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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 NE and IA. 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 $45.00. 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 $355.00 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) plan features an annual drug deductible of $355. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. For Tier 2 generic drugs, copays start at $7 for a one-month supply at standard pharmacies and preferred mail order. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs require an 18% coinsurance, while Tier 4 non-preferred drugs have a 50% coinsurance across all fulfillment options. Specialty drugs in Tier 5 carry a 29% coinsurance for a one-month supply.
Additional Benefits
The Medica Advantage Select (PPO) plan offers robust coverage with many essential healthcare services featuring no copays or coinsurance. Members benefit from no copay for primary care visits, preventive care, and home health services, while specialist visits require a fifty dollar copay. For acute inpatient hospital stays, there is a four hundred and fifty dollar daily copay for the first five days, and emergency room visits carry a one hundred and thirty dollar copay that is waived upon hospital admission. For extra wellness benefits, the plan provides routine dental and hearing exams with no copay, alongside a one hundred and twenty-five dollar annual eyewear allowance. Over-the-counter items are covered with no copay up to forty dollars every six months, while medical equipment and dialysis require up to twenty percent coinsurance. Skilled nursing facility stays also offer cost savings with no copay for the first twenty days.
Inpatient Hospital See details
Inpatient hospital services are covered by Medica Advantage Select (PPO) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $450 daily copay for days 1-5 and no copay for additional days, while psychiatric stays require a $400 daily copay for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Medica Advantage Select (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $450 (with a $450 daily copay for observation), while outpatient substance abuse services carry a copay of $30 for group sessions and $40 for individual sessions.
Partial Hospitalization See details
Partial hospitalization is covered by Medica Advantage Select (PPO) with a $100 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Select (PPO) covers ambulance services with no coinsurance, requiring a $370 copay for ground ambulance and a $475 copay for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Medica Advantage Select (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services feature a copay ranging from no copay to $45 with no coinsurance, while worldwide emergency services are partially covered with no copay and a 20% coinsurance for emergency care and transportation, though worldwide urgent care is not covered.
Primary Care See details
Medica Advantage Select (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, and speech therapies require a $50 copay and no coinsurance. Mental health and psychiatric services feature a $30 to $40 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Medica Advantage Select (PPO) with no copay and no coinsurance for services like annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay or coinsurance, offering fitness benefits and remote access technologies, while services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Medica Advantage Select (PPO) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $549.00 to $1,299.00, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are covered with a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Select (PPO) covers vision services, including annual routine eye exams with a $0 to $50 copay and no coinsurance, and other eye exams with no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a combined maximum benefit of $125 per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Medica Advantage Select (PPO) offers dental services with no copay and no coinsurance for most preventive and comprehensive treatments, subject to a $500 annual maximum for both in- and out-of-network care. Medicare-covered dental services require a $0 to $50 copay with no coinsurance, and orthodontics are not covered.
Home Infusion bundled Services See details
Medica Advantage Select (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Medica Advantage Select (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Medica Advantage Select (PPO) with no copays, though prior authorization is required for some items. Durable medical equipment and diabetic supplies feature a coinsurance ranging from 0% to 20%, while prosthetic devices, medical supplies, and diabetic shoes or inserts require a 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. Covered diagnostic procedures and tests carry a copay ranging from no copay to $90, while radiological services have 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 under the Medica Advantage Select (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Medica Advantage Select (PPO) plan, although some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
Medica Advantage Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, but does not require a prior three-day hospital stay. There is no copay for days 1 to 20 and days 42 to 100, a $218 daily copay for days 21 to 41, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medica Advantage Select (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $40 reimbursement limit every six months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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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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