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Benefits and Coverage

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Prime Solution Basic

2018 Plan Benefits

  • $0 copayment for primary care office visits
  • $20 copayment for specialist office visits
  • $50 emergency room copayment
  • $100 per day hospital inpatient copayment for Days 1-8 
  • $0 copayment for Medicare-covered preventive services
  • Out-of-network coverage available with snowbird coverage

Plan Features


Most of Medica's plans include a SilverSneakers® membership. This program gives members access to over 13,000 fitness locations nationwide. Enroll at multiple locations any time.

Learn more about SilverSneakers »

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.

HealthAdvocate website

Nationwide Travel and “Snowbird” Coverage

Whether you're going on a trip or spending part of the year in another area of the country, you'll have access to in-network medical benefits while you're away for up to nine consecutive months at a time with your Extended Absence Option (EAO). If you're going to be gone more than 90 days, please call us to activate your EAO.

About nationwide travel coverage

Preventive Care

When you receive preventive care, you won't have a copay. If during the visit you also receive care that's not considered preventive, then a copay will be charged. To avoid surprises, it's helpful to know what types of care are considered preventive care.

Learn more about preventive care »

Value-Added Services

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.

View the list of available discounts »

Prescription Eyewear and Hearing Aid Allowances

Receive reimbursement for up to $75 for eyewear per year, and up to $400 for a hearing aid evaluation, fitting and hearing aids per year. See your Evidence of Coverage for full details.

To request reimbursement, pay the purchase amount when you receive the items. Then complete and submit a claim form to us within 365 days from the date of service or purchase. We'll process your claim in about 30 days and will send you a check.

Get claim forms »

Member Rights and Responsibilities

As a Medicare member, you have certain rights and responsibilities, which the laws of your state outline.

Member rights and responsibilities

Medica is a Cost plan with a Medicare contract. Enrollment in Medica depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.

Y0088_5207 CMS Approved
Last Updated: November 2017

Date: 2/24/2018 5:46:23 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01