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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
  • Specialist office visits:
    • $50 copayment for H6154-001
    • $45 copayment for H6154-002
  • $90 emergency room copayment
  • In-network hospital inpatient stays:
    • $350 per day, days 1-5, for H6154-001
    • $320 per day, days 1-5, for H6154-002
  • $0 copayment for Medicare-covered preventive services
  • Out-of-network coverage available for most Medicare-covered benefits through Point-of-Service benefit at 40% coinsurance 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

This plan includes a SilverSneakers® membership. This program gives members access to over 16,000 fitness locations nationwide. Enroll at multiple locations any time.

Get started by calling toll free at 1-877-871-7053 (TTY: 711), 7 a.m. to 7 p.m. Central, Monday through Friday.

Or visit online at 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 CVS.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 $400 per year for our HMO-POS plans.

Dental Reimbursement Claim Form (PDF)

Health Advocacy and Nurse LineHealth Advocate

HealthAdvocateTM 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 40% 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.

Preventive Care

Many preventive care services and screenings are covered at no cost to you when received from in-network providers. 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




Last Updated: December 2019

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