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Medicare shift tight doctor, clinic network in Minnesota

Major changes in the state's Medicare market emphasize the need for shoppers to check which physicians and hospitals are part…

Major changes in the state’s Medicare market emphasize the need for shoppers to check which physicians and hospitals are part of the network when adapting new health plan options.

More than 300,000 people in Minnesota are introduced into new coverage for 2019, and they find a market with more Medicare Advantage plans that limit the number of doctors and hospitals providing care at lower rates in the network.

Insurance companies selling Advantage plans claim that their networks are available in different sizes – some very large, and other narrower – it provides a good choice for patients. Nevertheless, the limits appear to be a reason why some customers consider a return to original Medicare plus a Medigap supplementary policy, which gives more choices but generally with higher prizes.

“By 201

9, the networks have changed – they are smaller with many of the plans, and as a result, people find that they need to look at other alternatives if they want to stay with their doctors, clinics or hospital, “said Kelli Jo Greiner, health policy analyst with Minnesota Board on Aging. “Many people look at Medigap as an option, while they previously did not.”

Open enrollment for people in Medicare began earlier this month with major changes in the setting up of Medicare health plans. Federal law forces health insurers next year to eliminate Medicare Cost plans across 66 counties in Minnesota, resulting in more than 300,000 people changing coverage at once. Many people look at Medicare Advantage and Medigap plans as a result.

Nationwide, Medicare Advantage plans in the first half of 2018 saw premium revenues increase 10 percent year on year to $ 93.9 billion, according to Mark Farrah Associates. The Pennsylvania-based marketing company says insurance companies across the country saw premium income from Medicare’s supplementary policy growing in 2017 to $ 29.9 billion.

A network is the list of doctors and hospitals who have agreed to participate in a particular health insurance. Most Medicare Advantage plans in Minnesota allow patients to go to the healthcare network, state officials say, but with higher cost sharing requirements.

Insurance companies limit the network of doctors and hospitals to handle costs. Some healthcare professionals deal with discounts on their service costs for the chance of a higher volume of patients through the agreement. In addition, there is an argument that when care focuses on a subset of suppliers, doctors and hospitals can better coordinate care for efficiency.

“What’s important to consider is: There may be significantly higher costs if you go to a non-network doctor,” said Lukus Zuker, a community outreach specialist with the state’s Senior LinkAge Line, during an information session last week in Woodbury.

For more than a decade, the government has pressed to end cost plans due to cost problems. They will disappear next year in 66 counties in Minnesota, including Hennepin, Ramsey and others in the Twin Cities subway, while remaining in 21 counties, including the northeastern corner of the state.

More variation

Minnesota’s cost-plan network has been large and stable, there is more variation in the number of doctors and hospitals participating in the Medicare Advantage plans, “said Joshua Haberman, owner of Alexander & Haberman, a Bloomington-based insurance agency.

Some cost plans are rolled against a Medicare Advantage plan from their existing health insurers comparable to out-of-pocket costs, but do not necessarily provide the network to their doctors and hospitals. Subscribers have the choice to choose another plan, so cost plans must look closely at the network information.

At Bloomington-based HealthPartners, some cost plans in the metro are targeted at a Medicare Advantage plan that does not provide access to networks at clinics and hospitals run by Allina Health System, Fairview Health Services or Mayo Clinic.

HealthPartners said in a statement that it keeps premiums low in the Medicare Advantage plan “by focusing on a network of providers providing quality care at a lower cost.” Subscribers who want access to these healthcare systems can choose the company’s Medicare- supplementary products, says the insurer.

At Minnetonka-based Medica, cost plans could be found against Medicare Distribution Plan, where the network does not include hospitals and clinics in HealthPartners and Park Nicollet systems. The insurer said in a statement that it is expected that some cost plans, but not all, will be affected by network restrictions.

“We think these recipients are more likely to buy a Medicare supplementary plan,” Medica said in a statement. “Conversely, there are beneficiaries overwhelmed by their complex conditions and welcome the more integrated supplier support for a narrower network.”

Minor Selections in Some Areas

Eagan-based Blue Cross and Blue Shield in Minnesota said that it is managing some cost plans against a Medicare Advantage (MA) plan with a large network that is generally comparable to what consumers already has, especially in twin cities and western Minnesota. However, it is less true over 16 counties in southeastern Minnesota where Allina announced patients this month that its hospitals and clinics would not be included in the Blue Cross Network for Medicare Advantage plans.

Joel Stich, Blue Cross chief executive, said Thursday that Blue Cross and Allina recently reached an agreement where Owatonna Hospital will be in-network, but Allina’s New Ulm Medical Center is still out-of-network.

People lose their cost plans that are not controlled to a certain advantage. The plan still needs to look at potential networking issues as well, as all Medicare recipients are considering 2019 options during the current enrollment period. Medicare’s insurer continues a trend of developing responsible health care organizations (ACO) health plans that guide patients to care about a relatively small group of doctors and hospitals.

Blue Cross launches an ACO in Twin Cities in conjunction with Minneapolis-based Fairview Health Services. Minneapolis-based UCare launches an ACO-style health plan in Twin Cities with Fairview and North Memorial, while expanding an ACO in the Duluth area with the Essentia Health network in hospitals and clinics.

The new Advantage plan from Allina-Aetna in Twin Cities focuses on care at Allina Hospitals and Clinics, although a spokesman said other providers included.

Minnetonka-based UnitedHealthcare says its new Medicare Advantage option for Minnesota has broad supplier networks, but a search of the company’s website shows the Mayo Clinic is not included. Kentucky-based Humana extends the number of products in Minnesota, but says it does not sell any ACO products.

“You can get a lot of well-being in a narrow network,” says Haberman, the insurance agent. But he added, “They are leaving. You get some nice things in exchange for that funeral in terms of prizes and other benefits, but you give up some access and choice.”

Difficult to compare networks

There is no defined definition for what constitutes a large network of healthcare providers versus a small or narrow network. It can be difficult to compare exactly how large networks are on different health plans, “says Haberman, because insurers do not always count on suppliers in the same way. The Medicare website shows how many total providers are available in different plans, but the Greiner of the Minnesota Board on Aging says they are not a good way for individuals to trade.

“These supplier numbers are all types of Medicare suppliers … it’s not just doctors, clinics, and hospitals,” she said. “In order to get a clear picture of the providers involved, they must go to the health plan website.”

While Medicare supplements can look really good from a network perspective, the difference with some benefit plans may be less than consumers might think, says Ghita Worcester, senior vice president with UCare, who has been the largest seller of Medicare Advantage plans in Minnesota for several years. The insurer said that 96 percent of all state procurement sites are part of the network for the most popular plans.

“We’re selling it,” said Worcester. She added: “People have different goals, and if you look at the price of a Medicare Advantage plan versus a Medigap plan, there may be significant differences.”

Combined with the variation in premiums, cost-benefit and pharmacy’s benefits, network wrinkles have contributed to a harsh open enrollment season for Medicare consumers, complete with much frustration. There were tips on the unfortunate mood during the information event last week in Woodbury, where about a dozen people were present.

In one hour, Zuker of Senior LinkAge Line pointed out that people who leave cost plans have a special reason this year to look at Medigap policies, as they will have a special single “guaranteed question” right to coverage from 2 November. On other occasions, people may be denied access to Medigap plans based on their health history

At the end of the presentation, June Rhoads, 69, Woodbury summarized the choice of Medicare consumers in Minnesota as “excessive”. She is sad to lose her cost plan from Blåkorset and is not happy about the process of choosing a new plan.

“This is hard,” said Rhoads. “It’s really a tough transition.”

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