Some Medicare-based insurance programs for seniors are falling short, and Minnesota providers are opting out.

News Release from Minnesota Hospital Association, October 15, 2024

Saint Paul, Minnesota – Medicare open enrollment will kick off on Tuesday, and the options before seniors have never been more difficult to sort out.

At least five hospitals and health systems have recently announced plans to leave the networks of major national for-profit Medicare Advantage plans. They include Avera Health, Essentia Health, North Memorial Health, and Sanford. Media reports indicate this will impact about 60,000 Minnesota seniors, who may find their providers are no longer in-network and may need to seek care with another provider.

These changes also follow more limited terminations of Medicare Advantage agreements in 2023 and 2020 that included CentraCare.

Many Minnesota seniors are experiencing ever-greater challenges in accessing care due to insurance market barriers. Medicare Advantage programs are based on traditional Medicare and then customized by each insurer. Many insurers have chosen to add features like health club plans and food, dental, and vision benefits. Those benefits can help seniors stay healthy and need less medical care, but too often, there can be tradeoffs.

Some insurers have cut back on what health care they will pay for – either requiring lengthy pre-approvals for care or denying coverage altogether. This cost-cutting makes it harder than ever for seniors to get the care they need when they need it.

This situation is hitting a tipping point, as some providers are leaving for-profit Medicare Advantage plan networks that limit the care their patients receive. In fact, Medicare Advantage insurance denials grew by more than 50 percent in the U.S. last year, adding a significant bureaucratic burden for providers and hindering the care patients receive.

You won’t hear about this from celebrities or paid actors pitching for-profit Medicare Advantage plans on TV, brokers’ slick marketing offers, or advisors staffing booths at your local pharmacy.

More than ever before, Minnesota seniors need to treat Medicare plan decisions as they would any other major life investment. A recent survey found about 70 percent of seniors don’t comparison shop Medicare Advantage plans, and nearly half don’t check annually for coverage changes.

This year, Minnesota seniors need to do their homework; talk to their providers about the health plans they will accept in the coming year, and talk to friends, family, and financial advisors to weigh the options. Seniors need to be smart shoppers when it comes to choosing a plan that works for their healthcare needs in the community where they seek care.