Medica

What Medica does

Medica is a nonprofit health insurance company founded in 1975 by physicians and headquartered in Minnetonka, Minnesota. The company provides comprehensive health coverage products across four primary segments: Individual and Family plans, Medicare Advantage/Supplement/Cost plans, Medicaid (Medical Assistance) plans for Minnesota residents, and Employer-provided group plans. Medica serves approximately 1.4 million members across eight states (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin), with operations supported by regional offices in Madison (WI), Omaha (NE), and St. Louis (MO).

The company operates a co-branded distribution model with deep provider system partnerships — including Mayo Clinic, M Health Fairview, SSM Health, CHI Health, Essentia Health, Altru Health System, North Memorial Health, and Mercy — creating network-tailored products such as Bold by M Health Fairview, Altru & You, and Medica Complete Health. Underlying technology consists of a standard health insurance platform with member portal, claims processing, and provider network management. Pharmacy benefits are managed through Express Scripts (and Navitus for SSM Health plans), while UnitedHealthcare Choice Plus extends national network access for employer products. Medica holds HITRUST CSF certification and complies with HIPAA standards.

Revenue is generated almost entirely through recurring monthly health insurance premiums from individuals, families, employers, and government programs (Medicare and Medicaid), with pricing varying by plan type and geography (Medicare Advantage plans as low as $0 premium; metal-level ACA marketplace plans with subsidies for 100-400% FPL). Distribution combines direct consumer sales via medica.com, MNsure and federal marketplace participation, a licensed broker/agent network, and direct employer group sales teams. The most significant recent strategic action was the January 2026 acquisition of UCare's contracts and assets, which added approximately 300,000 members — predominantly in the Medicaid segment — and brought Medica's total membership to 1.4 million.

Name

Medica

Legal name

Medica

Website

https://medica.com

Company type

Private

Founded year

1975

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Medica is a nonprofit health insurer founded in 1975, serving approximately 1.4 million members across eight Midwestern states with individual/family, Medicare, Medicaid, and employer-sponsored health plans built around co-branded provider network partnerships.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicare Advantage (MA) Plans (FSAIAGAA)

akta.pro secondary industries

Medicare Supplement (Medigap) Plans (FSAIAGAB), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

Keywords

• Health insurance plans
• Medicare Advantage coverage
• Medicaid managed care
• Employer health benefits
• Individual family coverage

Headquarters

HQ city

Minnetonka

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. Health Insurance Premiums: Medica generates revenue primarily through monthly premium payments from individuals, families, employers, and government programs (Medicare and Medicaid). Premium revenue is recurring and forms the core revenue stream.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels4 records

Core offering

Medica is a nonprofit health plan that underwrites and administers health insurance coverage for individuals, families, Medicare beneficiaries, Medicaid recipients, and employer groups across eight U.S. states. The company sells branded health plan products tied to regional provider networks (Mayo Clinic, M Health Fairview, CHI Health, SSM Health, Essentia, Altru, etc.), Medicare Advantage and Supplement plans, Medicaid managed care plans, and group/employer-sponsored plans. Members access coverage through Medica-administered provider networks, pharmacy benefits managed by Express Scripts and Navitus, and member services including claims processing, care management, and wellness programs.

Product overview

Medica is a nonprofit health insurance company offering a comprehensive portfolio of health plans across eight states. The product portfolio includes: (1) Individual and Family Plans marketed under multiple branded names tied to specific provider networks (e.g., Altru Prime, Bold by M Health Fairview, Medica with CHI Health, Essentia Choice Care, Medica Solo, Medica Encore, Medica Applause, Medica Direct HSA, Medica Symphony for HSA, Medica Value, North Memorial Acclaim, Ridgeview Distinct, Harmony, Balance, Elevate, Inspire, Select, and Medica Individual Choice) across Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin; (2) Medicare plans including Medica Advantage Solution HMO-POS and PPO, Medica Advantage PPO for multi-state coverage, Medica Advantage Dual for dual-eligible beneficiaries, Medica Prime Solution Cost plans in multiple tiers, Medica Select Solution II and Signature Solution Medigap supplements, and Medica Group Medicare plans; (3) Medicaid plans for Minnesota residents including Medica MinnesotaCare, Medica Choice Care PMAP for families, Medica AccessAbility Solution SNBC for disabled individuals, Medica Choice Care MSC+ and DUAL Solution for seniors; and (4) Employer-provided plans with provider network options including Altru & You, Essentia Choice Care, Medica Choice National, Medica Complete Health with Mayo Clinic, Medica Elect, Medica Focus, VantagePlus, and co-branded plans with HealthPartners, Fairview, Mayo Clinic, Park Nicollet, Ridgeview, SSM Health, Mercy, and MU Health Care.

