Insurer profile · NAIC + CMS
Medica Insurance Company
Medica Insurance Company's complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- D
- Reputation grade
- 25.4%
- Claims denied
- 5
- States (CMS data)
The verdict
Medica Insurance Company earns a D reputation grade - a worse-than-average record versus peers, according to CMS Transparency in Coverage filings, 25.4% of its marketplace claims were denied across 5 states.
- D
- reputation grade
- 25.4%
- claims denied (CMS)
Graded on 1 of 3 measures: claim denials. The score is rescaled across the measures available, so it is not directly comparable with a carrier graded on more of them.
How we calculated this grade →NAIC CIS filing desk
NAIC NAIC D · 27.0
GRADE-D · INDEX-UNK · DENIAL-HOT · RANK-UNK · PHOTO-SOLO · LINES-0 · BOOK-MID
- GRADE-D D · 27.0
- INDEX-UNK Index blank
- DENIAL-HOT 25.4% denied
- RANK-UNK Rank pending
- PHOTO-SOLO No peer gap
- LINES-0 No lines
- BOOK-MID 3/7 fields
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.
Medica Insurance Company - claim denial rate by state
- OK
OK: 29.0% denied (129,285 of 445,895 claims)
29 % of claims denied
- KS
KS: 28.2% denied (17,004 of 60,305 claims)
28 % of claims denied
- IA
IA: 27.6% denied (127,452 of 461,507 claims)
28 % of claims denied
- MO
MO: 25.5% denied (107,624 of 422,314 claims)
26 % of claims denied
- NE
NE: 23.3% denied (319,019 of 1,367,373 claims)
23 % of claims denied
What this shows Denial rates vary by state plan and network. Across 5 reporting states, Medica Insurance Company denied 25.4% of marketplace claims on average.
Among states with enough reported claims to compare, Medica Insurance Company's highest marketplace denial rates in this dataset are in Oklahoma (29.0%), Kansas (28.2%), and Iowa (27.6%). State-level rates reflect the specific plans Medica Insurance Company offers there and how each state's regulators and utilization-review rules apply, not necessarily the carrier's national practice.
CMS marketplace filing
Reported appeal outcomes for Medica Insurance Company
The largest state samples are Nebraska (720 filed, 355 overturned), Missouri (208 filed, 100 overturned), and Iowa (195 filed, 98 overturned); 5 states contribute to the profile total.
CMS reports an overturn outcome for 1,294 of these 1,294 filed appeals; missing outcomes are excluded from the percentage. These filing totals are not a prediction for an individual appeal. View the CMS source ↗
What the NAIC filing desk shows for Medica Insurance Company
Medica Insurance Company's filing desk summarizes the NAIC complaint record and any CMS marketplace denial data on file.
See where Medica Insurance Company sits against every reporting carrier in the claim-denial rate ranking. Appeal notes for Medica Insurance.
Nationwide insurers with similar scores or complaint volume
Two corpus-wide peer sets for Medica Insurance Company: 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 (27.0 here). Floored at 50+ complaints and 5+ states.
Questions about Medica Insurance Company
What does Medica Insurance Company's grade mean?
How many complaints does Medica Insurance Company have?
How do I file a complaint against Medica Insurance Company?
Is Medica Insurance Company a good insurance company?
What types of insurance does Medica Insurance Company offer?
Source: NAIC published complaint index + CMS Transparency in Coverage PY2026 Complaint index, reputation grade and per-state claim denial rates for Medica Insurance Company · 2024
Share, download, and related pages for Medica Insurance
Download the data behind this page
The full PlainInsurer extract, covering every insurer including Medica Insurance Company, 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.