Medica Prime Solution Core (Cost)
Medica
Medicare Advantage Plan (without drug coverage)
Plan ID: H2450-046-0 | Stanton County, NE | 2021
Medicare Plan Overall Rating
Medica Prime Solution Core Drug Coverage and Costs in Stanton County, NE
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Drug Coverage |  |
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| Plan Type | Cost | Cost | Cost |
| Total Monthly Premium | $69.00 | $125.00 | $34.00 |
| Health Plan Premium | $69.00 | $125.00 | $34.00 |
| Drug Plan Premium |
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| Standard Part B Premium | $148.50 | $148.50 | $148.50 |
| Max You Pay for Health Services (in-network) | $4,000.00 | $3,000.00 | $6,700.00 |
| Part D Deductible |
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| Select Plan |
Doctors, Specialists, Tests, Labs, Imaging
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Primary Doctor Visit | $0 copay | $0 copay | 20% coinsurance per visit |
| Specialist Visit | $20 copay per visit | $0 copay | 20% coinsurance per visit |
| Diagnostic Tests & Procedures | $10 copay | $0 copay | 20% coinsurance |
| Lab Services | $0 copay | $0 copay | $0 copay |
| Diagnostic Radiology Services (like MRI) | $30 copay | $0 copay | 20% coinsurance |
| Outpatient X-rays | $10 copay | $0 copay | 20% coinsurance |
Hospitals, Skilled Nursing, Urgent Care
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Emergency Care | $50 copay per visit (always covered) | $0 copay | $50 copay per visit (always covered) |
| Urgent Care | $0-20 copay per visit (always covered) | $0 copay | $25 copay per visit (always covered) |
| Ambulance (Ground) | $50 copay | $0 copay | 20% coinsurance |
| Inpatient Hospital Coverage | $350 per stay | $100 per stay | $300 per day for days 1 through 4 $0 per day for days 5 through 90 |
| Outpatient Hospital Coverage | $100 copay per visit | $0 copay | 20% coinsurance per visit |
| Skilled Nursing Facility Stays | $0 per day for days 1 through 20 $50 per day for days 21 through 100 |
$0 per day for days 1 through 20 $25 per day for days 21 through 100 |
Coming soon |
| Preventive Services | $0 copay | $0 copay | $0 copay |
Hearing and Vision
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Hearing Exam | $0-20 copay | $0 copay | 20% coinsurance |
| Hearing Fitting / Evaluation | $0 copay | $0 copay | Not covered |
| Hearing Aides - All Types | $0 copay | $0 copay | |
| Routine Eye Exam | $0 copay | $0 copay | Not covered |
| Contact Lenses | $0 copay | $0 copay | Not covered |
| Eyeglasses (Frames & Lenses) | $0 copay | $0 copay | Not covered |
| Eyeglass Frames (only) | $0 copay | $0 copay | Not covered |
| Eyeglass Lenses (only) | $0 copay | $0 copay | Not covered |
| Upgrades (vision) | $0 copay | $0 copay | Not covered |
Physical, Occupational, Speech Therapy and Mental Health
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Occupational Therapy Visit | $20 copay | $0 copay | 20% coinsurance |
| Physical Therapy Visit | $20 copay | $0 copay | 20% coinsurance |
| Speech Pathology Visit | $20 copay | $0 copay | 20% coinsurance |
| Outpatient Group Therapy with a Psychiatrist | $20 copay | $0 copay | 20% coinsurance |
| Outpatient Individual Therapy with a Psychiatrist | $20 copay | $0 copay | 20% coinsurance |
| Outpatient Group Therapy Visit | $20 copay | $0 copay | 20% coinsurance |
| Outpatient Individual Therapy Visit | $20 copay | $0 copay | 20% coinsurance |
Dental Coverage
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| Oral Exam | $0 copay | $0 copay | Not covered |
| Oral Cleaning | $0 copay | $0 copay | Not covered |
| Flouride Treatment | $0 copay | $0 copay | Not covered |
| Dental X-rays | $0 copay | $0 copay | Not covered |
| Non-routine Services | $0 copay | $0 copay | Not covered |
| Diagnostic Services | $0 copay | $0 copay | Not covered |
| Restorative Services | $0 copay | $0 copay | Not covered |
| Endodontics | $0 copay | $0 copay | Not covered |
| Periodontics | $0 copay | $0 copay | Not covered |
| Extractions | $0 copay | $0 copay | Not covered |
| Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services | $0 copay | $0 copay | Not covered |
Medical Equipment, Dialysis, Diabetes
| Medica Prime Solution Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| 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 Core | Medica Prime Solution Premier | Medica Prime Solution Thrift | |
|---|---|---|---|
| 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 enrollee’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 |
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| Summary Rating of Health Plan Quality |
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| Staying Healthy: Screenings, Tests, & Vaccines |
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| Breast cancer screening |
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| Colorectal cancer screening |
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| Yearly flu vaccine |
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| Improving or maintaining physical health |
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| Improving or maintaining mental health |
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| Monitoring physical activity |
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| Checking to see if members are at a healthy weight |
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| Managing Chronic (Long-term) Conditions |
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| 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 |
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| Eye exam to check for damage from diabetes |
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| Kidney function testing for members with diabetes |
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| Plan members with diabetes whose blood sugar is under control |
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| Rheumatoid arthritis management |
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| Reducing the risk of falling |
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| Improving bladder control |
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| 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 |
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| Ease of getting needed care and seeing specialists |
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| Getting appointments and care quickly |
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| Health plan provides information or help when members need it |
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| Member's rating of health care quality |
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| Member's rating of health plan |
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| Coordination of members' health care services |
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| Member Complaints & Changes in the Health Plan's Performance |
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| Complaints about the health plan (more stars are better because it means fewer complaints) |
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| Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) |
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| Improvement (if any) in the health plan's performance |
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| Health Plan Customer Service |
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| Health plan makes timely decisions about appeals |
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| Fairness of the health plan's appeal decisions, based on an independent reviewer |
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| Availability of TTY services and foreign language interpretation when prospective members call the health plan | Not Available | |||
| Drug Plan (Part D) Star Rating |
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| Drug Plan Customer Service |
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| 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) |
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| Fairness of drug plan's appeal decisions, based on an independent reviewer |
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| Member Complaints & Changes in the Drug Plan's Performance |
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| Complaints about the drug plan (more stars are better because it means fewer complaints) |
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| Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) |
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| Improvement (if any) in the drug plan's performance |
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| Member Experience with the Drug Plan |
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| Members' rating of drug plan |
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| Ease of getting prescriptions filled when using the plan |
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| Drug Safety & Accuracy of Drug Pricing |
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| Plan provides accurate drug pricing information for Medicare's website |
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| Taking diabetes medication as directed |
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| Taking blood pressure medication as directed |
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| Taking cholesterol medication as directed |
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| Members who had a pharmacist (or other health professional) help them understand and manage their medications |
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| The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol |
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Last Updated: September 19, 2021
