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Avera Medicare Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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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.

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.

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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 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 $193.14 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 $126.98, 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.

Claims

Like most Medicare companies, Avera handles claims directly with the providers. It is rare that a member will need to become involved with a claim, but it may happen when an out of network provider is used.

Avera does not give much claims information on their website – which is not surprising – but there is a section for forms, including prescription reimbursement claims.

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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 2017. 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.

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.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

1 Comment

  1. Avera health insurance is by far the worse health insurance provider I have dealt with in my 63 years on the earth. If you have an accident outside of Avera’s network be prepared for bankruptcy. I broke my leg and have damage to all the ligaments requiring surgery for multi ligament knee reconstruction. I can’t move without a walker or wheelchair. Making a four day journey back to in-network was demanded to the extent of bullying or a patient prisoner to the border of Avera’s network. Summary to this point: I have a qualified surgeon, I can have a date for the three hour surgery, out of network my deductible $5,000 – my co-payment is 60% – 40% (I pay the 60%), this 60% is of the entire bill. I have no idea how much out of pocket I’m out. When I purchased the policy I was assured by the ACA navigator that this was the best plan for traveling outside SD through the PHCS/MULTIPLAN network. According to Avera Multiplan is used in the most narrow of interpretation. Healthcare.gov was wrong? Avera has applied the delay and deny tactics and their statements (EOBs) are unreadable. The people who have the power to make decisions are so isolated it is virtually impossible to communicate effectively. If at all possible stay away from this health insurer. By the way, my premium for the year is right around $14,000 dollars – partly subsidized by ACA. imagine paying $14,000 and then $5,000 out of network deductible an 60% of an unlimited amount. Is robbery or what?

    Susan

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