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Benefits and Coverage

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Prime Solution Basic

Plan Benefits

  • $0 copayment for primary care office visits
  • $10 copayment for specialist office visits
  • $50 emergency room copayment
  • $0 copayment for Medicare-covered preventive services
  • $100 maximum inpatient hospital copayment per stay
  • Out-of-network coverage available with Original Medicare coverage and benefits

Plan Features

Silver_Fit_logoSilver&Fit® Exercise and Healthy Aging Program

Your plan provides a standard membership at one of the many participating fitness centers so you can use exercise equipment, steam and sauna rooms, and attend exercise classes. You choose which activities you wish to participate in. Or, if you would rather work out at home, there's a home exercise option where you can choose two home exercise kits annually from a variety of options. No matter what your current fitness level, this program makes It easy participate.

Learn more at Silver&Fit »

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.

Learn more about HealthAdvocate »

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.

Learn more about your 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 Benefits

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.

Member Rights and Responsibilities

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

View your 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 co-payments/co-insurance may change on January 1 of each year.


Y0088_4226 CMS Approved
Last Updated: January 2016

Date: 7/31/2016 12:19:46 AM Version: 4.0.30319.34209 Machine Name: PWIVE-CMSWEB02