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Medica Advantage Value (PPO) Medicare Advantage Plan H8889-019-1 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$7150.00In-network
Part B Giveback
−$40.00 reduction
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
0 beneficiaries
Last update:

Medica Advantage Value (PPO) Introduction

This Medicare Advantage PPO plan, Medica Advantage Value, is offered by Medica and uses a Preferred Provider Organization (PPO) provider network. It comes with 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 $7150.00. The plan is identified by CMS Plan ID H8889-019-1. The 2027 Part D prescription drug deductible is $700.00.

Plan Benefits

Medica Advantage Value includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H8889-019-1.

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: $30 copay		 Coming soon
Specialist In-network: $75 copay
Out-of-network: $90 copay		 Coming soon

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		 Coming soon
Telehealth benefit In-network: $0-$75 copay Coming soon
Routine chiropractic Not covered Coming soon
Fitness benefits Coming soon Coming soon
Health education Not covered Coming soon
Counseling services Not covered Coming soon
Over-the-counter drug benefits In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Health transportation (non-emergency) Coming soon Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$325 copay
Out-of-network: $0-$325 copay		 Coming soon
Lab services In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Outpatient x-rays In-network: $50 copay
Out-of-network: $50 copay		 Coming soon
Diagnostic tests and procedures In-network: $0-$325 copay
Out-of-network: $0-$325 copay		 Coming soon

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 Coming soon
Worldwide emergency care Coming soon Coming soon
Urgent care $50 copay Coming soon
Inpatient hospital care In-network:
Tier 1
$459 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$575 per day for days 1-6
$0 per day for days 7-90
$0 per stay		 Coming soon
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		 Coming soon
Ground ambulance In-network: $350 copay
Out-of-network: $350 copay		 Coming soon

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $65 copay
Out-of-network: $80 copay		 Coming soon
Outpatient group therapy In-network: $55 copay
Out-of-network: $70 copay		 Coming soon
Inpatient psychiatric hospital care In-network:
Tier 1
$459 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$575 per day for days 1-6
$0 per day for days 7-90
$0 per stay		 Coming soon

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $75 copay
Out-of-network: $90 copay		 Coming soon
Occupational therapy In-network: $50 copay
Out-of-network: $65 copay		 Coming soon

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		 Coming soon
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 Coming soon
Prosthetics In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 Coming soon

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		 Coming soon
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 Coming soon

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		 Coming soon
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 Coming soon
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 Coming soon
Periodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 Coming soon
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 Coming soon
Restorative services In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 Coming soon
Implant services Not covered Coming soon
Orthodontics Not covered Coming soon
Oral/Maxillofacial surgery In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 Coming soon

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		 Coming soon
Contact lenses In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Eyeglass frames only In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Eyeglass lenses only In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Upgrades In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon

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		 Coming soon
Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Prescription hearing aids In-network: $549-$1299 copay
Out-of-network: $549-$1299 copay		 Coming soon
OTC hearing aids In-network: $999 copay
Out-of-network: $999 copay		 Coming soon

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 Coming soon
Home-based palliative care Not covered Coming soon
Personal emergency response system Coming soon Coming soon
Weight management programs Not covered Coming soon
Wigs for chemotherapy-related hair loss Coming soon Coming soon
Alternative therapies Not covered Coming soon
Massage therapy Not covered Coming soon
Home/bathroom safety devices Not covered Coming soon

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

Prescription Drug Coverage

Medica Advantage Value 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 Value (H8889-019-1) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$0.00
Supplemental Part D Premium:$$0.00
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$24.60
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

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

Prescription Drug Plan Deductible

This plan has a $700.00 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 Value may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medica Advantage Value (H8889-019-1) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$9.00 copayComing soon
Preferred Brand15% coinsuranceComing soon
Non-Preferred Drug25% coinsuranceComing soon
Specialty Tier25% coinsuranceComing soon
Select Care Drugs$0.00 copayComing soon
*Deductible does not apply.

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.

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 Value (PPO)

What is the monthly premium for Medica Advantage Value (PPO)?

The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.

What is the in-network MOOP for plan H8889-019-1?

For 2027, the in-network maximum out-of-pocket is $7150.00. The plan pays 100% of covered in-network services beyond this amount.

What is the star rating for plan H8889-019-1 in 2027?

For 2027, plan H8889-019-1 has a CMS star rating of ★0.0 out of 5 stars.

What is the total enrollment for plan H8889-019-1?

Total enrollment is 0 beneficiaries based on the latest CMS data.

Is there a Part D deductible for this plan?

The Part D deductible is $700.00.

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
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Your coverage options 25 May, 2025

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.