Skip to Main Content
Members

« Return to previous page

My Coverage

For Medica Prime Solution (Cost) Standard Members

Looking for a quick overview of your plan benefits?

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

  • $0 copayment for primary care office visits
  • $35 coinsurance for specialist office visits
  • $90 emergency room copayment
  • $280 per day for days 1-5 hospital inpatient copayment
  • $0 copayment for Medicare-covered preventive services
  • Out-of-network coverage available with snowbird coverage

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

Member plan documents

 

Plan Features

One Pass

Your plan includes a fitness benefit through One Pass with unlimited access to a national network of more than 20,000 fitness clubs, in-person, on-demand and live streaming fitness classes. A personalized, online brain training program to help improve memory, attention, focus and brain speed.  For more information visit medica.com/Fitness or call 1-877- 504-6830 (TTY: 711), available Monday-Friday, 8 a.m.-9 p.m. (Central).

Health Advocacy and Nurse LineHealth Advocate

You and your family have a place to turn for trusted advice and information when you need it most. 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 you with a variety of health and insurance-related issues. For more information, visit HealthAdvocate.com/MedicaMedicare or call 1-866-668-6548 (TTY: 711), available 24 hours a day, 7 days a week (Central) .

 

Nationwide Travel and “Snowbird” Coverage

You have coverage with full in-network benefits within the United States for up to 9 consecutive months. If you plan to be away from home for more than 90 days, simply call Medica's customer service to activate the Extended Absence Option to have access and coverage to out-of-network providers. We'll take care of the rest.

About nationwide travel coverage

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.

About preventive care

Discount 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

Caregiving Resources

Caring for loved ones in need of your help is an honorable act. However, taking care of a seriously ill family member can be emotionally and physically exhausting.

We want to support you. Here are some resources that can help you manage your caregiving responsibilities.

Caregiving resources

Tobacco Cessation Counseling Support

If you use tobacco, but would like to quit, you have access to two levels of counseling support depending on your health status. Signs or symptoms of tobacco-related disease determine your eligibility of coverage for counseling quit attempts as a preventive service at no extra cost to you.

Get tobacco free

This information is not a complete description of benefits. Call Medica at 1-800-234-8755 (TTY: 711) for more information.

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


Last Updated: December 2020

Y0088_55035

Date: 5/28/2023 3:41:16 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01