What is Happening in Minnesota?

[somarco]

6th health system may exit Medicare Advantage in Minnesota​

Minneapolis-based Allina Health, a 12-hospital system, has notified about 18,000 patients with Humana Medicare Advantage plans that their clinicians will be out-of-network in 2025 unless the payer agrees to a contract that reduces prior authorization hurdles and claims denials, The Star Tribune reported Oct. 24.

6th health system may exit Medicare Advantage in Minnesota

Allina Health may be the sixth Minnesota health system to exit a Advantage network program in 2025

www.beckershospitalreview.com

 

[NWSINS]

There are 3 major health care provider systems in Minnesota. They own most of the hospitals and throw there weight around. The all have basically said, they don't like for profit insurance companies and don't want to do business with them.

Minnesota has 4 non-profit insurance companies that provider systems here love. One MA company covers 98% of the state doctors and 100% of the state hospitals including Mayo Clinic. They have a national network in 48 states and out of network benefits. Another company covers 96% of the doctors and hospitals and includes Mayo Clinic and national network.

We have plans that cost $50 a month with a $3,000 MOOP

WOW - I thought Medicare Advantage was evil?

 

[annon123]

There are 3 major health care provider systems in Minnesota. They own most of the hospitals and throw there weight around. The all have basically said, they don't like for profit insurance companies and don't want to do business with them.

Minnesota has 4 non-profit insurance companies that provider systems here love. One MA company covers 98% of the state doctors and 100% of the state hospitals including Mayo Clinic. They have a national network in 48 states and out of network benefits. Another company covers 96% of the doctors and hospitals and includes Mayo Clinic and national network.

We have plans that cost $50 a month with a $3,000 MOOP

WOW - I thought Medicare Advantage was evil?

Well here in this state if you are paying that much max MOOP you are paying more than the premiums for G and the B deductible here and can be seen country wide was well, including the Mayo Clinic if you felt like traveling... In fact most of the MAP's here don't have a national network and some the network isn't even the entire state.

Not to mention you don't have to worry if the Mayo bails from MAP's and you now fail medical underwriting but want to go back.

Good though, in my opinion, that they are sticking with non-profit companies as then more of the money will go to patient care and not shareholder profits (since they don't have those) and big bonuses to the top brass (not allowed to do that with non-profits, you have to reinvest any left over money back into the company).

WOW - I thought MA was more expensive than MAP? LOL

 

[NWSINS]

I knew you would take the bait. FYI - Medicare supplements in this state range in price from $280 - $330 for a G plan per month...plus your part D.

You can also get Ozempic, Mounjaro, Jardiance, Trelegy, Xarelto & Eliquis for a $47 co-pay on that MAPD. I guess one size doesn't fit all......

 

[somarco]

paying that much max MOOP you are paying more than the premiums for G and the B deductible

The avg MOOP for MA plans here is $6 to $7k with some higher and a few (mostly HMO) in the $5k range.

Most of my clients are relatively healthy but you don't have to even come close to the MOOP before Medigap makes more sense. If a client is running up $15k or more in gross claims on a regular basis it's mostly outpt stuff, having 5+ docs and getting some kind of PT or injections . . . those folks are benefiting from the G plan.

One of the few clients I lost was a few years ago. He was type 1 with complications. I enrolled him when he was T65 (no underwriting) and stressed that if he left he may not be able to return.

After about 18 months or so someone talked him into an SNP and he took the bait. About a year or so later he called to see if he could get his Medigap back . . . the SNP was eating him alive with copays and coinsurance.

Some agents don't realize you don't have to be terminal to run up big medical bills. Chronic conditions will often do more damage to your bank account than cancer.

 

[Chazm]

Shouldn’t this say, 6th health system may exit one Medicare advantage plan?
In my opinion, they almost always come to an agreement before the end date. Not always, but close to it.

 

[NWSINS]

Chaz wins the prize. I won't name names (H), but that company has been kick out of 9 Minnesota health care systems in the past 2 years. Agreement with Allina seems highly unlikely.

 

[medicaresupplement]

I have clients that have the uhc.ppo plan which has worked out great for many years for several of my clients. I was just just notified that Health Partners will not accept.their United.PPO plan next year as in their network. I might have to go back to a Supplement plan if they can pass underwriting.since

After.doing my research it looks like Health Partners will only accept their local Mapd options which then don't work well when my clients.are in Arizona. Very frustrating. Any suggestions?

 

[somarco]

MA works well . . . until it doesn't.

Many times hospitals and carriers come to an agreement at the last minute . . . except when they don't.

I don't care to roll the dice when it comes to my health . . . and neither do my clients.

I get too many calls from folks who want to leave MA and go on a Medigap plan and then they are let down when I have to tell them no. One woman, a former client, who dropped her plan and then wanted to come back after she was seriously injured in a car accident started crying when I told her no one would take her.