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Plan H2450-036-0: Medica Prime Solution Premier (COST) – 2025 Coverage Details for Brown County, SD

This page provides coverage, cost, and availability details for Medica’s H2450-036-0 Medicare Advantage plan for 2025.

See more Medicare Advantage Plans in Brown County, South Dakota.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this Medica plan (H2450-036-0) 4 (Good) out of 5 stars.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Medica logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

Medica Prime Solution Premier Basic Plan Details

Plan ID
H2450-036-0
Plan Type
Cost
Plan Year
2025
Premium
$217.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
3,000.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Not Included
Supplemental Benefits
Vision, Hearing
Availability
Brown County, SD
Insured By
Medica
Summary of Benefits

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Health Plan Out-of-Pocket Costs

This Medica Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H2450-036-0.

NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.

Doctor's Office Visits

Primary
Not Covered
Specialist
$10 Copay

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
$100 Copay
Urgent care
Not Covered
Ground ambulance
Not Covered
Inpatient hospital care
$200.00 per stay
Skilled Nursing Facility
$0.00 per day for days 1 through 20
$100.00 per day for days 21 and beyond

Foot Care

Foot Exams and Treatments (Medicare-covered)
Not Covered
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
Not Covered
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
Not Covered
Outpatient group therapy
Not Covered
Inpatient psychiatric hospital care
$200.00 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
Not Covered
Occupational therapy
Not Covered

Medical Equipment and Supplies

Diabetes supplies
20% Coinsurance
Durable medical equipment
Not Covered
Prosthetics
Not Covered

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
$100 Copay
Lab services
Not Covered
Outpatient x-rays
Not Covered
Diagnostic tests and procedures
Not Covered

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
Not Covered
Oral exam
$0
Dental x-rays
$0
Cleaning
$0
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered
Maximum dental benefit
$400.00 (Every year)

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None

Get a copy of the Medica Prime Solution Premier Summary of Benefits.

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Do you have questions about costs in this plan? Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent and learn more about this plan and other plans on this site (Mon-Fri 5am-6pm, Sat 6am-5pm PT).

Prescription Drug Costs & Benefits

This plan does not include a Medicare Part D plan for prescriptions.

Citations & References

Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.

For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.

Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.