Is Medica and UnitedHealthcare the Same?

UnitedHealthcare and Medica are two major health insurance providers in the United States, but they have some key differences in their business models and operations. While there is some overlap and partnership between the companies, they remain distinctly separate entities.

An Overview of UnitedHealthcare

UnitedHealthcare is one of the largest health insurers in the U.S. and serves over 50 million members across all 50 states. It offers a wide range of insurance plans including employer-sponsored plans, individual plans, Medicare Advantage plans, and Medicaid plans.

Key facts about UnitedHealthcare:

• Headquarters is in Minnetonka, MN
• Founded in 1977 as part of UnitedHealth Group
• Employs over 300,000 people worldwide
• Offers plans directly or through employers
• Has large national provider network with over 1.2 million providers
• Operates OptumRx for pharmacy benefit management
• Owns many subsidiaries and brands like AARP, AmeriChoice, and Oxford Health Plans

As one of the biggest players in the insurance industry, UnitedHealthcare has the scale and resources to offer competitive rates on plans. It appeals to many large employers and customers looking for extensive provider network access across the country.

An Overview of Medica

Medica is a regional health insurance company focused primarily in the Upper Midwest. It offers group health plans for employers as well as individual health plans. Medica also participates in state public health care programs like Medicaid and MinnesotaCare.

Key facts about Medica:

• Headquarters is in Minnetonka, MN
• Founded in 1976
• Employs around 5,000 people
• Operates in MN, WI, ND, SD, KS, MO, NE, IA, AZ, and WY
• Has partnered with other insurers like UnitedHealthcare and HealthPartners
• Maintains own regional provider networks
• Has about 4 million members nationwide

As a smaller regional insurer, Medica can be more tailored to local markets in certain states. It partners with larger national insurers to broaden offerings for customers. Medica plans may appeal most to employers and residents concentrated in their main Midwestern markets.

The Relationship Between UnitedHealthcare and Medica

UnitedHealthcare and Medica operate as independent companies but have an intertwined history and some partnerships between the insurers.

Here are some key points about the UnitedHealthcare and Medica relationship:

• Both companies founded in Minnesota in the 1970s
• UnitedHealthcare was originally focused on hospital management
• Medica started by providing administrative services to self-insured employers
• Medica previously administered plans for UnitedHealthcare in late 1990s
• UnitedHealthcare bought Medica health plans in Florida in 2012
• Companies partner on employer group plan options
• Medica leases the UnitedHealthcare provider network in some markets
• Medica offers UnitedHealthcare Medicare Advantage plans in some states
• UnitedHealthcare owns about 15% stake in Medica as an investor

The two companies clearly cooperate based on synergies in certain markets and plan types. However, they maintain distinct provider networks, business strategies, leadership, and geographic footprints.

Comparing Plan Offerings

The types of health plans available from UnitedHealthcare vs. Medica can vary based on state and market. There is some overlap in options, but also key differences.

UnitedHealthcare Plan Types

• Employer-sponsored plans (PPO, HMO, POS, EPO, CDHP)
• Individual and family plans (on or off exchange)
• Medicare Advantage (PPO, HMO, PFFS, SNPs)
• Medicaid plans
• Student health plans

UnitedHealthcare provides a vast array of commercial group plans for employers. They can craft plans based on specific employer budgets and preferences. The individual market plans tend to have fewer options, but are available in most areas. UnitedHealthcare has a major presence in public programs like Medicare Advantage and Medicaid as well.

Medica Plan Types

• Employer-sponsored plans (PPO, HMO, POS, HDHP)
• Individual and family plans (on exchange)
• Medicare Advantage plans (via UnitedHealthcare partnership)
• Medicaid plans (MN, WI, IA)

Medica focuses heavily on employer group plans, particularly in its core Midwestern markets. The individual plan options are more limited outside Minnesota and Iowa. For Medicare Advantage, Medica leverages the UnitedHealthcare network and resources. Medica participates selectively in Medicaid programs that align with existing state footprints.