Differentiator

Problem solved

Functional benefit

Brands

• Medica Foundation: Community giving and health equity initiatives arm of Medica

Products and services

• Elevate by Medica Individual and family health insurance plan offered in Iowa, purchased directly by consumers or through the marketplace.
• Inspire by Medica Individual and family health insurance plan offered in Iowa for consumers purchasing coverage directly.
• Medica with CHI Health Co-branded individual and family health plan with CHI Health provider network available in Iowa and Nebraska.
• Select by Medica Individual and family health insurance plan available in Kansas and Missouri.
• Altru Prime by Medica Individual and family health plan available in Minnesota featuring the Altru Health System provider network.
• Bold by M Health Fairview and Medica Co-branded individual and family plan in Minnesota featuring M Health Fairview provider network.
• Engage by Medica Individual and family health insurance plan available in Minnesota.
• Essentia Choice Care with Medica Individual and family health plan in Minnesota featuring Essentia Health provider network.
• Medica Applause Individual and family health insurance plan available in Minnesota.
• Medica Direct HSA HSA-compatible individual and family plan in Minnesota with high-deductible options for tax-advantaged savings.
• Medica Encore Individual and family health insurance plan available in Minnesota.
• Medica Solo Individual and family health insurance plan available in Minnesota.
• Medica Symphony for HSA HSA-compatible individual and family plan in Minnesota designed for health savings account benefits.
• Medica Value Individual and family health insurance plan available in Minnesota.
• North Memorial Acclaim by Medica Co-branded individual and family plan in Minnesota featuring North Memorial Health provider network.
• Ridgeview Distinct by Medica Co-branded individual and family plan in Minnesota featuring Ridgeview provider network.
• Balance by Medica Individual and family health insurance plan available in Missouri.
• Medica with MU Health Care Co-branded individual and family plan in Missouri featuring MU Health Care provider network.
• Medica with SSM Health (Individual + Family) Co-branded individual and family plan featuring SSM Health provider network in Missouri.
• Medica Individual Choice Individual and family health insurance plan available in North Dakota.
• Harmony by Medica Individual and family health insurance plan available in Oklahoma.
• Medica Advantage Solution (HMO-POS) Medicare Advantage HMO-POS plan available in Minnesota combining hospital, medical, and often prescription drug coverage for adults 65+ and eligible disabled individuals.
• Medica Advantage Solution (PPO) Medicare Advantage PPO plan in Minnesota offering flexible in-network and out-of-network coverage for Medicare beneficiaries.
• Medica Advantage (PPO) Medicare Advantage PPO plan available in Iowa, Nebraska, North Dakota, and South Dakota for Medicare beneficiaries.
• Medica Advantage Dual (PPO D-SNP) Dual-Eligible Special Needs Plan in North Dakota combining Medicare and Medicaid benefits for individuals eligible for both programs.
• Medica Prime Solution (Cost) Medicare Cost plan with multiple tiers (Basic, Core, Enhanced, Focus, Premier, Standard, Thrift) available with or without prescription drug coverage for Medicare beneficiaries.
• Medica Select Solution II Medicare Supplement insurance (Medigap) plan covering costs that Original Medicare does not cover, with age-tiered premiums.
• Medica Signature Solution Medicare Supplement insurance (Medigap) plan providing additional coverage beyond Original Medicare for Medicare beneficiaries.
• Medica Group Advantage Solution (PPO) Employer-sponsored Medicare Advantage PPO plan for group retiree coverage purchased by employers.
• Medica Group Prime Solution w/Rx (Cost) Employer-sponsored Medicare Cost plan with prescription drug coverage for group retiree benefits.
• Medica AccessAbility Solution (SNBC) Special Needs BasicCare (SNBC) Medicaid plan for people ages 18-64 with certified disabilities in Minnesota, providing additional support services.
• Medica Choice Care MSC+ Minnesota Senior Care Plus (MSC+) Medicaid plan for people age 65 and older eligible for Medicaid in Minnesota.
• Medica Choice Care PMAP Prepaid Medical Assistance Program (PMAP) plan for people ages 0-64, including adults, children, and families in Minnesota.
• Medica DUAL Solution (HMO D-SNP) (MSHO) Minnesota Senior Health Options (MSHO) HMO D-SNP plan for people age 65 and older eligible for both Medicare and Medicaid.
• Medica MinnesotaCare Medical Assistance (Medicaid) plan providing no-cost coverage for low-income Minnesota residents ages 0-64 who meet income and eligibility requirements.
• Altru & You with Medica Employer-sponsored health plan in Minnesota, North Dakota, and Wisconsin featuring Altru Health provider network.
• Clear Value with Medica Employer-sponsored health plan in Minnesota, North Dakota, and Wisconsin.
• Essentia Choice Care with Medica (Employer) Employer-sponsored health plan in Minnesota, North Dakota, and Wisconsin featuring Essentia Health provider network.
• Medica Choice National National employer-sponsored health plan offering broad provider network access across multiple states.
• Medica Choice Passport with UnitedHealthcare Employer-sponsored plan combining Medica with UnitedHealthcare provider networks for expanded national coverage options.
• Medica Complete Health (featuring care at Mayo Clinic) Employer-sponsored health plan featuring Mayo Clinic as the primary care destination for employees seeking Mayo's specialized medical services.
• Medica Elect Employer-sponsored health plan option available in Minnesota, North Dakota, and Wisconsin.
• Medica Focus Employer-sponsored health plan option available in Minnesota, North Dakota, and Wisconsin.
• Medica Health Plan Solutions Employer-sponsored health plan solution for employers providing customizable health benefit options.
• VantagePlus with Medica Employer-sponsored health plan available in Minnesota, North Dakota, and Wisconsin.
• Medica with Mercy Employer-sponsored health plan in Missouri St. Louis area featuring Mercy Health provider network.
• Medica with SSM Health (Employer) Employer-sponsored health plan featuring SSM Health provider network for Missouri St. Louis area employers.

