Is Medica a Medicare Insurance Company?

Medica is a private insurance company that offers Medicare plans, but it is not the same as Medicare itself

Medica is a regional health insurance company that sells Medicare Advantage and Medicare Supplement plans. It operates in several states, primarily in the upper Midwest. When you enroll in a Medica Medicare plan, you are buying insurance from Medica — not directly from Medicare. Medicare (run by the federal government) remains your primary coverage, and Medica acts as the middleman, handling claims and coordinating your care.

This matters because Medica's rules, costs, and networks are separate from Medicare's. A Medica plan covers certain services in certain ways, and you pay Medica's premiums and deductibles, not Medicare's. If you move out of Medica's service area or want to switch plans, you will need to choose a different insurance company — you cannot straightforward stay with "Medicare" the way you might think.

Key Takeaways

Medica sells Medicare Advantage and Medicare Supplement insurance plans, but is not Medicare itself — it is a private company contracted to administer Medicare benefits.
Medica operates in a limited number of states, mostly in the upper Midwest, so availability depends on where you live.
Your costs, covered services, and doctor networks depend on which specific Medica plan you choose, not on Medicare's standard rules.
You can switch away from Medica during Medicare's annual open enrollment period (October 15 to December 7) or if you have a may have access to life event.

How Medica's Medicare Plans Work

Medica offers two main types of Medicare plans. Medicare Advantage plans (also called Part C) bundle your hospital, doctor, and prescription drug coverage into one plan run by Medica. You pay Medica a monthly premium, and Medica pays your doctors and hospitals. Medicare Supplement plans (also called Medigap) work alongside Original Medicare — you keep your Medicare coverage and add a Medica supplement plan to cover costs that Medicare does not pay, like copayments and deductibles.

The choice between them affects your out-of-pocket costs and which doctors you can see. Medicare Advantage plans usually have lower premiums but require you to use doctors and hospitals in Medica's network. Medicare Supplement plans let you see any doctor who accepts Medicare, but the monthly premium is typically higher. Both types require you to pay Medica directly for your coverage.

Where Medica Medicare Plans Are Available

Medica does not operate nationwide. It is licensed to sell Medicare plans in a handful of states, with the strongest presence in Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska. Availability can change year to year, and within a state, Medica may only serve certain counties or cities.

Before assuming Medica is an option for you, check whether it operates in your county. You can search Medica's website by entering your ZIP code, or you can call 1-800-352-2573 to ask whether Medica Medicare plans are sold where you live. If Medica does not serve your area, you will need to choose from other insurance companies that do.

Medica Medicare Advantage vs. Medicare Supplement

The type of Medica plan you choose shapes how you use your coverage. With a Medicare Advantage plan through Medica, you see doctors in Medica's network, pay copayments for visits, and may need prior approval from Medica before certain procedures. Medica sets the rules for what is covered and how much you pay. You do not pay a separate Medicare premium — Medica handles that — but you do pay a monthly plan premium to Medica and out-of-pocket costs when you use care.

With a Medicare Supplement plan through Medica, you keep Original Medicare and add Medica's supplement on top. You can see any doctor who accepts Medicare, and Medicare pays its share first, then Medica's plan pays the portion Medicare does not cover. You pay both a Medicare premium (to Medicare) and a Medica supplement premium (to Medica). There is no network restriction, but your total monthly cost is usually higher.

Neither type is "better" — it depends on your doctors, your budget, and how much medical care you expect to need. If you have a preferred doctor outside Medica's network, a supplement plan may work better. If you want lower monthly premiums and do not mind using Medica's network, an Advantage plan may suit you.

Costs and Coverage Under Medica Plans

Medica's premiums, deductibles, and copayments vary by plan and by year. A Medica Medicare Advantage plan might have a $0 monthly premium but a $250 deductible and $25 copayments for doctor visits. Another Medica plan might charge $50 per month with different cost-sharing. Medica Medicare Supplement plans have their own premium structure and typically cover a percentage of what Medicare does not pay.

Medica also sets which prescription drugs are covered under its plans. If you take medications, check whether your drugs are on Medica's formulary (the list of covered drugs) before you enroll. Costs can change each year, so even if you were happy with a Medica plan last year, you should review the new rates and coverage during open enrollment.

How to Enroll in or Switch Away from Medica

If Medica serves your area and you want to enroll, you can do so during Medicare's annual open enrollment period, which runs from October 15 to December 7 each year. You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or directly through Medica. Coverage begins January 1 of the following year.

If you are already in a Medica plan and want to switch to a different company or plan, you have the same window: October 15 to December 7. You can also switch if you have a may have access to life event — such as moving out of Medica's service area, losing other health coverage, or getting married — which opens a special enrollment period outside the annual window. Contact Medica or Medicare to confirm whether your situation qualifies.

What to Do If Medica Does Not Serve Your Area

If you live in a state or county where Medica does not offer Medicare plans, you will need to choose from other insurance companies. Medicare.gov has a plan finder tool where you enter your ZIP code and see all Medicare Advantage and Supplement plans available to you. You can compare premiums, deductibles, networks, and drug coverage across all companies at once.

Your state's Health Insurance Counseling and information Program (SHIP) also offers free, one-on-one help comparing plans. You can find your state's SHIP by calling 1-800-MEDICARE or visiting the Eldercare Locator at 1-800-677-1116. A counselor can walk you through your options and answer questions about how each plan works.

Frequently Asked Questions

Is Medica the same as Medicare?

No. Medicare is the federal health insurance program for people 65 and older. Medica is a private insurance company that sells plans that work with or within Medicare. When you enroll in a Medica plan, you are buying insurance from Medica, not from Medicare.

Can I use my Medica Medicare plan if I move to another state?

No. Medica only operates in certain states, and your coverage ends if you move out of its service area. You will need to enroll in a different Medicare plan offered in your new state. Contact Medica or Medicare as soon as you know you are moving so you can find a new plan before your current one ends.

Do I still pay Medicare premiums if I have a Medica Medicare Advantage plan?

You still owe the Medicare Part B premium (for doctor and outpatient services), which is deducted from your Social Security check. You do not pay a separate Medicare Part A premium if you are 65 or older. You do pay Medica's monthly plan premium on top of that. With a Medica Medicare Supplement plan, you pay both the Medicare premium and Medica's supplement premium.

What happens to my Medica coverage if I move to a different county within the same state?

It depends on whether Medica serves your new county. Some Medica plans cover multiple counties, while others are limited to specific areas. Contact Medica to confirm whether your plan is still available at your new address. If not, you may be able to switch plans outside the normal enrollment period because you moved.

How do I know if a doctor is in Medica's network?

Call Medica at 1-800-352-2573 or use the provider search tool on Medica's website. You can search by doctor name or specialty. If your doctor is not in the network and you have a Medicare Advantage plan, you will pay more to see them or may not be covered at all. If you have a Medicare Supplement plan, network does not matter — you can see any doctor who accepts Medicare.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.