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H2450 - 048 - 0
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Medica Prime Solution Premier (Cost)is a Medicare Advantage (Part C) Plan by Medica.
This page features plan details for 2024 Medica Prime Solution Premier (Cost)H2450 – 048 – 0 available in Select counties in KS, MO, and OK.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Medica Prime Solution Premier (Cost)is offered in the following locations.
Adair County, Oklahoma
Alfalfa County, Oklahoma
Barber County, Kansas
Click to see more locations
Plan Overview
Medica Prime Solution Premier (Cost)offers the following coverage and cost-sharing.
| Insurer: | Medica |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,000 In-network |
| Drugs Covered: | No |
Ready to sign up for Medica Prime Solution Premier (Cost)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
Premium Breakdown
Medica Prime Solution Premier (Cost)has a monthly premium of $138.00. This amount includes your Part C premium but does not include your Part B premium.
| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $138.00 | $0.00 | $312.70 |
Please Note:
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Medica Prime Solution Premier (Cost)also provides the following benefits.
| $0 |
| In-network | No |
| $3,000 In-network |
| No |
| In-network | No |
| $100 copay per visit (Authorization is not required.) (Referral is not required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $0 copay (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $0 copay (Not applicable.) (Not applicable.) |
| Urgent care | $0 copay (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0 copay (Authorization is not required.) (Referral is not required.) |
| Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $0-50 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient x-rays | $0 copay (Authorization is not required.) (Referral is not required.) |
| Hearing exam | $0 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Occupational therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
| Physical therapy and speech and language therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
| $0 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $0 copay (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is not required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is not required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is not required.) (Not applicable.) |
| $100 per stay (Authorization is not required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $100 per stay (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $25 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.) |
Ready to sign up for Medica Prime Solution Premier (Cost)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
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Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
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