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Medica Prime SolutionSM with Part D Prescription Drug Coverage Summary Table

2008 Information
Supplemental Medicare Coverage


This table shows you what your monthly prescription drug plan premium costs if you qualify and receive extra help paying for your Medicare Part D prescription benefits with Prime Solution.

Your Level of Extra Help

Monthly Premium* with Medica Part D Rider – Modified Standard Rx

Monthly Premium* with Medica Part D Rider – Enhanced Rx

100%

$0.00

$13.10

75%

$6.70

$19.50

50%

$13.30

$26.00

25%

$20.00

$32.40



Contact Medica Customer Service for details at 952-992-2345 or 1-800-906-5432. TTY users may call 952-992-3650 or 1-800-234-8819.
Hours of operation: 8 AM – 8PM, CST 7 days a week.

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How to Contact Us

CMS File #H2409, H2450, H2458, H7526_14727 (10/2007)