2019 Medica Prime Solution Core (Cost) H2450-034 By Medica Insurance Company

2019 Medicare Advantage Plan Services for
Medica Prime Solution Core (Cost)


Medica Prime Solution Core (Cost) H2450-034 is a 2019 Medicare Advantage or Medicare Part-C plan by Medica Insurance Company available to residents in North Dakota South Dakota. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Medica Prime Solution Core (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 Core (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 provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Medica Prime Solution Core (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 Plans you are always covered for urgently needed and emergency care. Plus 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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2019 Medica Insurance Company Medicare Advantage Plan Details

Name:
Medica Prime Solution Core (Cost)
ID:
H2450-034
Provider:Medica Insurance Company
Year:2019
Type: Cost *
Monthly Premium C+D: $79.00
Part C Premium:
MOOP: $4,000






Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $50 per visit (always covered)
Urgent care $10-20 per visit (always covered)



Diagnostic procedures/lab services/imaging


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



Hearing


Hearing exam $10-20
Fitting/evaluation $0 copay
Hearing aids $0 copay



Preventive dental


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



Comprehensive dental


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



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


Inpatient hospital - psychiatric $100 per day for days 1 through 8
$0 per day for days 9 through 90
Outpatient group therapy visit with a psychiatrist $20
Outpatient individual therapy visit with a psychiatrist $20
Outpatient group therapy visit $20
Outpatient individual therapy visit $20



Skilled Nursing Facility


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



Rehabilitation services


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



Ground ambulance


$50



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment $20
Routine foot care Not covered



Medical equipment/supplies


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



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)


$4,000 In-network



Optional supplemental benefits


No



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


$100 per day for days 1 through 8
$0 per day for days 9 through 90



Outpatient hospital coverage


$100 per visit



Doctor visits


Primary $10 per visit
Specialist $20 per visit



Preventive care


$0 copay




Ratings for Medica Prime Solution Core (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


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
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


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 Core (Cost) Plans Performance

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


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

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


Medica Prime Solution Core (Cost) Drug Plan Customer Service ratings

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


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


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
Statin with Diabetes


Coverage Area for Medica Prime Solution Core (Cost)

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Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, 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 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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