Medica Prime Solution Thrift (Cost)

Medica
Medicare Advantage Plan (without drug coverage)
Plan ID: H2450-030-0 | Hamilton County, NE | 2021
4/5 stars
Medicare Plan Overall Rating
Select Plan

Medica Prime Solution Thrift Drug Coverage and Costs in Hamilton County, NE

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Drug Coverage Drug Coverage excluded in plan Drug Coverage excluded in plan Drug Coverage excluded in plan
Plan Type Cost Cost Cost
Total Monthly Premium $34.00 $125.00 $69.00
Health Plan Premium $34.00 $125.00 $69.00
Drug Plan Premium This plan does not include Drug Coverage This plan does not include Drug Coverage This plan does not include Drug Coverage
Standard Part B Premium $148.50 $148.50 $148.50
Max You Pay for Health Services (in-network) $6,700.00 $3,000.00 $4,000.00
Part D Deductible This plan does not include Drug Coverage This plan does not include Drug Coverage This plan does not include Drug Coverage
Select Plan

Doctors, Specialists, Tests, Labs, Imaging

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Primary Doctor Visit 20% coinsurance per visit $0 copay $0 copay
Specialist Visit 20% coinsurance per visit $0 copay $20 copay per visit
Diagnostic Tests & Procedures 20% coinsurance $0 copay $10 copay
Lab Services $0 copay $0 copay $0 copay
Diagnostic Radiology Services (like MRI) 20% coinsurance $0 copay $30 copay
Outpatient X-rays 20% coinsurance $0 copay $10 copay

Hospitals, Skilled Nursing, Urgent Care

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Emergency Care $50 copay per visit (always covered) $0 copay $50 copay per visit (always covered)
Urgent Care $25 copay per visit (always covered) $0 copay $0-20 copay per visit (always covered)
Ambulance (Ground) 20% coinsurance $0 copay $50 copay
Inpatient Hospital Coverage $300 per day for days 1 through 4
$0 per day for days 5 through 90
$100 per stay $350 per stay
Outpatient Hospital Coverage 20% coinsurance per visit $0 copay $100 copay per visit
Skilled Nursing Facility Stays Coming soon $0 per day for days 1 through 20
$25 per day for days 21 through 100
$0 per day for days 1 through 20
$50 per day for days 21 through 100
Preventive Services $0 copay $0 copay $0 copay

Hearing and Vision

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Hearing Exam 20% coinsurance $0 copay $0-20 copay
Hearing Fitting / Evaluation Not covered $0 copay $0 copay
Hearing Aides - All Types $0 copay $0 copay
Routine Eye Exam Not covered $0 copay $0 copay
Contact Lenses Not covered $0 copay $0 copay
Eyeglasses (Frames & Lenses) Not covered $0 copay $0 copay
Eyeglass Frames (only) Not covered $0 copay $0 copay
Eyeglass Lenses (only) Not covered $0 copay $0 copay
Upgrades (vision) Not covered $0 copay $0 copay

Physical, Occupational, Speech Therapy and Mental Health

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Occupational Therapy Visit 20% coinsurance $0 copay $20 copay
Physical Therapy Visit 20% coinsurance $0 copay $20 copay
Speech Pathology Visit 20% coinsurance $0 copay $20 copay
Outpatient Group Therapy with a Psychiatrist 20% coinsurance $0 copay $20 copay
Outpatient Individual Therapy with a Psychiatrist 20% coinsurance $0 copay $20 copay
Outpatient Group Therapy Visit 20% coinsurance $0 copay $20 copay
Outpatient Individual Therapy Visit 20% coinsurance $0 copay $20 copay

Dental Coverage

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Oral Exam Not covered $0 copay $0 copay
Oral Cleaning Not covered $0 copay $0 copay
Flouride Treatment Not covered $0 copay $0 copay
Dental X-rays Not covered $0 copay $0 copay
Non-routine Services Not covered $0 copay $0 copay
Diagnostic Services Not covered $0 copay $0 copay
Restorative Services Not covered $0 copay $0 copay
Endodontics Not covered $0 copay $0 copay
Periodontics Not covered $0 copay $0 copay
Extractions Not covered $0 copay $0 copay
Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services Not covered $0 copay $0 copay

Medical Equipment, Dialysis, Diabetes

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
Durable medical equipment (like wheelchairs & oxygen) 20% coinsurance per item $0 copay 20% coinsurance per item
Prosthetics (like braces, artificial limbs) 20% coinsurance per item $0 copay 20% coinsurance per item
Diabetes Supplies 20% coinsurance per item $0 copay 20% coinsurance per item

Drug Coverage and Costs (Initial Coverage Phase)

Medica Prime Solution Thrift Medica Prime Solution Premier Medica Prime Solution Core
This plan does not include drug coverage. Please select another plan to compare Part D drug coverage.

Important Plan Information

Plan limits may apply for the above services - There may be limits on how much the plan will provide.

