In July, Ramsey County officials learned that an impasse between the HealthPartners health system and UnitedHealthcare over the insurer’s senior Medicare Advantage plans could kick 2,400 county retirees and spouses out of network, effectively excluding them from Regions Hospital in St. Paul, Lakeview Hospital in Stillwater and other HealthPartners sites.

Former county workers who spent 20 years or more paying into their employee retirement benefits now face the prospect of losing access to HealthPartners cardiologists, cancer care specialists and other doctors they or their loved ones have seen for years. With a Jan. 1 deadline to break the impasse approaching, Ramsey County Board Chair Victoria Reinhardt has been urging the county’s human resources department to explore a fix.

“UnitedHealthcare keeps saying, ‘oh yeah, we’ll work this out.’ HealthPartners seems pretty strong in saying, ‘No, we won’t,’” said Reinhardt on Monday. “They are still talking, but I don’t know that they’ll come to an agreement.”

“When you’re of retirement age, generally you want to stay with the same doctors that you had before,” she added. “I’m in pretty good health, but I’m 71 years old. Things change when you get older. You don’t want to change your doctor. It’s not that simple.”

Tuesday debate

On Tuesday, the county board will debate whether to approve up to $1.2 million to cover the county’s portion of the cost of a senior supplemental plan that retirees could opt into at higher costs than their current UnitedHealthcare Medicare Advantage premiums. The exact amount of monthly payments will vary with their date of retirement, date of hire and years of service.

Victoria Reinhardt (Courtesy of the Ramsey County Board of Commissioners)

Employees hired after Jan. 1, 2006 would not receive a county contribution toward the senior supplemental and prescription drug plan.

“It’s different for every person, because everyone gets a different amount,” Reinhardt said. “Is it going to be a lot more? If you don’t get a county contribution, it’s going to be about double.”

The supplemental plan aims to maintain county retiree access to HealthPartners sites in 2025, though it could be extended for up to three years, according to a staff report to the county board. It’s unclear, however, if the spending proposal has the votes to pass. One seat on the seven-member board is currently vacant.

Funding and other details

About 2,400 county retirees and spouses are insured by one of two UnitedHealthcare Medicare Advantage plans, and 45% of them — or more than 1,000 — rely on HealthPartners hospitals and clinics, according to the county. To cover the cost of the supplemental plan, up to $1.2 million would come from an existing 6% payroll surcharge, currently charged to all county departments, which covers vacation pay-outs, severance pay and the costs of other post-employment benefits.

“It’s one-time money,” Reinhardt said. “And it’s coming out of the retiree benefits reserves, which are set aside for that. It cannot be used for anything else. I think it will cost significantly less than that, but you’ve got to budget for the worst that can happen.”

Open enrollment for county retirees begins in late October. If the impasse between HealthPartners and UnitedHealthcare is broken by Dec. 31, the county would host a special open enrollment period for county retirees again in January, allowing them to switch out of the supplemental plan and back to the cheaper UHC Medicare Advantage program, according to the proposal.

And if retirees opt to leave the county system entirely and subscribe to a different health insurer on their own, without a county contribution, they would still be welcome back anytime in 2025 or 2026 under a one-time exception to the policy of permanently dropping enrollees who choose to leave the county’s retirement benefits programs.

“Normally if you leave, you can’t come back,” Reinhardt said. “We wanted to make sure if people chose to leave in 2025, they’d be able to get back into the county system in 2026.”

HealthPartners opts out

In July, HealthPartners informed some 30,000 seniors by letter that UnitedHealthcare has been denying Medicare Advantage insurance claims at a much higher rate — sometimes 10 times higher — than other insurers and forces unnecessary waits for medical care. The health system has said it won’t be making appointments with the insurer’s patients at all next year, even if they’re willing to pay much higher, out-of-network rates.

Also impacted are retirees from the city of St. Paul and the St. Paul School District.

It’s possible the next county board could choose to explore other health insurance options, though Reinhardt won’t be around to weigh in as an elected official.

Reinhardt, who has served on the county board for 28 years, is not running for re-election this November, and neither is Commissioner Nicole Frethem. Former Commissioner Trista Martinson stepped down in August to accept a position in county employment. That means three of seven county board members will be new come January.

“It is anticipated we will do a request for proposals for retirement health insurance sometime after the first of the year,” Reinhardt said. “It’s a new county board. Until they see all the things that come in, you can’t promise it. But I believe that will happen. But that one will be up to the next county board.”

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