Avera Medicare Insurance Review & Complaints: Health Insurance (2023)

Based in Sioux Falls, SD, Avera serves South Dakota as well as parts of Nebraska, Iowa, and Minnesota. They are a faith-based company providing Christian services to the members in addition to health insurance and medical services. Avera’s products include individual health insurance plans and Medicare Supplement plans.

This Avera Medicare review will cover which plans are available, Avera Medicare quotes, and the company’s ratings.

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About Avera

Avera’s history goes back to the partnership of two Catholic orders, the Benedictine Sisters of Yankton, SD, and the Presentation Sisters of Aberdeen, SD. While they are no longer directly involved with Avera, they continue to be a sponsor, which means Avera is a part of the Catholic Church. They operate today as a ministry, combining modern health care with faith-based values.

As a healthcare provider, Avera has been at the forefront of technology, having created their online system, eCare back in 1993. They were the first to offer liver transplant and bone marrow services in their area.

The health plans division of Avera was started in 1999 to provide coverage for employees, but not long after they expanded to offer coverage to the general public.

With over 330 locations in 86 counties, Avera has good coverage in the areas they serve. The provide health plans to anyone in their service area who does not have an employer-provided plan. Although they do not require members of their health plan to be a part of the Catholic Church, they do operate from faith-based tenets, which is something all those seeking coverage should know. In addition to medical services, spiritual services including counseling are available.

Avera writes a selection of individual health plans. Currently, Avera’s Medicare offerings are limited to supplement plans and they are only available in South Dakota and Iowa.

Avera Medicare Supplement Plans

Avera writes Medicare Supplement in two states: Iowa and South Dakota, and while rates vary, the same plans are offered in both states.

The available standard letter-coded plans are A, B, C, F, F with a high deductible, G, K, L, M, and N. That is most of the possible variations of Medicare supplement under the standard system, and one of the best lists we have seen from any company writing supplement plans.

All Medicare companies offer Plan A, which is the base plan and pays for coinsurance amounts for hospital, medical, and hospice as well as the first three pints of blood each year.

From there, the plans add additional coverage, up to Plan F, which covers all out-of-pocket expenses that are not paid for under Medicare. Avera also offers the high deductible option for that plan, which reduces the rates to make the coverage more affordable.

Plans are available with either Standard or Select provider networks; Select is a more limited network of providers.

Avera Medicare Rates

Avera has a rate chart for each state that outlines what each person will pay for coverage based on their age and gender.

For a 65-year-old female, the standard Plan will cost $199.09 a month. Since Avera only serves a limited area, we are unable to truly compare these premiums to companies operating nationwide or to our usual sample rate taken based on a California resident. That said, this is one of the highest rates we have seen anywhere for Plan A.

The Select version of the plan, using a more limited network, is considerably less expensive. With the Select network, the rate for the same plan and person drops to $82.84, which is much more in line with Plan A prices elsewhere.

It is common for insurance companies to charge less for service in a more limited network, so this is not surprising, but we do find the Standard network price to be very high in any situation.

Navigating the Avera Medicare Claims Process

Ease of Filing a Claim

When it comes to the claims process, Avera Medicare Insurance aims to provide policyholders with ease and convenience. They offer multiple methods for filing a claim, ensuring that individuals can choose the one that suits them best.

Policyholders have the option to file a claim online through their user-friendly digital portal, over the phone by speaking directly with a representative, or even through mobile apps for added convenience. This flexibility simplifies the process, allowing policyholders to report incidents and initiate claims through their preferred channel.

Average Claim Processing Time

Avera Medicare Insurance prioritizes swift and efficient claim processing to minimize any delays in providing coverage. While the specific processing time may vary depending on the complexity of the claim and individual circumstances, Avera aims to handle claims promptly.

On average, policyholders can expect their claims to be processed within a reasonable time frame, typically within 7 to 10 business days. This commitment to timely resolutions ensures that policyholders receive the support they need when it matters most.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback plays a vital role in evaluating the effectiveness of an insurance provider’s claims process. Although there may be limited available feedback specific to Avera Medicare Insurance, reviews and overall industry reputation suggest that they are dedicated to fair and efficient claim resolutions.

Positive experiences shared by policyholders align with Avera’s commitment to providing exceptional service during claim resolutions.

Exploring the Avera Medicare Digital and Technological Features

Mobile App Features and Functionality

Recognizing the importance of digital convenience, Avera Medicare Insurance offers a comprehensive mobile app equipped with various features and functionalities. The mobile app empowers policyholders to manage their insurance matters effortlessly.

With this app, policyholders can file claims, access policy details, and conveniently oversee their accounts. It is a valuable digital tool that enables customers to handle insurance-related tasks conveniently, anytime and anywhere.

Online Account Management Capabilities

Avera Medicare Insurance provides a user-friendly online platform that enhances online account management for policyholders. This platform enables easy access to essential services, including policy management, billing information, and document retrieval.

By offering transparent and convenient online account management capabilities, Avera ensures that customers stay informed and maintain control over their insurance affairs.

Digital Tools and Resources

In addition to their online services, Avera Medicare Insurance offers a range of digital tools and resources designed to empower policyholders with valuable information. These resources include informative articles, guides, and interactive tools that provide insights into various healthcare topics.

Furthermore, Avera’s online quote generation tools allow customers to obtain cost estimates, facilitating effective assessment of their insurance needs. These digital assets underscore Avera’s commitment to providing customers with knowledge and resources to make informed decisions regarding their healthcare coverage.

Avera Medicare Ratings and Consumer Reviews

Avera currently has an A+ rating with the Better Business Bureau (BBB), with only one complaint on file in the past three years. That complaint was closed in the past twelve months.

The National Committee for Quality Assurance gives Avera a 3.5 rating overall for 2019, the most recent available. In the underlying categories, they were given a 2.0 rating overall for consumer satisfaction, ranking fairly low in most areas of the survey. Higher rankings in specific treatment areas push their overall rating up to 3.5.

There are 12 reviews of Avera on Google, for an overall 2.3 rating. None of the reviews are directly related to Medicare. There are multiple complaints of increasing rates and poor service.

In general complaint volume for Avera is very low, but the NCQA ranking is lower than we like to see.

Avera Medicare: The Bottom Line

Avera’s Medicare plans are on the pricey side, but this company may appeal to those who like the idea of a local company. If you are ok with a more limited network for your care, the rates can be more competitive. As a faith-based healthcare company, Avera may have an added appeal to those of the Catholic faith.

Affordable Avera Medicare plans might be a good choice for you, but shopping around is a great choice. Just enter your ZIP code for free comparison quotes.