The rise of exchanges has not led many regional plans to expand into new states. Most expansions have been the province of upstarts (New York's Oscar Health Plan) and CO-OPs (Montana Health Cooperative, Maine Community Health Options, and Minuteman Health).

But few regional players can capitalize on a strong partnership with a world-renown provider. With the Mayo Clinic in its network, Medica can. It already did in its home state of Minnesota. In, 2014, Minnesota's state-exchange had just one silver-level exchange plan available in Mayo's southeastern Minnesota region, Medica hammered out a narrow network in southeastern Minnesota built around the clinic.

Now it's taking the partnership across the Midwest to Iowa and Nebraska. Plan benefits include Mayo as a center of excellence, allowing members and a companion to travel to Mayo for services and receive travel, meal and lodging stipends.

It's not hard to miss the message in Medica's announcement. That message is that the Mayo partnership is more of a main course than a garnish. The carrier will offer a broad network available in both new states, but Mayo could be additional enticement.

Obviously, this kind of expansion doesn?t fit every market or insurer. Medica already sold plans in parts of Wisconsin and both Dakotas. Iowa and Nebraska appear to be logical next steps.

But Iowa and Nebraska lie at an odd confluence of health insurer and exchange issues. Iowa has had low exchange adoption due to the extension of non-compliant health coverage through 2017 and the continued absence of its largest insurer, Wellmark Blue Cross Blue Shield, from the state's health exchange.

The CO-OP that operated in both states, CoOportunity Health, grew to more than 100,000 lives before it ran into a mountain of claims and fell apart after being unable to pay its bills. But the demand CoOportunity elicited signals those markets are eager for competitors.

Iowa could still be a difficult needle for newcomers to thread (UnitedHealthcare is also joining for 2016). The volume of members with expensive and complex medical conditions led to CoOportunity's demise. Wellmark's exchange absence leaves a huge share of the state's individual market outside the exchange.

However, Medica is serving up something different. Giving members from Nebraska and Iowa access to Mayo providers could help it spread enrollment more broadly in 2016.

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