Medica Prime Solution Standard w/Rx (Cost)
North Dakota Medicare Advantage Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
Medica Prime Solution Standard w/Rx (Cost) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, 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.
Cost Summary
Medica Prime Solution Standard w/Rx (Cost) has a monthly premium cost of $49 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 w/Rx (Cost) are defined below.
Additional Benefits and Coverage
Medica Prime Solution Standard w/Rx (Cost) is a Medicare Advantage plan which does 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 w/Rx (Cost) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Medica Prime Solution Standard w/Rx (Cost) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of Medica Prime Solution Standard w/Rx (Cost) to Other Plans in North Dakota
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 w/Rx (Cost) received an overall government quality rating of 4.0 stars out of 5 stars.
Medica Prime Solution Standard w/Rx (Cost) performed the same as North Dakota’s State average overall quality score of 4.0 stars.
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 w/Rx (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.
Medica Prime Solution Standard w/Rx (Cost) received 4.5 stars for its drug plan quality score which is better than the North Dakota State average drug plan quality score of 4.2 stars.
Plan Benefits and Coverage Details
Medical Benefits
Doctor Services
Tests, labs, & imaging
Hospital Services
$0 per day for days 5 through 90
Skilled nursing facility
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Mental health services
Opioid treatment services
Other services
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $0.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $15.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | 50% | ||
| Specialty Tier | 33% |
Part B Drugs
Extra Benefits
Hearing
Preventive Dental
Comprehensive dental
Vision
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