2018 Medica Prime Solution Premier w/Rx (Cost) H2450-037 By Medica Insurance Company

2018 Medicare Advantage Medica Prime Solution Premier w/Rx (Cost)

Medica Prime Solution Premier w/Rx (Cost) H2450-037 is a 2018 Medicare Advantage or Medicare Part-C plan by Medica Insurance Company available to residents in North Dakota South Dakota. This plan includes additional Medicare prescription drug (Part-D) coverage. The Medica Prime Solution Premier w/Rx (Cost) has a monthly premium of $234.00 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 once you pay out of pocket $3,000 this can be a very nice safety net.

Medica Prime Solution Premier w/Rx (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 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 Premier w/Rx (Cost) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medica Insurance Company and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Medica Insurance Company except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2018 Medica Insurance Company Medicare Advantage Plan Details

Name:
Medica Prime Solution Premier w/Rx (Cost)
ID:
H2450-037
Provider:Medica Insurance Company
Year:2018
Type: Cost
Monthly Premium C+D: $234.00
MOOP: $3,000




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


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



Hearing


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



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


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



Mental health services


$0 copay
Outpatient group therapy visit with a psychiatrist $0 copay
Outpatient individual therapy visit with a psychiatrist $0 copay
Outpatient group therapy visit $0 copay
Outpatient individual therapy visit $0 copay



Skilled Nursing Facility


$0 for days 1 through 20
$25 for days 21 through 100



Rehabilitation services


Occupational therapy visit $0 copay
Physical therapy and speech and language therapy visit $0 copay



Ambulance


$0 copay



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment $0 copay
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) $0 copay
Prosthetics (e.g., braces, artificial limbs) $0 copay
Diabetes supplies $0 copay



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


Covered



Medicare Part B drugs


Chemotherapy 20%
Other Part B drugs 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$3,000 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


$0 copay



Outpatient hospital coverage


$0 copay



Doctor visits


Primary $0 copay
Specialist $0 copay



Preventive care


$0 copay



Emergency care/Urgent care


Emergency $0 copay
Urgent care $0 copay






Ratings for Medica Prime Solution Premier w/Rx (Cost) H2450

2018 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 Premier w/Rx (Cost) Plans Performance

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


Health Plan Customer Service Rating for Medica Prime Solution Premier w/Rx (Cost)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Staying Healthy, Screening, Testing, & Vaccines

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


Managing Chronic And Long Term Care for Older Adults

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
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


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
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

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


Medica Prime Solution Premier w/Rx (Cost) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


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

Medica Prime Solution Premier w/Rx (Cost) has a monthly drug premium of $45.00 and a $215.00 drug deductible. This Medica Insurance Company plan offers a $45.00 Part D Basic Premium that is not 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 $45.00. 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 Premier w/Rx (Cost) medicare insurance offers a $11.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $19.50 for 75% low income subsidy $28.00 for 50% and $36.50 for 25%.



Part C Premium:
Part D (Drug) Premium: $45.00
Part D Supplemental Premium $0.00
Total Part D Premium: $45.00
Drug Deductible: $215.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health: Basic Alternative
Drug Benefit Type: Basic
Full LIS Premium: $11.00
75% LIS Premium: $19.50
50% LIS Premium: $28.00
25% LIS Premium: $36.50
Initial Coverage Limit:$3750
Gap Coverage: No


Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Medica Insurance Company plan does not offer additional coverage through the gap.



Coverage Area for Medica Prime Solution Premier w/Rx (Cost)

(Click county to compare all available Advantage plans)





Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

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

Notes: Data are subject to change as contracts are finalized. For 2018, 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 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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