Quantifiable outcome

• 1.73 million members rely on Medica
• +2 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Partnerships

Eleven partnerships are on record, tiered core and minor.

• UCarecoreStrategic or Co-development Partner · 17 November 2025Medica acquired certain contracts and assets from UCare, a Minnesota nonprofit health insurer. This acquisition preserved health coverage for approximately 300,000 UCare members and expanded Medica's membership to 1.4 million. The transaction closed in Q1 2026.
• Mayo CliniccoreStrategic or Co-development PartnerMedica offers Medica Complete Health plan featuring care at Mayo Clinic, and Mayo Medical Plan for Mayo Clinic employees through Medica.
• Express ScriptscoreTechnology or IntegrationExpress Scripts serves as Medica's pharmacy benefit manager for most Medica plans including Medicare, Medicaid, individual and family, and employer coverage.
• Special OlympicsminorGTM or Marketing PartnerGold Partner supporting 2026 Special Olympics USA Games, June 20-26 in Minneapolis.
• Altru Health SystemcoreStrategic or Co-development PartnerAltru & You with Medica health plan offering in Minnesota, providing coverage through Altru Health System network.
• M Health FairviewcoreStrategic or Co-development PartnerBold by M Health Fairview and Medica health plan offering, combining Fairview's provider network with Medica insurance.
• Essentia HealthcoreStrategic or Co-development PartnerEssentia Choice Care with Medica health plan providing coverage through Essentia Health's regional network in Minnesota and North Dakota.
• SSM HealthcoreStrategic or Co-development PartnerMedica with SSM Health health plan for Missouri and Wisconsin markets, offering coverage through SSM Health provider network.
• CHI HealthcoreStrategic or Co-development PartnerMedica with CHI Health plan offering in Iowa and Nebraska, providing coverage through CHI Health network.
• Delta DentalcoreStrategic or Co-development PartnerDelta Dental provides dental insurance services for Medica health plan members in Minnesota, Nebraska, and other markets.
• UCare Transportation ServicesminorImplementation/ SI/ Consulting PartnerMedica took over UCare operations on Jan. 1, 2026, including medical transportation services, and has implemented staffing adjustments and a new transportation portal for self-scheduling.

Scale indicators4 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Humana: National Medicare Advantage leader with a strong senior-focused portfolio overlapping Medica's Medicare Advantage, D-SNP, and Group Medicare products across the Midwest.
• Elevance Health (Anthem): Multi-state Blues licensee offering individual, Medicare, Medicaid, and employer plans across many of the same Midwest states where Medica operates, including Blue Cross Blue Shield plans in Missouri, Kansas, and Nebraska.
• CVS Health (Aetna): Aetna's health insurance arm competes with Medica's Medicare Advantage, individual, and employer products, while CVS Caremark represents a potential PBM alternative to Medica's Express Scripts partnership.
• UnitedHealthcare: Largest US health insurer providing the network backbone for Medica's Choice Passport product. Competes broadly across Medica's Medicare, Medicaid, individual, and employer markets and is the principal national-carrier threat to Medica's regional base.
• Cigna Group: National insurer with significant commercial and Medicare Advantage footprints competing with Medica's employer group and senior lines in overlapping Midwest geographies.

Emerging players

• Molina Healthcare: Government-program-focused health plan with strong Medicaid and D-SNP offerings, overlapping Medica's Minnesota Medicaid, D-SNP, and ACA business. Increasingly competes for state Medicaid contracts across the Midwest.

Direct peers

• Blue Cross and Blue Shield of Minnesota: Largest Minnesota-based health insurer offering a comparable portfolio of individual, Medicare, Medicaid, and group plans. Competes head-to-head with Medica in Minnesota and is co-petitioner on MNsure rate increases.
• HealthPartners: Minnesota-based nonprofit health plan and integrated care system with overlapping individual, Medicare, and Medicaid offerings. HealthPartners and Medica jointly seek rate increases on MNsure and compete directly for employer group and government-program membership in the Twin Cities.
• UCare: Minnesota nonprofit health plan serving Medicaid, Medicare, and individual ACA members, whose membership was largely absorbed by Medica in January 2026. Was a direct Minnesota competitor prior to the acquisition and retains a residual small-block business.

Regional players

• Blue Cross and Blue Shield of Kansas City: Regional Blues plan serving Kansas and Missouri markets where Medica also offers individual, Medicare, and group products, providing a focused regional competitor in overlapping states.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/medica4me
• LinkedInlinkedin.com/company/medica
• Instagraminstagram.com/medica4me
• Xx.com/medica4me

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments1 record

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Medica