Medicare Advantage · Local PPO
Medica
Plan year 2026

Medica Advantage Value (PPO) H8889-017

3.5 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$25
+ your Part B premium
Max out-of-pocket
$6,750
in-network annual cap
Primary care
$0
per visit copay
Specialist
$60
per visit

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$615
Inpatient hospital
Days 1-5: $500/day, Days 6-90: $0/day
no limit on covered hospital days
Inpatient mental health
Days 1-8: $290/day, Days 9-90: $0/day
Outpatient surgery
$550
Emergency room
$130
Urgent care
$50

What's included, and what it's actually worth5 benefits included. Tap any card for the detail

Hearing

$549–$1,299copay per hearing aid
Details$549–$1,299 copay per hearing aid
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Dental

$400/yr preventive dental allowance
Details$400/yr preventive dental allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$75/yr eyewear allowance
Eyewear allowance$75/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

OTC allowance

$30per 6 months OTC allowance
Prepaid card$30 per 6 months OTC allowance
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$60 copay
In-network$60 copay per visit
Inpatient Hospital$500/day, days 1–5
In-networkDays 1-5: $500/day, Days 6-90: $0/day
Benefit limitNone — additional covered days are unlimited
Outpatient Surgery$550 copay
In-network$550 copay per procedure
Mental HealthDays 1-8: $290/day, Days 9-90: $0/day
Inpatient psychiatricDays 1-8: $290/day, Days 9-90: $0/day
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$0
Preferred Generic
Tier 2
$5
Generic
Tier 3
18%
Preferred Brand· after deductible
Tier 4
50%
Non-Pref Brand· after deductible
Tier 5
25%
Specialty· after deductible

Our take

Where this plan shines

See your primary doctor for $0.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
The specialist copay ($60) is on the higher side — worth comparing if you see specialists often.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Medica Advantage Value (PPO) (Local PPO)

What does Medica Advantage Value (PPO) (Local PPO) cover?

Medica Advantage Value (PPO) (Local PPO) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental ($400/yr preventive dental allowance), vision ($75/yr eyewear allowance), hearing ($549–$1,299 copay per hearing aid), and over-the-counter (OTC) ($30 per 6 months OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Medica Advantage Value (PPO) (Local PPO) cost in 2026?

The published 2026 monthly plan premium for Medica Advantage Value (PPO) (Local PPO) is $25. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $615. The in-network medical out-of-pocket maximum is $6,750; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $60. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Medica Advantage Value (PPO) (Local PPO)?

CMS lists Medica Advantage Value (PPO) (Local PPO) as a Local PPO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does Medica Advantage Value (PPO) (Local PPO) cover my prescriptions?

Medica Advantage Value (PPO) (Local PPO) has 5 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $0, Tier 2 at $5, Tier 3 at 18%, Tier 4 at 50%, and Tier 5 at 25%. The listed Part D deductible is $615. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

Check your prescriptions

What dental, vision, and hearing benefits does Medica Advantage Value (PPO) (Local PPO) include?

The current plan record for Medica Advantage Value (PPO) (Local PPO) lists dental ($400/yr preventive dental allowance), vision ($75/yr eyewear allowance), and hearing ($549–$1,299 copay per hearing aid). It also lists over-the-counter (OTC) ($30 per 6 months OTC allowance). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in Medica Advantage Value (PPO) (Local PPO)?

Medica Advantage Value (PPO) (Local PPO) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Browse the full 2026 Medicare Advantage with drug coverage directory. This plan is offered in South Dakota. Plan availability can vary by county.

Helpful next steps