2027 Medicare Advantage plan
Medica Advantage Salute (PPO): 2027 benefits and costs
Medica PPO
CMS plan ID: H8889-009-0 · Plan year: 2027
Medica Advantage Salute (PPO) is a 2027 Medicare Advantage plan offered by Medica.
2027 plan costs at a glance
Monthly plan premium$0.00
In-network medical out-of-pocket maximum$4,450.00
- Organization
- Medica
- Plan organization
- MEDICA HEALTH PLANS
- Parent company
- Medica Holding Company
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $49.50 (estimated)$209.50 standard premium less $160.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $4,450.00
- Combined in/out-of-network medical maximum
- $6,700.00
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $160.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0
| $30.00 copay
| |
| Specialist visit | $50.00 copay
| $65.00 copay
|
|
| Telehealth | $0.00 to $50.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $150.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 30% coinsurance
|
|
| Dialysis | 20% coinsurance
| 30% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
| Kidney disease education services | $0
| $0
|
|
| Medicare-covered chiropractic | $15.00 copay
| $35.00 copay
|
|
| Medicare-covered foot care | $50.00 copay
| $65.00 copay
|
|
| Other health professionals | $0.00 to $50.00 copay
| $30.00 to $65.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–6: $405.00 copay per day Days 7–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–6: $345.00 copay per day Days 7–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–42: $221.00 copay per day Days 43–100: $0.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $300.00 copay
| $0.00 to $375.00 copay
| |
| Hospital observation services | $405.00 copay
| $455.00 copay
| |
| Ambulatory surgical center | $0.00 to $200.00 copay
| $0.00 to $250.00 copay
|
|
| Outpatient blood | $0
| $50.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $90.00 copay
| $0.00 to $90.00 copay
|
|
| Laboratory services | $0
| $0
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $90.00 copay
| $0.00 to $90.00 copay
|
|
| Therapeutic radiology | $80.00 copay
| $80.00 copay
|
|
| X-rays | $25.00 copay
| $25.00 copay
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $130.00 copay
| $140.00 copay
|
|
| Intensive outpatient program | $130.00 copay
| $140.00 copay
|
|
| Substance use treatment, individual sessions | $40.00 copay
| $55.00 copay
|
|
| Substance use treatment, group sessions | $30.00 copay
| $55.00 copay
|
|
| Opioid treatment program | $40.00 copay
| $55.00 copay
|
|
| Mental health, individual sessions | $40.00 copay
| $55.00 copay
|
|
| Mental health, group sessions | $30.00 copay
| $55.00 copay
|
|
| Psychiatry, individual sessions | $40.00 copay
| $55.00 copay
|
|
| Psychiatry, group sessions | $30.00 copay
| $55.00 copay
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $50.00 copay
| $65.00 copay
|
|
| Physical and speech therapy | $50.00 copay
| $65.00 copay
|
|
| Cardiac rehabilitation | $40.00 copay
| $60.00 copay
|
|
| Intensive cardiac rehabilitation | $50.00 copay
| $70.00 copay
|
|
| Pulmonary rehabilitation | $35.00 copay
| $70.00 copay
|
|
| Supervised exercise for peripheral artery disease | $25.00 copay
| $50.00 copay
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $395.00 copay
| $395.00 copay
|
|
| Air ambulance | $475.00 copay
| $475.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 30% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 30% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 30% coinsurance
|
|
| Diabetic supplies | 0% to 20% coinsurance
| 0% to 20% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
| 30% coinsurance
|
|
| Diabetic monitors | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $0.00 to $50.00 copay | $0.00 to $50.00 copay
| |
| Oral examsAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0 | 50% coinsurance
| |
| FluorideAdditional plan benefit | $0 | 50% coinsurance
| |
| Other preventive dentalAdditional plan benefit | $0 | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 50% coinsurance | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $50.00 copay
| $0.00 to $65.00 copay
|
|
| Routine eye examsAdditional plan benefit | $0 | $0
|
|
| Medicare-covered eyewear | $0
| $0
|
|
| Contact lensesAdditional plan benefit | $0 | $0
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 | $0
|
|
| Eyeglass lensesAdditional plan benefit | $0 | $0
|
|
| Eyeglass framesAdditional plan benefit | $0 | $0
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Other Eye Exam ServicesAdditional plan benefit | Out-of-network | $0
| |
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| UpgradesAdditional plan benefit | Out-of-network | $0
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $0.00 to $50.00 copay
| $0.00 to $65.00 copay
|
|
| Routine hearing examsAdditional plan benefit | $0 | $0
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | $0
|
|
| Prescription hearing aids (all types)Additional plan benefit | $549.00 to $1,299.00 copay
| $549.00 to $1,299.00 copay
|
|
| Over-the-counter hearing aidsAdditional plan benefit | $999.00 copay
| $999.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| $0
| |
| Annual physical examAdditional plan benefit | $0
| $0
|
|
| Fitness benefitAdditional plan benefit | $0
| $0
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | $0
| |
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | $0
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | $0
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Allowances and optional benefits
Benefits for qualifying members
Additional benefits for qualifying members with chronic conditions
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; Chronic lung disorders; Neurologic disorders; Stroke
- To qualify
- Participation in a Care Management Program
- Included services
- Meal Benefit; Home and Bathroom Safety Devices and Modifications
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- No
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 4 states or territories. Availability can vary by county and ZIP code.
