Medica is one of the biggest names in health insurance across the upper Midwest and one of the least understood outside it. It is a nonprofit, it is not a Blue Cross plan, it is not Medicare, and its individual-market footprint is about to get smaller.
This page uses CMS’s own 2026 Exchange Public Use Files, which list the filed premium for every plan in every federal-platform state, plus Minnesota’s approved rate filings and Medica’s own published statements. Every figure is 2026 plan year data unless labeled otherwise, and the CMS data was imported to CMS systems by August 4, 2026.
What Is Medica Insurance
Medica is a nonprofit health plan headquartered in Minnetonka, Minnesota. Its newsroom states that nearly 1.5 million members rely on it as their insurance partner. It sells in four separate markets: individual and family coverage through the ACA marketplaces, employer group coverage, Medicaid, and Medicare.
It is worth separating those, because “Medica insurance” means something different in each. This page is about the individual and family side, the plans you buy yourself on MNsure or HealthCare.gov when you do not have coverage through a job.
Medica is not Medicare, and not a Blue Cross plan
The name collision is real and it costs people time. Medicare is the federal program. Medica is a private company. You can be on Medicare and buy a Medica Medicare Advantage plan to administer your benefits, but the words are not interchangeable. If you are shopping the Medicare side, that is a different comparison entirely, and something like Medicare Advantage versus Original Medicare is the better starting point.
Medica is also not part of the Blue Cross Blue Shield federation. In Minnesota, Blue Plus is the Blue-branded individual carrier and Medica is a separate competitor. That distinction matters if you are comparing it against something like Anthem Blue Cross Blue Shield or Florida Blue, which are licensees of a national trademark.
Where Medica Actually Sells Individual Plans
Medica’s own shopping page says it serves individuals and families across eight states: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin.
Its corporate boilerplate says something different. The December 2025 news release about the UCare transition describes Medica as operating in Minnesota, Iowa, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin, and Wyoming. That list adds two states and drops Kansas. Both statements come from Medica. The reconciliation is that the corporate list covers all four business lines, so South Dakota and Wyoming appear on the strength of employer or Medicare business while Kansas, where Medica does sell individual plans, is simply missing. We are publishing both rather than picking one.
The independent check settles it. In CMS’s 2026 Exchange PUF, Medica has 207 individual, non-dental plan IDs across seven federal-platform states: Iowa, Kansas, Missouri, North Dakota, Nebraska, Oklahoma, and Wisconsin. There are no Medica individual plans filed in South Dakota, Wyoming, or Arizona. Minnesota is absent from the file for a different reason: MNsure is a full state-based exchange and does not report into the federal PUFs at all. Minnesota’s own Department of Health confirms Medica is one of the plans approved to sell individual coverage there in 2026.
The 2027 shrinkage
Medica is leaving the individual marketplace in Iowa, Kansas, and Oklahoma effective January 1, 2027. A Medica spokesperson confirmed the Oklahoma exit to StateImpact Oklahoma in June 2026, putting roughly 8,400 members in that state alone, and said the decision came from a review of product offerings “to ensure they support stability, sustainability and affordability.”
That takes Medica’s individual footprint from eight states to five for 2027: Minnesota, Missouri, Nebraska, North Dakota, and Wisconsin. If you are in Iowa, Kansas, or Oklahoma, your 2026 coverage runs to the end of the year and you will need a new carrier at the next open enrollment.
Moving the other direction, Medica is absorbing UCare’s Medicaid and individual and family plans in Minnesota as UCare winds down through 2026, an agreement announced November 17, 2025 that Medica says preserves coverage for more than 300,000 Minnesotans.
What Medica Insurance Costs in 2026
These are filed, unsubsidized monthly premiums for a 40-year-old non-smoker from CMS’s 2026 Rate PUF, covering the seven federal-platform states. Minnesota premiums are not in this dataset.
| Metal level | Lowest | Median | Highest |
|---|---|---|---|
| Expanded bronze | $357.86 | $564.03 | $1,084.48 |
| Silver | $543.21 | $811.93 | $1,460.12 |
| Gold | $537.81 | $796.90 | $1,441.81 |
| All Medica plans | $357.86 | $703.71 | $1,460.12 |
For scale, the median age-40 individual premium across every carrier in the national file is $691.56, so Medica sits almost exactly at the national middle. Geography drives most of the spread. Nebraska is Medica’s most expensive state by a wide margin, with silver plans running $814 to $1,460, while North Dakota silver starts at $543.
