Health Plan RadarIn this article we rank South Dakota Medicare Advantage plans based on our evaluation of government 5-star quality scores.
Read more →Medica Advantage Essential (PPO)
by Medica
2027 Medicare Advantage plan available in South Dakota
Plan ID H8889-027-2
Additional coverage:
RxHearingVisionDental
Medicare Advantage PPO
Monthly plan premium $34 / mo
Annual deductible $250 / yr
Max out-of-pocket · in-network $7,150 / yr
Drug deductible $700 / yr
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Plan Overview
Medica Advantage Essential (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 the in-network doctors who accept the plan and whether a referral is needed.
Plan Name Medica Advantage Essential (PPO)
Insurance Carrier Medica
Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type PPO
Cost Summary
Medica Advantage Essential (PPO) has a monthly premium cost of $34 per month, with an annual deductible of $250 annual deductible and a maximum out-of-pocket cost sharing of $7,150. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $34 / mo
Health portion of premium $15
Drug portion of premium $19
Annual Deductible $250 annual deductible / yr
Max Out-of-Pocket · in-network $7,150 / yr
Primary doctor visit $0 copay
Specialist visit $75 copay
ER visit $130 copay
Ambulance $370 copay
Additional Benefits and Coverage
Medica Advantage Essential (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Medica Advantage Essential (PPO) includes coverage for hearing, vision, dental.
Part D Prescription Drug Coverage Yes
Dental Yes
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Not covered
Over-the-counter drug benefits Not covered
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Not covered
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $25 copay
Out-of-network: $25 copay
Specialist visit In-network: $75 copay
Out-of-network: $90 copay
Out-of-network: $90 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0-$500 copay
Out-of-network: $0-$500 copay
Out-of-network: $0-$500 copay
Lab services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI) In-network: $0-$500 copay
Out-of-network: $0-$500 copay
Out-of-network: $0-$500 copay
Outpatient x-rays In-network: $75 copay
Out-of-network: $75 copay
Out-of-network: $75 copay
Emergency care $130 copay
Urgent care $50 copay
Hospital Services
Inpatient hospital coverage In-network:
Tier 1
$459 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$575 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Tier 1
$459 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$575 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Outpatient hospital coverage In-network: $0-$650 copay
Out-of-network: $0-$815 copay
Out-of-network: $0-$815 copay
Skilled nursing facility
Skilled nursing facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-54
$0 per day for days 55-100
Out-of-network:
$100 per day for days 1-20
$221 per day for days 21-61
$0 per day for days 62-100
$0 per stay
Tier 1
$0 per day for days 1-20
$221 per day for days 21-54
$0 per day for days 55-100
Out-of-network:
$100 per day for days 1-20
$221 per day for days 21-61
$0 per day for days 62-100
$0 per stay
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $370 copay
Out-of-network: $370 copay
Out-of-network: $370 copay
Therapy services
Occupational therapy visit In-network: $50 copay
Out-of-network: $65 copay
Out-of-network: $65 copay
Physical therapy & speech & language therapy visit In-network: $75 copay
Out-of-network: $90 copay
Out-of-network: $90 copay
Mental health services
Outpatient group therapy with a psychiatrist In-network: $55 copay
Out-of-network: $70 copay
Out-of-network: $70 copay
Outpatient individual therapy with a psychiatrist In-network: $65 copay
Out-of-network: $80 copay
Out-of-network: $80 copay
Outpatient group therapy visit In-network: $55 copay
Out-of-network: $70 copay
Out-of-network: $70 copay
Outpatient individual therapy visit In-network: $65 copay
Out-of-network: $80 copay
Out-of-network: $80 copay
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: 18% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Out-of-network: 0%-30% coinsurance
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic $0.00 copay $0 copay
Generic $10.00 copay $0 copay
Preferred Brand 15% coinsurance $0 copay
Non-Preferred Drug 25% coinsurance $0 copay
Specialty Tier 25% coinsurance $0 copay
Part B drugs
Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Out-of-network: 0%-30% coinsurance
Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Out-of-network: 0%-30% coinsurance
Extra Benefits
Hearing
Hearing exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription In-network: $549-$1299 copay
Out-of-network: $549-$1299 copay
Out-of-network: $549-$1299 copay
Hearing aids - over the counter In-network: $999 copay
Out-of-network: $999 copay
Out-of-network: $999 copay
Preventive dental
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Fluoride treatment Not covered
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
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 In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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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