This fall's big shopping season for Medicare health plans in Minnesota includes a number of options where subscribers might not have access to their doctors on an in-network basis.
The market for 2019 includes more products that are similar to "accountable care organizations" (ACOs) that steer subscribers to a relatively small number of doctors and hospitals. The idea is that these ACO-style plans can better manage care for quality and efficiency, but a side effect is that not all doctors and hospitals are part of the network.
Plus, more than 300,000 Minnesotans will lose next year their Medicare Cost health plans, which traditionally have had very large networks of doctors and hospitals. Insurers that run those Cost plans are steering people to Medicare Advantage plans with smaller lists of in-network doctors and hospitals.
Most Medicare Advantage plans in Minnesota allow subscribers to see doctors and hospitals on an out-of-network basis, but that could mean significantly more in out-of-pocket costs depending on the health plan.
The difference in network size between Cost and Advantage plans varies by insurance company, and it can be tough to get a big picture understanding of precisely how they compare.
The designated Advantage plan for Cost plan enrollees at HealthPartners doesn't include in-network access to Allina Health System, Fairview Health Services and Mayo Clinic. The comparable product at Minnetonka-based Medica doesn't include the doctors and clinics within the care system at Health Partners, which is based in Bloomington, on an in-network basis.
At Eagan-based Blue Cross and Blue Shield of Minnesota, network issues for Cost plan enrollees being steered to a new Medicare Advantage have been most prominent in southeast Minnesota.
Consumer advocates say individual patients should check with insurers about whether their doctors are part of any health plan's network. What's more, consumers can avoid worries about the network if they stay in original Medicare, although the government program includes cost-sharing requirements that prompt many to purchase Medigap policies.
Medigap supplemental insurance policies carry relatively high premiums compared to Medicare Advantage plans, some of which are available for a $0 monthly premium.
Medicare beneficiaries can get free help at the state's Senior LinkAge Line, which is run in part by the Minnesota Board on Aging.
Kelli Jo Greiner, a health policy analyst with the board, said last week that it's taking longer per-person for operators at the help line to wade through options when consumers call. With more Medigap and standalone drug plans on the market for 2019, the overall landscape of Medicare health plan options is shifting in complicated ways.
"It's very challenging for a lot of people," Greiner said in an interview. "There are a lot of very frustrated people."