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Medica Health Insurance Review

13 Customer Comments & Reviews - see all comments
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Medica is a non-profit health services company that offers high-deductible, tiered health plans with employer, individual, family, pet, and Medicare coverage. Medica features several broad, regional networks that serve members across their service area. The company is headquartered in Minnetonka, Minneapolis, and is active in the Upper Midwest of the country, including the states of Iowa, Kansas Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin.

What’s Included with Aetna?

  • Most same-day services
  • Emergency services
  • Prescription drugs
  • Laboratory services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Pediatric services
  • Rehabilitative and habilitative services and devices
  • Mental health and substance abuse services 
  • Preventive care and chronic disease management

Types of Health Insurance Plans

Businesses and Organizations

Yes

Individuals and Families

Yes

Short-Term Health Insurance

Yes

Other Plans Offered:

  • Pet Insurance
  • Dental Insurance
  • Medicare Insurance

Plans Reviewed

Bronze Plan

  • Overall Deductibles: $6,350 per individual for in-network providers, $12,700 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
  • No overall annual limit for specific covered services
  • Out-of-pocket limit: $6,350 per individual for in-network providers, $12,700 for family coverage. No out-of-pocket maximum out of network.
  • Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse

Silver Plan

  • Overall deductibles: $2,600 per individual for in-network providers, $7,800 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
  • No overall annual limit for selected covered services
  • Out-of-pocket limit: $5,750 per individual for in-network providers, $11,500 for family coverage. No out-of-pocket maximum out of network.
  • Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse

Gold Plan

  • Overall deductibles: $300 per individual for in-network providers, $900 for family plans. For out-of-network providers, $10,000 per individual or $20,000 for family plans.
  • No overall annual limit on specific covered services.
  • Out-of-pocket limit: $5,000 per individual for in-network providers, $10,000 for family coverage. No out-of-pocket maximum out of network.
  • Other covered services: Chiropractic care, prenatal care, labor, delivery and postpartum care, mental health and substance abuse 

*Information stated above are for customers residing in the state of Minnesota

How Much Does It Save You?

 

Bronze

Silver

Gold

Services Offered

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

Prescription Drugs (Preferred Drug List)

Tier 1 drugs: $20 copay
Tier 2 drugs: 100% coverage after

deductible

Tier 3 drugs: 100% coverage after deductible

Not covered

Tier 1 drugs: $10 copay
Tier 2 drugs: 60% coverage after

deductible

Tier 3 drugs: 40% coverage after deductible

Not covered

Tier 1 drugs: $10 copay
Tier 2 drugs: 70% coverage after

deductible

Tier 3 drugs: 50% coverage after deductible

Not covered

Outpatient Surgery

100% coverage after deductible

Not covered

60% coverage after deductible

Not covered

70% coverage after deductible

Not covered

Emergency Room Services and Medical Transportation

100% coverage after deductible

0% co-insurance

60% coverage after deductible

Room services: $500 co-pay per visit

Medical transportation: 40% co-insurance

70% coverage after deductible

Room services: $250 co-pay per visit

Medical transportation: 20% co-insurance

Office and Urgent Care Visits

$60 copay (No visit limit)

Not covered

$30 copay (No visit limit)

Not covered

$30 copay (No visit limit)

Not covered

Convenience Care Visits

$20 copay for most providers

$10 copay for our preferred providers (No visit limit)

Not covered

$20 copay for most providers

$10 copay for our preferred providers (No visit limit)

Not covered

$20 copay for most providers

$10 copay for our preferred providers (No visit limit)

Not covered

Preventive Care Services

100% coverage (deductible does not apply)

Not covered

100% coverage (deductible does not apply)

Not covered

100% coverage (deductible does not apply)

Not covered

Diagnostic Tests and Imaging

100% coverage after deductible

Not covered

60% coverage after deductible

Not covered

70% coverage after deductible

Not covered

Hospitalization

100% coverage after deductible

Not covered

60% coverage after deductible

Not covered

70% coverage after deductible

Not covered

*Information stated above are for customers residing in the state of Minnesota

Annual maximum

Bronze

None

Silver

None

Gold

None

The Bottom Line

For those who live in the company's service area, Medica is an excellent health insurance choice. High-deductibles and low premium make Medica plans best for healthy consumers that experience few medical expenses in their average year.


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13 Customer Comments & Reviews

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Ann M
2/22/2024
I take messalmine for my ulcerative colitis and they are refusing to cover medication. When asked to talk to supervisor was told none were available..


