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October 2025 Top of Mind

Medica to exit select markets in 2026

Effective Jan. 1, 2026, Optum will no longer administer behavioral health benefits for select Medica benefit plans in 5 markets across the U.S. This change is in conjunction with Medica’s announcement that it is exiting select markets for the 2026 plan year.

In Minnesota, the Medica Special Needs BasicCare Plan will no longer be offered in the state. In Iowa, Kansas, South Dakota and Wyoming, the service area for Medica Prime Solution® (Cost) Plans will be reduced. Here are the details:

Medica market exits

  • Minnesota – Medica Special Needs BasicCare Plan* : All 38 counties where this plan is currently offered
  • Wyoming – Medica Prime Solution® (Cost) Plans : All 8 counties where this plan is currently offered (Albany, Campbell, Crook, Goshen, Laramie, Niobrara, Platte, Weston)
  • Kansas – Medica Prime Solution® (Cost) Plans : All 10 counties where this plan is currently offered (Graham, Jewell, Lincoln, Mitchell, Norton, Ottawa, Phillips, Republic, Smith, Washington)
  • Iowa – Medica Prime Solution® (Cost) Plans : 2 counties where this plan is currently offered (Mitchell, Winnebago)
  • South Dakota – Medica Prime Solution® (Cost) Plans : 6 counties where this plan is currently offered (Butte, Custer, Fall River, Lawrence, Meade, Pennington)

What this means for you

  • Member notifications: Members affected by the service area reductions will receive a non-renewal notice, along with information on other plans available to them in their county.
  • Other Medica benefit plans: The service area reductions apply only to the plans/markets noted. Other Medica plans available in the markets are not affected.
  • Your participation agreement: As an Optum Behavioral Health network provider, you’ll still be contracted with other Medica plans offered in these markets.

Questions?

Please contact Medica at 1-800-458-5512.

*The Medica Special Needs BasicCare Plan* is also known as the AccessAbility Solution® Enhanced Highly Integrated Dual Eligible Special Needs Plan.


 

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