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Medica AccessAbility Solution Enhanced (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medica AccessAbility Solution Enhanced (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medica AccessAbility Solution Enhanced (HMO D-SNP) in 2025, please refer to our full plan details page.
Medica AccessAbility Solution Enhanced (HMO D-SNP) is a HMO D-SNP plan offered by Medica Holding Company available for enrollment in 2025 to people living in Specific Minnesota counties. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Medica AccessAbility Solution Enhanced (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Medica AccessAbility Solution Enhanced (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medica AccessAbility Solution Enhanced (HMO D-SNP).
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 AccessAbility Solution Enhanced (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.30. 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 $590.00 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 Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 AccessAbility Solution Enhanced (HMO D-SNP) plan has a deductible of $590. Once you meet your deductible, you will pay the costs for your drugs in each tier. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $34.30 per month for Part D. The plan's formulary provides more details on specific drug coverage.
Additional Benefits
The Medica AccessAbility Solution Enhanced (HMO D-SNP) plan offers a range of services. Many services are covered with a 20% coinsurance, including outpatient services, primary care, vision, dental, and medical equipment. Preventive services are covered with no copay. Home Health Services are covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay (see plan documents for more information), but additional days, non-Medicare covered stays, and upgrades are not covered. Prior authorization is required for Inpatient Hospital-Acute services.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while individual and group outpatient substance abuse sessions have a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a 20% coinsurance and no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered, but Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered. For Emergency Services and Urgently Needed Services, there is no copay and a 20% coinsurance.
Primary Care See details
The Mediac AccessAbility Solution Enhanced (HMO D-SNP) plan covers 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, speech-language pathology services, additional telehealth benefits, and opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies with no copay. Additional services such as Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered under the Medica AccessAbility Solution Enhanced (HMO D-SNP) plan. Hearing exams are covered with at most 20% coinsurance, while routine hearing exams, and fitting/evaluation for hearing aids are not covered; prescription hearing aids, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams and eyewear. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Oral exams and dental x-rays are covered, with 1 oral exam and 1 dental x-ray covered per year, and one additional full mouth x-ray covered once every five years; however, prophylaxis and fluoride treatments are not covered. Other services, including orthodontic, restorative, and general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Medica AccessAbility Solution Enhanced (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered under the plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Diabetic Supplies. There is also a 20% coinsurance for Medical Supplies, and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medica AccessAbility Solution Enhanced (HMO D-SNP) plan. There is no copay for these services, and you pay at most 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Medica AccessAbility Solution Enhanced (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. 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 AccessAbility Solution Enhanced (HMO D-SNP) plan. 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, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and cost sharing information is available in the plan details.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with the plan offering Nicotine Replacement Therapy (NRT) as a Part C OTC benefit, but not covering 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.
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