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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 2026 to people living in Select counties in SD. 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 $80.00. 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 $5000.00 (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 $5000.00 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 $355. Tier 1 preferred generic drugs have no copay when filled at a standard pharmacy or through preferred mail order, while standard mail order copays range from $10 to $30. Tier 2 generic drugs cost between $7 and $21 at standard pharmacies and preferred mail order, increasing to a $20 to $60 copay for standard mail order. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs have a 50% coinsurance across all pharmacy and mail order channels. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The Medica Advantage Select (PPO) plan offers robust medical coverage with no copays or coinsurance for primary care visits, home health services, and routine preventive care. For more specialized needs, members will pay a $50 copay for specialist visits and a $130 copay for emergency room visits, with no coinsurance required for either. Inpatient hospital stays are covered with no coinsurance, though they require a $450 copay per stay for acute care and a $485 copay per stay for psychiatric care. This plan also features valuable everyday benefits, including dental care with no copay or coinsurance up to a $550 annual limit, and vision services that include annual eye exams starting at no copay and up to $150 yearly for eyewear. Routine hearing exams are available with no copay, while prescription hearing aids require copays ranging from $549 to $1,299. Additionally, members receive a $35 reimbursement every six months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Medica Advantage Select (PPO) covers inpatient hospital services with no coinsurance, requiring a $450 copay per stay for acute care and a $485 copay per stay for psychiatric care, both of which require prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medica Advantage Select (PPO) covers outpatient services with no coinsurance, offering outpatient hospital services with a $0 to $450 copay and observation services with a $450 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 to $30 copay and no coinsurance.
Partial Hospitalization See details
Medica Advantage Select (PPO) covers partial hospitalization services with a $100 copay and no coinsurance.
Ambulance and Transportation Services See details
Medica Advantage Select (PPO) covers ground ambulance services for a $375 copay and air ambulance services for a $475 copay, with no coinsurance required for either service. However, transportation services to plan-approved or any 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 require no copay to a $45 copay with no coinsurance, while worldwide emergency services are partially covered with no copay and a 20% coinsurance for emergency care and transportation, excluding worldwide urgent coverage.
Primary Care See details
Primary care benefits under the Medica Advantage Select (PPO) plan include primary care physician services with no copay and no coinsurance, alongside specialist visits and therapy services for a $50 copay and no coinsurance. Mental health, psychiatric, and telehealth services feature no coinsurance and copays ranging from no copay up to $50, while podiatry is not covered and chiropractic services are only partially covered because routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services are covered by Medica Advantage Select (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Medica Advantage Select (PPO) offers hearing services featuring one annual routine exam and fitting with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $549.00 and $1,299.00—excluding inner ear, outer ear, and over the ear types—while OTC hearing aids require a $499.50 copay and no coinsurance.
Vision Services See details
Medica Advantage Select (PPO) covers vision services with no deductibles, offering annual eye exams with copays ranging from no copay to $50 and no coinsurance. Eyewear is covered with no copay and no coinsurance, providing a combined maximum benefit of $150 per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by Medica Advantage Select (PPO) with no copay and no coinsurance for most preventive and comprehensive care up to a $550 annual limit, while Medicare-covered dental has a $0 to $50 copay and no coinsurance. This benefit is partially covered because orthodontics are not covered.
Home Infusion bundled Services See details
Medica Advantage Select (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Medica Advantage Select (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Medica Advantage Select (PPO) plan with no copays, though coinsurance and prior authorization may apply. Durable medical equipment and diabetic supplies feature no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Medica Advantage Select (PPO) with no coinsurance, though prior authorization is required and laboratory services are not covered. Diagnostic procedures and radiological services feature no coinsurance, with copays ranging from no copay up to $90, including a $25 copay for outpatient X-rays and copays starting at $85 for therapeutic 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 Medica Advantage Select (PPO), meaning some services are covered, though standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Medica Advantage Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 45 to 100, and a $218 daily copay for days 21 to 44. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered under the Medica Advantage Select (PPO), which offers a $35 reimbursement every six months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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