Haris Ashley
Medica is an independent, nonprofit company that offers health insurance plans to individuals and families. It is one of the largest health insurers in the Upper Midwest, with approximately 1.5 million members in Minnesota, Wisconsin, North Dakota, South Dakota, and other states. The company provides a range of health coverage options, including individual and family health plans, with varying costs and benefits. Individuals can purchase Medica insurance plans directly through the company or through their state's health insurance marketplace, which may offer financial subsidies and tax credits for eligible individuals.
| Characteristics | Values |
|---|---|
| Location | Minnesota, Wisconsin, North Dakota, South Dakota, Nebraska, and Missouri |
| Company Type | Non-profit |
| Number of Members | 1.4 million or 1.5 million |
| Accreditation | Excellent by the National Committee for Quality Assurance (NCQA) |
| Plan Types | Individual, family, business groups, and seniors |
| Plan Costs | Monthly premium, deductible, co-insurance, and copay |
| Enrollment Period | Open enrollment from Nov 1 to Jan 15, special enrollment outside of these dates |
| Website | medica.com, ehealthinsurance.com, mnhealthnetwork.com, and mo-central.medica.com |
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What You'll Learn
Minnesota, Wisconsin, North Dakota, and South Dakota
In North Dakota, residents can enrol in individual or family health coverage through the ACA Marketplace (exchange) plan and receive income-based subsidies. The North Dakota Department of Human Services administers Medicaid and CHIP, alongside other social services programs.
In South Dakota, Medicaid expansion took effect in mid-2023, meaning that people who are now eligible for Medicaid are no longer eligible for premium subsidies as of 2024. The open enrolment period for individual and family health coverage runs from November 1 to January 15.
In Wisconsin, Medica Insurance offers access to one of its largest networks, with nearly 33,000 providers of all types at more than 6,000 offices, clinics, and hospitals in the state.
In Minnesota, Medica Insurance also offers a large network of providers, with residents free to see any provider but receiving the highest level of benefits and typically the lowest out-of-pocket costs when they see providers in the Individual Choice network.
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Missouri
The open enrollment period for Missouri residents to sign up for ACA-compliant individual and family health plans is from November 1 to January 15. During the open enrollment period for 2024 coverage, a record number of 359,369 people signed up for private health plans through Missouri's marketplace. This increase in enrollment was likely due to larger subsidies from the American Rescue Plan and the Inflation Reduction Act, as well as the end of the pandemic-era Medicaid continuous coverage rule.
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Nebraska
Medica, an independent and nonprofit health insurance company, offers plans in Nebraska. It is one of the largest insurers in the Upper Midwest, with 1.4 million members across Minnesota, Wisconsin, North Dakota, South Dakota, and other states. Members in Nebraska can access care from over 20,000 physicians and healthcare professionals, 320 hospitals, and 1,500 healthcare facilities in Iowa and Nebraska, as well as bordering states. Medica has achieved the highest accreditation status, "Excellent," from the National Committee for Quality Assurance (NCQA) for its Minnesota Medicaid HMO plans and commercial fully-insured health plans in multiple states.
Short-term health plans are also available in Nebraska for those who need temporary coverage. These plans can provide a safety net for consumers who may be without comprehensive health insurance for a period of time.
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Medica's health insurance exchange plans
Medica is an independent, nonprofit company that provides health insurance to individuals, families, business groups, and seniors. It is Minnesota's second-largest health insurance company and is based in suburban Minneapolis-St. Paul. With approximately 1.4 to 1.5 million members, Medica provides health care coverage in Minnesota, Wisconsin, North Dakota, and South Dakota and other states.
Medica offers a range of health insurance plans, including individual and family plans, as well as employer-based coverage and Medicare and Medicaid plans. Their health insurance exchange plans, also known as Marketplace plans, are available during open enrollment, which typically occurs from November 1 through January 15. During this period, anyone can enroll in an individual or family plan, and financial assistance in the form of subsidies and tax credits may be available to those who qualify.
When choosing a health insurance plan, it is important to consider your healthcare needs and financial situation. All individual and family plans must cover ten categories of services under the Affordable Care Act (ACA), including doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, and mental health services. Additionally, some plans offer extra programs to help you stay well, such as pregnancy support programs and other online and in-person extras. It is also worth noting that if you take prescription drugs regularly, you should check if your medications are covered by the plan and what your share of the costs will be.
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Gold plans
The cost of a Gold plan can vary based on several factors, including your age, location, family size, and tobacco use. The average cost of gold medical insurance in 2022 across all 50 states was $462 according to the Kaiser Family Foundation. However, some states are more expensive than others. For instance, the average cost of a Gold plan in Virginia is $839, while the average cost in Maryland is $296.
It's important to note that while Gold plans are not eligible for cost-sharing reductions (CSRs), individuals who qualify for premium tax credits based on income can apply those subsidies to reduce or eliminate their monthly premium. Therefore, when considering a Gold health plan, it is essential to review the plans offered in your state and compare the costs and benefits to make an informed decision based on your healthcare needs and budget.
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Frequently asked questions
Medica is a health insurance company that offers a range of health insurance plans for individuals, families, business groups, and seniors.
Medica is headquartered in Minneapolis and serves the Upper Midwest region. This includes Minnesota, Wisconsin, North Dakota, South Dakota, and select counties within these states.
Medica offers various plans such as Prime Solutions, Applause, and Inspiration. These plans cater to different needs, with options for those who anticipate frequent medical visits and those seeking cost-efficient coverage.
Enrollment in Medica health insurance plans typically occurs during the open enrollment period, which is annually from November 1 through January 15. During this period, anyone can enroll in an individual or family plan. However, special enrollment periods may also be available outside of these dates if you experience a qualifying life event, such as marriage or a change in residence.
