MESSA offers six health insurance plans, but, according to several school districts, only four plans effectively exist. The six official MESSA health plans include: Super Med I, Super Care I, Super Med II, Super Care II, MESSA 250/20, and MESSA Limited. Many school districts are angry, however, because the two least expensive plans MESSA 250/20 and MESSA Limited-have restrictions on their purchase. Many school districts contend that MESSA is not providing them with a complete set of options when they consider which MESSA health plan to purchase.

The 250/20 and Limited plans are geared towards a pre-defined segment of the school district market. Specifically, those plans exist for both poorer school districts and groups of employees, such as hourly workers, who typically are paid lower wages. The MESSA 250/20 plan, for example, offers a $250 deductible with a $20 co-payment for certain procedures and protects against major catastrophe. It was developed primarily for lower-level support personnel whose monthly insurance premiums often exceed their monthly wages. Certain school districts must understand that the 250/20 and Limited plans offer minimal benefits and are targeted at a certain market segment. It would therefore be somewhat unrealistic to expect that all of a district's employees would even consider this coverage.

Even then, school districts have claimed that both of these plans are available only for certain periods of time, and these availability periods rarely coincide with contract negotiation periods when the actual health insurance plan is decided.⁷⁶ Furthermore, only one school district in the state is known to participate in the MESSA Limited Plan. The districts are justified in stating that they deserve a chance to negotiate the 250/20 and Limited plans and that MESSA should make these plans more available. Consequently, school districts are generally forced to choose between the more expensive Super Med and Super Care plans. On a related note, some districts have expressed the desire to customize their MESSA health insurance plans. Doing so would give school districts the flexibility to design benefit structures in accordance with their own needs and budgets, rather than a limited choice between four very expensive plans.