Insurer profile · Medica · NAIC + CMS
Medica Health Plans
Medica Health Plans's complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- C
- Reputation grade
- 0.78
- Complaint index
- 23.5%
- Claims denied
- 3
- States active
The verdict
Medica Health Plans earns a C reputation grade - a record near the industry median, according to the NAIC's published complaint index, its ratio runs 0.78, below the 1.0 market average, and according to CMS Transparency in Coverage filings, 23.5% of its marketplace claims were denied across 1 state.
- C
- reputation grade
- 0.78
- NAIC complaint index
- 23.5%
- claims denied (CMS)
Graded on 3 of 3 measures: NAIC complaints, claim denials, prior authorisation.
How we calculated this grade →NAIC CIS filing desk
NAIC 95832 C · 63.2
GRADE-C · INDEX-LOW · DENIAL-ELEV · RANK-UPPER · PHOTO-FINISH · LINES-1 · BOOK-FULL
- GRADE-C C · 63.2
- INDEX-LOW 0.78
- DENIAL-ELEV 23.5% denied
- RANK-UPPER #24/72
- PHOTO-FINISH Openly Insurance · B
- LINES-1 1 line
- BOOK-FULL 7/7 fields
Nearest complaint-index peer: Openly Insurance (±0.00 index pts)
Instrument codes from this carrier’s NAIC Consumer Information Source filing: grade band, complaint index, CMS denial band, corpus rank, photo-finish peer, line book, and field completeness. Not an official NAIC rating.
Complaint-index neighbourhood around Medica Health Plans
Quietest and hottest poles plus nearest index peers, not a full NAIC corpus board reprint.
Medica Health Plans - complaint index neighbourhood
- Northwestern Mutual… · quietest 0
Northwestern Mutual… · quietest
0 complaint index
- John Hancock Life · near 1
John Hancock Life · near
1 complaint index
- American Family Insu… · near 1
American Family Insu… · near
1 complaint index
- Cigna Health · near 1
Cigna Health · near
1 complaint index
- Medica Health Plans · this carrier 1
Medica Health Plans · this carrier
1 complaint index
- Openly Insurance · near 1
Openly Insurance · near
1 complaint index
- Gainsco Insurance · hottest
Gainsco Insurance · hottest
4 complaint index
What this shows According to PlainInsurer's dataset, Medica Health Plans has a lower (better) NAIC complaint index than 65% of the 72 rated insurers it tracks and ranks #5 of 18 carriers by complaint ratio in Health Insurance (Individual).
Where Medica Health Plans sits on complaints
- Best in data 0
Lowest complaint index in PlainInsurer's dataset: 0.23
0 complaint index
- Market avg 1
Market average complaint index = 1.0 (NAIC benchmark)
1 complaint index
- Medica Health Plans 1
Medica Health Plans: complaint index 0.78
1 complaint index
- Worst in data
Highest complaint index in PlainInsurer's dataset: 3.87
4 complaint index
What this shows Medica Health Plans's complaint index of 0.78 is 22% below the 1.0 market average for a carrier of its size.
Medica Health Plans vs. the full rated-insurer dataset
78% Among the most affordable more affordable than 65% of 72 rated insurers
Each bar is a band; taller bars hold more rated insurers. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source NAIC published complaint index (2024) · 2024
Scale vs. complaint-adjusted score
Complaint record by line of business
| Line | Est. complaints | Complaint index | States active |
|---|---|---|---|
| Health Insurance (Individual) | ~310 | 0.78 | 3 |
Health insurance market share
National ranking by direct written premiums, NAIC 2024
What the NAIC filing desk shows for Medica Health Plans
According to PlainInsurer's dataset, Medica Health Plans has a lower (better) NAIC complaint index than 65% of the 72 rated insurers it tracks and ranks #5 of 18 carriers by complaint ratio in Health Insurance (Individual).
See where Medica Health Plans sits against every reporting carrier in the claim-denial rate ranking. Appeal notes for Medica Health Plans.
Nationwide insurers with similar scores or complaint volume
Two corpus-wide peer sets for Medica Health Plans: nearest national-scale carriers by composite score and by NAIC complaint volume. These are cross-market neighborhoods, not the corporate-family list or same-grade chips above.
Similar composite score
Nearest carriers by composite score (63.2 here). Floored at 50+ complaints and 5+ states.
Similar complaint volume
Nearest carriers by NAIC complaint count (310 here). Deduped against the score peers so the two sets stay distinct.
Questions about Medica Health Plans
What does Medica Health Plans's grade mean?
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Verify Medica Health Plans
Medica Health Plans is filed with the NAIC under company number 95832. Search that number directly in the NAIC's own public consumer-information tool to cross-check this page against the primary source.
Verify on NAIC Consumer Information SourceSource: NAIC published complaint index + CMS Transparency in Coverage PY2026 Complaint index, reputation grade and per-state claim denial rates for Medica Health Plans · 2024
Share, download, and related pages for Medica Health Plans
Download the data behind this page
The full PlainInsurer extract, covering every insurer including Medica Health Plans, is available as CSV and JSON. Underlying federal data is public domain; see our methodology for the compilation and grading method.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2026. Not affiliated with NAIC or CMS.
Every figure on PlainInsurer comes directly from NAIC MCAS and CMS Transparency in Coverage data; no editor types in numbers. See our editorial standards or methodology, or report an error. Data current as of 2026-08-11. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.