Reputation grade
C
Peer-relative, A–F
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
- 22.8%
- Claims denied
- 3
- States active
The verdict
Medica Health Plans earns a C reputation grade — a record near the industry median, its NAIC complaint index runs 0.78, below the 1.0 market average, and CMS records show 22.8% of its marketplace claims denied across 1 state.
- C
- reputation grade
- 0.78
- NAIC complaint index
- 22.8%
- claims denied (CMS)
Grades are peer-relative within PlainInsurer's dataset. A high complaint ratio is not proof of wrongdoing — larger insurers draw more complaints by volume, which the index normalises.
NAIC complaint data Grade C CMS denial data · 1 states 3 states NAIC #95832
NAIC complaint index
0.78
1.0 = market average; lower is better
Claim denial rate
22.8%
CMS, 1 states
Reputation grade C (composite score 63.2) — A=Excellent, F=Failing. Based on NAIC complaint ratios and CMS denial data.
Where Medica Health Plans sits on complaints
NAIC complaint index vs the market average and the dataset range (1.0 = market average; lower is better)
- Best in data 0.23
Lowest complaint index in PlainInsurer's dataset: 0.23
0.23 complaint index
- Market avg 1
Market average complaint index = 1.0 (NAIC benchmark)
1 complaint index
- Medica Health Plans 0.78
Medica Health Plans: complaint index 0.78
0.78 complaint index
- Worst in data
Highest complaint index in PlainInsurer's dataset: 3.87
3.87 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.
Complaint record by line of business
| Line | Confirmed complaints | Complaint index | States active |
|---|---|---|---|
| Health Insurance (Individual) | 234 | 0.78 | 3 |
What the data shows for Medica Health Plans
Medica Health Plans, part of Medica, carries a C reputation grade in PlainInsurer's dataset, with a composite score of 63.2 (higher means more consumer friction relative to size). Its NAIC complaint index of 0.78 sits below the 1.0 market average, meaning policyholders escalate fewer disputes to regulators than is typical for a carrier of its premium volume.
On the claims side, CMS Transparency-in-Coverage filings show Medica Health Plans denied 22.8% of marketplace claims across 1 reporting state — an elevated rate that warrants checking the plan's appeal-success record before enrolling. The carrier reports activity across 1 line of business.
The practical implication: complaint and denial data give a comparative view of how Medica Health Plans treats policyholders relative to peers, but they cannot predict your individual claim experience. Compare the grade against named alternatives in your state, and weigh price, coverage terms and state licensing before any purchase. Source: NAIC Consumer Information Source complaint data (2024). Source: CMS Transparency in Coverage PUF (PY2025), cms.gov.
Use this data wisely. Complaint and denial figures reflect regulatory filings, not individual claim outcomes. A high complaint ratio is not proof of illegal behaviour. This page is informational and is not financial, legal, or insurance advice — verify coverage decisions with your insurer or a licensed agent.
Frequently asked questions
What does Medica Health Plans's grade mean?
Medica Health Plans received a grade of C, indicating a record near the industry median. PlainInsurer grades insurers on a curve relative to the ~200 carriers in our dataset, using the NAIC complaint index (normalized by premium volume), CMS claim denial rates, and Medicare Advantage prior-authorization data where available.
How many complaints does Medica Health Plans have?
Medica Health Plans has 234 confirmed complaints on record across 3 states, based on published NAIC complaint data. Raw counts favour smaller insurers — PlainInsurer uses the complaint index (complaints relative to premium volume, where 1.0 is the market average) to compare carriers fairly.
How do I file a complaint against Medica Health Plans?
Contact your state's Department of Insurance — every state has an insurance commissioner's office that accepts consumer complaints online, by phone, or by mail. The NAIC also runs a central complaint portal at naic.org. Document your policy number, claim number, dates, and the specific issue before filing.
Is Medica Health Plans a good insurance company?
It depends on your coverage needs, state, and budget. PlainInsurer's C grade reflects a record near the industry median relative to peers. Always compare quotes from multiple carriers and check complaint data for your specific state and line of coverage.
What types of insurance does Medica Health Plans offer?
Based on NAIC filing data, Medica Health Plans reports activity in 1 line of business: Health Insurance (Individual). Availability varies by state.
What to do with this
How to act on Medica Health Plans's complaint and denial record.
- Compare this carrier side-by-side with another before you buy. Compare insurers
- See how every insurer in your state ranks on complaints and denials. Browse by state
- Denied a claim? Learn the internal and external appeal process. Appeal a denial
Complaint ratios normalise by premium volume so larger carriers are not penalised for writing more policies.
Source: NAIC published complaint index + CMS Transparency in Coverage PY2025 Complaint index, reputation grade and per-state claim denial rates for Medica Health Plans · 2024 NAIC complaint index aggregates state-DOI consumer complaints, normalized against premium volume (1.0 = market average). Denial rates from CMS Transparency in Coverage PY2025. Reputation grade is PlainInsurer's peer-relative methodology applied to this public data.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2025. Not affiliated with NAIC or CMS. Read our methodology.