2023 Medica Prime Solution Standard (Cost)

Medica Prime Solution Standard (Cost) H2450-044 is a 2023 Medicare Advantage Plan or Part-C by Medica available to residents in Nebraska and North Dakota. This plan does not provide additional prescription drug (Part-D) coverage. Medica Medica Prime Solution Standard (Cost) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,000 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 Standard (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 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 Nebraska or Medicare Advantage in North Dakota.




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2023 Medica Medicare Advantage Plan Overview

Name:Medica Prime Solution Standard (Cost)
Plan ID:H2450 044 0
Provider:Medica
Year:2023
Type:Cost *
Combined Premium (C+D):$0/mo
MOOP:$5,000/yr
Similar Plan: H2450-045




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

Medica Prime Solution Standard (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 Standard (Cost) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Medica charges a $0 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 Standard (Cost) by Medica MOOP is $5,000. Once you spend $5,000 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 Standard (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



Contact lenses


Vision$0 copay



Eyeglass frames


Vision$0 copay



Eyeglass lenses


Vision$0 copay



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


Vision$0 copay




TransportationNot covered
Skilled Nursing FacilityIn 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100



Occupational therapy visit


Rehabilitation services$40 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$40 copay



Cleaning


Preventive dental$0 copay



Dental x-ray(s)


Preventive dental$0 copay



Fluoride treatment


Preventive dental$0 copay



Oral exam


Preventive dental$0 copay




Preventive care$0 copay
Outpatient hospital coverage$250 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$325 per day for days 1 through 4
$0 per day for days 5 through 90



Outpatient group therapy visit


Mental health services$30 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$40 copay



Outpatient individual therapy visit


Mental health services$30 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$40 copay



Diabetes supplies


Medical equipment/supplies$35 copay per item



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


Medical equipment/supplies20% coinsurance per item



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


Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$5,000 In-network
Inpatient hospital coverage$325 per day for days 1 through 4
$0 per day for days 5 through 90



Fitting/evaluation


Hearing$0 copay



Hearing aids


Hearing$0 copay



Hearing exam


Hearing$40 copay




Health plan deductible$0
Ground ambulance$200 copay



Foot exams and treatment


Foot care (podiatry services)$40 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$110 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$10-40 copay per visit (always covered)



Primary


Doctor visits$10 copay per visit



Specialist


Doctor visits$40 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$40-150 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$10-40 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$10-40 copay



Diagnostic services


Comprehensive dental$0 copay



Endodontics


Comprehensive dental$0 copay



Extractions


Comprehensive dental$0 copay



Non-routine services


Comprehensive dental$0 copay



Periodontics


Comprehensive dental$0 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dental$0 copay



Restorative services


Comprehensive dental$0 copay




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




Medica Prime Solution Standard (Cost) Reviews


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

2022 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
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H2450-044 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 Plans Performance

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


Health Plan Customer Service Rating for Medica

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


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



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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 Standard (Cost) requires you to live in that plan’s service area. The service area is listed below:



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How much does Medica Prime Solution Standard (Cost) cost?

Medica charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Medica Prime Solution Standard (Cost) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Medica Prime Solution Standard (Cost) by Medica MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services.

What type of plan is Medica Prime Solution Standard (Cost)?

Medica Prime Solution Standard (Cost) is a Cost * plan. A Cost plan is operated by a (HMO) in accordance with a cost reimbursement contract. You may use the cost plans network of providers or receive their health care services through Original Medicare.

Is Medica Prime Solution Standard (Cost) a good plan?

Medica Prime Solution Standard (Cost) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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