Medica Insurance Review & Complaints: Health Insurance

Medica Insurance Company offers health insurance for individuals and also offers a range of supplemental plans. Medica healthcare plans include Altru Prime, Inspiration Health, Medica Applause, and Medica Connect alongside a selection of Medica Medicare Supplement and Advantage plans.

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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 place to get it.

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Written by Eric Stauffer
Founder & Former Insurance Agent Eric Stauffer

Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years Leslie Kasperowicz

UPDATED: Jun 1, 2022

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Minnesota-based Medica provides health insurance to members in several surrounding states. Medica offers a range of options including employer-sponsored, individual and family, and supplemental coverage.

This Medica insurance review will cover all of the Medica Insurance plans available, including Medicare Advantage health coverage options. We’ll look at how to obtain Medica insurance quotes and how the insurance company stacks up.

Before you buy Medica insurance coverage, make sure you have looked at all of your options

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What is Medica?

Medica was founded as the first open-access plan in Minnesota in 1975, under the name Physician’s Health Plan. Medica was formed in 1991 after a merger with Share, although it only lasted a few years. In 1994, a merger with Healthspan resulted in a change to the name Allina Health System. Medica re-emerged as an independent health insurance provider in 2001.

Today Medica offers individual plans in Minnesota, Iowa, Kansas, Nebraska, North Dakota, and parts of Wisconsin. Employer and government-sponsored plans are offered in Minnesota and some parts of North Dakota, South Dakota, and Wisconsin. The company covers 1.2 million people according to the Medica website.

Medica offers both direct and marketplace health plans for individuals to choose from. This affordable health insurance plan can be purchased through the company directly or through open enrollment on the marketplace website.

The company’s headquarters is in Minnetonka, Minnesota. The Medica Insurance phone number is available on the company website.

Medica Insurance providers include the Mayo Clinic doctors. For Medica Insurance COVID testing, contact your healthcare provider.

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What products does Medica offer?

Medica writes health insurance directly and also offers a range of supplemental plans and health insurance options through partnerships with local health systems. Each of the plans provides a local provider network as well as nationwide out-of-network coverage.

What are the Individual Medica Health Plans?

Medica offers a fairly wide range of health plan options, but not all plans are available in all areas. Some offer a limited in-network coverage area, while others are much broader. Copays and deductibles will depend on which plan you choose and the state in which you reside. Due to a large number of plans, this review will give a basic overview of each.

Altru Prime by Medica is offered in a small section of northeast Minnesota and northwest North Dakota. Altru Health System, along with a selection of partner systems including the Mayo Clinic, provides in-network coverage. There are two different plan options offered depending on the state.

Inspiration Health by HealthEast and Medica is a partnership between Medica and HealthEast Care System. This plan is offered only in the east metro area of the Twin Cities, Minneapolis/St. Paul. There are bronze, silver, and gold level plans offered with this option.

Medica Applause is a plan offered through the majority of Minnesota and North Dakota. This plan has the most options for service, with nearly 26,000 providers in the Applause network. There are bronze, silver, and gold level medical coverage plans offered and coverage is available across a multi-state area, as well as out of network nationwide.

Medica Connect is the newly introduced health plan for the state of Kansas. It is offered throughout the state and offers a statewide network of providers. There are many different options, including bronze, silver, and gold, as well as HSA and catastrophic plans.

Medica Individual Choice is offered in several counties of northeastern Wisconsin. Like Kansas, plans available are a broad selection of choices, and coverage is offered in-network in multiple areas, even outside covered counties.

Medica Insure is the plan offered in Iowa and Nebraska, with statewide availability. The network includes 97% of doctors and 100% of the hospitals in both states. Again, there are multiple plan levels available including HSA and catastrophic options.

Medica health care services with Mayo Clinic are offered in southern Minnesota, and the network centers on the Mayo Clinic Health System. Like the other plans, members can choose from bronze, silver, and gold level plans as well as catastrophic and HSA options.

