Key Takeaways From Large Hospital System Leaving UnitedHealthcare’s Medicare Advantage Network

The announcement was posted on July 23, 2024, on the Star Tribune website. For Star Tribune subscribers or if you have free articles left for the month, you can read the entire news story here:  HealthPartners is leaving UnitedHealthcare’s Medicare Advantage network

Almost all doctors and hospitals are part of original Medicare, but Medicare Advantage plans have limited networks of doctors and hospitals that agree to provide care for the lowest out-of-pocket cost to seniors.

HealthPartners, one of the largest hospital and clinic systems in the Twin Cities, is leaving UnitedHealthcare’s Medicare Advantage network effective January 1, 2025. HealthPartners is sending letters to 300,000 of their patients with this MA plan.

Their concerns about the nation’s largest health insurer, UnitedHealthcare, point to an excessively high rate of unnecessary waits and delays for patients that interfere with appropriate care. “UnitedHealthcare delays and denies approval of payment for our patients’ Medicare Advantage claims at a rate unlike any other insurer in our market,” the letter from HealthPartners says. “At times, this denial rate has been up to 10 times higher than other insurers we work with.”

What does this mean for the 300,000 patients with this Medicare Advantage plan who receive care at HealthPartners in MN?

During open enrollment from Oct. 15 through Dec. 7., patients have 4 options to consider for 2025:

1. Switch to a new doctor, clinic, or hospital that accepts UnitedHealthcare’s Medicare Advantage network – at least for 2025.
2. Switch to original Medicare; consider adding a Medicare supplement called Medigap and enrolling in a Medicare drug plan (Part D) for prescription drug coverage.
3. Keep the same doctors and pay higher out-of-network prices for primary and specialty care. (This does not mean there still won’t be potential delays in approved care and coverage denials.)
4. Apply for a new Medicare Advantage plan accepted at HealthPartners. (Be aware that fewer plans are accepted. Last summer, HealthPartners announced they were dropping in-network coverage for Medicare Advantage plans from Humana for 2024.)