MercyCare Health Insurance Review & Complaints: Health Insurance (2023)

Covering residents of southern Wisconsin and northern Illinois, MercyCare is a regional HMO insurer. They provide individual and family plans as well as Medicare coverage through clinics and hospitals throughout the region.

What are MercyCare Health plans?

MercyCare was formed as a subsidiary of MercyHealth in 1994 to provide a health insurance plan through the providers in the health system network. Operating as an HMO, MercyCare offers access to five hospitals and 80 medical facilities located across its coverage network. Among their services is the only Small Baby Unit for the youngest preemies in the region, and they plan to open two more hospitals in the near future. MercyHealth headquarters is located in Janesville, WI.

MercyCare’s plans include individual and family plans, group plans for employers, and Medicare Supplement in a few counties. We’ve covered the Medicare offerings separately here.

As noted, all plans are HMO, which means that insurance coverage is only offered through providers in the MercyHealth network. Coverage is only available in specific coverage area counties.

What MercyCare Health plans are offered?

MercyCare health plans are offered at the Bronze, Silver, and Gold levels, available both on and off the insurance marketplace. At each metal tier, there are several levels of health insurance coverage available to choose from.

Gold Plans

Gold Option A has a $1,500 individual deductible and a $3,000 family deductible. Primary care visits have a $30 copay, while specialist visits and urgent care both have a $60 copay. Prescription coverage starts at $20 for Tier 1 drugs.

Gold Option B is the Standard Gold plan. The deductibles are a bit lower, at $1,400 for individuals and $2,800 for families. Copays are also a bit lower, with a $20 copay for a primary care visit and a $50 copay for a specialist; urgent care is still a $60 copay. Prescription drug coverage starts at $10 for Tier 1.

Gold Option C has the highest deductible of this metal tier, at $2,000 individual and $4,000 family. With this plan, however, the deductible is also the out-of-pocket limit, and after it is met all services are covered in full. The deductible applies to all services with the exception of preventative care.

Silver Plans

Like the Gold plans, there are three levels of Silver plans. Each level has several cost-sharing options only available through the marketplace to those who meet income requirements.

Silver Option A has deductibles of $5,750 for individuals and $11,500 for a family. Copays are $35 for primary care visits and $70 for both specialists and urgent care visits. Generic drugs start at $20.

Silver Option B is the Standard Plan, with a $3,500 individual copay that, like the rest, is doubled for a family. Copays on this plan are $30 for primary care, $65 for specialists, and $75 for urgent care. Tier 1 generic drugs start at $10.

Silver Option C works much like the Gold Option C; it has deductibles of $4,000 individual and $8,000 family that are also the out-of-pocket limit. After these are met, all services are covered in full. Preventative care is not subject to the deductible and is covered in full.

Bronze Plans

At the Bronze level, there are four plans available.

Bronze Option A has a $5,000 individual deductible that is double for a family. After the deductible is met, all services are covered with a 30% coinsurance amount. Again, preventative care is covered in full.

Bronze Option B is the Standard Plan at this level. It has a $6,650 individual deductible, and a $13,300 family deductible. Copays are $35, for primary care and $75 for specialist and urgent care visits. Prescription coverage starts at $35 for Tier 1 generic drugs.

Like the other Option C plans, Bronze Option C has deductibles that are also the out of pocket limit. They are $6,550 individual and are doubled for a family. After that deductible is met, all services are covered in full, with all services except preventative care subject to the deductible.

Bronze Option D is the same as Option C but has slightly lower deductibles. The individual deductible is $6,000, and the family deductible is $12,000. Again, all services except preventative care are subject to the deductible and covered in full once it is met.

Are the company’s rates competitive?

We ran a quote for a 30-year-old male non-smoker in the same zip code as MercyCare’s headquarters. The lowest rate returned was $222 a month for the Bronze Option C plan. The highest rate returned was $345 for the Gold Option C plan.

These rates are reasonable given the coverage, and in fact, there is a surprising lack of range in the prices, meaning you can get much lower deductibles for only a relatively small increase in monthly costs.

It is worth repeating that these plans are all HMO, and we generally expect HMO plans to be more affordable given the limitations on the network of providers. Even with that in mind, we found MercyCare’s options to be a good value.

How are claims handled?

Because MercyCare is an HMO, claims should be handled directly and swiftly. HMOs have little in the way of middlemen due to the fact that they are only dealing with in-house claims. MercyCare provides no real information on claims, and that’s not surprising; most people will not have to deal with a claim directly as they are submitted by the medical provider.

Are the ratings and consumer reviews positive?

MercyCare has an A+ rating with the Better Business Bureau (BBB), and there is only one complaint on file in the past three years. No complaints were closed in the past twelve months.

The National Committee for Quality Assurance gives MercyCare an overall 4.0 rating out of 5. A close look shows some less than ideal ratings, however, in the specific customer satisfaction ratings, including a 2.0 for claims handling and a 2.0 for ease of getting care.

Consumer reviews are limited; there are two on Google, one of which is negative and the other a four-star rating with no comments added. In general, the complaint volume for MercyCare is low.

What’s the bottom line?

MercyCare offers affordable HMO care in a limited region of Wisconsin and Illinois. They have a fairly good reputation and have a variety of plans to choose from. For those who do not mind the network limits of an HMO, MercyCare may be a good choice for individual health insurance.