2022 Medica Prime Solution Premier (Cost)


Medica Prime Solution Premier (Cost) H2450-048 is a 2022 Medicare Advantage Plan or Part-C by Medica available to residents in Kansas and Missouri. This plan does not provide additional prescription drug (Part-D) coverage. The Medica Prime Solution Premier (Cost) has a monthly premium of $125.00 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 a extremely nice safety net.

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.

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 additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medica and not Original Medicare. With Medicare Advantage 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 even if you sign up for Medicare Advantage.




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2022 Medica Medicare Advantage Plan Costs

Name:
Medica Prime Solution Premier (Cost)
Plan ID:
H2450-048
Provider:Medica
Year:2022
Type: Cost *
Monthly Premium C+D: $125.00
Part C Premium:
MOOP: $3,000
Similar Plan: H2450-049
New Plan: 2023 H2450-049




2021 Medica Prime Solution Premier (Cost) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


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



Doctor Visits


Primary $0 copay
Specialist $0 copay



Emergency care/Urgent Care


Emergency $0 copay
Urgent care $0 copay



Foot Care (podiatry services)


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



Ground Ambulance


$0 copay



Hearing


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



Inpatient Hospital Coverage


$100 per stay



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $100 per stay
Outpatient group therapy visit $0 copay
Outpatient group therapy visit with a psychiatrist $0 copay
Outpatient individual therapy visit $0 copay
Outpatient individual therapy visit with a psychiatrist $0 copay



MOOP


$3,000 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0 copay



Preventive Care


$0 copay



Preventive Dental


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



Rehabilitation Services


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



Skilled Nursing Facility


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



Transportation


Not covered



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Medica Prime Solution Premier (Cost) H2450



2021 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

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


Member Complaints and Changes in Medica Prime Solution Premier (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 Premier (Cost)

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


Medica Prime Solution Premier (Cost) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for Medica Prime Solution Premier (Cost)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.