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News & Press: General

Medicare Advantage Update from Payer Relations Committee

Thursday, November 8, 2018   (0 Comments)
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The MMGMA Payer Relations Committee is receiving a lot of inquiries on the transitioning of Medica Cost products to Medicare Advantage products for all payers effective January 1, 2019. The individual product name and plan is now available on all health plan websites.


Quick summary: 300,000 Senior Minnesotans will be moved from Medicare Cost products to Medicare Advantage products on January 1, 2019. The BIG difference between Medicare Cost products and Medicare Advantage products are the benefits AND the network that is sold with the products. Medicare Cost in Minnesota allows Seniors to go to Non-Contracted Clinics with little to no out of pocket differential. Medicare Advantage does not. CMS allows Medicare Advantage products sold in Minnesota to set narrow provider networks for the product. If the Senior goes outside of the narrow network set up by the health plan, the Senior must pay more out of pocket than they did with the Medicare Cost product they are currently in. This change will affect the “Minnesota Snowbirds” (who travel outside of Minnesota during the winter) more than those Seniors that spend all year in our state.


VERY IMPORTANT! For all Medicare Advantage products sold by health plans you have a contract with, you need to verify your clinic is listed in their network. Unlike Medicare Cost, health plans are allowed to sell narrow networks for each Medicare Advantage product they sell. You will need to make sure your clinic is listed on the provider directory for all of the Medicare Advantage products shown. If your clinic is not listed, contact your health plan representative (either provider rep or contract manager) and let them know so that it can be corrected.


Now, if there is any silver lining in all of this, it’s the following: CMS is allowing a 3 month window for all Seniors moving from a Medicare Cost product to a Medicare Advantage product. So, if a Senior patient you are seeing does not like the Medicare Advantage product that they selected (or they were moved into by the health plan), they have until March 31 to switch to another product - another Medicare Advantage, Supplemental, Medigap, or even straight Medicare. Be sure to point this out for any Seniors that are concerned about this switch.


If seniors ask you about their options, ask them to contact their health plan they are currently in or the Senior LinkAge Line. It offers one-on-one sessions by appointment on specific days and at specific places. A Senior can schedule an appointment, at (800) 333-2433.


If you have any questions about this update, please contact MMGMA via


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