Medica Prime Solution Standard (Cost)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Medica
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: South Dakota

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$0
$4,500 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

$0 copay
$35 copay per visit

Tests, labs, & imaging

$0-35 copay
$0 copay
$35-150 copay
$0-35 copay
$90 copay per visit (always covered)
$0-35 copay per visit (always covered)

Hospital Services

$280 per day for days 1 through 5
$0 per day for days 6 through 90
$200 copay per visit

Skilled nursing facility

Coming soon

Preventive services

$0 copay

Ambulance

$200 copay

Therapy services

$35 copay
$35 copay

Mental health services

$35 copay
$35 copay
$30 copay
$30 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
20% coinsurance per item

Prescription Drug Benefits

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

Part B Drugs

20% coinsurance
20% coinsurance

Extra Benefits

Hearing

$35 copay
$0 copay
$0 copay

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Vision

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 4.5
 4
 3
 4
 5
 5

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