|Medicare Advantage Plan Benefit Details in Plain Text|
|The following Medicare Advantage plan benefits apply to the Medica Prime Solution Core w/Rx (Cost) (H2450 - 035) in Traill, North Dakota . |
This plan is administered by MEDICA INSURANCE COMPANY. To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Medica Prime Solution Core w/Rx (Cost) health and prescription benefit details in chart format
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|The Medica Prime Solution Core w/Rx (Cost) has a monthly premium of $115.70. That is $1,388.40 for 12 months. There are a few factors that can increase or decrease this premium.
If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.
Please remember that the $115.70 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).|
|This Medicare Advantage Plan with Prescription Drug Coverage is a Cost plan.|
|Plan Membership and Plan Ratings|
|The Medica Prime Solution Core w/Rx (Cost) (H2450 - 035) currently has 4,301 members. There are 53 members enrolled in this plan in Traill, North Dakota, and 2,031 members in North Dakota.|
|The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $325 deductible. So, you are 100% responsible for the first $325 in medication costs. After you have met the deductible, the Medica Prime Solution Core w/Rx (Cost) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2019 is $415, but this plan (Medica Prime Solution Core w/Rx (Cost)) has a $325. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.|
|The following information is about the Medica Prime Solution Core w/Rx (Cost) formulary (or drug list). There are 3282 drugs on the Medica Prime Solution Core w/Rx (Cost) formulary. Click here to browse the Medica Prime Solution Core w/Rx (Cost) Formulary.|
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $325, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Medica Prime Solution Core w/Rx (Cost)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: |
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 63% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Medica Prime Solution Core w/Rx (Cost)) offers No Coverage during the Coverage Gap phase.
|The Medica Prime Solution Core w/Rx (Cost) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.|