2023 Medica Prime Solution Premier (Cost)

Medica Prime Solution Premier (Cost) H2450-036 is a 2023 Medicare Advantage Plan or Part-C by Medica available to residents in North Dakota and South Dakota. This plan does not provide extra prescription drug (Part-D) coverage. Medica Medica Prime Solution Premier (Cost) has a monthly premium of $195.00 and has an in-network maximum out-of-pocket limit of $3,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,000 out-of-pocket. This can be an extremely nice safety net.

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 Premier (Cost) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medica and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in North Dakota or Medicare Advantage in South Dakota.

2023 Medica Medicare Advantage Plan Overview

What type of plan is Medica Prime Solution Premier (Cost)

Medica Prime Solution Premier (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.

How much does Medica Prime Solution Premier (Cost) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Medica charges a $195.00 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medica Prime Solution Premier (Cost) by Medica MOOP is $3,000. Once you spend $3,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Medica Prime Solution Premier (Cost) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Medica helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Contact lenses

Eyeglass frames

Eyeglass lenses

Eyeglasses (frames and lenses)

Other

Routine eye exam

Upgrades

Occupational therapy visit

Physical therapy and speech and language therapy visit

Cleaning

Dental x-ray(s)

Fluoride treatment

Oral exam

Inpatient hospital - psychiatric

Outpatient group therapy visit

Outpatient group therapy visit with a psychiatrist

Outpatient individual therapy visit

Outpatient individual therapy visit with a psychiatrist

Diabetes supplies

Durable medical equipment (e.g., wheelchairs, oxygen)

Prosthetics (e.g., braces, artificial limbs)

Fitting/evaluation

Hearing aids

Hearing exam

Foot exams and treatment

Routine foot care

Emergency

Urgent care

Primary

Specialist

Diagnostic radiology services (e.g., MRI)

Diagnostic tests and procedures

Lab services

Outpatient x-rays

Diagnostic services

Endodontics

Extractions

Non-routine services

Periodontics

Prosthodontics, other oral/maxillofacial surgery, other services

Restorative services

Medica Prime Solution Premier (Cost) Reviews

Is Medica Prime Solution Premier (Cost) a good plan? Medica Prime Solution Premier (Cost) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Medica Prime Solution Premier Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H2450-036 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Medica

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

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Medica Prime Solution Premier (Cost) requires you to live in that plan’s service area. The service area is listed below:

Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.