Medica’s plan mix is unusual: of those 207 plans, 153 are EPOs, 27 are HMOs, and 27 are PPOs. An EPO covers no routine out-of-network care at all, so if that structure is new to you, read EPO vs. PPO and in-network vs. out-of-network before you enroll.
In Minnesota, Medica sells through a long list of named networks rather than one statewide product. Only Medica Applause has a statewide service area. Altru Prime, Engage by Medica, Essentia ChoiceCare, North Memorial Acclaim, Ridgeview Distinct, and Bold by MHealth Fairview are each tied to specific regions and health systems.
What you actually pay
Almost nobody pays the sticker price. But 2026 is the first year in five where the sticker matters, because the enhanced premium tax credits created in 2021 expired on December 31, 2025 and have not been restored as of September 2026.
KFF reports the average monthly net premium payment across marketplace enrollees rose 58%, from $113 in 2025 to $178 in 2026, and the share of enrollees receiving any tax credit fell from 92% to 87%. Average deductibles rose 37% to $3,786 as people bought down to bronze plans. Effectuated enrollment fell to about 17.5 million, down 4.8 million. If you are above 400% of the federal poverty line you now pay full price, which is what makes the table above suddenly relevant. See ACA subsidy income limits and what the subsidy expiration changed.
Minnesota rate increases
The Minnesota Department of Commerce approved a 30.76% average individual-market rate increase for Medica for 2026, the steepest of the six individual carriers on that list. Blue Plus came in at 18.70%, HealthPartners at 13.31% and 19.15% across two entities, UCare at 27.48%, and Quartz at 7.40%. Medica’s small group increase was far gentler at 9.98%. For 2027, Medica has proposed a 13.0% individual and 18.9% small group increase, not yet final as of September 2026.
Is Medica Good Insurance?
CMS rates marketplace plans on a 1-to-5 star scale through the Quality Rating System, and almost nobody looking at these carriers uses it. Medica has five rated products in the PY2026 nationwide file, averaging 2.8 stars against a 3.41 national average across 298 rated products.
| State and plan type | Overall stars | Clinical quality | Plan administration |
|---|---|---|---|
| Wisconsin EPO | 4 | 3 | 4 |
| Iowa EPO | 3 | 2 | 3 |
| Missouri EPO | 3 | 3 | 3 |
| Nebraska EPO | 3 | 3 | 4 |
| Oklahoma PPO | 1 | 1 | 3 |
The Oklahoma PPO is one of only two 1-star products in the entire national file, and it is the market Medica is leaving. The Wisconsin plan is a genuinely good 4. That spread inside a single carrier is the real finding: “Is Medica good insurance” has no national answer, only a state answer. The rating unit here is a product (one issuer, one state, one plan type), not a plan and not an enrollee, and Minnesota’s products are not rated in this file because MNsure sits outside it.
Who Medica Is Good For, and Who Should Skip It
Medica makes sense if you live in Minnesota, Wisconsin, or the Dakotas, if your doctors are inside one of its named health-system networks, and if you want a nonprofit rather than a publicly traded insurer. Its North Dakota and Wisconsin pricing is competitive and its Wisconsin quality score is above the national average.
Skip it if you are in Iowa, Kansas, or Oklahoma, where you will be shopping again for 2027 anyway. Think hard if you travel or split time between states, because 153 of its 207 plans are EPOs with no out-of-network coverage. And if you are in Nebraska, price-check hard against every other carrier on the exchange before committing.
Medica vs. the National Carriers
Medica is a regional nonprofit competing against national for-profit marketplace specialists. Ambetter, Oscar, and Molina all operate across far more states, and all three carry lower median age-40 premiums in the 2026 file: $576 for Oscar Insurance Company, $616 for Molina Healthcare, and $686 for Ambetter Health, against Medica’s $704. Those are different state mixes rather than a head-to-head in any one market, but the direction is consistent. What Medica offers instead is deep local provider relationships, particularly the Minnesota health-system networks, and a nonprofit structure.
The honest tradeoff: you are buying local network depth and paying roughly the national median for it, with quality scores that run below average outside Wisconsin.
The Bottom Line
Medica individual plans cost $358 to $1,460 a month for a 40-year-old before subsidies in 2026, clustered around a $704 median that is close to the national middle. It is a real, substantial nonprofit carrier in eight states, dropping to five in 2027. Check the CMS star rating for your specific state rather than trusting the brand, confirm your doctors are in the specific named network you are buying, and if you are self-employed or between jobs, run the numbers in self-employed health insurance cost or health insurance for the unemployed before you decide what tier to buy.