2027 Medicare Cost plan

Medica Prime Solution Standard (Cost): 2027 benefits and costs

Medica Cost

CMS plan ID: H2450-044-0 · Plan year: 2027

Medica Prime Solution Standard (Cost) is a 2027 Medicare Cost plan offered by Medica.

2027 plan costs at a glance

Monthly plan premiumNot listed in this release

In-network medical out-of-pocket maximum$7,150.00

Organization: Medica
Plan organization: MEDICA INSURANCE COMPANY
Parent company: Medica Holding Company
Plan type: Cost
Part C premium: Not listed in this release
Prescription drug coverage: No
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: $200.00
Applies to certain in-network supplemental services and certain in-network Medicare-covered services.
In-network medical maximum: $7,150.00
Applies to certain in-network supplemental services.

2027 benefit summary

Doctor visits and medical care

Plan-level deductibles may still apply when a service-specific deductible is listed as No.

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$15.00 copay Service-specific deductible No
Specialist visit	$60.00 copay Service-specific deductible No	Approval required No Referral required No
Emergency care	$130.00 copay
Urgent care	$50.00 copay
Home health	$0 Service-specific deductible No	Approval required No Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required No
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required No
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$60.00 copay Service-specific deductible No	Approval required No Referral required No
Other health professionals	$15.00 to $60.00 copay Service-specific deductible No	Approval required No Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $425.00 copay per day Days 6–90: $0.00 copay per day	Approval required No Referral required No Benefit period Original Medicare
Inpatient mental health care	$0.00 copay per stay Days 1–5: $425.00 copay per day Days 6–90: $0.00 copay per day	Approval required No Referral required No Benefit period Original Medicare
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required No Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0.00 to $500.00 copay Service-specific deductible No
Hospital observation services	$500.00 copay Service-specific deductible No
Ambulatory surgical center	$0.00 to $400.00 copay Service-specific deductible No	Approval required No Referral required No
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$15.00 to $60.00 copay Service-specific deductible No	Approval required No Referral required No
Laboratory services	$0 Service-specific deductible No	Approval required No Referral required No
Diagnostic radiology (CT, MRI)	$300.00 copay Service-specific deductible No	Approval required No Referral required No
Therapeutic radiology	$80.00 copay Service-specific deductible No	Approval required No Referral required No
X-rays	$60.00 copay Service-specific deductible No	Approval required No Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Intensive outpatient program	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Substance use treatment, individual sessions	$30.00 copay Service-specific deductible No	Approval required No Referral required No
Substance use treatment, group sessions	$30.00 copay Service-specific deductible No	Approval required No Referral required No
Opioid treatment program	$30.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$35.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$35.00 copay Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$60.00 copay Service-specific deductible No	Approval required No Referral required No
Psychiatry, group sessions	$60.00 copay Service-specific deductible No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$45.00 copay Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	$60.00 copay Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	$10.00 copay Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$350.00 copay Service-specific deductible No	Approval required No
Air ambulance	20% coinsurance Service-specific deductible No	Approval required No
Durable medical equipment	30% coinsurance Service-specific deductible No	Approval required No
Prosthetic devices	30% coinsurance Service-specific deductible No	Approval required No
Medical supplies	0% to 30% coinsurance Service-specific deductible No	Approval required No
Diabetic supplies	20% coinsurance Service-specific deductible No	Approval required No
Diabetic shoes and inserts	30% coinsurance Service-specific deductible No	Approval required No
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required No

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$15.00 to $60.00 copay
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
Other preventive dentalAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$15.00 to $60.00 copay Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$45.00 copay Service-specific deductible No	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$60.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$549.00 to $1,299.00 copay Service-specific deductible No	Approval required No Referral required No
Over-the-counter hearing aidsAdditional plan benefit	$999.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required 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.