Medica Prime Solution Standard (Cost)

North Dakota Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Medica

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Name
Medica Prime Solution Standard (Cost)
Insurance Carrier
Medica
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
COST

Medica Prime Solution Standard (Cost) is a Medicare Advantage Plan Without Prescription Drugs, which is available in North Dakota and offered by the health insurance company Medica. This plan’s network type is COST which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,000
Primary doctor visit
$15 copay per visit
Specialist visit
$50 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$250 copay

Medica Prime Solution Standard (Cost) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Medica Prime Solution Standard (Cost) are defined below.

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Medica Prime Solution Standard (Cost) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Medica Prime Solution Standard (Cost) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Medica Prime Solution Standard (Cost) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Medica Prime Solution Standard (Cost) received an overall government quality rating of 4.0 stars out of 5 stars.

Medica Prime Solution Standard (Cost) performed the same as North Dakota’s State average overall quality score of 4.0 stars.

This Plan’s 5-star Gov’t Quality Score
North Dakota State Average Score
Overall Government 5 Star Quality Rating
 4.0
 4.0
Summary rating of health plan quality
 3.5
 3.9
Staying healthy: screenings, tests, & vaccines
 3
 3.6
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
 4
 3.8
Member complaints & changes in the health plan's performance
 4
 4.1
Health plan customer service
 5
 4.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Medica Prime Solution Standard (Cost) received 3.5 stars for its health plan quality score which is worse than the North Dakota State average health plan quality score of 3.9 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
$15 copay per visit
Specialist visit
$50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$15-50 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$50-150 copay
Outpatient x-rays
$15-50 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$15-50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$325 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient hospital coverage
$325 copay per visit

Skilled nursing facility

Skilled nursing facility
In 2024 the amounts for each benefit period are:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$250 copay

Therapy services

Occupational therapy visit
$45 copay
Physical therapy & speech & language therapy visit
$50 copay

Mental health services

Outpatient group therapy with a psychiatrist
$50 copay
Outpatient individual therapy with a psychiatrist
$50 copay
Outpatient group therapy visit
$30 copay
Outpatient individual therapy visit
$30 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$25 copay per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$50 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay

Comprehensive dental

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

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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