About 13,000 Minnesota seniors on Medicare could lose in-network access to their doctors

Seniors with Humana Medicare Advantage plans are being told they'll lose in-network access to HealthPartners' hospitals and clinics next year.

The move would affect 13,000 Medicare beneficiaries who are covered through Humana, a large Kentucky-based health insurer that has a significant presence in Minnesota.

Bloomington-based HealthPartners says these patients will need to either change health plans or pay more out-of-pocket in 2024 to see its network of doctors.

HealthPartners is alerting its patients of the change in letters being sent out this month.

"Beginning January 1, our hospitals and clinics will no longer be in the Humana Medicare Advantage network," HealthPartners said in a statement to the Star Tribune. "With many other good Medicare Advantage options available, we're committed to helping our patients ease the transition."

A spokesman for Humana said the health insurer remains open to further discussions with HealthPartners and hopes to reach a new agreement before next year.

"At the same time, we must ensure the health care systems and physicians we contract with provide quality, cost-effective care to keep health coverage and out-of-pocket costs as affordable as possible for our health plan members," Humana said in a statement to the Star Tribune.

Three years ago, Humana's health plans for seniors also lost Minneapolis-based M Health Fairview and St. Cloud-based CentraCare from their in-network options.

Network disputes between health plans and health care providers occur occasionally and often get resolved without disruption for patients. There wasn't a resolution in 2020, however, after the Star Tribune first reported on earlier contract disputes with Humana; representatives for CentraCare and M Health Fairview said this week their health systems remain out-of-network with Medicare Advantage plans from Humana.

The open enrollment period for seniors to join, drop or switch to another Medicare Advantage plan typically starts in mid-October.

"If you have a Humana insurance plan, there's nothing you need to do right now," HealthPartners says in the letter being sent to patients. "But as you consider your Medicare needs for 2024, we want to provide some resources to help you explore health plan options that would continue to allow you to receive in-network care from us."

HealthPartners operates Regions Hospital in St. Paul, Methodist Hospital in St. Louis Park and the Park Nicollet network of clinics. The nonprofit also runs a large health insurance business that includes Medicare Advantage health plans.

Advantage plans are a newer form of Medicare coverage, where beneficiaries opt to receive their government benefits through a private managed-care company. Whereas almost all doctors and hospitals are part of original Medicare, the Advantage plans have limited networks of doctors and hospitals that agree to provide care for the lowest out-of-pocket cost.

These network rules effectively limit choices for enrollees if they can't afford the higher fees with out-of-network care. And network providers can change from year to year, potentially prompting seniors to make changes.

The trade-off is that monthly premiums with Medicare Advantage plans typically are significantly less than with Medicare Supplement policies, which often are called "Medigap" because they help fill gaps in coverage with original Medicare.

In Minnesota and across the country, a growing number of seniors have been opting for Medicare Advantage.

These health plans typically offer extra benefits, such as for vision, hearing and dental services, and offer the chance for lower out-of-pocket spending than for seniors with original Medicare who don't also purchase a Medigap supplement. Advantage plans bundle together medical benefits with Part D drug coverage, whereas people in original Medicare buy stand-alone plans for medication benefits.

Trade-offs with Medicare Advantage go beyond network limitations. While people every year can shop different Advantage plans or move back into original Medicare, they might not be able to purchase a Medicare Supplement depending on their health status.

In addition, the California-based health policy group KFF reported last month that "Medicare Advantage plans typically use tools to manage utilization and costs that may limit access to care, such as prior authorization requirements and referrals for specialists and mental health providers."