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 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
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,000
Primary doctor visit
$15 copay per visit
Specialist visit
$60 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$350 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.
Additional Benefits and Coverage
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
Comparing the Quality Score of Medica Prime Solution Standard (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 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 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 Standard (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.
In this article we rank South 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 South 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 South Dakota.