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Medica Prime Solution Thrift (Cost)

South Dakota Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$47
by Medica

Additional Coverage

Hearing

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Overview

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

Medica Prime Solution Thrift (Cost) is a Medicare Advantage Plan Without Prescription Drugs, which is available in South 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

Monthly Premium
$47
Annual Deductible
$50 In-network
Max Out-of-Pocket
$6,700
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
ER visit
$50 copay per visit (always covered)
Ambulance
20% coinsurance

Medica Prime Solution Thrift (Cost) has a monthly premium cost of $47 per month, with an annual deductible of $50 In-network and a maximum out of pocket cost sharing of $6,700 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 Thrift (Cost) are defined below.

Additional Benefits and Coverage

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

Medica Prime Solution Thrift (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 Thrift (Cost) includes coverage for hearing.

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

Other benefits

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

Comparing the Quality Score of Medica Prime Solution Thrift (Cost) to Other Plans in South 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 Prime Solution Thrift (Cost) received an overall government quality rating of 4.0 stars out of 5 stars.

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

This Plan’s 5-star Gov’t Quality Score
South Dakota State Average Score
Overall Government 5 Star Quality Rating
 4.0
 4.0
Summary rating of health plan quality
 4.5
 4.0
Staying healthy: screenings, tests, & vaccines
 3
 3.6
Managing chronic (long term) conditions
 3
 3.1
Member experience with health plan
 4
 4.1
Member complaints & changes in the health plan's performance
 5
 4.5
Health plan customer service
 5
 4.1

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 Thrift (Cost) received 4.5 stars for its health plan quality score which is better than the South Dakota State average health plan quality score of 4.0 stars.

Plan Benefits and Coverage Details

Monthly Premium
$47
Health Portion of Premium
$47
Drug Portion of Premium
$0
Health Plan Deductible
$50 In-network
Health Plan Max Out-of-Pocket
$6,700 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
No
Dental Coverage included
No
Doctor Lookup Link
http://medica.com/Members
Plan Link
http://medica.com

Medical Benefits

Doctor Services

Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
20% coinsurance
Lab services
$0 copay
Diagnostic radiology services (like MRI)
20% coinsurance
Outpatient x-rays
20% coinsurance
Emergency care
$50 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$300 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient hospital coverage
20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$214 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
20% coinsurance

Therapy services

Occupational therapy visit
20% coinsurance
Physical therapy & speech & language therapy visit
20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
20% coinsurance
Outpatient individual therapy with a psychiatrist
20% coinsurance
Outpatient group therapy visit
20% coinsurance
Outpatient individual therapy visit
20% coinsurance

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
0-20% coinsurance per item

Prescription Drug Benefits

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

Extra Benefits

Hearing

Hearing exam
20% coinsurance
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
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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