Medica Advantage Value (PPO)
South Dakota Medicare Advantage Plan (2025 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
Medica Advantage Value (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in South 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
Medica Advantage Value (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 $3,900 In and Out-of-network $3,900 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 Value (PPO) are defined below.
Additional Benefits and Coverage
Medica Advantage Value (PPO) 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 Advantage Value (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Medica Advantage Value (PPO) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
$3,900 In-network
Medical Benefits
Doctor Services
Out-of-network: $25 copay per visit
Out-of-network: $55 copay per visit
Tests, labs, & imaging
Out-of-network: $0-125 copay
Out-of-network: $0 copay
Out-of-network: $0-125 copay
Out-of-network: $20 copay
Hospital Services
$0 per day for days 6 through 90
Out-of-network: $500 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $0-545 copay per visit
Skilled nursing facility
$214 per day for days 21 through 38
$0 per day for days 39 through 100
Out-of-network: $100 per day for days 1 through 20
$214 per day for days 21 through 38
$0 per day for days 39 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $295 copay
Therapy services
Out-of-network: $55 copay
Out-of-network: $55 copay
Mental health services
Out-of-network: $55 copay
Out-of-network: $55 copay
Out-of-network: $55 copay
Out-of-network: $55 copay
Opioid treatment services
Other services
Out-of-network: 30% coinsurance per item
Out-of-network: 30% 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
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|---|---|
Preferred Generic | $0.00 copay | $0 copay |
Generic | $15.00 copay | $0 copay |
Preferred Brand | 18% coinsurance | $0 copay |
Non-Preferred Drug | 50% coinsurance | $0 copay |
Specialty Tier | 27% coinsurance | $0 copay |
Part B Drugs
Out-of-network: 0-30% coinsurance
Out-of-network: 0-30% coinsurance
Extra Benefits
Hearing
Out-of-network: $25-40 copay
Out-of-network: $0 copay
Out-of-network: $549-1,299 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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