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Medicare Shift tightens doctor, clinic networks in Minnesota



Great changes in the state Medicare market highlight the need for buyers to examine which physicians and hospitals are part of the network when developing new health plan options.

More than 300,000 people in Minnesota will be forced into new cover in 2019, and they are finding a market with more Medicare Advantage plans limiting the number of physicians and hospitals offering care at lower network rates.

Insurers selling Advantage plans argue that their networks of various sizes are very large and others are narrower – a good choice for patients. Still, the limitations seem to be one reason why some buyers are considering a return to initial Medicare plus a Medigap supplementary policy that brings more choice but generally with higher premiums.

"What people will find in 201

9 is that the networks have changed – they are smaller in many of the plans and, as a result, people find that they have to consider other options when they come to [might] They want to stay with the doctor, clinic or hospital, "said Kelli Jo Greiner, health policy analyst on the Minnesota Board on Aging. "Many people consider Medigap as an option, while before it did not."

Open enrollment for people in Medicare began earlier this month with major changes in the preparation of Medicare health plans. Federal law is forcing healthcare insurers to abolish Medicare cost plans in 66 counties in Minnesota next year, with the result that more than 300,000 people change insurance at the same time. Many see as a consequence Medicare Advantage and Medigap plans.

Nationwide, Medicare Advantage plans during the first half of 2018 saw premium sales grow 10 percent year on year to $ 93.9 billion, according to Mark Farrah Associates. Market data company Pennsylvania says premium Medicare reinsurance premiums nationwide increased to $ 29.9 billion in 2017.

A network is the list of doctors and hospitals that have agreed to a particular health insurance. Most Medicare Advantage plans in Minnesota allow patients outside the network to take care of themselves, state officials said, but with higher cost-sharing requirements.

Insurers limit the network of doctors and hospitals to manage costs. Some health care providers have discounts on their service costs for the chance of getting higher volumes of patients through the agreements. There is also an argument that if care is concentrated on a subset of providers, these physicians and hospitals can better coordinate care for efficiencies.

"The thing to keep in mind is that there can be a significantly higher cost to a doctor who is not on the network," said Lukus Zuker, a community outreach specialist with the state's senior LinkAge line, during one Information session last week in Woodbury.

For more than a decade, the government has been pushing for cost plans due to cost issues They will disappear into 66 counties in Minnesota, including Hennepin, Ramsey and others, in the Twin Cities Metro next year, while in 21 counties including the remain northeast corner of the state.

Further Variation

During Cost Plan Networks in Minnesota According to Joshua Haberman, owner of Alexander & Haberman, an insurance agency based in Bloomington, the differences between doctors and hospitals participating in Medicare Advantage plans are even bigger and more stable.

Some cost plan participants are directed toward a Medicare Advantage plan from their existing health insurer that is comparable in terms of cost of delivery but does not necessarily provide in-network access to their physicians and hospitals. Subscribers have a choice of choosing a different plan, so cost plan attendees should take a close look at network details

At Bloomington-based HealthPartners, some Metro cost plan participants are routed to a Medicare Advantage plan that does not Providing in-network access to clinics and hospitals operated by Allina Health System, Fairview Health Services or Mayo Clinic.

HealthPartners said in a statement that premiums in the Medicare Advantage plan are kept low "by focusing on a network of providers" subscribers who want access to these healthcare systems can sign up for the Medicare supplement products The insurer said, "The insurer said."

Minnetonka Medica could help cost plan beneficiaries focus on Medicare Benefit plan, where the network does not include hospitals and clinics in the HealthPartners and Park Nicollet systems, the insurer said in a statement that he expects some cost plan candidates, but not all, to ban network restrictions.

"We believe that these beneficiaries are more likely to purchase a Medicare supplement plan," Medica said in a statement. "Conversely, there are beneficiaries who overwhelmed by their complex conditions, and welcome the more integrated providers Supporting a Closer Network. "

Less Choice in Some Areas

Eagan's Blue Cross and Minnesota's Blue Shield said some cost plan registrations on a Medicare Advantage (MA) plan with a large network, in general comparable to what consumers already have, especially in the Twin Cities and western Minnesota. However, this applies less to 16 districts in southeastern Minnesota, where Allina informed patients this month that their hospitals and clinics would not be part of the Blue Cross network for Medicare Advantage plans

Joel Stich, senior director at Blue Cross said Thursday that Blue Cross and Allina have recently reached an agreement that Owatonna Hospital will be in-network, but Allina New Ulm Medical Center is still outside the network.

People Lose Their Costs Plans that are not under control of a given Advantage Plan must continue to pay attention to potential network issues, as do all Medicare beneficiaries considering 2019 options during the current open enrollment period. Medicare insurers continue to pursue a trend towards developing "Accountable Care Organization" (ACO) health plans that treat patients from a relatively small group of physicians and hospitals.

Blue Cross launches an ACO in the Twin Cities in collaboration with Minneapolis. based Fairview health services. Minneapolis-based UCare launches an ACO-type health plan in the Twin Cities with Fairview and North Memorial and expands an ACO in Duluth with the Essentia Health Network of hospitals and clinics.

The Allina-Aetna Advantage Plan in the Twin Cities focuses on providing care at Allina Hospitals and clinics, although one spokeswoman said other vendors are included.

UnitedHealthcare Minnetonka says its new Medicare Advantage options for Minnesota have broad provider networks, but a search of the company website shows Mayo Clinic is not included. Kentucky Humana expands the number of products in Minnesota, but says it does not sell any ACO products here.

"They can be very well served in a tight network," said Haberman, the insurance agent. But he added, "You funnel it, you'll get a few nice things in return for this funnel in terms of bonuses and other benefits, but you'll give up some access and choice."

Difficult to compare networks [19659002] There is no definition for a large network of health care providers versus a small or tight network. It can be difficult to compare exactly how large networks are in different health plans, said Haberman, because insurers do not always count providers in the same way. The Medicare website lists how many providers are in different plans overall, but Greiner of the Minnesota Board on Aging says they are not a good option for retailers.

"These provider numbers are all types of Medicare providers … it's not just doctors, clinics, and hospitals," she said. "In order to get a clear picture of the participating providers, they need to go to the health plan website."

While Medicare supplements might look good from a network perspective, the difference to some Advantage plans may be smaller than that of consumers, "said Ghita Worcester, senior vice president of UCare, who has been the largest seller of Medicare Advantage for years. Plans is in Minnesota. The insurer said that 96 percent of all supplier locations in the state are included in the network for its most popular plans.

"We sell on it," Worcester said. She added, "People have different goals, and if you look at the price of a Medicare Advantage plan vs. a Medigap plan, there can be significant differences."

Combined with the variation in premiums, out-of-pocket costs and benefits for the pharmaceutical industry, the network wrinkles have contributed to a difficult open enrollment season for Medicare consumers, which has ended with much frustration. There was evidence of this unfortunate mood during the briefing last week at Woodbury, where about a dozen people were present.

Over the course of an hour, Zuker of the Senior LinkAge Line pointed out that people who leave the cost plans have a special reason to look this year, as they have a special "guaranteed spending" right on Medigap policies to have coverage from 2 November. At other times, people may be denied access to Medigap plans based on their medical history

At the end of the presentation, June Rhoads, 69, of Woodbury summed up the election that sees Medicare consumers in Minnesota as "insane." She is sorry to lose her Blue Cross budget, and is not he pleased with the process of choosing a new plan.

"That's hard," Rhoads said. "It's really a tough transition."

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