North Memorial Acclaim by Medica covers the western part of the Twin Cities metro area. It offers the same options for plan coverage as the rest of the health system partnerships.

Are Medicare plans available?

Medica offers a selection of Medicare Advantage and Supplement plans. For a sample, we used a zip code in the Twin Cities metro area.

There are five Medicare Advantage plans available. The Thrift plan has the lowest monthly Medicare premiums and is also the only plan with a deductible, although it is only $50. The remaining plans have no deductible, and copays decrease as premium increases. The most expensive plan option offers a $3,000 out of pocket maximum and primary care visits covered with no copay.

Two of the plans, Basic and Advanced, offer hearing aid coverage as well as coverage for eyewear, while the other three plans have no coverage for these services. Value, Basic, and Enhanced all offer dental coverage.

All of the plans have the option to add a Part D prescription drug rider.

The Medica Select Solution II is the company’s Medicare Supplement Insurance Plan or Medigap coverage, and there are two plans to choose from under this heading. The Basic and Extended plans provide health coverage for out-of-pocket costs not paid for by Medicare.

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What other products are offered?

Medica lists several supplemental plans on its website: Critical Illness and Accident, Pet Insurance, Dental Insurance, and Short-term Insurance. All of these are underwritten and administered by other companies, and not directly by Medicare. When considering these additional services, it’s best to read our reviews of the companies that will actually handle the administration.

Are Medica’s insurance rates competitive?

The area in which you live and which of the plans you select will affect rates. We ran a quote in the HealthEast coverage area of the Twin Cities to obtain sample rates. The quote system returned several options for a 30-year-old single non-tobacco user.

The lowest available rate was the Bronze level HSA plan at $315.51 per month. This plan has a $6,400 individual deductible. The most expensive option was the Gold Copay Plus plan, at $476.21. This plan has a $1,000 individual deductible.

Since there are many plans and so many variables, it is difficult to compare these rates to other insurance companies. They come in around what we have seen in other major metro areas for single coverage, but overall seem a little on the high side for an affordable price.

Medica Medicare Advantage rates are straightforward and listed along with the plan descriptions. They start at $49 for the Thrift plan and go up to $157 for the Enhanced plan. Medica does not offer a $0 premium Advantage plan as many other insurance companies do – at least not in our sample zip code.

How are claims processed?

Each of the Medica plans will handle claims directly with the health care providers; for each plan, in-network coverage will likely be processed faster than out-of-network coverage.

Products that are sold by other companies, such as Delta Dental, will have claims handled directly by that company’s claims department.

Use your Medica Insurance login to follow up on claims.

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Does the company have positive consumer reviews?

The Better Business Bureau (BBB) gives Medica a D+ rating, based on 16 complaints in the past three years and one complaint to which the business failed to respond. This is a surprisingly harsh reduction in rating, given the fact that Medica is a large company and 16 complaints in three years is quite a low complaint volume.

There are other companies with more than one complaint that was not responded to that have received higher ratings than this.

Medica’s last rating with the National Committee for Quality Assurance was in 2014 when the company was given an overall rating of 3, which is not particularly impressive. In the specific area of claims handling, however, the company ranks with a 5 and has 4 and 5 ratings in several other areas.

There are 13 complaints about Medica on Pissed Consumer. Most of these cite poor customer service, while a few mention difficulties with authorizations for surgery and other procedures.

What’s the bottom line?

Medica is a large company covering several states and uses several different health systems across those states to provide its networks. Some people may find Medica’s networks limited, depending on the location.

Medica’s health insurance plan options may cause some confusion, and the rates are on the high side, but the company does appear to have a fairly good reputation and offer access to the renowned Mayo Clinic on many of its plans.

Medica Insurance is worth considering for those in the coverage area, but we would recommend a more state and county-specific rate comparison based on your own zip code.

While an affordable Medica Insurance plan might be a good choice for you, you can be sure you have the right plan when you shop around. Compare rates for health insurance right now with our free quote tool.

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