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My Coverage

For Medica Medicare Advantage Solution (HMO-POS) Members

Looking for a quick overview of your plan benefits?

Here's a summary of your plan benefits and common associated costs.

  • $20 copayment for primary care office visits
  • $45 copayment for specialist office visits
  • $90 emergency room copayment
  • $320 per day in-network hospital inpatient copayment for days 1-5
  • $0 copayment for Medicare-covered preventive services
  • $6,700 annual out-of-pocket maximum for in-network benefits
  • Out-of-network coverage available for most benefits through Point-of-Service benefit at 20% coinsurance after deductible
  • 20% coinsurance for worldwide emergency coverage
  • Part D drugs with up to $2 copay for Tier 1 drugs (after deductible)

For a complete record of your plan benefits and any plan notices, see your legal plan documents.

Legal plan documents

 

Plan Features

SilverSneakersSilverSneakers

Most of Medica's plans include a SilverSneakers® membership. This program gives members access to over 14,000 fitness locations nationwide. Enroll at multiple locations any time.

SilverSneakers website

Over-the-Counter Drugs and Supplies Allowance

Your Medica Advantage Solution plan has a benefit allowance that can be used toward the purchase of eligible over-the-counter (OTC) health and wellness products. This quarterly allowance varies by plan. Orders can be placed online at MedicaHealthPlans.otchs.com or by phone. To see the list of available products, view the OTC Catalog.

OTC Catalog (PDF)

Dental Reimbursement Offered

Advantage Solution offers reimbursement for non-Medicare covered dental services provided by any licensed dentist. This covers both preventive and restorative care. The annual reimbursement amount is up to $150 per year for our HMO-POS plans.

Dental Reimbursement Claim Form (PDF)

Health Advocacy and Nurse LineHealth Advocate

HealthAdvocate℠ combines nurse line services with personal health advocacy services. Through one simple call, you can consult with a nurse to get support for non-urgent illnesses or receive guidance on treatment options. You can also work with a personal health advocate who can help a variety of health and health care issues.

About HealthAdvocate

Point-of-Service (POS) Benefit

When you visit an out-of-network provider anywhere in the U.S. and its territories for non-emergency care, you pay 20% coinsurance for most covered services after your $400 out-of-network deductible is met. You may use any provider that accepts Medicare. Not all services are covered. We pay up to $100,000 per year for covered services received from out-of-network providers.

Preventive Care

Many preventive care services and screenings are covered at no cost to you. This includes immunizations such as flu and pneumonia shots. For easy access to recommended preventive screenings for men, women and children of all ages, view our preventive care information. 

About preventive care

Discounts Programs

As a Medica Medicare member, you can get discounts on a variety of health and leisure goods and services through our value-added programs at no extra cost.

Discounts on value added-services



Medica is an HMO-POS plan with a Medicare contract.  Enrollment in Medica depends on contract renewal.

This information is not a complete description of benefits. Call Medica at 1-866-269-6804 (TTY: 711) for more information.

Value-Added Items and Services (VAIS) is not a plan benefit.


Last Updated: May 2019

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