Teresa R
1/9/2024
I have to say, I am new to this company. I am disappointed that I cannot seem to get through to customer service without an hour wait or more. And when someone does answer, I am moved to different extensions and then it hangs up on me. And the online portal always seems to be down. Not sure if I will stay with this company. Still waiting on my id cards. Its been almost 5 weeks now.


Bruce D
12/30/2022
Steer well clear of this company, they discontinue coverage on diabetic supplies (insulins, cgm etc) that i have been using for years and expect me to change, you will get sicker using this insurance and don’t get me started on the no doctors in network bs. Well medica as per your request yes i will change for you, change to a different insurance company.


ltlpeanut683
8/18/2021
Not walk but RUN from this company. (CIRCUS FIASCO) This has to be one of the worst companies. I wish I had seen the reviews before. No one at this company seems to know **ANYTHING** about anything, except to ask you if they can send you a complaint form, OR PUT YOU ON FOREVER HOLD. No ma'am, could we focus on the problem ? no,but may I send you a complaint form.? May I speak to a supervisor who can help?, I'm sorry, no supervisor is available anytime ! ! They are very much incompetent with any customer care, all the way to express scripts problems, to claims etc.. We paid some visits up front 48 days ago because Medica had a glitch in the system and they haven't even looked at... Read More


S
Shayan A
4/13/2021
Pathetic insurance company. I paid for the expensive $300 plan on 24th December, 2020. I had to go for a CT scan in January. The insurance card did not even reach me till 16th January, 2021. I called them several times and they did not even tell me my credentials so that I could go through with the CT scan. I had to wait for 14 days until one of the representatives finally told me the credentials. When I asked for the refund, they responded 2 months later saying they are not going to give refund for the 14 days when I couldnt use their service even when I paid for it. Stay far away from these thugs.


hehejj48
6/17/2020
Medica is the worst insurance I have ever had! I have MS and take 3600mg of Gabapentin for neurologic pain. In January 2020 I had to pay out of pocket $95.22 for the medication because of a problem between Medica and Express Scripts. The pharmacy was unable to rerun it at a later time so I sent in the claim and did receive the $80.22 check in the mail. However, I was not able to fill my last 30 day prescription because of the claim. The pharmacy called twice and then was told I needed to call. I called twice and the second time I held for over an hour trying to get things resolved. When I asked for a return call Kim said she would. After not hearing back I called the pharmacy to... Read More


C
CHERYL M
1/30/2020
Medica, Medica, Medica. What a truly disappointing experience. I have asthma and you have decided to discontinue coverage for asthmatics medicines...that are reasonably priced anyway. I just went to re-up my asthma inhaler and have been slapped with sticker shock! What in the world are you thinking? Do you care about people? Do you realize that you will be responsible for the deaths of these people who cannot afford $50.00 every time they need an inhaler? I honestly don't think you gave that aspect much thought. What a disappointment. I had the option of choosing a different insurance company and chose you because I knew from previous experience, that you guys were the best....my how times... Read More


Sherry P
1/28/2020
I changed medicare supplement plans this year. Because I had moved to a different county, I was eligible for a different, less expensive Medica plan. I stayed with Medica because I was happy with the plan and because Medica is highly rated and is a non-profit. HOWEVER - in early January I was billed for LAST year's plan as well as my new plan!! I called Medica right away and was told I'd get a refund. When a refund had not been received after almost 3 weeks, I called Medica again and was transferred THREE TIMES to representatives who couldn't figure out why I was double billed, although they did agree I should get refunded, but couldn't figure it out.... I got a call back today and was... Read More


G
Gene
10/3/2019
I have Medica Signature solutions. The plan has a zero Dollar co-pay if you visit doctors who accept Medicare. A claim was submitted by my doctor on 2/1/19. Medicare paid its portion of the claim & now it is Oct 2019 and Medica has failed to take care of their portion of the claim. The Doctor's billing dept has now turned it over to a collection agency. I finally had to turn in a formal complaint to the Mn dept of Commerce. Been with Medica for years and may have forced to search for a new medical plan. don't know what happened to them, they always had great customer service in the past


Michael B
8/19/2019
I have been working on behalf of one of your members now for over 4 months to get medication claims paid. They keep asking for me to call other people other departments, etc. Meanwhile, a wonderful 82-year-old client is getting dunned for bills she does not owe. I am going to do everything in my power to make sure no one I know or am affiliated with will ever own a Medicare Supplement through Medica. Medica, you should be ashamed of yourself for not helping your clients with good service, attention to issues. Nataly in your customer service department is horrible. Call at 2:53pm CST on 08/19/19



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