The "Medica Advantage Select (PPO)" plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. It also covers physician specialist services with a $35 copay, mental health specialty services with a copay of $25-$35, and physical therapy and speech-language pathology services with a $35 copay.
Preventive Services See details
The Medca Advantage Select (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education, and other preventive services with no copay. Additional preventive services, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $549 and $1299, while OTC hearing aids are not covered, and prescription hearing aids for the inner, outer, and over the ear are also not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $35, and eyewear with a combined maximum plan benefit of $200 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Medica Advantage Select (PPO) plan covers Medicare Dental Services with a copay ranging from $0 to $35, and covers other dental services with a maximum benefit of $700 per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medica Advantage Select (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Medica Advantage Select (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medica Advantage Select (PPO) plan. Diagnostic Procedures/Tests have a maximum copay of $95, while Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a copay of $20; however, Lab Services are not covered.
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 technically covered, but not covered in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medica Advantage Select (PPO) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-37, and no copay for days 38-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50 every six months, but does not cover 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.
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