Advanced Plan Approval May be Required for the above services - A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.

Physician Referral May be Required - A process through which the enrolleeā€™s primary care physician or other network physician (depending on the plan policy) permits or instructs the enrollee to obtain an item or service from another physician or other provider type.

FOR INFORMATIONAL PURPOSES ONLY

The plans listed on this page are for informational purposes only. SeniorFax has no plan affiliations and does not endorse any plans displayed. The information provided is based on publicly available data from the Centers for Medicare & Medicaid Services (CMS). Current data is accessible on medicare.gov. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Actual plan costs and coverage can vary. Always consult a licensed insurance agent before purchasing insurance products.

Medicare Star Rating Performance

MEDICA INSURANCE COMPANY
Medica
4/5 stars
Summary Rating of Health Plan Quality 4.5/5 stars
Staying Healthy: Screenings, Tests, & Vaccines 4/5 stars
Breast cancer screening 4/5 stars
Colorectal cancer screening 4/5 stars
Yearly flu vaccine 5/5 stars
Improving or maintaining physical health 3/5 stars
Improving or maintaining mental health 5/5 stars
Monitoring physical activity 3/5 stars
Checking to see if members are at a healthy weight 4/5 stars
Managing Chronic (Long-term) Conditions 3/5 stars
Members whose plan did an assessment of their health needs and risks Not Available
Yearly review of all medications and supplements being taken Not Available
Yearly assessment of how well plan members are able to do activities of daily living Not Available
Yearly pain screening or pain management plan Not Available
Osteoporosis management 1/5 stars
Eye exam to check for damage from diabetes 5/5 stars
Kidney function testing for members with diabetes 3/5 stars
Plan members with diabetes whose blood sugar is under control 5/5 stars
Rheumatoid arthritis management 5/5 stars
Reducing the risk of falling 1/5 stars
Improving bladder control 3/5 stars
The plan makes sure member medication records are up-to-date after hospital discharge Not Available
The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol Not Available
Member Experience with Health Plan 4/5 stars
Ease of getting needed care and seeing specialists 4/5 stars
Getting appointments and care quickly 5/5 stars
Health plan provides information or help when members need it 4/5 stars
Member's rating of health care quality 4/5 stars
Member's rating of health plan 4/5 stars
Coordination of members' health care services 4/5 stars
Member Complaints & Changes in the Health Plan's Performance 5/5 stars
Complaints about the health plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 5/5 stars
Improvement (if any) in the health plan's performance 4/5 stars
Health Plan Customer Service 5/5 stars
Health plan makes timely decisions about appeals 5/5 stars
Fairness of the health plan's appeal decisions, based on an independent reviewer 4/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the health plan Not Available
Drug Plan (Part D) Star Rating 4/5 stars
Drug Plan Customer Service 5/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the drug plan Not Available
Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays) 5/5 stars
Fairness of drug plan's appeal decisions, based on an independent reviewer 5/5 stars
Member Complaints & Changes in the Drug Plan's Performance 4/5 stars
Complaints about the drug plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 5/5 stars
Improvement (if any) in the drug plan's performance 3/5 stars
Member Experience with the Drug Plan 3/5 stars
Members' rating of drug plan 1/5 stars
Ease of getting prescriptions filled when using the plan 4/5 stars
Drug Safety & Accuracy of Drug Pricing 4/5 stars
Plan provides accurate drug pricing information for Medicare's website 5/5 stars
Taking diabetes medication as directed 4/5 stars
Taking blood pressure medication as directed 5/5 stars
Taking cholesterol medication as directed 5/5 stars
Members who had a pharmacist (or other health professional) help them understand and manage their medications 3/5 stars
The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol 3/5 stars
Last Updated: September 19, 2021

More Medicare Advantage Plans Available in Hamilton County, NE

UnitedHealthcare
UNITEDHEALTHCARE OF THE MIDLANDS, INC.
4.5/5 stars
View Plans
UnitedHealthcare
UNITEDHEALTHCARE OF THE MIDWEST, INC.
4.5/5 stars
View Plans
Aetna Medicare
AETNA HEALTH INC. (PA)
4/5 stars
View Plans
Blue Cross and Blue Shield of Nebraska
SAPPHIRE EDGE, INC.
4/5 stars
View Plans
Medica
MEDICA INSURANCE COMPANY
4/5 stars
View Plans
Aetna Medicare
COVENTRY HEALTH AND LIFE INSURANCE COMPANY
3.5/5 stars
View Plans
UnitedHealthcare
UNITEDHEALTHCARE INSURANCE COMPANY
3/5 stars
View Plans
Blue Cross and Blue Shield of Nebraska
SAPPHIRE EDGE, INC.
Medicare Star Rating Not Available
View Plans
UnitedHealthcare
HARKEN HEALTH INSURANCE COMPANY
Medicare Star Rating Not Available
View Plans