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Medica Advantage Select (PPO) Medicare Advantage Plan H8889-002 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$122.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$7150.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $420.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
11,319 beneficiaries
Last update:

Medica Advantage Select (PPO) Introduction

Medica Advantage Select is a Medicare Advantage PPO plan offered by Medica. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $122.00 monthly premium, $0.00 medical deductible, and $7150.00 in-network maximum out-of-pocket. CMS Plan ID H8889-002 identifies this plan. The 2027 Part D prescription drug deductible is $420.00.

Plan Benefits

Medica Advantage Select has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H8889-002.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $15 copay		 In-network: $0 copay
Out-of-network: $15 copay
Specialist In-network: $60 copay
Out-of-network: $75 copay		 In-network: $50 copay
Out-of-network: $55 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Telehealth benefit In-network: $0-$60 copay In-network: $0-$50 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$250 copay
Out-of-network: $0-$250 copay		 In-network: $0-$90 copay
Out-of-network: $0-$90 copay
Lab services In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Outpatient x-rays In-network: $35 copay
Out-of-network: $35 copay		 In-network: $25 copay
Out-of-network: $25 copay
Diagnostic tests and procedures In-network: $0-$250 copay
Out-of-network: $0-$250 copay		 In-network: $0-$90 copay
Out-of-network: $0-$90 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $150 copay
Worldwide emergency care Coming soon 20% coinsurance
Urgent care $45 copay $0-$45 copay
Inpatient hospital care In-network:
Tier 1
$600 per stay
Out-of-network:
$750 per stay		 In-network:
Tier 1
$400 per stay
Out-of-network:
$550 per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-54
$0 per day for days 55-100
Out-of-network:
$100 per day for days 1-20
$221 per day for days 21-61
$0 per day for days 62-100
$0 per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-41
$0 per day for days 42-100
Out-of-network:
$100 per day for days 1-20
$218 per day for days 21-32
$0 per day for days 33-100
$0 per stay
Ground ambulance In-network: $395 copay
Out-of-network: $395 copay		 In-network: $395 copay
Out-of-network: $395 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $50 copay
Out-of-network: $65 copay		 In-network: $40 copay
Out-of-network: $45 copay
Outpatient group therapy In-network: $40 copay
Out-of-network: $55 copay		 In-network: $30 copay
Out-of-network: $45 copay
Inpatient psychiatric hospital care In-network:
Tier 1
$600 per stay
Out-of-network:
$750 per stay		 In-network:
Tier 1
$400 per stay
Out-of-network:
$550 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $60 copay
Out-of-network: $75 copay		 In-network: $50 copay
Out-of-network: $55 copay
Occupational therapy In-network: $50 copay
Out-of-network: $65 copay		 In-network: $50 copay
Out-of-network: $55 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Periodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Restorative services In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Implant services Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Contact lenses Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass frames only Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass lenses only Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglasses (frames & lenses) Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Upgrades Not covered In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Prescription hearing aids In-network: $549-$1299 copay
Out-of-network: $549-$1299 copay		 In-network: $549-$1299 copay
Out-of-network: $549-$1299 copay
OTC hearing aids In-network: $999 copay
Out-of-network: $999 copay		 In-network: $499.5 copay
Out-of-network: $499.5 copay

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Medica Advantage Select as a Part B benefit.

Prescription Drug Coverage

Medica Advantage Select includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Medica Advantage Select (H8889-002-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$19.20
Supplemental Part D Premium:$$0.00
Total Part D Premium:$19.20
Low-Income Premium Subsidy:$24.60
Low-Income Premium Subsidy Paid by CMS:$19.20
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $420.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Medica starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Medica Advantage Select may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medica Advantage Select (H8889-002-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$11.00 copayComing soon
Preferred Brand18% coinsuranceComing soon
Non-Preferred Drug25% coinsuranceComing soon
Specialty Tier28% coinsuranceComing soon
Select Care Drugs$0.00 copayComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H8889)

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.

2027 Medicare Star Ratings for Contract H8889
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Medica Advantage Select (PPO)

How much does plan H8889-002 cost per month?

The plan’s monthly premium is $122.00 for 2027. The Part B premium is not included.

What is the MOOP for Medica Advantage Select in 2027?

The 2027 in-network MOOP is $7150.00. Once this limit is reached, covered in-network costs are fully covered.

What is the CMS star rating for Medica Advantage Select?

The 2027 CMS star rating for Medica Advantage Select is ★0.0 out of 5.

How many beneficiaries are enrolled in this plan?

CMS reports 11,319 beneficiaries enrolled in this plan.

What is the prescription drug deductible for 2027?

For 2027, the prescription drug deductible is $420.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Medica (official source) http://medica.com/ October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.