Medica Insurance Review & Complaints: Health & Medicare Insurance (2024)

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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. If you are under medicare, it could be effective to search for Medicare supplement insurance quotes.

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. Search online for Minnesota Medicare supplement companies if you need this coverage.

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 Medicare 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.

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.

Simplified Claim Process at Medica Insurance

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Medica Insurance offers a streamlined and convenient claims process for its policyholders. Whether you prefer filing a claim online, over the phone, or through mobile apps, Medica provides multiple options to suit your needs. This flexibility ensures that you can easily submit your claims in a way that is most convenient for you.

Average Claim Processing Time

Medica Insurance is committed to efficient claim processing. While the exact processing time may vary depending on the nature of the claim and the documentation provided, the company strives to handle claims promptly. Policyholders can typically expect a reasonable turnaround time for claim resolutions.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback is essential in evaluating an insurance company’s claim resolution process. Medica Insurance values customer input and continuously works to improve its claims handling. Policyholders’ experiences with claim resolutions and payouts play a crucial role in shaping the company’s commitment to providing satisfactory outcomes.

Medica Insurance’s Digital and Technological Features

Mobile App Features and Functionality

Medica Insurance offers a feature-rich mobile app that empowers policyholders with convenient access to their insurance information. The app provides functionalities such as viewing policy details, checking claim status, making payments, and even accessing digital insurance ID cards. This user-friendly mobile app enhances the overall customer experience.

Online Account Management Capabilities

Managing your insurance policy is effortless with Medica’s online account management capabilities. Policyholders can log in to their accounts through the company’s website to review policy documents, update personal information, and make payments online. This digital convenience ensures that you have easy access to your policy information at your fingertips.

Digital Tools and Resources

Medica Insurance understands the importance of providing digital tools and resources to assist policyholders in making informed decisions. Whether you need assistance in choosing the right coverage or want to explore wellness programs, Medica’s online resources are designed to provide valuable insights and support throughout your insurance journey.

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.