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

About 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 their website.

Medica offers both direct and marketplace health plans for individuals to choose from. They can be purchased through the company directly or through the marketplace website. The company’s headquarters is in Minnetonka, Minnesota.

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Medica Products

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

Individual Health Plans

Medica offers several 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. Co pays 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 the 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 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 with Mayo Clinic is 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.

Medicare Plans

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 premium and is also the only plan with a deductible, although it is only $50. The remaining plans have no deductible, and co pays decrease as premium increases. The most expensive plan offers a $3,000 out of pocket maximum and primary care visits covered with no co pay.

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 or Medigap coverage, and there are two plans to choose from under this heading. The Basic and Extended plans provide coverage for out of pocket costs not paid for by Medicare.

Other Products

Medica lists several supplemental plans on their 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 products, it’s best to read our reviews of the companies that will actually handle the administration.

Medica Rates

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.

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.

Claims

Each of the Medica plans will handle their claims directly with the providers; for each plan, in-network 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.

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Ratings and 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 who 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 which cite poor customer service, while a few mention difficulties with authorizations for surgery and other procedures.

The Bottom Line

Medica is a large company covering several states and uses several different health systems across those states to provide their networks. Some people may find their networks limited, depending on the location. Their plan options may cause some confusion, and their rates are on the high side, but they do appear to have a fairly good reputation and offer access to the renowned Mayo Clinic on many of their plans. They are 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.

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

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Review Information

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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.

4 Comments

  1. I had a medical appointment with my PCP 12/12/18 in Miami Lakes. Transaction did not call me a day ahead to confirm pick up time. Transportation arrived 50 minutes after the start of my appointment. I got to my appointment super late. My PCP office called for pick up to return home with the insurance transportation. I waited beyond an hour for transportation and didn’t come. My PCP office called my insurance transportation back. My insurance stated that my previous information for pick up wasn’t saved and no previous order for pick up was placed. Once again I was waiting. Insurance transportation was called again and they said that they are coming. My PCP ‘s office called and called and called some more because I was still in my wheelchair waiting. They started getting no answer because it was now after 5pm. My PCP office closed at 5pm also. My PCP office told transportation earlier in conversation. Insurance transaction was initially called for pick up to return home minutes after 2pm. I didn’t know how I was getting home. I began to cry. I was tired, extremely upset and hungry. My PCP’s gave me crackers and juice. I finally left at 6:10pm enroute home thanks to my nephew (NOT INSURANCE).

    Reply
  2. I have had Medica for many years and have been very happy with them. Their employees are kind and personable and mostly, always helpful when I have a question needing an answer. I switched insurance companies recently but have found out numerous complaints and concerns about this new company, verified my concerns with the companies review and complaints site, and am going to go back to Medica because I have NEVER had any problems with their paying bills nor with their customer service. I feel their rates are more than fair especially with this new Medicare Advantage rules being mandated.

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  3. I have Medica insurance in Johnson County, Kansas (a surprisingly affluent area in northeast Kansas, near Kansas City). The coverage is abominable. I’ve never paid so much for such crappy insurance. My old doctor takes Medica (one of a very few I’ve been able to find), but not the particular Medica that I got through the Exchange. We pay $1200/mo for two adults, and can’t even use it! I needed to see a podiatrist. The closest one that takes this insurance is 1.5 hours away in a tiny town! I’ve never had a worse experience (their website shows lots of doctors, but when you call them, it’s “no, we don’t take Medica”). I’m thinking about filing a fraud claim.

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  4. has medica ever sold a policy to a smoker, and then when asked to pre approve a surgery make a stipulation that they have to be 30 days nicotine free. of course this request for approval was denied. it was clearly asked and answered on the application throu the market place if this person used tobacco. id like to know who else has run into this, I know first hand of one other person who has.

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