2022 Medica Prime Solution Focus (Cost)

Medica Prime Solution Focus (Cost) H2450-038 is a 2022 Medicare Advantage Plan or Part-C by Medica available to residents in Wisconsin. This plan does not provide additional prescription drug (Part-D) coverage. The Medica Prime Solution Focus (Cost) has a monthly premium of $79.00 and has an in-network maximum out-of-pocket limit of $4,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,000 out-of-pocket. This can be a extremely nice safety net.

Medica Prime Solution Focus (Cost) is a Cost * plan. A Cost plan is operated by a Health Maintenance Organization (HMO) in accordance with a cost reimbursement contract. A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. You may use the cost plans network of providers or receive their health care services through Original Medicare. With a Cost Plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Medicare Part A and Part B coinsurance and deductibles.

Medica works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medica Prime Solution Focus (Cost) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medica and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Medica except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Medica Medicare Advantage Plan Costs

2021 Medica Prime Solution Focus (Cost) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	$0 copay
Endodontics	$0 copay
Extractions	$0 copay
Non-routine services	$0 copay
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$30 copay
Diagnostic tests and procedures	$10 copay
Lab services	$0 copay
Outpatient x-rays	$10 copay

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Doctor Visits

Primary	$0 copay
Specialist	$20 copay per visit

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Emergency care/Urgent Care

Emergency	$50 copay per visit (always covered)
Urgent care	$0-20 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$20 copay
Routine foot care	Not covered

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Ground Ambulance

$50 copay

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Hearing

Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing exam	$0-20 copay

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Inpatient Hospital Coverage

$500 per stay

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$500 per stay
Outpatient group therapy visit	$20 copay
Outpatient group therapy visit with a psychiatrist	$20 copay
Outpatient individual therapy visit	$20 copay
Outpatient individual therapy visit with a psychiatrist	$20 copay

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MOOP

$4,000 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$100 copay per visit

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Preventive Care

$0 copay

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Preventive Dental

Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Fluoride treatment	$0 copay
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$20 copay
Physical therapy and speech and language therapy visit	$20 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $50 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Upgrades	$0 copay

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Medica Prime Solution Focus (Cost) H2450

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Medica Prime Solution Focus (Cost) Plans Performance

Health Plan Customer Service Rating for Medica Prime Solution Focus (Cost)

Medica Prime Solution Focus (Cost) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Medica Prime Solution Focus (Cost)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.