Medica Prime Solution Thrift (Cost) H2450-030 is a 2023 Medicare Advantage Plan or Part-C by Medica available to residents in Iowa and Oklahoma. This plan does not provide extra prescription drug (Part-D) coverage. Medica Medica Prime Solution Thrift (Cost) has a monthly premium of $40.00 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $6,700 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 Thrift (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 Iowa or Medicare Advantage in Oklahoma.

2023 Medica Medicare Advantage Plan Overview

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

Medica Prime Solution Thrift (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 Thrift (Cost) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Medica charges a $40.00 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 Thrift (Cost) by Medica MOOP is $6,700. Once you spend $6,700 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 Thrift (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.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

Vision	Not covered

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Upgrades

Vision	Not covered

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Transportation	Not covered
Skilled Nursing Facility	In 2023 the amounts for each benefit period are: $0 copay for days 1 through 20 $200 copay per day for days 21 through 100

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Occupational therapy visit

Rehabilitation services	20% coinsurance

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Physical therapy and speech and language therapy visit

Rehabilitation services	20% coinsurance

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Cleaning

Preventive dental	Not covered

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Dental x-ray(s)

Preventive dental	Not covered

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

Preventive dental	Not covered

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Preventive care	$0 copay
Outpatient hospital coverage	20% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Mental health services	$300 per day for days 1 through 4 $0 per day for days 5 through 90

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Outpatient group therapy visit

Mental health services	20% coinsurance

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Outpatient group therapy visit with a psychiatrist

Mental health services	20% coinsurance

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Outpatient individual therapy visit

Mental health services	20% coinsurance

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Outpatient individual therapy visit with a psychiatrist

Mental health services	20% coinsurance

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Diabetes supplies

Medical equipment/supplies	20% coinsurance per item

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

Medical equipment/supplies	20% coinsurance per item

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

Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$6,700 In-network
Inpatient hospital coverage	$300 per day for days 1 through 4 $0 per day for days 5 through 90

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Fitting/evaluation

Hearing	Not covered

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Hearing aids - inner ear

Hearing	Not covered

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Hearing aids - outer ear

Hearing	Not covered

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Hearing aids - over the ear

Hearing	Not covered

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Hearing exam

Hearing	20% coinsurance

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Health plan deductible	$50 In-network
Ground ambulance	20% coinsurance

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Foot exams and treatment

Foot care (podiatry services)	20% coinsurance

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$50 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$25 copay per visit (always covered)

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Primary

Doctor visits	20% coinsurance per visit

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Specialist

Doctor visits	20% coinsurance per visit

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Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging	20% coinsurance

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Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging	20% coinsurance

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Lab services

Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

Diagnostic procedures/lab services/imaging	20% coinsurance

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	Not covered

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Extractions

Comprehensive dental	Not covered

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	Not covered

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	Not covered

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Restorative services

Comprehensive dental	Not covered

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Medica Prime Solution Thrift (Cost) Reviews

Is Medica Prime Solution Thrift (Cost) a good plan? Medica Prime Solution Thrift (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 Thrift Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H2450-030 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 Thrift (Cost) requires you to live in that plan’s service area. The service area is listed below:

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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.