View all locations 117 county listings across 4 states or territories
Minnesota
- Anoka, Minnesota
- Beltrami, Minnesota
- Benton, Minnesota
- Big Stone, Minnesota
- Blue Earth, Minnesota
- Brown, Minnesota
- Carver, Minnesota
- Cass, Minnesota
- Chisago, Minnesota
- Cottonwood, Minnesota
- Dakota, Minnesota
- Dodge, Minnesota
- Douglas, Minnesota
- Faribault, Minnesota
- Fillmore, Minnesota
- Freeborn, Minnesota
- Hennepin, Minnesota
- Houston, Minnesota
- Isanti, Minnesota
- Jackson, Minnesota
- Kandiyohi, Minnesota
- Lac qui Parle, Minnesota
- Lincoln, Minnesota
- Lyon, Minnesota
- Martin, Minnesota
- Mower, Minnesota
- Murray, Minnesota
- Nicollet, Minnesota
- Nobles, Minnesota
- Olmsted, Minnesota
- Pennington, Minnesota
- Pope, Minnesota
- Ramsey, Minnesota
- Redwood, Minnesota
- Scott, Minnesota
- Sherburne, Minnesota
- Stearns, Minnesota
- Steele, Minnesota
- Wabasha, Minnesota
- Waseca, Minnesota
- Washington, Minnesota
- Watonwan, Minnesota
- Winona, Minnesota
- Wright, Minnesota
Nebraska
- Adams, Nebraska
- Antelope, Nebraska
- Boone, Nebraska
- Buffalo, Nebraska
- Cedar, Nebraska
- Clay, Nebraska
- Cuming, Nebraska
- Custer, Nebraska
- Dakota, Nebraska
- Dixon, Nebraska
- Franklin, Nebraska
- Frontier, Nebraska
- Furnas, Nebraska
- Garfield, Nebraska
- Gosper, Nebraska
- Greeley, Nebraska
- Hall, Nebraska
- Hamilton, Nebraska
- Harlan, Nebraska
- Holt, Nebraska
- Howard, Nebraska
- Jefferson, Nebraska
- Kearney, Nebraska
- Knox, Nebraska
- Loup, Nebraska
- Madison, Nebraska
- Merrick, Nebraska
- Nance, Nebraska
- Nemaha, Nebraska
- Nuckolls, Nebraska
- Pawnee, Nebraska
- Phelps, Nebraska
- Pierce, Nebraska
- Platte, Nebraska
- Sherman, Nebraska
- Stanton, Nebraska
- Thayer, Nebraska
- Thurston, Nebraska
- Valley, Nebraska
- Wayne, Nebraska
- Webster, Nebraska
- Wheeler, Nebraska
North Dakota
South Dakota
- Brookings, South Dakota
- Butte, South Dakota
- Campbell, South Dakota
- Clark, South Dakota
- Codington, South Dakota
- Corson, South Dakota
- Custer, South Dakota
- Davison, South Dakota
- Day, South Dakota
- Deuel, South Dakota
- Dewey, South Dakota
- Fall River, South Dakota
- Haakon, South Dakota
- Hamlin, South Dakota
- Harding, South Dakota
- Jackson, South Dakota
- Kingsbury, South Dakota
- Lawrence, South Dakota
- Marshall, South Dakota
- Meade, South Dakota
- Pennington, South Dakota
- Perkins, South Dakota
- Roberts, South Dakota
- Sanborn, South Dakota
- Spink, South Dakota
- Walworth, South Dakota
- Ziebach, South Dakota