Significant changes in the public health insurance market highlight the need for purchasers to verify which physicians and hospitals are part of the network when evaluating new health plan options.

More than 300,000 Minnesota residents are being offered new coverage for 2019 and are discovering a market with more Medicare Advantage plans limiting the number of doctors and hospitals providing care at lower rates in the network.

Insurers who sell Advantage plans claim that their networks are offered in different sizes, some very large and others narrower, offering good choices to patients. Even in this case, the limits seem to be one of the reasons why some buyers are considering returning to the original Medicare and additional Medigap policy, which gives them more choice, but generally with higher premiums .

"For 2019, what people are seeing is that the networks have changed – they are smaller with many plans, which means that [might] should consider other options if they wish to stay with their doctor, clinic or hospital, "said Kelli Jo Greiner, Minnesota Board on Aging Health Policy Analyst. "Many people consider Medigap as an option, whereas they did not do it before."

The open registration for Medicare people started earlier this month with major changes in the range of Medicare health plans. Next year, a federal law requires health insurers to remove health insurance plans from 66 counties in Minnesota, which will allow more than 300,000 people to change coverage at the same time. As a result, many are reviewing Medicare Advantage and Medigap.

In the United States, Medicare Advantage generated a 10% increase in sales in the first half of 2018, reaching $ 93.9 billion, according to Mark Farrah Associates. The Pennsylvania-based market data company said insurers across the country had seen premium income from Medicare supplement policies rise by $ 29.9 billion in 2017.

A network is the list of doctors and hospitals that have agreed to participate in any health insurance plan. Most Minnesota Medicare Advantage plans have allowed patients to leave the network for treatment, state officials said, but with higher cost-sharing requirements.

Insurers limit the network of doctors and hospitals to manage costs. Some health care providers are negotiating rebates on their service costs to increase the number of patients under the agreements. In addition, it can be said that when care is concentrated on a subset of providers, these physicians and hospitals can better coordinate care to become more effective.

"What we have to keep in mind, is that if you consult a doctor not belonging to the network, the costs can be significantly higher," said Lukus Zuker. , a specialist in community outreach to the state's Senior LinkAge line, at an information session held last week. at Woodbury.

For more than a decade, the government has been trying to put an end to cost plans because of cost issues. They will disappear next year in 66 counties of Minnesota, including Hennepin, Ramsey and others in the Twin Cities metro, while remaining in 21 counties, including the northeast corner of the state. .

More variation

While cost-plan networks in Minnesota are large and stable, the number of physicians and hospitals participating in Medicare Advantage programs varies more, said Joshua Haberman, owner of Alexander & Haberman, an insurance company based in Bloomington.

Some cost plan members are referred to a Medicare Advantage plan from their existing health insurer, comparable in terms of direct costs, but not necessarily providing network access to their physicians and hospitals. Subscribers have the choice to choose another plan. Therefore, those enrolled in the cost plan should take a close look at the details of the network.

At HealthPartners in Bloomington, some metro cost plan members are being referred to a Medicare Advantage plan that does not provide network access to clinics and hospitals managed by Allina Health System, Fairview Health Services or the clinic Mayo.

HealthPartners said in a statement that the Medicare Advantage plan kept premiums low "by focusing care on a network of providers offering quality care at a lower cost." Subscribers who wish to have access to these health systems can opt for Medicare products, the supplement, the insurer said.

At Medica, based in Minnetonka, cost plan enrollees could end up facing a Medicare Advantage plan in which the network does not include HealthPartners and Park Nicollet hospitals and clinics. The insurer said in a statement that it expected some, but not all, of the cost plan members to oppose network restrictions.

"We think these beneficiaries are more likely to take out a Medicare supplement plan," Medica said in a statement. "Conversely, some beneficiaries are overwhelmed by the complexity of their conditions and welcome more integrated support from providers in a narrower network."

Fewer choices in some areas

Blue Cross and Blue Shield Minnesota, based in Eagan, have indicated that they are referring some members of a Medicare plan to a Medicare Advantage (MA) plan with an extensive network that is generally comparable to what consumers have already, especially in twinned cities and western Minnesota. This is less true in 16 counties in southeastern Minnesota, where Allina informed patients this month that her hospitals and clinics would not be part of the Blue Cross network for Medicare Advantage plans.

Joel Stich, chief executive of Blue Cross, said Blue Cross and Allina had recently reached an agreement that Owatonna Hospital would be connected to the network, but the Allina Medical Center, New Ulm, was still offline. .

People who lose their cost plans and who are not geared to a particular Advantage plan still need to monitor potential network problems, just like all Medicare beneficiaries considering using 2019 in the current period open registration. Medicare insurers continue the trend of developing health plans for Responsible Care Organizations (COAs) that direct patients to the care of a relatively small group of physicians and hospitals.

Blue Cross launches COA in twin cities in conjunction with Minneapolis-based Fairview Health Services. Minneapolis-based UCare is launching an ACO-type health plan in twinned cities with Fairview and North Memorial, while developing an ACO in the Duluth area with Essentia Health's hospital and clinic network.

Allina-Aetna's new Advantage plan in Twin Cities focuses on the care provided in Allina hospitals and clinics, although one spokesperson said other providers were included.

UnitedHealthcare, based in Minnetonka, says its new Medicare Advantage options for Minnesota have extensive supplier networks, but a search on the company's website shows that the Mayo Clinic is not included. Humana, based in Kentucky, is increasing the number of products in Minnesota, but says it does not sell ACO products here.

"You can get very good care in a close network," said Haberman, the insurance agent. But he added, "They are channeling it. You get good things in exchange for this funnel in terms of bonuses and other benefits, but you give up access and choice. "

Difficult to compare networks

There is no precise definition of a large network of health care providers in relation to a small or narrow network. It can be difficult to accurately compare the size of networks in different health plans, Haberman said, because insurers do not always count providers the same way. The Medicare website lists the total number of claimants in different plans, but Greiner from Minnesota Board on Aging says they are not a great way to shop.

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

While Medicare supplements may look really good from a network perspective, the difference with some Advantage plans may be less than that of consumers, said Ghita Worcester, senior vice president at UCare, who was the biggest seller of Medicare Advantage plans in Minnesota. several years. The insurer said that 96% of all providers located in the state are included in the network for its most popular packages.

"We sell on that," said Worcester. She added, "The goals are different and if you compare the price of a Medicare Advantage plan to that of a Medigap plan, you may find some significant differences."

Combined with the variation in premiums, reimbursable expenses and pharmacy benefits, network wrinkles have contributed to a difficult open registration season for Medicare consumers, with a lot of frustration. There were allusions to this unfortunate mood at the information event held last week in Woodbury, where about a dozen people were present.

In the space of an hour, Zuker, from the Senior LinkAge line, pointed out that people who were coming out of cost plans had this year a particular reason to take a look at the policies of Medigap, since they would have a special "guaranteed" right unique to the coverage. from November 2nd. At other times, access to Medigap plans may be denied to people based on their medical history.

At the end of the presentation, 69-year-old June Rhoads of Woodbury summed up the consumer choice of Medicare in Minnesota as "bewildering". She regrets losing her Blue Cross cost plan and is not happy with the process. to choose a new plan.

"It's difficult," Rhoads said. "It's really a difficult transition."