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Medica DUAL Solution (HMO D-SNP) H2458-002 • 2027 • Koochiching County, MN

CMS Rating: Not yet rated by CMS.
Monthly Premium
$24.60Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Koochiching County, MN
Local Enrollment
58 beneficiaries in Koochiching County
Last update:

Introduction

Medica DUAL Solution, offered by Medica, is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) identified by CMS Plan ID H2458-002. The plan's Health Maintenance Organization (HMO) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $24.60 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.

This plan is available to eligible beneficiaries who live in Koochiching County, Minnesota. According to CMS, 58 beneficiaries in Koochiching County are enrolled in this plan. New members can contact the plan at (800)266-2157 (TTY 711) for help and additional plan information.

Eligibility

Medica DUAL Solution is a Dual Eligible Special Needs Plan (D-SNP) designed for individuals enrolled in both Medicare and Medicaid.

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Koochiching County

Compare this plan with the most-enrolled other HMO D-SNP plan available in Koochiching County, Minnesota. Enrollment is based on CMS local enrollment data.

HMO D-SNP plan comparison for Koochiching County, Minnesota
Plan Detail Medica DUAL Solution SecureBlue
CMS Plan ID H2458-002-0 H2425-001-0
Local Enrollment 58 142
Monthly Premium $24.60 $0.00
Medical Deductible Coming soon Coming soon
Maximum Out-of-Pocket $9,850.00 $9,850.00
Part B Giveback Coming soon Coming soon
Primary Care Coming soon Coming soon
Specialist Coming soon Coming soon
Part D Deductible $700.00 $700.00
CMS Star Rating Not yet rated Not yet rated
Dental Coming soon Coming soon
Vision Coming soon Coming soon
Hearing Coming soon Coming soon

Plan Benefits

Medica DUAL Solution 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 H2458-002.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2458-002-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0 copay

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
In-network: $0 copay
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$0 copay
Worldwide emergency care
Coming soon
Urgent care
$0 copay
Inpatient hospital care
Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$0 per day for days 21-100
Ground ambulance
In-network: $0 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 copay
Outpatient group therapy
In-network: $0 copay
Inpatient psychiatric hospital care
Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Occupational therapy
In-network: $0 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: $0 copay
Prosthetics
In-network: $0 copay

Medicare Part B Drugs

Chemotherapy
In-network: $0 copay
Other Part B drugs (Medicare-covered)
In-network: $0 copay

Dental Services

Oral exam
Not covered
Dental x-rays
Not covered
Cleaning
Not covered
Periodontics
Not covered
Endodontics
Not covered
Restorative services
Not covered
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
Not covered

Vision Services

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
Not covered
Upgrades
In-network: $0 copay

Hearing Services

Hearing exam
Not covered
Fitting/evaluation
Not covered
Prescription hearing aids
Not covered
OTC hearing aids
Not covered

Additional and Special Needs Services

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

Certain preventive services are covered 100% by Medica DUAL Solution as a Part B benefit.

Prescription Drug Coverage

Medica DUAL Solution 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.

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 DUAL Solution (H2458-002-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$24.60
Supplemental Part D Premium:$0.00
Total Part D Premium:$24.60
Low-Income Premium Subsidy:$24.60
Low-Income Premium Subsidy Paid by CMS:$24.60
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 DUAL Solution may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medica DUAL Solution (H2458-002-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic25% coinsurance25% coinsurance
Generic25% coinsurance25% coinsurance
Preferred Brand25% coinsurance25% coinsurance
Non-Preferred Drug25% coinsurance25% coinsurance
Specialty Tier25% coinsurance25% coinsurance
Select Care Drugs$0.00 copay$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H2458)

CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.

2027 Medicare Star Ratings for Contract H2458
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 ☆☆☆☆☆
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 Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
CMS.gov Medicare Advantage Plan Fact Sheet April 28, 2026
Medicare.gov Joining a plan April 28, 2026

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