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Medica Prime Solution Thrift (Cost)

Medica Prime Solution Thrift (Cost) H2450-030 Plan Details
4 out of 5 stars

Medica Prime Solution Thrift (Cost) is a Medicare Advantage (Medicare Part C) plan offered by Medica Holding Company.
Plan ID: H2450-030.

$34.00
Monthly Premium

Medica Prime Solution Thrift (Cost) is a Medicare Advantage (Medicare Part C) plan offered by Medica Holding Company.
Plan ID: H2450-030.

Medica Prime Solution Thrift (Cost) H2450-030 Plan Details
4 out of 5 stars

Medica Prime Solution Thrift (Cost) is a Medicare Advantage (Medicare Part C) plan offered by Medica Holding Company.
Plan ID: H2450-030.

$34.00
Monthly Premium

Iowa Counties Served

Adair Adams Allamakee Audubon Boone Carroll Cass Clay Crawford Dickinson Emmet Fremont Greene Guthrie Howard Kossuth Lyon Mitchell Monona Montgomery O'Brien Osceola Palo Alto Plymouth Shelby Sioux Union Winnebago Worth

Kansas Counties Served

Barber Butler Chase Chautauqua Coffey Cowley Elk Greenwood Harper Harvey Jackson Jefferson Jewell Kingman Lincoln Lyon Mitchell Morris Norton Osage Ottawa Phillips Pottawatomie Republic Smith Stafford Wabaunsee Washington Woodson

Minnesota Counties Served

Aitkin Carlton Cook Goodhue Itasca Kanabec Koochiching Lake Le Sueur McLeod Meeker Mille Lacs Pine Pipestone Rice Rock Sibley St. Louis Stevens Traverse Yellow Medicine

Missouri Counties Served

Barry Barton Jasper McDonald Newton Vernon

Nebraska Counties Served

Adams Antelope Boone Boyd Buffalo Burt Cedar Cheyenne Clay Colfax Cuming Custer Dakota Dawes Dixon Fillmore Franklin Frontier Furnas Gage Garfield Gosper Greeley Hall Hamilton Harlan Holt Howard Jefferson Johnson Kearney Keya Paha Knox Loup Madison Merrick Nance Nemaha Nuckolls Otoe Pawnee Phelps Pierce Platte Polk Rock Saline Seward Sherman Stanton Thayer Thurston Valley Wayne Webster Wheeler York

North Dakota Counties Served

Adams Barnes Benson Billings Bowman Burleigh Cass Cavalier Dickey Dunn Eddy Emmons Foster Grand Forks Grant Griggs Hettinger Kidder LaMoure Logan McHenry McIntosh McLean Mercer Morton Nelson Oliver Pembina Pierce Ramsey Ransom Richland Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman Towner Traill Walsh Ward Wells Williams

Oklahoma Counties Served

Delaware Ottawa

South Dakota Counties Served

Aurora Beadle Bennett Bon Homme Brookings Brown Brule Buffalo Butte Campbell Charles Mix Clark Clay Codington Corson Custer Davison Day Deuel Dewey Douglas Edmunds Fall River Faulk Grant Gregory Haakon Hamlin Hand Hanson Harding Hughes Hutchinson Hyde Jackson Jerauld Jones Kingsbury Lake Lawrence Lincoln Lyman Marshall McCook McPherson Meade Mellette Miner Minnehaha Moody Oglala Lakota Pennington Perkins Potter Roberts Sanborn Spink Stanley Sully Todd Tripp Turner Union Walworth Yankton Ziebach

Wisconsin Counties Served

Ashland Barron Bayfield Burnett Chippewa Douglas Dunn Eau Claire Pierce Polk Sawyer St. Croix Washburn

Wyoming Counties Served

Crook Weston

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $-1
Out of Pocket Max In-Network: $-1
Out-of-Network: 6700
Initial Coverage Limit $0
Catastrophic Coverage Limit $7,050
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Coinsurance for Primary Care Office Visit 20%
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Coinsurance for Physician Specialist Office Visit 20%
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$300.00 per day for days 1 to 4
$0.00 per day for days 5 to 90
Urgent Care
Copayment for Urgent Care $25.00
Emergency Room Visit
Copayment for Emergency Care $50.00
Ambulance Transportation
In-Network:

Ground Ambulance:
Coinsurance for Ground Ambulance Services 20%

Air Ambulance:
Coinsurance for Air Ambulance Services 20%

Health Care Services and Medical Supplies

Medica Prime Solution Thrift (Cost) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Coinsurance for Medicare-covered Chiropractic Services 20%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Coinsurance for Medicare-covered Diabetic Supplies 20%
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare-covered Diagnostic Procedures/Tests 20%
Copayment for Medicare-covered Lab Services $0.00

Outpatient Diag/Therapeutic Rad Services:
Coinsurance for Medicare-covered Diagnostic Radiological Services 20%
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Coinsurance for Medicare-covered X-Ray Services 20%
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$300.00 per day for days 1 to 4
$0.00 per day for days 5 to 90
Mental Health Outpatient Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20%
Coinsurance for Medicare-covered Group Sessions 20%
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 20%

Outpatient Observation Services:
Coinsurance for Medicare Covered Observation Services 20%

Ambulatory Surgical Center Services:
Coinsurance for Ambulatory Surgical Center Services 20%
Outpatient Substance Abuse Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20%
Coinsurance for Medicare-covered Group Sessions 20%
Podiatry Services
In-Network:
Coinsurance for Medicare-Covered Podiatry Services 20%
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$170.50 per day for days 21 to 100

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Comprehensive Dental:
Coinsurance for Medicare-covered Benefits 20%

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Coinsurance for Medicare Covered Benefits 20%

Eyewear:
Coinsurance for Medicare-Covered Benefits 20%

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Coinsurance for Medicare Covered Benefits 20%

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
    • Tobacco use cessation
    Yearly "Wellness" visit
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