Important Information for patients with UnitedHealthcare Medicare Advantage plan insurance 

Beginning Jan. 1, 2025, Essentia Health will no longer serve as an in-network health care provider for UnitedHealthcare’s (UHC) Medicare Advantage plan. This applies to care at all Essentia Health hospitals and clinics. As part of this change, for patients who are covered by UnitedHealthcare’s Medicare Advantage plan, we will no longer schedule any appointments that occur after Dec. 31. 

Like other health care organizations, Essentia has been re-evaluating Medicare Advantage plans to make sure they are administered in the best interest of our patients. In evaluating UHC’s Medicare Advantage plan, we found excessive prior authorizations and denial rates for patients who are covered by the plan. 

Prior authorizations are requests that health care providers make to insurance companies seeking approval before care can proceed. Prior authorizations check whether certain treatments, medications or procedures are covered by the insurance plan. Excessive prior authorizations and denials can lead to delays in providing care that patients need, which can be frustrating and stressful.

We know that the relationships our patients have developed with members of their care team are important to them. We would like to continue providing care to patients who currently have Medicare Advantage plan through UnitedHealthcare. We hope these patients will consider switching to another Medicare plan in which Essentia Health is listed as an in-network care provider. 

The best time to switch to a Medicare plan that covers care provided at Essentia Health is during the annual Medicare open enrollment period, Oct. 15, 2024-Dec. 7, 2024. Some of the Medicare plans that cover care provided at Essentia Health include: Medica, Essentia Care, UCare, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, HealthPartners, Security Health, traditional Medicare and Medicare supplemental plans. 

If your UnitedHealthcare Medicare Advantage plan health insurance is provided by a former employer, you are encouraged to reach out to your former employer for information on group options.  

We are here to help. If you would like to speak to an Essentia Health representative about these options, please contact us at 1-800-985-4675. We are available Mondays through Thursdays, 8 a.m. to 5 p.m. and Fridays between 9 a.m.-4:30 p.m. 

Thank you for trusting Essentia Health with your care.

 Frequent questions and answers

  • Why will Essentia Health no longer be an in-network care provider for patients with UnitedHealthcare Medicare Advantage insurance in 2025? 
    In evaluating UnitedHealthcare’s Medicare Advantage plan, we found excessive prior authorizations and denial rates for patients who are covered by the plan. Prior authorizations are requests made by your health care provider to your insurance company. They check whether certain treatments, medications or procedures are covered by your insurance plan. Excessive prior authorizations and denials cause hardships for our patients. We believe that our patients deserve prompt access to the care that they need. 
  • If I choose to stay with UnitedHealthcare’s Medicare Advantage plan, how long do I have to seek care at Essentia Health before my health insurance coverage ends? 
    The contract between Essentia Health and UnitedHealthcare (UHC), for the coverage of Medicare Advantage plan patients, ends on Dec. 31, 2024. Essentia will continue to be considered in-network for patients covered under the plan until that date. A small number of patients with certain conditions will be able to schedule appointments and receive care at Essentia Health for a limited time beyond Dec. 31, 2024 to provide continuity of care. Please see the chart below for conditions and timelines. Essentia Health will also continue to provide care for UHC’s Medicare Advantage plan patients within our hospital emergency rooms, as we do for all patients. 
    Covered Service Continuity of Care Period beyond Dec. 31

    Inpatient covered services

    		 30 days or until discharge, whichever comes first

    Non-surgical cancer treatment

    		 30 days or a complete cycle of radiation or chemotherapy, whichever is greater

    End stage kidney disease and dialysis

    		 30 days

    Symptomatic patients with AIDS undergoing active treatment

    		 30 days
  • I plan to continue to seek care at Essentia Health in 2025, what do I need to do to make sure my care and/or procedures are still covered? 
    We recognize that the relationships our patients have with their physicians and advanced practice providers is especially important to our patients. We encourage those currently covered by UnitedHealthcare to find alternative Medicare plans that have Essentia Health in their network. These options include Medica, EssentiaCare, UCare, Blue Cross Blue Shield of Minnesota and North Dakota, HealthPartners, Security Health,  traditional Medicare and Medicare supplemental plans. 

    We are here to help. If you would like to speak to an Essentia Health representative, please contact us at 1-800-985-4675, Monday through Thursday 8 a.m. - 5 p.m. and Friday 9 a.m.- 4:30 p.m. 
     
  • If I am covered through my former employer’s group plan, what does this mean for me?
    If your UnitedHealthcare Medicare Advantage plan health insurance is provided by a former employer, you are encouraged to contact your former employer for information on group options. 
  • If I decide to choose a new provider for my Medicare plan, when should I do this? 
    The best time to make changes in your Medicare plan is during Medicare open enrollment. For 2025, the Medicare open enrollment will be Oct. 15, 2024, through Dec. 7, 2024. Changes made during open enrollment take effect on Jan. 1, 2025. 
  • Who can help me change my Medicare plan? 

    If you are currently covered by UnitedHealthcare’s Medicare Advantage plan, Essentia Health can provide information about Medicare plans that include Essentia in their network of covered providers. These options include Medica, UCare, Essentia Care, Blue Cross Blue Shield of Minnesota and North Dakota, HealthPartners, Security Health, traditional Medicare and Medicare supplemental plans.

    • If you would like to speak to an Essentia Health representative, please contact us at 1-800-985-4675 Monday through Thursday between 8 a.m. and 5 p.m. or Friday between 9 a.m. and 4:30 p.m.

    There are several ways you can shop and compare Medicare plans:

    • If you’ve worked with an insurance broker or advisor previously, they may be able to help you. You can also find a new Medicare broker.
    • If you want to navigate plan options on your own, medicare.gov is a great resource. Please note that plan details for 2025 won’t be available until October 1, 2024.
    • If you have available coverage through a group retirement plan, reach out to your former employer for more information.
  • Which Medical plans cover care at Essentia Health?
    Insurance providers that include Essentia Health in their Medicare plan network include Medica, UCare, Essentia Care, Blue Cross Blue Shield of Minnesota and North Dakota, HealthPartners, Security Health, traditional Medicare and Medicare supplemental plans. 
  • If I have a Wisconsin Dual Special Needs (D-SNP) or Minnesota Senior Health Options (MSHO) plan through UnitedHealthcare, will my insurance still be accepted at Essentia Health in 2025?
    No. This change also applies to patients who have Wisconsin D-SNP or MSHO insurance through UnitedHealthcare, which means Essentia Health will be an out-of-network provider as of Jan. 1, 2025.  As such, Essentia will not schedule any appointments that would occur after Dec. 31.
  • What are the differences between traditional Medicare and Medicare Advantage plans? I thought I could go to any provider with my Medicare plan.
    • With traditional Medicare, you can see any provider who accepts Medicare.
    • Medicare Advantage plans typically have a network of specific doctors, clinics and hospitals that have contracted with your insurer to provide care. These plans often offer additional coverage and benefits that traditional Medicare does not cover.

    Learn more about Medicare Advantage plans: https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf

     
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