Avera Health Plans Insurance Review & Complaints: Health Insurance (2023)

Avera Health Plans, Inc. is a not-for-profit health insurance company serving South Dakota and Iowa. The health plans are part of the larger Avera Medical Group, Avera’s award-winning health care system.

Named for Avera, Queen of Peace, the system is known for providing comprehensive health care with a faith-based approach as they were founded by two Catholic orders as a mission, based on Christian values.

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What is Avera?

Avera Medical Group goes back to 1897 and was founded in Sioux Falls, South Dakota. The group was started by the Benedictine Sisters of Yankton, SD, and the Presentation Sisters of Aberdeen, SD; two Catholic orders that continue to sponsor the system to this day. In 1999 they launched Avera Health Plans, initially for employees and then later expanded to the public to provide a local health care option in South Dakota and Iowa.

Today the company is the largest employer in the state and provides health care through more than 300 locations. They offer health insurance to people without access to an employer-sponsored policy. As a part of the Catholic Church, they continue to provide spiritual guidance as well as modern medical care, and plan members do not have to be Catholic. Avera has frequently been on the cutting edge of medicine in the region, having been first to offer liver and bone marrow transplant services locally.

Avera has several levels of health insurance coverage available to individuals and families. They also offer Medicare Supplement insurance, which we have reviewed separately here. Plans can be purchased through agents or directly from Avera.

What Health Plans Are Offered?

Avera has plans at the Bronze, Silver, Gold, and Catastrophic levels, allowing consumers to choose their combination of coverage and cost. One of the plans at the Silver level includes an HSA option to save pre-tax for health care costs.

Catastrophic

The Avera 7150 is a catastrophic plan available only to those who qualify. This plan has a $7,150 individual deductible and a $14,300 family deductible. With this plan the deductible is the out-of-pocket limit, meaning that you pay all of the costs until the deductible is met, and then all services are covered at 100%, with no copay or coinsurance. This includes prescription drugs and hospital stays.

Bronze

Avera has two levels of Bronze coverage. The Avera 6550 plan is the highest deductible bronze-level plan, with the $6,550 deductible applying to individuals in-network and a $13,100 family deductible. Out of network deductibles are actually lower, at $5,000 and $10,000 respectively.

Like the 7150, the deductible is also the out-of-pocket limit; meaning services are covered at 100% across the board once the deductible is met. There is no coinsurance or copay amount after the deductible has been paid, and this also applies to prescription drugs. This only applies to in-network care, and out of network care has a variety of coinsurance amounts after the deductible is met.

The second Bronze plan has lower deductibles and is also available with the option of pediatric dental coverage. The in-network and out of network deductibles are the same, at $5,000 individual and $10,000 family. After the deductible, there is a 40% coinsurance amount for most services, up to the out of pocket limit.

Prescription drugs are covered with coinsurance as low as 0% after the $50 individual/$100 family pharmacy deductible.

Silver

The Avera 2500 has the lowest deductible of the silver plans. The individual deductible is $2,500 and the family deductible $5,000 in-network, while deductibles double for out-of-network.

There is a $25 copay for primary care visits and a $60 copay for specialists. Copays and coinsurance vary for other services. Prescription drug coverage starts at $0 for generic drugs, with no separate deductible.

The Avera 3000 is very similar to the 2500 plan, with slightly higher deductibles, probably in return for a lower premium. In-network deductibles are $3,000 individual and $6,000 family, with out-of-network at $5,000 and $10,000 respectively. Copays are the same as the 2500 plan.

Both of these two health insurance plans offer an option to add pediatric dental.

The Avera 3500 plan automatically includes pediatric dental. The deductibles are $3,500 individual and $7,000 family, with $5,000 individual and $10,000 family for out of network care. Copays are $30 for primary care and $65 for a specialist visit. As with the other plans, prescription drugs start at $0 for generics.

The final Silver plan is the 4000 HSA plan. This plan is like some of the Bronze plans in that the deductible is also the out of pocket limit, allowing 100% coverage after it has been met. The individual deductible is $4,000 and the family deductible $8,000 with out of network the same as the other silver plans. This plan also includes an HSA to save pre-tax dollars for medical costs.

Gold

Avera has one Gold level plan that is available with or without pediatric dental coverage. The Avera 1500 has a $1,500 individual deductible and a $3,000 family deductible for in-network care. Out of network deductibles are $5,000 and $10,000 respectively.

All office visits have a $20 copay, whether primary care or specialist. Prescription drug coverage starts at $0 copay for generic drugs.

Are the Company’s Insurance Rates Competitive?

The insurer does not offer rates online. The company does have a good range of quality service and comprehensive health care delivery, but some insurance plans will have a higher monthly premium than others. As a nonprofit health care delivery system with a religious affiliation, we would expect Avera to offer affordable rates for coverage.

Quotes can be obtained by contacting an Avera agent or contacting Avera Health Plans directly.

Is the Claims Process Simple?

As a health insurer, Avera handles claims directly through the providers. For this reason, it is not surprising to not see information regarding how claims are processed on their website.

Are the Company’s Ratings and Consumer Reviews Positive?

The Better Business Bureau (BBB) gives Avera an A+ rating, and there have been no complaints filed against them in the past three years.

Likewise, we were unable to find customer service complaints against this company anywhere else online. This is not entirely unusual for a small, regional company, but it is always a good sign when there are no complaints at all to be found against an insurance company.

The National Committee for Quality Assurance (NCQA) ranked Avera at 3.0 overall based on several factors, a rating that is on the low side. The three areas in which NCQA rates insurance companies are Consumer Satisfaction, Prevention, and Treatment. Avera ranked 3.5 in Consumer Satisfaction, which is fairly good, but earned only a 2.0 in Prevention. The Treatment ranking is a 3.0. Although these rankings seem somewhat low, there are only three companies that ranked higher for this area (South Dakota) with 4.0 ratings overall.

Without much in the way of complaints, and a solid BBB rating, this company does appear to enjoy a good reputation among its customers.

What’s the Bottom Line?

Avera is likely to appeal to those who prefer a faith-based medical group, as well as those who like a regional company to serve their health care needs. There is a good selection of plans to choose from at all levels, and likely something for everyone. The company has a long history and a good reputation, and are likely to be a solid choice for affordable health insurance in South Dakota or Iowa.