Primary Payer Information for Medicare and Medicaid Products

• Medicare is primary for all part A and B services
• No Out-of-Network benefits (unless case of emergency)
• If Medicare denies: Plan pays for routine screening procedures, preventive health services and state mandated services

For more comprehensive details, see the following resources:

• Medica Medicare and Medicaid Products Grid
• Medica Select Solution Fact Sheet (PDF)

• Medicare is primary for all part A and B services
• If Medicare denies; plan pays for state mandated services
• Members may have purchased additional preventive non-Medicare covered health services (annual physical, eye exam, hearing exam, etc)

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Signature Solution Fact Sheet (PDF)

• Medica is primary for all Medicare and Medicaid-covered services
• No Out-of-Network benefits (unless case of emergency or prior authorized)
• All members are assigned a care system, but can receive covered services from any network provider within the service area

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica AccessAbility Solution Enhanced/Special Needs BasicCare (SNBC) SNP Fact Sheet (PDF)

• For SNBC members who are not eligible for Medicare coverage; Medica is the only payer for all Medicaid covered services 
• For SNBC members who are eligible for Medicare; Medicare is the primary payer and Medica coordinates benefits via CMS
• No Out-of-Network benefits (unless case of emergency or prior authorized)
• All members are assigned a care coordinator and can receive care from any network provider within the service area

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica AccessAbility Solution/Special Needs BasicCare (SNBC) Fact Sheet (PDF)

• For in-network providers, Medicare is primary for all part A services, or any part B services billed on a UB-04. Medica is primary for all part B services billed on a CMS-1500.
• For out-of-network providers, Medicare is primary for all part A and B services
• In most cases, there are no out-of-network benefits (unless in case of emergency) within the Medica service area- Medicare is the only payer.
• Out-of-network travel benefits apply outside of the Medica service area, Medicare is primary for all part A and B services, Medica will coordinate on all Medicare allowed charges

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Prime Solution Fact Sheet (PDF)

• Medica is primary for all part A and B services
• No Out-of-Network benefits (unless case of emergency)

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Advantage Solution (HMO) Fact Sheet (PDF)

• Medica is primary for all part A and B services
• Most Medicare-covered services are also covered out-of-network through Point-of-Service (POS) benefit.

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Advantage Solution (HMO-POS) Fact Sheet (PDF)

• Medica is primary for all part A and B services
• Members may receive coverage for both in-network and out-of-network services.

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Advantage Solution (PPO) Fact Sheet (PDF)

• For MSC+ members who are not eligible for Medicare coverage; Medica is the only payer for all Medicaid-covered services 
• For MSC+ members who are eligible for Medicare; Medicare is the primary payer and Medica coordinates benefits via CMS
• All members are assigned a care coordinator and can receive care from any network provider within the service area
• No Out-of-Network benefits (unless case of emergency or prior authorized)

For more comprehensive details, see the following resources:

• Medica Medicare and Medicaid Products Grid
• Medica Choice Care MSC+/Minnesota Senior Care Plus (MSC+) Fact Sheet (PDF)

• Medica is primary for all Medicare and Medicaid-covered services
• No Out-of-Network benefits (unless case of emergency or prior authorized)
• All members are assigned a care system, but can receive care from any network provider within the service area

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Dual Solution/Minnesota Senior Health Options (MSHO) Fact Sheet (PDF)

• Medica is primary for all Medicaid-covered services
• No Out-of-Network benefits (unless case of emergency or prior authorized)
• All members choose or are assigned a Primary Care Clinic (PCC) but can receive care from any network provider within the service area and can choose a different PCC

For more comprehensive details, see the following resources: 

• Medica Medicare and Medicaid Products Grid
• Medica Choice Care PMAP & Medica MinnesotaCare Fact Sheet (PDF)