Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO
Medica Advantage Solution H8889-009 (PPO) 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 PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$4,900
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$325 copay
Medica Advantage Solution H8889-009 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,900 In and Out-of-network
$4,900 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 Advantage Solution H8889-009 (PPO) are defined below.
Additional Benefits and Coverage
No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
Medica Advantage Solution H8889-009 (PPO) 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 Advantage Solution H8889-009 (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Medica Advantage Solution H8889-009 (PPO) 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
Comparing the Quality Score of Medica Advantage Solution (PPO) 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 2025, Medica Advantage Solution (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.
Medica Advantage Solution (PPO) performed worse than North Dakota’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
North Dakota State Average Score
Overall Government 5 Star Quality Rating
3.5
3.8
Summary rating of health plan quality
3.5
4.0
Staying healthy: screenings, tests, & vaccines
4
3.6
Managing chronic (long term) conditions
3
3.1
Member experience with health plan
4
4.0
Member complaints & changes in the health plan's performance
5
4.4
Health plan customer service
3
4.0
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 Advantage Solution (PPO) received 3.5 stars for its health plan quality score which is worse than the North Dakota State average health plan quality score of 4.0 stars.
In-network: $350 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $400 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
In-network: $0-395 copay per visit
Out-of-network: $0-445 copay per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 43
$0 per day for days 44 through 100
Out-of-network: $100 per day for days 1 through 20
$214 per day for days 21 through 43
$0 per day for days 44 through 100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $325 copay
Out-of-network: $325 copay
Therapy services
Occupational therapy visit
In-network: $35 copay
Out-of-network: $50 copay
Physical therapy & speech & language therapy visit
In-network: $35 copay
Out-of-network: $50 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $50 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $50 copay
Outpatient group therapy visit
In-network: $25 copay
Out-of-network: $50 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $50 copay
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
In this article we rank North Dakota Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in North Dakota is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in North Dakota.
Health Plan Radar