2027 Medicare Cost plan

Medica Prime Solution Thrift w/Rx (Cost): 2027 benefits and costs

Medica Cost

CMS plan ID: H2450-007-0 · Plan year: 2027

Medica Prime Solution Thrift w/Rx (Cost) is a 2027 Medicare Cost plan offered by Medica.

2027 plan costs at a glance

Monthly plan premium$91.00
Drug deductible$700.00
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
$53.00
Part D premium
$38.00
Prescription drug coverage
Yes
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
$50.00

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
ServiceIn-networkWhat to know
Primary care doctor

20% coinsurance

Service-specific deductible
No
Specialist visit

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Emergency care

$130.00 copay

Urgent care

$25.00 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

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered foot care

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Other health professionals

20% coinsurance

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.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–5: $350.00 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: $350.00 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
ServiceIn-networkWhat to know
Outpatient hospital care

0% to 20% coinsurance

Service-specific deductible
No
Hospital observation services

20% coinsurance

Service-specific deductible
No
Ambulatory surgical center

0% to 20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Outpatient blood

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

20% coinsurance

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)

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
X-rays

20% coinsurance

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
ServiceIn-networkWhat to know
Partial hospitalization

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Intensive outpatient program

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Substance use treatment, individual sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Substance use treatment, group sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Opioid treatment program

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Mental health, individual sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Mental health, group sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Psychiatry, individual sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Psychiatry, group sessions

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Physical and speech therapy

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Cardiac rehabilitation

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Intensive cardiac rehabilitation

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Pulmonary rehabilitation

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Supervised exercise for peripheral artery disease

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

20% coinsurance

Service-specific deductible
No
Approval required
No
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
No
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
No
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
No
Medical supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
No
Diabetic supplies

20% coinsurance

Service-specific deductible
No
Approval required
No
Diabetic shoes and inserts

20% 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
ServiceIn-networkWhat to know
Medicare-covered dental

20% coinsurance

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered eyewear

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

20% coinsurance

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

These benefit details are not listed.

Prescription drug coverage

Costs shown are for initial coverage.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$10.00

$20.00

$30.00

Tier 3Preferred Brand

19%

19%

19%

Tier 4Non-Preferred Drug

45%

45%

45%

Tier 5Specialty Tier

25%

Not listedNot listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Preferred mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$10.00

$20.00

$30.00

Tier 3Preferred Brand

19%

19%

19%

Tier 4Non-Preferred Drug

45%

45%

45%

Tier 5Specialty Tier

25%

Not listedNot listed

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days90 days
Tier 1Preferred Generic

$10.00

$20.00

$30.00

Tier 2Generic

$20.00

$40.00

$60.00

Tier 3Preferred Brand

19%

19%

19%

Tier 4Non-Preferred Drug

45%

45%

45%

Tier 5Specialty Tier

25%

Not listedNot listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$10.00

Tier 3Preferred Brand

19%

Tier 4Non-Preferred Drug

45%

Tier 5Specialty Tier

25%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$10.00

Tier 3Preferred Brand

19%

Tier 4Non-Preferred Drug

45%

Tier 5Specialty Tier

25%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only

Special cost protections apply to covered insulin and recommended adult vaccines.

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 125 county listings across 4 states or territories

Minnesota

North Dakota

South Dakota

Wisconsin