The Albert Lea Healthcare Coalition had specific and focused goals when it began its work to bring healthcare back to the region.
To this end, the coalition was successful in raising funds and completing the first phase of building a new clinic, which included securing their building at 2510 Bridge Ave., securing a primary care clinic and its staffing. They even found a partner in MercyOne.
That was the whole idea of building the clinic: to provide options for the residents of Albert Lea and surrounding communities when it comes to care.
Another part of caregiving was insurance.
“What we need to make sure is that insurance companies that are licensed to do business in the state of Minnesota for health insurance purposes, that our clinic is in that network so to speak,” said Brad Arends, chair of the Albert Lea Healthcare Coalition and co-founder and CEO of Intelligentnts.
He said the five health insurance companies that do business in the state — Blue Cross, HealthPartners, Medica, PreferredOne and UnitedHealthcare — have contracted with MercyOne to include the clinic in their networks for insurance purposes. provided by the employer.
But there was a problem with an insurance company offering individual policies.
According to Arends, individual policies include people who do not receive care through an employer and are not eligible for Medicare. But the problems weren’t with Blue Cross or Medica, the companies he described as the “main carriers” for individual policies. The problem — at least until last week — was HealthPartners, a company he and his staff at Intelligents had spoken with for more than a year.
“HealthPartners really wasn’t active in southern Minnesota, and we encouraged them to become active in southern Minnesota,” he said.
Back in the game
Arends reached out to them a few weeks ago about getting back to individual insurance – specifically regarding individual insurance choices, and last week it was learned that the provider was “back in the game” to provide one-on-one coverage in southern Minnesota, especially in Freeborn County.
“We have been working and discussing with HealthPartners for over a year,” he said, referring to him and his staff.
More importantly to him, citizens of Freeborn County (and only Freeborn County) will have insurance options from HealthPartners. Options include having an open network (where everyone is networked) or having what he described as more affordable insurance.
According to Arends, there were no insurance providers in southern Minnesota and Freeborn County that had an individual policy similar to more affordable group insurance plans. At least until HealthPartners comes into play.
HealthParters will provide insurance plans that it described as “significantly cheaper”.
For example, a 2023 Silver Individual Pricing Plan from HealthPartners will cost $1,502 per month for a family of four (with one 15-year-old and one 18-year-old). By comparison, a BlueCross BlueShield plan covering the same family of four will cost almost $2,100 (that’s over 39% more). Arends said the price difference was whether Mayo was in-network.
An Individual Bronze 2023 plan will cost $1,321 per month for this family, while a BlueCross BlueShield Bronze plan will cost over 25% more.
“That puts individual policies on par with small group policies or large group fully insured policies,” he said. “It’s a great thing for the citizens.”
And it was important to both recover HealthPartners and provide a more affordable healthcare option. Arends also wants companies to have options and choices with companies using individual policies (as opposed to small groups).
“The Albert Lea Healthcare Coalition wants high quality healthcare at an affordable price,” he said.
He compared the option of a company using small group or individual policies to the option of using Mayo or MercyOne – having options.
“We wanted the same with individual policies, where there was coverage that was going to be more affordable,” he said.
He was quick to point out that the change would not affect Medicare. What the change affects are fully insured individual policies and people who do not have insurance as part of their job. This also affects people taking the state’s exchange program, which will provide more options for county residents.
Reason for local optimism
HealthPartners will not offer individual plans to residents of neighboring counties, including Mower, Steele or Olmsted. Arends said the decision was a HealthPartners decision, but he speculated that the decision could be a test to see how it worked.
After learning of HealthPartners’ decision to offer individual policies as early as 2023, he said it was “really, really good” because the county had options, not only in terms of care, but also insurance.
According to Arends, more and more employers across the country were creating health insurance plans consisting of individual policies, which he said was illegal. But the law has changed and employers now have the option of creating a group of individual policies.
“They do it because in certain circumstances it would actually be cheaper,” he said.
Because insurers were groups of people banding together to cover risks, small employers, what he defined as employers of less than 150 to 200 people, anyone with a chronic illness could ruin the costs of every member of a global program.
Arends used the example of a group of 125 people and noted that this is a small group over which to spread significant risk, which could lead to unaffordable health insurance renewals and bankruptcies. ‘a company.
“What we did was we went out and set up insurance coverage based on individual policies,” he said. “When you look at individual policies, insurance companies have a much larger group to spread the risk over.”
This is because they have thousands and thousands of people in a risk pool buying individual policies, which means they can spread that risk over many more people.
He said the ability to select individual fonts would be a “lifeline” for some companies.
A case study
To prove his point, he cited the case of a local employer using an individual health coverage reimbursement arrangement on the smarts website. A long-term care facility’s group insurance plan was affected by a single chronic claim. This claim caused the group to pay more, change carriers and plans, or have more limited coverage.
In 2018, 97 employees out of a possible 133 were enrolled in a group plan and $1.008 million was spent on health insurance. But there was an $800,000 claim for chronic illness.
In 2019, renewal increased by more than 49% and registrations fell to just 71 people due to the greater increase in premiums.
But in 2020, individually covered health care reimbursement accounts became legal in the state, and this approach reduced total health insurance costs to $458,000. Thus, the employer and the employees saved $950,000.
“When we set this up for them, they only had individual fonts available that were open to everyone, including Mayo,” he said. “They didn’t have the ability to have options that ruled out Mayo.
“Now anyone who uses individual policies as a group plan will have a cheaper, more affordable option,” he said.
According to Arends, the most common way for Americans to obtain insurance is through their employer, which meant that small groups faced the possibility of not being large enough to cover a significant risk for a small number. of employees.
“Now that’s available to employers who might want to use individual policies as a mechanism instead of a small group or people who don’t have coverage,” he said.
Trisha Tyson, Senior Director of Medicare and Individual Health and Sales Solutions for HealthPartners, said in an email, “We are excited to offer residents of Freeborn County a coverage option that helps them meet their their health care needs and access services close to home. ”
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