Minnesota seniors navigating ‘incredibly complex’ system for Medicare Advantage

A Minnesota Star Tribune analysis shows roughly two-thirds of state residents in Medicare Advantage will lose their plans next year, forcing about 340,000 people to find new private coverage or evaluate options with original Medicare.

The disruption in Minnesota is greater than in any other state, reflecting a mix of local and national financial challenges for health insurers, the analysis shows.

The costs of health care are rising everywhere. Insurers argue that federal funding for Medicare Advantage, the privatized form of the federal health care program for seniors and some younger people, hasn’t kept pace with the expenses.

In Minnesota, there’s the added problem of UCare — the popular health insurer in Minneapolis that shut down at the end of 2025, sending tens of thousands of enrollees to other insurers’ Medicare Advantage plans, which were already were struggling to break even.

“When you add that membership into the overall market pool, it creates greater financial challenges,” said Andrea Walsh, the chief executive at HealthPartners, a nonprofit health insurer based in Bloomington.

The current open enrollment period for Medicare beneficiaries ends Dec. 7.

Here’s what seniors and other Medicare beneficiaries need to know about the changes.

Seniors age 65 and older, plus people with certain disabilities and health conditions such as end-stage kidney disease, can get health insurance through Medicare, the massive program administered by the federal government.

Instead of getting it through the government, half of eligible Americans now choose Medicare Advantage (MA) plans, which are privatized versions of Medicare offered through commercial insurers.

Yes. Nonprofit health insurers that have been dominant in Minnesota for decades have begun losing money on their MA plans. So they’re now trying to cut their losses.

It’s essentially a “reset” on benefits in MA plans across the country, said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans.

“We went through a period where MA plans were doing very well and they were really providing maybe overly generous benefits, or benefits that were not improving the health of their members,” Connolly said.

That period of time appears to be ending.

Yes. Seniors won’t have any Medicare Advantrage options in 15 counties across Minnesota next year.

In 12 of those counties, though, insurers will sell Medicare Cost plans, which typically sell at monthly premiums substantially higher than Advantage plans.

Crow Wing, Lake of the Woods and Wadena will have no Advantage plans nor Cost plans in 2027.

That means seniors in these counties will be covered by original Medicare by default, and they should consider buying supplemental coverage.

Yes. Two insurance companies in Minnesota — HealthPartners and Sanford Health — will only allow a certain number of people to enroll next year to limit the insurers’ financial risks.

Both insurers say they’ve never done this before, reflecting the high degree of instability across Minnesota’s market going into 2027.

HealthPartners is listing information about the caps on its website.

The original Medicare program has no annual out-of-pocket limit on medical costs — it generally covers about 80% of the bill. The remaining 20% could be huge for someone who is hospitlized or needs a lot of health care.

Seniors are encouraged to buy Medicare Supplement coverage, often called “Medigap,” to help cover the remainder.

Counselors also recommend buying a separate “Part D” plan for prescription costs not covered by original Medicare.

“If people don’t enroll in a Part D plan, they will not have drug coverage on January 1,” the Minnesota Board on Aging said in a statement. “They can also opt to purchase a Medigap policy, which can cover their Medicare costs, such as copayments, co-insurance, and deductibles.

The state offers a free service called Minnesota Aging Pathways at 800-333-2433.

Help from the federal government is available at 800-MEDICARE or by visiting the Medicare Plan Finder tool at Medicare.gov.

Insurance brokers can also help seniors consider their options. And the insurance companies provide information, as well.

Minnesota Aging Pathways has online presentations people can sign up for. There are also in-person sites for information throughout the Twin Cities metro, and limited in-person support in Duluth, Grand Marais, Little Falls, St. Cloud, Staples and Warren.

Call volume at Minnesota Aging Pathways already is up this fall and slightly higher than last year at this time.

The service has been receiving more than 1,000 calls per day since open enrollment began on Oct. 15. Wait times are averaging 26 minutes, which is higher than last year at this point.

Insurance agents and counselors say seniors need to study the fine print coverage options, to make sure they have access to preferred doctors and hospitals plus the best possible coverage for medications.

People losing plans have what’s called a guaranteed issue right to buy a Medigap plan. This is key, because otherwise insurers could deny coverage based on pre-existing health conditions.

Medicare Supplement policies, however, generally sell at much higher premiums than Advantage plans and even Cost plans.

“A guaranteed issue does not mean you can afford it,” said Jeannie Fuglesten Biniek, a researcher who specializes in Medicare policy at California-based KFF.

“It is incredibly complex,” she said.

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