Medica Advantage Salute (PPO) Medicare Advantage Plan H8889-009 • 2027
CMS Rating:
(4.0 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4450.00In-network
- Part B Giveback
- −$160.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 3,651 beneficiaries
Last update:
Medica Advantage Salute (PPO) Introduction
This Medicare Advantage PPO plan, Medica Advantage Salute, is offered by Medica and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $4450.00. The plan is identified by CMS Plan ID H8889-009.
Plan Benefits
Cost-sharing for Medica Advantage Salute includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H8889-009.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $30 copay |
In-network: $0 copay Out-of-network: $30 copay |
| Specialist | In-network: $50 copay Out-of-network: $65 copay |
In-network: $50 copay Out-of-network: $65 copay |
Preventive and Wellness Services
| 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-$50 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 | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$90 copay Out-of-network: $0-$90 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: $25 copay Out-of-network: $25 copay |
In-network: $25 copay Out-of-network: $25 copay |
| Diagnostic tests and procedures | In-network: $0-$90 copay Out-of-network: $0-$90 copay |
In-network: $0-$90 copay Out-of-network: $0-$90 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $130 copay |
| Worldwide emergency care | Coming soon | 20% coinsurance |
| Urgent care | $40 copay | $0-$45 copay |
| Inpatient hospital care | In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $455 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $455 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-42 $0 per day for days 43-100 Out-of-network: $100 per day for days 1-20 $221 per day for days 21-43 $0 per day for days 44-100 $0 per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-52 $0 per day for days 53-100 Out-of-network: $100 per day for days 1-20 $218 per day for days 21-43 $0 per day for days 44-100 $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
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $40 copay Out-of-network: $55 copay |
In-network: $40 copay Out-of-network: $55 copay |
| Outpatient group therapy | In-network: $30 copay Out-of-network: $55 copay |
In-network: $30 copay Out-of-network: $55 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $455 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $455 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $50 copay Out-of-network: $65 copay |
In-network: $50 copay Out-of-network: $65 copay |
| Occupational therapy | In-network: $50 copay Out-of-network: $65 copay |
In-network: $50 copay Out-of-network: $65 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 0%-20% 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: 20% coinsurance |
Medicare Part B Drugs
| 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
| 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
| 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 | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| 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
| 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 Salute as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H8889)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| 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 |
Contact Information for Medica
- Website
- Medica Plan Page
- Providers
- Medica Providers Page
- Formulary
- Medica Formulary Page
- Pharmacy
- Medica Pharmacy Page
- New Member Health Plan Help
- (800)906-5432
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Medica Advantage Salute (H8889-009-0) is available in the following locations:
Iowa Counties Served
Minnesota Counties Served
- Anoka
- Becker
- Beltrami
- Benton
- Big Stone
- Blue Earth
- Brown
- Carver
- Cass
- Chippewa
- Chisago
- Clay
- Clearwater
- Cottonwood
- Crow Wing
- Dakota
- Dodge
- Douglas
- Faribault
- Fillmore
- Freeborn
- Grant
- Hennepin
- Houston
- Hubbard
- Isanti
- Jackson
- Kandiyohi
- Kittson
- Lac Qui Parle
- Lake Of The Woods
- Lincoln
- Lyon
- Mahnomen
- Marshall
- Martin
- Morrison
- Mower
- Murray
- Nicollet
- Nobles
- Norman
- Olmsted
- Otter Tail
- Pennington
- Polk
- Pope
- Ramsey
- Red Lake
- Redwood
- Renville
- Roseau
- Scott
- Sherburne
- Stearns
- Steele
- Swift
- Todd
- Wabasha
- Wadena
- Waseca
- Washington
- Watonwan
- Wilkin
- Winona
- Wright
Nebraska Counties Served
North Dakota Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Medica Advantage Salute (PPO)
What is the monthly premium for Medica Advantage Salute (PPO)?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H8889-009?
For 2027, the in-network maximum out-of-pocket is $4450.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H8889-009?
Total enrollment is 3,651 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H8889-009?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Medicare Plan Data Sources and Methodology
| 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.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Medica (official source) | http://medica.com | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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