2015 Medica Prime Solution Basic with Part D Option 1 (Cost) H2450-016 By Medica Insurance Company

Medica Prime Solution Basic with Part D Option 1 (Cost) By Medica Insurance Company



Medica Prime Solution Basic with Part D Option 1 (Cost) is a 2015 Medicare Advantage ("Part C" or "MA Plan") plan by Medica Insurance Company. This plan from Medica Insurance Company works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medica Prime Solution Basic with Part D Option 1 (Cost) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Medica Insurance Company and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



2015 Medicare Advantage Plan Details

Plan Name:
Medica Prime Solution Basic with Part D Option 1 (Cost)
Plan ID:
H2450-016
Provider: Medica Insurance Company
Plan Year:2015
Plan Type: Cost
Monthly Premium C+D: $102.80
MOOP: $3,000


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Coverage Area for Medica Prime Solution Basic with Part D Option 1 (Cost)

(Click county to compare all available plans)

State: Minnesota
North Dakota
South Dakota
Wisconsin
County:Aitkin,
Anoka, Becker, Beltrami,
Benton, Big Stone, Blue Earth,
Brown, Carlton, Carver,
Cass, Chippewa, Chisago,
Clay, Clearwater, Cook,
Cottonwood, Crow Wing, Dakota,
Dodge, Douglas, Faribault,
Fillmore, Freeborn, Goodhue,
Grant, Hennepin, Houston,
Hubbard, Isanti, Itasca,
Jackson, Kanabec, Kandiyohi,
Kittson, Koochiching, Lac qui Parle,
Lake, Lake of the Woods, Le Sueur,
Lincoln, Lyon, Mahnomen,
Marshall, Martin, McLeod,
Meeker, Mille Lacs, Morrison,
Mower, Murray, Nicollet,
Nobles, Norman, Olmsted,
Otter Tail, Pennington, Pine,
Pipestone, Polk, Pope,
Ramsey, Red Lake, Redwood,
Renville, Rice, Rock,
Roseau, Scott, Sherburne,
Sibley, St. Louis, Stearns,
Steele, Stevens, Swift,
Todd, Traverse, Wabasha,
Wadena, Waseca, Washington,
Watonwan, Wilkin, Winona,
Wright, Yellow Medicine, Adams,
Barnes, Bowman, Burleigh,
Cass, Cavalier, Dickey,
Dunn, Eddy, Emmons,
Foster, Grand Forks, Grant,
Griggs, Hettinger, Kidder,
LaMoure, Logan, McHenry,
McIntosh, McLean, Mercer,
Morton, Oliver, Pembina,
Pierce, Ransom, Richland,
Sargent, Sheridan, Sioux,
Stark, Steele, Stutsman,
Traill, Walsh, Ward,
Aurora, Beadle, Bennett,
Bon Homme, Brookings, Brown,
Brule, Buffalo, Butte,
Campbell, Charles Mix, Clark,
Clay, Codington, Custer,
Davison, Day, Deuel,
Dewey, Douglas, Edmunds,
Fall River, Grant, Gregory,
Haakon, Hamlin, Hand,
Hanson, Harding, Hughes,
Hutchinson, Jackson, Jerauld,
Jones, Kingsbury, Lake,
Lawrence, Lincoln, Lyman,
Marshall, McCook, McPherson,
Meade, Mellette, Miner,
Minnehaha, Moody, Pennington,
Perkins, Roberts, Sanborn,
Shannon, Spink, Stanley,
Todd, Tripp, Turner,
Union, Yankton, Ziebach,
Ashland, Barron, Bayfield,
Burnett, Chippewa, Douglas,
Dunn, Eau Claire, Pierce,
Polk, Sawyer, St. Croix,
Washburn,


The Medica Prime Solution Basic with Part D Option 1 (Cost) H2450-016 is available to residents in Minnesota, North Dakota, South Dakota, Wisconsin, and has a in-network Maximum Out-of-Pocket limit of $3,000 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Medica Prime Solution Basic with Part D Option 1 (Cost) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $3,000 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

Medica Prime Solution Basic with Part D Option 1 (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.





Ratings for Medica Prime Solution Basic with Part D Option 1 (Cost) H2450

2015 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Medica Prime Solution Basic with Part D Option 1 (Cost) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Medica Prime Solution Basic with Part D Option 1 (Cost)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Ratings For Managing Chronic And Long Term Care

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Ratings For Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
High Risk Medication
Diabetes Treatment
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Medica Prime Solution Basic with Part D Option 1 (Cost) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld


Part-C Premium

Medica Insurance Company plan charges a Part-C 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.



Part-D Deductible and Premium

The Medica Prime Solution Basic with Part D Option 1 (Cost) plan has a monthly drug premium of $23.80 and a $320.00 drug deductible. This Medica Insurance Company plan offers a $23.80 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Medica Insurance Company above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $23.80. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Medica Prime Solution Basic with Part D Option 1 (Cost) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.90 for 75% low income subsidy $11.90 for 50% and $17.80 for 25%.



Part C Premium:
Part D (Drug) Premium: $23.80
Part D Supplemental Premium $0.00
Total Part D Premium: $23.80
Drug Deductible: $320.00
Tiers with No Deductible: 0
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Defined Standard Benefit
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $5.90
50% LIS Premium: $11.90
25% LIS Premium: $17.80
Inital Coverage Limit:$2960
Gap Coverage: No


Gap Coverage

In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs. Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. This Medica Insurance Company plan does not offer additional coverage through the gap.





Source: CMS.

Plans as of September 2, 2014.

Star Rating as of Oct 3, 2014.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change. All contracts for 2015 have been finalized. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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