When the Albert Lea Healthcare Coalition launched its efforts to bring healthcare back to the community, it had specific and targeted goals.
To that effect, the Coalition managed to raise funds and completed Phase 1 of building a new clinic, including securing a building at 2510 Bridge Avenue and acquiring and staffing a primary care clinic. They found a partner in his MercyOne.
The overall idea behind building the clinic was to provide care options for residents of Albert Lea and the surrounding area.
Another part of providing care was insurance.
“What we have to make sure is that we are an insurance company that is licensed to do business in Minnesota for health insurance purposes, and that our clinic is in that network, so to speak.” Co-founder and CEO of Lea Healthcare Coalition and Intellicents.
He said all five health insurance companies operating in the state (Blue Cross, HealthPartners, Medica, PreferredOne, and UnitedHealthcare) have signed up to include clinics in their networks for the purposes of employer-provided insurance. I have a contract with MercyOne.
However, there was a problem with one insurance company doing individual insurance contracts.
Arends said individual policies include people who can’t get care through their employer and aren’t covered by Medicare. But the problem was not with Blue Cross or Medica. He explained that these companies are the “primary carriers” of individual insurance. The problem, at least until last week, was his HealthPartners, whom he and his Intellicents staff had been talking to for over a year.
“HealthPartners did not actually operate in Southern Minnesota, but encouraged them to do so in Southern Minnesota,” he said.
back to the game
Arends contacted them about returning to private insurance a few weeks ago. Specifically, because it was related to personal insurance choices. Last week, we received word that providers were “back in the game” offering personal coverage in Southern Minnesota, specifically Freeborn County.
“We have been working and talking with HealthPartners for over a year,” he said, referring to him and his staff.
More importantly to him, citizens of Freeborn County (and Freeborn County only) have access to HealthPartners insurance options. Options include having an open network (everyone is in the network) or having more affordable insurance, he explained.
There were no insurance companies in Southern Minnesota and Freeborn County that had similar individual insurance as more affordable group insurance plans, Arends said. At least until HealthPartners entered the game.
HealthParters offers an insurance plan that he described as “dramatically cheap.”
For example, HealthPartners’ 2023 Silver Individual rate plan costs $1,502 per month for a family of four (one child aged 15 and one child aged 18). By comparison, a BlueCross BlueShield plan covering the same her family of four would cost about $2,100 (or more than 39% more). Arends said the price difference is whether he has Mayo in the network.
The 2023 Bronze Individual plan costs $1,321 per month for that family, while the BlueCross BlueShield Bronze plan is over 25% more expensive.
“This makes the individual policy equivalent to a small group policy or a large group full insurance policy,” he said. “It’s a big deal for citizens.”
And it was important to both bring back HealthPartners and provide more affordable healthcare options. Arends also wants companies to have options and choices with companies using individual policies (rather than small groups).
“Albert Lea Healthcare Coalition wants affordable, high-quality healthcare,” he said.
He compared the company’s option of using small groups or individualized policies to the option of using either Mayo or MercyOne (there are options).
“We wanted the same thing with individual policies that had coverage that would make them more affordable,” he said.
He was also quick to point out that the change would not affect Medicare. is. It also affects those who take advantage of the state’s exchange programs, providing county residents with more choice.
Reasons for local optimism
HealthPartners does not offer individual plans to residents of neighboring counties such as More, Steele and Olmsted. Arends said the decision was that of HealthPartners, but speculated that the decision could be a test to see how it works.
After learning that HealthPartners made the decision to offer individual insurance in 2023, he said he was “really, really glad” because the county had options when it came to insurance as well as care.
According to Arends, more and more employers across the country were creating health insurance plans that consisted of individual policies. However, the law has changed and employers now have the option to create individual policy groups.
“They do it because it’s actually cheaper in certain situations,” he said.
An insurance company is a group of people who come together to cover a risk and is defined as a small employer, he defined 150 to less than 200 employers, so one person with a chronic illness but can ruin the cost for all members of the entire program.
Arends used the example of a group of 125 people and pointed out that it is the small group that spreads the big risks.
“What we’ve done is put insurance coverage together based on individual policies,” he said. “When you look at individual policies, insurers have a larger group of risk spreads.”
This is because risk pools have thousands of individuals purchasing individual policies. That means you can spread that risk over more people.
He said being able to choose individual policies could be a “lifesaver” for some companies.
Case Study
To prove his point, he cites the case of a local employer using the Individual Insurance Health Insurance Reimbursement Scheme on the Intellicent website. Long-term care facility group insurance plans were impacted by one chronic claim. That allegation led the group to pay more, change carriers and plans, or cover a more limited range.
In 2018, 97 out of 133 employees had group plans and $1.08 million was spent on health insurance. However, there was an $800,000 chronic disease claim.
In 2019, enrollment fell to just 71 as renewal fees increased by more than 49% and higher premium increases.
However, personal health insurance reimbursement accounts were legalized in the state in 2020, and this approach has reduced the total cost of health insurance to $458,000. Thus, employers and employees saved him $950,000.
“When we put it together for them, they only had a separate policy available that was open to everyone, including Mayo,” he said. , did not have the ability to have the option to exclude Mayo.
“Now anyone with an individual policy as a group plan will have a cheaper and more affordable option,” he said.
According to Arends, the most common way Americans get insurance is through their employer. In other words, a small group faced the possibility of not being large enough to cover the large risks of a small number of employees.
“Now it’s available to employers who want to use individual policies as a mechanism instead of smaller groups or people without coverage,” he said.
Trisha Tyson, Senior Director of Medicare and Personal Sales and Wellness Solutions at HealthPartners, said in an email. ”