In side-by-side comparisons, UnitedHealthcare almost always has more plan diversity than Medica. But in certain states, the Medica options may be more competitively priced or a better fit for local employer needs.

Provider Network Differences

The provider networks for UnitedHealthcare and Medica plans can vary significantly depending on geographical market.

UnitedHealthcare Provider Networks

• Offers national Choice Plus Network with over 1.2 million providers
• Also has other tiered networks like Core, Select, Select Plus
• Broad coverage across all provider types and specialties
• Typically includes most major hospital systems

The UnitedHealthcare provider networks aim for extensive access nationwide. They contract with providers in all 50 states to ensure adequate geographic spread and choice. With so many providers participating, the networks typically cover a very wide range of specialties.

Medica Provider Networks

• Uses own Medica Choice with UnitedHealthcare Options network
• Has over 700,000 providers but more concentrated regionally
• Focuses networks in WI, MN, ND, SD, NE, IA, KS, MO
• Uses UnitedHealthcare networks in some markets
• Includes major systems like Mayo Clinic, Sanford, Essentia

Since Medica operates regionally, its networks are more concentrated in certain states. There is still broad provider access for customers in Medica’s core service states. The company partners with UnitedHealthcare to expand coverage in markets outside its regional footprint.

For employers and residents in Medica’s Midwestern strongholds, the Medica networks should provide adequate choice. But for broader national coverage, the UnitedHealthcare networks are usually larger.

Customer Service Comparison

The customer service resources available to members can be an important factor in the health plan experience. Here is how UnitedHealthcare and Medica compare:

UnitedHealthcare Customer Service

• National call centers and online support
• Mobile app for claims, providers, ID cards
• Online member portal to access benefits
• Large self-service knowledge base
• Usually 24/7 phone support

With so many members nationwide, UnitedHealthcare provides extensive self-service tools and call center support. There are both national 800 numbers and local support numbers. Hours are typically 24 hours given the scale of membership served.

Medica Customer Service

• Regional call centers in core states
• Mobile app for benefits and claims
• Online member portal for coverage info
• Targeted service based on local needs
• Phone support from 7am-8pm weekdays

Medica has more localized service centers to align with market needs. There is still robust online self-service capacity, but phone support has more limited hours. The service approach focuses on common issues for Medica’s employer group members.

For most routine inquiries, the customer service experience will be similar. For complex issues or off-hour needs, UnitedHealthcare may have more resources available.

Cost and Plan Value Comparison

The rates and overall value proposition for UnitedHealthcare vs. Medica will depend on many variables:

• State or region – pricing and competition level can vary
• Employer size – larger firms tend to get better rates
• Plan type – HMOs tend to cost less than PPOs
• Provider network used – impacts negotiated discounts
• Drug formularies – more restrictive formularies have lower premiums
• Cost-sharing amounts like deductibles and co-pays
• Customer service – better service has a cost
• Plan sponsor administration – self-funded plans have lower premiums
• Government fees and taxes – impact final pricing

Some general observations:

• In the same market, UnitedHealthcare rates are often slightly below Medica
• But Medica can be more competitive in their core Midwestern region
• For nationwide coverage, UnitedHealthcare likely has economies of scale
• Both make use of narrow provider networks and pharmacy controls to reduce cost
• Medica offloads some overhead by partnering with UnitedHealthcare in certain markets

There are many factors impacting how the rates between the two insurers compare for a given employer or customer situation. In general, UnitedHealthcare leverages their size and scale to be competitive, while Medica aims for regional segmentation advantages.

Which Insurer Is a Better Fit?

There is no definitive answer on whether UnitedHealthcare or Medica is better overall. The right option depends on factors like:

Employer size and locations – Is it a national company or regional footprint? Does the workforce span multiple states?

Covered population needs – Are broad provider choices important? What types of health services are heavily utilized?

Current doctors or facilities – Do employees want to retain existing provider access?

Plan management approach – Does the employer prefer self-funded plans?

Budget and cost factors – What monthly premiums are affordable? How are deductibles and co-pays structured?

Service preferences – Is